Dosing, measuring, redosing
TRT microdosing is easy: you just change two things: injection cycle and injection dose. Begin with a fair dose and get comfortable with the treatment. Most men go through a TRT Honeymoon and initially feel both overstimulated and unsettled. After stabilising, you might need to tweak the dose and see how it feels again. How you feel overall is the key guide for changing doses, but regular blood tests and body checks (like blood pressure, skin health, and so on) are key to spot problems or under- or overdosing. Most issues get fixed by changing the dose and checking again in 8-12 weeks. Every new dose needs time for your body and mind to get used to it and settle. Finding the sweet spot with trial and error needs exact dosing and steady uptake, which only works with injections.
Minimum effective vs. maximum sustainable
There's a difference between the smallest dose that eases symptoms and the biggest dose you can handle without side effects. The minimum effective dose (MED) is safest in the short term, well studied, and already lifechaning for hypogonadic men. But the maximum sustainable dose (MSD) might give more energy, better daily benefits, and better long-term health. And then there's your personal “sweet spot,” usually higher than MED but lower than MSD. Your best dose depends on blood tests, your health records, and how you feel. Within safe ranges, your exact dose is up to you. Start relatively low and adjust in steps. Some men hit their best levels at 75 mg/week, others need 200 mg/week—it's very personal.
Injection Frequency
The frequency of injections is crucial for maintaining stable hormone levels and minimizing side effects. A long interval between large injections creates a "peak and trough" effect, where levels spike uncomfortably high right after the shot and then fall low enough for symptoms to return before the next dose. With more frequent injections, you smooth out these fluctuations, resulting in more stable blood levels, consistent symptom relief, and a reduction in side effects. Because men metabolize testosterone at different rates, some will need higher doses or more frequent injections to maintain the same stable blood levels as others.
Comparing a 30mg/3days and a 60mg/6days protocol (cypionate)
Injection Method
Testosterone cypionate can be injected both in a skinfold (subcutaneous or 'SC') and in a muscle (intramuscular or 'IM'). Both give consistent absorption but SC provides more stable levels and less side-effects. IM injections are typically given in the thigh (vastus lateralis muscle) for self-injection using a 25G needle 25-40mm long at a 90-degree angle. SC in a skinfold on the abdomen, flanks or thigh, using a 25G 4-16mm needle at a 45-degree angle.
SC injections may cause allergic reactions in some individuals (approx. 1 in 6) including red, itchy, swollen injection sites that can persist for days or weeks. These reactions can develop suddenly even after months of successful injections+ these people may need to switch to IM injections.
Other methods such as gels, patches or pills have very inconsistent absorption rates which makes precision dosing impossible.
Other esters than cypionate, such as enanthate, decanoate are fine too but even the long lasting undecanoate needs microdosing for stable feel.
TRT MICRODOSING PROTOCOL
Andropause Diagnoses
Safety Checks
At this point you should have done two consecutive bloodtests. This protocol needs your most recent Estradiol/E2, Hematocrite/Ht and PSA values for the safety assessement.
2.1 Absolute exclusion criteria
If any of the following absolute criteria are met, do not start TRT:
- No desire to be on TRT for life (it will shutdown natural testosterone)
- Hematocrit > 54 % or 0.54
- Active or suspected prostate cancer
- Active or suspected male breast cancer
- Untreated severe obstructive sleep apnea
- Severe lower urinary tract symptoms (IPSS > 19)
- Recent major cardiovascular event (MI, stroke, revascularization in past 6 months)
- Uncontrolled heart failure or unstable angina
- History of unprovoked venous thromboembolism or known thrombophilia
- Desire for future fertility (unless you’re willing to accept spermatogenesis suppression)
2.2 Conditional exclusion criteria
If either of these is true, you should start TRT only after these are corrected:
- PSA > 4 ng/mL (or > 3 ng/mL with risk factors) without urology evaluation
- Estradiol > 220 pmol/L or > 60 pg/mL with gynecomastia, water retention or mood swings
- Hematocrit 50% or 0.50 (risk of erythrocytosis—monitor and adjust dose)
- Severe uncontrolled hypertension or diabetes
- Untreated thyroid, liver, or kidney disease
- You like big balls (TRT will shrink them by half)
2.3 Informed decision
If both of these are true, go on to step 3
- I have consulted a specialist or my general physician
- I am informed, I know the risks, I want to do TRT
TRT Start
3.1 Obtain
- 1mL injection syringes
- 25G/16mm injection needles
- 200mg/mL Testosterone-cypionate vials (also possible -enanthate, -decanoate)
- Alcohol wipes
- Log book or trt tracker app
3.2 Decide
- Injection type (intramuscular or subcutaneous)
- Initial injection dose (50mg/week-200mg/week)
- Initial injection frequency (every 2-7 days or 2x/week)
- Initial injection sites (skinfold of abdomen or flank for subcutaneous, thigh, gluteal, or deltoid muscle for intramuscular)
Safe start:
- Injection type: subcutaneous
- Injection site: abdominal skinfold
- Injection dose: 60mg/week
- Injection cycle: bi-weekly (30mg/injection)
3.3 Calculate Injection Volume
3.4 Learn
- Basic injection hygiene
- Injection technique
3.5 Start
- First injection
- Daily logging of sleep, mood, erections and libido, changes in symptoms or feelings
- Weekly logging of blood pressure and resting heart rate.
3.6 Expectation Management
For some men the first 3 months can be both rough and (over-) exciting. This is called the TRT honeymoon. During this time, your body adapts to new hormone levels, which can cause fluctuations in mood and libido, and flares of elevated blood pressure. You might experience moments of euphoria followed by periods of feeling unsettled. Keep cool and sit it out. It can take up to six months for your system to fully stabilize. Typically, benefits like mental clarity and increased energy appear first, while improvements in libido and erectile function develop much slower.
Protocol Optimisation
(2-3 months after every dose adjustment)
4.1 Measure
- Total Testosterone (tT)
- Estradiol (E2)
- Hematocrit (Ht)
- Free Testosterone (fT)
Measure blood markers right before next injection.
4.2 Overdosing check
If either of these is true, you MUST decrease the dose:
- Total Testosterone > 31 nmol/L or 900 ng/dL
- Hematocrit (Ht) > 54% or 0.54
If either of these is true, decreasing the dose COULD give better results:
- Estradiol > 220 pmol/L or > 60 pg/mL
- Testosteron:Estradiol < 10 (both in pmol/L) or < 60 (both in pg/mL)
4.3 Underdosing check
If either of these is true, you should increase the dose:
- Not enough symptom relief
- Total testosterone < 16 nmol/L or 460 ng/dL
- Free testosterone < 420 pmol/L or 120 pg/mL
If needed adjust dose in small amounts only, e.g. 20% or 20-30mg/week.
4.4 Injection frequency check
If you feel stable (no mood or energy swings related to the injection cycle) you can try a longer interval, else you can try a shorter interval. Adjust the dose accordingly. Always work with weekly doses divided by number of injections per week.
Specialist Evaluation
(6 months after start and every 12 months)
5.1 Periodic evaluation
After starting TRT, patients should undergo a focused evaluation at 6 months and then yearly to ensure safety, efficacy, and timely adjustments. Each assessment involves both laboratory tests and clinical examinations, with results interpreted using both EU (SI) and US (conventional) units.
- Total Testosterone (tT)
- Free Testosterone (fT)
- Hematocrit (Ht)
- Prostate-Specific Antigen (PSA)
- Estradiol (E2)
- Liver Function Tests; ALT/AST to detect hepatotoxicity
- Lipid Profile; Total cholesterol, LDL, HDL, triglycerides—evaluate cardiovascular risk
- Fasting Glucose or HbA1c; Screen for insulin resistance
- Blood Pressure
- Clinical Exam; Evaluate mood, libido, energy, sleep quality, injection sites, and any adverse effects
- Lifestyle Screen
- Psychological Screen; Assess for depression, anxiety, and quality-of-life metrics
- Review of Comorbidities: Update on cardiovascular events, prostate symptoms (IPSS score), sleep apnea status, and fertility desires.