The Biggest TRT Mistakes (And How to Avoid Them)

Last Updated On March 31, 2025

Starting Testosterone Replacement Therapy (TRT) can be a life-changing decision, but mistakes in your protocol can lead to unnecessary complications and setbacks. Here are the biggest TRT mistakes people make – and actionable tips to avoid them.

1. Skipping Baseline Bloodwork

Bloodwork isn’t just a formality – it’s the foundation of a safe and effective TRT protocol. Skipping it can lead to misdiagnoses, improper dosages, and unresolved underlying health issues.

Why It’s a Mistake:

• You might not even need TRT; symptoms of low testosterone can overlap with other conditions like hypothyroidism or chronic stress.
• Without a baseline, it’s impossible to monitor progress accurately.

How to Avoid It:

• Get comprehensive bloodwork before starting TRT. Include Total Testosterone, Free Testosterone, Estradiol, SHBG, and CBC. Regularly repeat these tests to track changes.

2. Using Improper Dosages

Jumping straight into high doses or under-dosing can throw your hormones out of balance and lead to unpleasant side effects.

Why It’s a Mistake:

• Overdosing can cause high estradiol, acne, mood swings, and cardiovascular risks.
• Under-dosing won’t provide the benefits of TRT, leaving symptoms unresolved.

How to Avoid It:

• Start with a conservative dose (e.g. 80-200 mg per week) and adjust based on bloodwork and symptoms (you can use our Testosterone Dosage Calculator to help you calculate your starting dosage).
• Work with a healthcare provider or monitor your protocol carefully if going the DIY route.

3. Misunderstanding Estradiol’s Role

Testosterone and estradiol (E2) are closely linked, and concerns about estradiol levels are often overblown. High estradiol isn’t necessarily bad and is only a concern if accompanied by symptoms.

Why It’s a Mistake:

• Overuse of aromatase inhibitors (AIs) to lower estradiol can lead to joint pain, fatigue, and poor libido.
• Many individuals focus on “managing” estradiol unnecessarily when high levels cause no symptoms.

How to Avoid It:

• Monitor estradiol levels regularly, but treat only if you experience specific symptoms like significant water retention or mood instability.
• Avoid AIs unless absolutely necessary, and use the smallest effective dose if prescribed.
• Remember, estradiol plays a crucial role in bone health, libido, and overall well-being, so balance—not elimination—is key.

4. Overlooking Injection Techniques

Improper injection techniques can cause discomfort, infections, or ineffective testosterone delivery.

Why It’s a Mistake:

• Poor sterility increases the risk of infection.
• Incorrect needle size or injection site can cause pain, scarring, or uneven absorption.

How to Avoid It:

• Learn proper injection methods, including choosing the right needle size for IM or SubQ injections.
• Always use sterile techniques and rotate injection sites to prevent scar tissue buildup.
• Watch our in-depth Injection Guides For TRT videos.

5. Not Rotating Injection Sites

Injecting in the same spot repeatedly is a common mistake that leads to tissue damage and lumps.

Why It’s a Mistake:

• Repeated injections in one area can cause scar tissue or painful nodules.
• Scar tissue can reduce testosterone absorption over time.

How to Avoid It:

• Alternate between multiple sites (e.g. glutes, thighs, shoulders for IM; abdomen or thighs for SubQ).

6. Neglecting Lifestyle Factors

TRT isn’t a magic fix. Ignoring lifestyle factors like diet, exercise, and sleep will limit your results.

Why It’s a Mistake:

• Poor habits can blunt the effectiveness of TRT.
• Excess body fat increases aromatization, converting testosterone to estradiol.

How to Avoid It:

• Pair TRT with strength training, cardio, and a testosterone-friendly diet rich in zinc, magnesium, and healthy fats.
• Prioritize 7-8 hours of sleep per night.

7. Failing to Monitor Long-Term Health

TRT affects more than just testosterone levels. Neglecting regular health check-ups can result in overlooked issues.

Why It’s a Mistake:

• High hematocrit (thickened blood) increases the risk of blood clots.
• Liver and kidney function may be impacted by long-term TRT.

How to Avoid It:

• Get regular bloodwork to monitor hematocrit, liver, and kidney health.

8. Discontinuing TRT Abruptly

Stopping TRT without proper planning can lead to severe hormonal crashes and symptoms of hypogonadism.

Why It’s a Mistake:

• Your body reduces natural testosterone production while on TRT, and stopping suddenly can leave you with low or no testosterone.
• TRT is usually for life, in most cases.

How to Avoid It:

• If you decide to stop TRT, work with a doctor to taper off slowly.
• Consider post-cycle therapy (PCT) to stimulate natural testosterone production.

Final Thoughts

Avoiding these common TRT mistakes can save you time, money, and frustration, while ensuring you get the full benefits of testosterone therapy. Whether you’re just starting or fine-tuning your protocol, staying informed and proactive is key.