TRT FAQ – Frequently Asked Questions About Testosterone Replacement Therapy

The most common signs of low testosterone include fatigue, low libido, erectile dysfunction, brain fog, depression, loss of muscle mass, increased body fat, and poor recovery from exercise. Many men also experience irritability, lack of motivation, and disrupted sleep.

However, symptoms alone aren’t enough to confirm low testosterone. Bloodwork is essential to check total testosterone, free testosterone, and other key markers like SHBG and estradiol. Low levels combined with persistent symptoms may indicate a need for TRT, but lifestyle factors such as poor diet, high stress, obesity, and alcohol consumption can also contribute to low testosterone. Addressing these factors first can sometimes improve levels naturally.

If symptoms persist despite lifestyle improvements, a proper evaluation with a TRT-literate doctor or self-directed research is the next step.

Only you and a knowledgeable TRT provider/specialist can determine if TRT is right for you. It requires a thorough assessment of your testosterone levels, full blood panel, lifestyle, diet, medical history, and most importantly, your symptoms.

Low testosterone symptoms can stem from various causes unrelated to testosterone itself. In some cases, low levels may be temporary and reversible through lifestyle, diet, or health improvements. TRT should only be considered if your symptoms are clearly linked to low testosterone and cannot be corrected through other means.

TRT isn’t an instant fix – it takes weeks, months, and even a year or more for full benefits to develop. Most men start noticing improvements in energy, mood, and mental clarity within a few weeks. Libido and erectile function often improve within 3-6 weeks, while body composition changes, muscle growth, and fat loss take longer, typically 3-6 months or more.

The first 3-6 months can be an adjustment period, especially if you have high body fat, inflammation, or a history of alcohol use, which can affect hormone metabolism. Patience is key, as TRT works gradually to restore optimal function. Regular bloodwork and symptom tracking help fine-tune your protocol over time.

Most side effects of TRT come from improper dosing, poor protocol management, or pre-existing health issues. Common temporary effects include increased water retention, acne, and changes in mood, which often improve as your body adjusts.

Some men experience elevated estrogen or hematocrit, but these are rarely an issue unless symptoms arise. Overcorrecting estrogen with aromatase inhibitors or donating blood unnecessarily can cause more harm than good. Hair thinning can occur in men genetically predisposed to hair loss, but TRT doesn’t create baldness – it only accelerates what was already going to happen.

Serious side effects are rare when TRT is managed properly. Regular bloodwork, dialing in your dose, and maintaining a healthy lifestyle help minimize any issues.

For most men, TRT should be considered a lifelong commitment. If you have primary hypogonadism (testicular failure) or irreversible secondary hypogonadism, your body can no longer produce sufficient testosterone on its own, meaning you will need TRT permanently. Before starting, it’s essential to identify the root cause of your low testosterone to determine if it can be corrected naturally.

Stopping TRT is possible, but it’s not a simple process. Exogenous testosterone suppresses natural production through the body’s feedback loop, shutting down your own testosterone. While recovery is possible, it can be slow, uncomfortable, and may not return you to your previous baseline. In some cases, natural production remains permanently lower than before, particularly in men with past androgen use.

TRT should never be started as a short-term “trial” without fully considering the long-term implications. Recovery from TRT can be difficult, and most men revert to their pre-TRT hypogonadal state when they stop. This is why a thorough evaluation, comprehensive bloodwork, and an informed decision are crucial before starting TRT.

Your TRT dose should be based on bloodwork, symptoms, and how your body responds over time. Most men start with 1-2 mg per kg of body weight per week, which typically falls between 70-150 mg for lighter individuals and up to 150-250 mg for larger men. A conservative starting point is 125-150 mg per week, divided into at least two injections per week (or more frequent dosing if side effects occur). Some men may require adjustments due to factors like SHBG levels, metabolism, or testosterone absorption differences.

Dose increases should be gradual, with adjustments of 10-25 mg (about 10% of the starting dose) every 3-4 months if needed. This allows time for the body to adjust and reduces the likelihood of unnecessary side effects. Many men make the mistake of chasing an ideal testosterone number on bloodwork, but the goal is to relieve symptoms while avoiding unwanted effects like excess water retention, mood swings, or energy crashes.

Finding the right dose is a process that requires patience, proper monitoring, and adjustments based on symptoms rather than numbers alone. Regular bloodwork and self-assessment will help fine-tune your protocol over time. To help you determine your starting dose, check out How to Determine Your Starting Dose of Testosterone for DIY TRT.

The ideal injection frequency depends on your dose, individual response, and how your body metabolizes testosterone. At a minimum, twice per week (every 3.5 days) is recommended to maintain stable levels and reduce fluctuations. Many men prefer 3x per week or daily injections for even smoother hormone balance, especially if they experience side effects like mood swings, water retention, or fatigue on less frequent dosing.

Testosterone has a half-life, meaning levels rise after an injection and then gradually decline. Injecting once per week or less can lead to peaks and crashes, causing inconsistent energy, mood, and libido. More frequent injections help minimize these fluctuations and often improve symptom control.

If you’re new to TRT, starting with 2-3 injections per week is a good approach, with adjustments based on how you feel. Some men do well with daily microdosing, while others feel fine with 2-3x per week. The key is finding what works best for your body while keeping levels stable.

Both intramuscular (IM) and subcutaneous (SubQ) injections can be effective for TRT, and the best choice depends on personal preference, absorption rate, and side effect management.

Intramuscular injections are the traditional method, delivering testosterone into the muscle (usually the glutes). This provides rapid absorption and stable levels but may cause more injection site soreness and require larger needles.

Subcutaneous injections involve injecting into the fat layer (usually around the abdomen or thighs) with a smaller needle. Many men find SubQ injections less painful, easier to administer, and better for reducing post-injection pain or lumps. Some also report fewer estrogen spikes and smoother hormone levels, but absorption may vary between individuals.

Both methods are effective, and the choice comes down to what works best for you. If IM injections cause discomfort or side effects, switching to SubQ is worth trying. For more details, see TRT Injection Techniques: IM vs. SubQ Explained.

Testosterone injections can be done using either intramuscular (IM) or subcutaneous (SubQ) methods, depending on your preference and how your body responds. Intramuscular injections deliver testosterone deep into the muscle, typically using a 25-27 gauge needle, 1-1.5 inches long, injected into the quads, glutes, or delts. The quad (vastus lateralis) is a popular site because it’s easy to reach, requires minimal flexibility, and provides good absorption.

Subcutaneous injections involve injecting testosterone into the fat layer under the skin, often using a 27-29 gauge needle, 0.5 to 0.75 inch long. The most common injection sites are the abdomen or upper thigh, where fat is easily pinched. Many men prefer SubQ because it requires a smaller needle, is less painful, and can lead to smoother hormone levels with fewer estrogen spikes. However, absorption rates may vary between individuals.

Regardless of the method, proper sterile injection technique is crucial. Always use a new needle and rotate injection sites to prevent scar tissue buildup. If you’re new to injections, it may take time to get comfortable, but following proper technique minimizes discomfort and improves consistency. For a full demo of both IM and SubQ injection techniques, see our Injection Guides for TRT.

DIY Testosterone Replacement Therapy (DIY TRT) means managing your own testosterone treatment without a clinic or doctor. This includes sourcing testosterone independently (through reputable suppliers), administering doses based on research or prior medical guidance, and monitoring hormone levels through private labs. While it offers cost savings, convenience, and privacy, it requires thorough knowledge and preparation. For more, check out What Is DIY Testosterone Replacement Therapy? A Beginner’s Guide.

DIY TRT is a serious commitment and best suited for experienced individuals with a stable TRT protocol. If you’re new to TRT, it’s advisable to start with a clinic or specialist to determine if TRT is necessary and establish a solid foundation.

If DIY TRT is your only option, thorough education is essential – ideally with guidance from a knowledgeable TRT specialist or coach. Additionally, optimizing your lifestyle, health, and diet should be a priority before considering TRT.

If you’re not sure what to do, then you should probably not start with DIY TRT until you’ve worked with a specialist first.

DIY TRT gives you full control over your treatment, but it also comes with significant risks. Without medical oversight, you are responsible for sourcing testosterone safely, managing side effects, and monitoring your health. One major concern is obtaining low-quality or counterfeit testosterone, which can lead to contamination, inconsistent dosing, and unpredictable results.

Another risk is mismanaging dosage or overcorrecting estrogen, which can cause unnecessary side effects. If issues arise, you must rely on research and self-monitoring to adjust your protocol effectively. Legal concerns are also a factor, as purchasing testosterone without a prescription may not be legal in your country.

While DIY TRT can be done successfully, it requires proper education, responsible self-monitoring, and a commitment to optimizing health beyond just testosterone levels.

Starting DIY TRT requires thorough research, proper planning, and a commitment to monitoring your health. Before beginning, it’s essential to get baseline bloodwork done. This provides a reference point for tracking changes and adjusting your protocol as needed.

Sourcing testosterone responsibly is crucial. Ensuring you have a high-quality product from a reputable vendor reduces the risk of contamination or underdosed compounds. When starting, a conservative dose is recommended, with frequent injections (2-3 times per week or daily) to maintain stable levels and minimize side effects.

Regular bloodwork is essential for monitoring hormone balance and overall health. However, lab numbers should not be the sole focus – how you feel matters just as much, if not more. Adjustments should be made based on symptoms rather than chasing an arbitrary target on a blood test.

DIY TRT carries risks, so education is key before starting. Understanding proper dosing, injection techniques, and long-term health management is essential for a safe and effective experience

Not necessarily. High estradiol on paper doesn’t automatically mean problems. Many men on TRT have elevated estradiol without symptoms and feel great. Estrogen plays a vital role in libido, mood, bone health, and cardiovascular function.

Symptoms matter more than numbers. If you experience severe water retention, mood swings, or sensitivity, adjusting your testosterone dose, injection frequency, or body composition is often more effective than using an aromatase inhibitor (AI). Lowering estrogen unnecessarily can cause fatigue, joint pain, and other serious issues.

For a deeper understanding, see The Complete Guide To Estrogen And Estradiol.

In most cases, no. Estrogen is essential for libido, mood, bone density, and heart health. Lowering it too much with an aromatase inhibitor (AI) can cause fatigue, joint pain, anxiety, and other issues.

Adjusting to TRT takes time – months or even a year – especially if you have high body fat, stress, or a history of heavy alcohol use. Instead of taking an AI, try injecting more frequently, improving diet, reducing alcohol, and being patient. Most estrogen-related side effects resolve as your body adapts.

Only consider an AI if symptoms are severe and confirmed by bloodwork. For more, see The Complete Guide To Estrogen And Estradiol.

Not necessarily. While TRT can increase hematocrit levels, this isn’t always a cause for concern. Many men see a rise in hematocrit without experiencing negative effects. The real issue is not just hematocrit alone but blood viscosity – how thick your blood is – which is influenced by multiple factors like hydration, platelet count, and overall cardiovascular health.

A hematocrit of 54-57% is common on TRT and isn’t inherently dangerous unless accompanied by symptoms like headaches, dizziness, or high blood pressure. Routine blood donations are often unnecessary and can deplete iron and reduce energy levels. Instead, proper hydration, managing iron intake, and monitoring other blood markers (hemoglobin, RBC count, ferritin, platelets) are more effective ways to manage hematocrit.

If your hematocrit is very high and causing symptoms, work with a TRT-literate doctor to assess whether action is needed. For a deeper understanding, see The Ultimate Guide To Hematocrit On TRT.

Not necessarily. Many men on TRT see their hematocrit rise to 54-57% without issues, and donating blood too frequently can lead to low iron, fatigue, and reduced oxygen delivery.

Blood donation should only be considered if you have symptoms like dizziness, headaches, or high blood pressure, and other blood markers (like platelets, ferritin, and viscosity) suggest a real risk. Hydration, managing iron intake, and proper monitoring are often enough to keep hematocrit in check without unnecessary donations.

If you’re unsure whether blood donation is needed, work with a TRT-literate doctor rather than donating reflexively. For more details, see The Ultimate Guide To Hematocrit On TRT.

Testosterone Replacement Therapy (TRT) can significantly impact male fertility. While not designed as a contraceptive, TRT often suppresses the body’s natural testosterone production, leading to reduced sperm production. Studies indicate that TRT can cause subfertility or even azoospermia (absence of sperm) in many men. However, this effect is not universal; some men may experience only a slight reduction in fertility or none at all.

It’s important to note that the extent of fertility suppression varies among individuals. Factors such as dosage, duration of therapy, and individual physiology play significant roles. If maintaining fertility is a concern, it’s crucial to discuss this with a healthcare provider before starting TRT. Alternative treatments or adjunctive therapies may be considered to preserve fertility.

Yes, HCG can help restore fertility by mimicking LH (luteinizing hormone), which stimulates natural testosterone and sperm production. However, while some men use HCG alongside TRT to prevent infertility, this approach is not always effective and can cause side effects in about half of users.

If TRT has suppressed sperm production, a fertility protocol using HCG and bioidentical FSH for 12-16 weeks can often restore sperm count to pre-TRT levels. Importantly, using HCG during TRT does not impact the effectiveness of this protocol—it works just as well regardless.

If fatherhood is a priority in the near future, consider delaying TRT until after conception.

No, TRT does not cause prostate cancer. The belief that testosterone fuels prostate cancer is outdated and based on flawed research. Modern studies, along with expert insights from doctors like Abraham Morgentaler, show no clear link between TRT and an increased risk of prostate cancer. In fact, men with low testosterone may have a higher risk of aggressive prostate cancer.

However, if you already have prostate cancer, TRT should be carefully evaluated with a knowledgeable provider. Monitoring PSA levels and overall prostate health is essential, but for most men, TRT poses no significant prostate cancer risk.

For a more in-depth look at TRT and prostate health, see our guide The Complete Guide To Prostate Health And TRT.

TRT does not directly cause an enlarged prostate (benign prostatic hyperplasia, or BPH), but it can increase prostate size slightly, especially in older men. This is because testosterone plays a role in prostate growth, but it is not the root cause of BPH. Studies show that TRT does not significantly worsen urinary symptoms in most men, and some even experience improvements due to better bladder control and muscle function.

However, if you already have BPH and experience urinary issues like frequent urination or weak flow, TRT could exacerbate symptoms in some cases. If this happens, adjustments to your protocol or medications like Tadalafil (which supports prostate health) may help. For a full breakdown, see our guide The Complete Guide To Prostate Health And TRT.

Having a history of prostate cancer does not automatically mean you can’t take TRT, but it requires careful evaluation. The outdated belief that testosterone fuels prostate cancer has been debunked, and modern research suggests that TRT does not increase prostate cancer risk. Some studies even indicate that men with low testosterone are at greater risk of developing aggressive prostate cancer.

If you have had prostate cancer, TRT should only be considered under close medical supervision, with regular PSA monitoring and follow-up tests. Many men successfully resume TRT after treatment, but it depends on individual factors like cancer severity and response to treatment. Always consult with a TRT-literate doctor before making a decision.

For a more in-depth look at TRT and prostate health, see our guide The Complete Guide To Prostate Health And TRT.