Key Takeaways

  • TRT dosing is highly individualized—FDA labeling indicates 50-400 mg every 2-4 weeks, adjusted to individual response
  • Many clinicians use smaller, more frequent doses for steadier levels
  • Injection frequency matters as much as total dose—more frequent injections provide more stable hormone levels
  • Your optimal dose depends on age, SHBG levels, body composition, and individual metabolism
  • Regular blood work is essential for dialing in your personalized protocol

Table of Contents

Need a Personalized TRT Protocol?

Dr. Lindsley is board-certified in obesity and emergency medicine. Get a TRT protocol based on your labs, health history, and goals — not a generic chart.

Finding the right testosterone injection dosage is crucial for successful TRT. Too little, and you won't feel the benefits. Too much, and you risk side effects and long-term health issues. This guide provides comprehensive dosage charts and explains how to work with your physician to dial in your optimal protocol.

TRT Dosing Principles

Testosterone replacement therapy dosages differ significantly from the supraphysiological doses used in bodybuilding. TRT aims to restore testosterone to the normal physiological range—not push it to extreme levels.

According to the FDA-approved labeling for testosterone cypionate, dosing ranges from 50-400 mg every 2-4 weeks, adjusted based on clinical response and testosterone levels. Dosing is highly individualized—there is no universal "standard" dose that works for everyone.

Common clinical approaches include:

  • Conservative starting dose: 50-100mg every 1-2 weeks
  • Dose adjustment: Titrated based on symptoms and lab monitoring
  • Individual factors: SHBG levels, body composition, and metabolism affect requirements

The goal is finding the minimum effective dose that achieves symptom relief while minimizing side effects. More is not always better with TRT.

Testosterone Injection Dosage Chart

The following chart shows typical TRT dosing ranges and expected testosterone levels. These are general guidelines—individual response varies significantly.

Weekly Dose Typical Peak (ng/dL) Typical Trough (ng/dL) Best For
80-100mg 500-700 350-500 Low SHBG, older men, starting dose
100-120mg 600-800 450-600 Most men starting TRT
120-160mg 700-950 550-750 Optimal range for most men
160-200mg 850-1100 650-850 High SHBG, high body weight
200mg+ 1000+ 800+ Rarely needed, higher side effect risk

Understanding Peak and Trough

Peak levels occur 24-48 hours after injection. Trough levels are measured just before your next injection, representing your lowest point. Most clinics measure trough levels, as this ensures you're adequately dosed throughout your injection cycle.

Testosterone Types Compared

The two most common testosterone esters for TRT are cypionate and enanthate. Here's how they compare:

Characteristic Testosterone Cypionate Testosterone Enanthate
Half-life 8-10 days 7-10 days
Injection frequency 1-2x weekly 1-2x weekly
Common concentration 200mg/mL 200-250mg/mL
Availability More common in US More common internationally
Dosing Identical to enanthate Identical to cypionate

Bottom line: Cypionate and enanthate are essentially interchangeable. Same doses, same frequency, same results. Use whichever your pharmacy provides.

Testosterone Propionate

Propionate has a much shorter half-life (2-3 days) and requires every-other-day or daily injections. It's rarely used for standard TRT due to the inconvenient injection schedule, though some men prefer it for steadier levels.

Injection Frequency Guide

How often you inject affects your hormone stability more than most men realize. Here are the common protocols:

Frequency Example (160mg/week) Pros Cons
Once weekly 160mg every 7 days Convenient, fewer injections Bigger peaks/troughs, more side effects
Twice weekly 80mg every 3.5 days Stable levels, balanced convenience Slightly more injections
Every other day ~46mg EOD Very stable levels, minimal estrogen More injections, more planning
Daily ~23mg daily Extremely stable, mimics natural release Daily commitment, more supplies
I recommend twice-weekly injections as the starting protocol for most men. It balances convenience with hormone stability, and most men feel great on this schedule without needing additional medications to manage estrogen. — Dr. Joshua Lindsley, Highland Longevity

Why Frequency Matters

More frequent injections with smaller doses lead to:

  • Steadier testosterone levels throughout the week
  • Lower estrogen conversion (aromatase activity is higher with big peaks)
  • Better mood stability without the roller coaster effect
  • Less need for AI medications to manage estrogen
  • Lower hematocrit elevation over time

If you're having side effects on weekly injections, switching to twice-weekly often resolves them without needing to lower your dose.

Factors Affecting Your Optimal Dose

Why do some men thrive on 100mg weekly while others need 180mg? Several factors influence your ideal dose:

SHBG (Sex Hormone Binding Globulin)

SHBG binds to testosterone, making it unavailable for use. Men with high SHBG often need higher doses to achieve adequate free testosterone levels. Conversely, low SHBG men may need lower doses and more frequent injections.

  • High SHBG (>50 nmol/L): May need 150-200mg weekly
  • Normal SHBG (20-50 nmol/L): Standard dosing works well
  • Low SHBG (<20 nmol/L): May do well on 80-120mg weekly, frequent dosing helps

Body Composition

Men with more body fat tend to convert more testosterone to estrogen (fat tissue contains aromatase enzyme). They may need either:

  • Lower doses with more frequent injections, OR
  • Standard doses with estrogen management

Heavier men (over 220 lbs) sometimes need slightly higher doses to achieve target levels.

Age

Older men often respond well to lower doses. As we age, SHBG typically increases while receptor sensitivity may change. Starting low (100mg/week) and titrating up is wise for men over 60.

Metabolism and Clearance

Some men simply metabolize testosterone faster than others. If your trough levels are consistently low despite adequate dosing, you may be a "fast metabolizer" who benefits from more frequent injections.

Important: Always Work with a Physician

These charts are educational guidelines, not medical advice. Your optimal dose should be determined through blood work and clinical evaluation with an experienced TRT provider. Self-dosing without monitoring can lead to serious health complications.

Results Timeline: What to Expect

Testosterone doesn't work overnight. Here's a realistic timeline for what to expect:

TRT Results Timeline

Week 1-2 Initial energy boost, improved sleep quality beginning
Week 2-4 Mood improvements, increased motivation, libido beginning to improve
Week 4-8 Sexual function improvements, morning erections returning, workout recovery better
Week 8-12 Noticeable strength gains, body composition starting to change
Month 3-6 Significant muscle gain, fat loss (with proper diet/exercise), full cognitive benefits
Month 6-12 Maximum body composition changes, bone density improvements, cardiovascular benefits

Most men notice the biggest subjective improvements in the first 6-8 weeks. Body composition changes take longer—expect 3-6 months for visible muscle and fat changes with proper training and nutrition.

Signs You Need a Dose Adjustment

Signs Your Dose May Be Too Low

  • Persistent fatigue despite adequate sleep
  • Low libido or weak erections
  • Difficulty building muscle despite training
  • Continued brain fog or poor concentration
  • Trough testosterone below 500 ng/dL

Signs Your Dose May Be Too High

  • Acne (especially back and shoulders)
  • Water retention or bloating
  • Elevated blood pressure
  • Mood swings or irritability
  • Nipple sensitivity or gynecomastia symptoms
  • Sleep disturbances or worsening sleep apnea
  • Elevated hematocrit (>52%)
  • Elevated estradiol (>40-50 pg/mL for most men)

Blood Work Markers to Monitor

Regular blood work is essential for safe TRT. Key markers include:

  • Total testosterone: Target 600-900 ng/dL (trough)
  • Free testosterone: Should be upper-normal range
  • Estradiol (E2): 20-40 pg/mL ideal for most men
  • Hematocrit: Should stay below 52%
  • PSA: Monitor for prostate health
  • Lipid panel: TRT can affect cholesterol

Frequently Asked Questions

What are typical testosterone injection dosages for TRT?

TRT dosing is highly individualized. FDA labeling for testosterone cypionate indicates 50-400 mg every 2-4 weeks, adjusted based on clinical response. Many clinicians use smaller, more frequent doses for more stable levels. Your optimal dose depends on factors like SHBG levels, body composition, and individual metabolism—there is no one-size-fits-all "standard" dose.

How often should I inject testosterone for TRT?

Most TRT protocols use twice-weekly injections (every 3.5 days) to maintain stable testosterone levels. Some men inject weekly, though this can cause more peaks and troughs. Daily or every-other-day micro-dosing is growing in popularity for even more stable levels.

What's the difference between testosterone cypionate and enanthate dosing?

Testosterone cypionate and enanthate are dosed identically—both have similar half-lives (8-10 days) and are interchangeable. The main difference is cypionate is more common in the US while enanthate is more common internationally. Same dose, same frequency.

How long until I see results from testosterone injections?

Energy and mood improvements often appear within 2-4 weeks. Sexual function improvements take 3-6 weeks. Body composition changes (muscle gain, fat loss) typically take 3-6 months. Full optimization may take 6-12 months of dialed-in therapy.

What happens if my testosterone dose is too high?

Excessive dosing can cause elevated estradiol (leading to water retention, mood issues, gynecomastia), increased hematocrit (thickened blood), acne, hair loss acceleration, and sleep apnea worsening. This is why regular blood monitoring and proper dosing are essential.

Ready to Optimize Your Testosterone?

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References

  1. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95(6):2536-2559.
  2. Morgentaler A, Zitzmann M, Traish AM, et al. Fundamental concepts regarding testosterone deficiency and treatment: International Expert Consensus Resolutions. Mayo Clin Proc. 2016;91(7):881-896.
  3. Testosterone Cypionate Injection, USP. Prescribing Information. Pfizer Inc.
  4. Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624.
  5. Handelsman DJ. Pharmacology of testosterone replacement therapy preparations. Endocrinol Metab Clin North Am. 2007;36(2):313-331.
  6. Corona G, Giagulli VA, Maseroli E, et al. Testosterone supplementation and body composition: results from a meta-analysis of observational studies. J Endocrinol Invest. 2016;39(9):967-981.
  7. Hackett G, Cole N, Bhartia M, et al. Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. J Sex Med. 2013;10(6):1612-1627.
  8. Saad F, Aversa A, Isidori AM, Gooren LJ. Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review. Curr Diabetes Rev. 2012;8(2):131-143.