TRT Protocols & Dosing: The Science of Optimization
Moving beyond “normal ranges” to optimal stability. Understanding pharmacokinetics, injection frequencies, and why the modern standard of care prioritizes stable blood serum levels.
Check Your Eligibility for TRT Consultation
Answer 8 questions to see if you meet the basic criteria for a medical assessment. This is not a diagnosis.
What is your age?
TRT consultation requires minimum age criteria
Have you noticed changes in energy levels?
Common concern for men considering consultation
What about changes in body composition?
Physical changes despite consistent lifestyle
Changes in libido or sexual function?
Common concern prompting medical consultation
Mood or cognitive changes?
Brain fog, irritability, or low mood
Do you have any of these conditions?
Medical contraindications that may affect eligibility
Have you had testosterone levels tested before?
Previous blood work can streamline assessment
What’s your main goal for seeking consultation?
Understanding your consultation priorities
The Philosophy of Stable Levels
Why modern TRT focuses on pharmacokinetics rather than arbitrary calendars.
The “Roller Coaster” Effect
Old-school protocols (injections every 2–3 weeks) create massive supraphysiological peaks followed by crashes into hypogonadal troughs. This fluctuation causes side effects like acne, mood swings, and estrogen spikes. Modern protocols eliminate this.
Mimicking Natural Rhythm
A healthy male produces testosterone daily (diurnal rhythm). The goal of optimized TRT is to mimic this natural stability as closely as possible through appropriate delivery methods and administration frequency.
Bio-Individual Dosing
Two men can take 100mg of testosterone and have vastly different serum levels due to SHBG (Sex Hormone Binding Globulin) clearance rates and androgen receptor sensitivity. Protocols must be titrated to the patient, not the textbook.
Primary Delivery Methods & Protocols
Comparing the most effective administration routes used in Australian medical practice.
Injectable Esters (Cypionate / Enanthate)
The “Gold Standard” for optimization. Provides 100% bioavailability and precise dose control.
In Australia, Testosterone Enanthate (Primoteston) and compounded Cypionate are most common.
Standard Protocol
Frequency: 2x per week (e.g., Mon/Thu)
Goal: Reduces peak-to-trough variance.
Best For: Men with average SHBG seeking stability and convenience.
Micro-Dosing Protocol
Frequency: Every other day (EOD) or Daily
Goal: mimics natural production, minimizes aromatization (estrogen conversion).
Best For: Men with Low SHBG (who excrete T fast) or those sensitive to estrogen side effects.
Administration Technique: IM vs SubQ
While Intramuscular (IM) is traditional, modern evidence supports Subcutaneous (SubQ) injections using insulin needles. SubQ is less painful, causes less scar tissue, and provides a slower, steadier release rate, often resulting in more stable levels.
Transdermal Creams (Compounded)
Applied daily to the scrotum or inner arm. Scrotal application has significantly higher absorption due to thin skin and high vascularity. Note: This is distinct from standard alcohol-based gels (like Testogel) which often have absorption issues.
Daily Application
Frequency: Every morning (creates a 24h peak/trough).
DHT Impact: Scrotal cream typically raises DHT (Dihydrotestosterone) higher than injections, which can boost libido and mood but may accelerate hair loss in predisposed men.
Transfer Risk
Transference to women or children is a real risk. Care must be taken to cover the application site and wash hands thoroughly.
Ancillary Medications
TRT is often not just about Testosterone. A comprehensive protocol considers fertility and estrogen.
Purpose: Mimics LH (Luteinizing Hormone) to keep testes active.
Why use it: Preserves fertility, maintains testicular size, and may support libido/upstream hormones (neurosteroids).
Protocol: Typically injected 2-3x weekly alongside testosterone.
Purpose: Blocks conversion of Testosterone to Estrogen.
Philosophy: “Use only if absolutely necessary.” Estrogen is neuroprotective and cardioprotective. We do not treat a number; we treat high estrogen symptoms (spicy nipples, severe bloating).
Protocol: Micro-dosed only when symptomatic.
Purpose: Precursor hormone often suppressed by TRT.
Why use it: Can improve mood, energy, and libido if blood work confirms low DHEA-S levels.
Protocol: Daily oral capsule (slow release) if indicated by pathology.
The Dialling-In Phase: What to Expect
Optimization is not immediate. It requires patience and data.
The “Honeymoon” & Shutdown
In the first few weeks, your natural production overlaps with exogenous testosterone, often creating a surge in energy and libido. By week 4, natural production shuts down. This transition can sometimes feel like a temporary dip in energy.
First Blood Review (Trough Levels)
Blood work is taken at the “trough” (the morning of your next scheduled dose, before taking it). We check:
- Total & Free Testosterone: Are we in the therapeutic window?
- Estradiol (E2): Is conversion excessive relative to T levels?
- Hematocrit: Is the blood becoming too thick?
- SHBG: Has it dropped or risen?
Symptom Resolution & Titration
Full symptom relief (body composition, mental clarity) often takes 3-6 months. Based on Week 8 bloods and symptoms, we titrate the dose up or down. This is the “dialling in” phase.
Maintenance Mode
Once stable, blood work frequency reduces to every 6 months. The goal is to maintain the minimum effective dose that resolves symptoms with healthy blood markers.
Managing Common Side Effects
Most side effects are dose-dependent and manageable with protocol adjustments.
High Hematocrit (Thick Blood)
Testosterone stimulates red blood cell production. If hematocrit rises above reference range:
- Hydration: Dehydration artificially raises hematocrit.
- Frequency: Switching to more frequent injections (micro-dosing) often lowers hematocrit.
- Donation: Therapeutic blood donation may be required in some cases.
- Sleep Apnea: Treating underlying sleep apnea often resolves this issue.
Acne & Oily Skin
Usually caused by hormonal fluctuations (peaks and troughs) or elevated DHT.
- Stability: Splitting the dose to inject more frequently usually resolves acne by preventing hormonal spikes.
- Hygiene: Salicylic acid washes.
- Protocol Change: Reducing dose if levels are supraphysiological.
Gynecomastia / Sensitive Nipples
Caused by elevated Estradiol (E2) relative to Testosterone.
- Body Fat: Adipose tissue contains aromatase enzymes. Losing weight is the best long-term fix.
- Zinc: High dose zinc can naturally inhibit aromatase.
- Medication: Temporary use of an AI (Arimidex) only if symptoms are persistent and severe.
Testicular Atrophy
The testes stop producing T and sperm, causing shrinkage.
- Acceptance: Some men are unbothered by this cosmetic change.
- hCG: Adding Human Chorionic Gonadotropin to the protocol can maintain size and function.
Protocol FAQ
Can I switch from Cream to Injections (or vice versa)?
Yes, switching delivery methods is common if one doesn’t suit your lifestyle or biochemistry.
However, you must allow 6-8 weeks on the new protocol before assessing its effectiveness via blood work.
Constant switching makes dialling-in impossible.
Why do you prescribe injections 2-3x per week when the label says “Every 2 weeks”?
Pharmaceutical labels for Testosterone Enanthate/Cypionate were written decades ago.
The half-life of these esters is approx 4.5 to 8 days. Injecting every 14 days guarantees
you spend the last week in a hypogonadal state (low T). Frequent administration ensures
stable, optimal levels 24/7.
What is “SubQ” and is it effective?
Subcutaneous (SubQ) injection involves injecting into the fat layer (usually belly fat or glute)
using a tiny insulin needle. Studies show it achieves similar or better stable serum levels compared
to deep muscle (IM) injections, with significantly less pain and scar tissue.
Do I really need to take this for life?
Generally, TRT is considered a lifelong therapy. If you stop, your levels will return to their
pre-treatment low baseline (after a recovery period). However, you are not “trapped”—proper
PCT (Post Cycle Therapy) protocols can help restart your natural production if you decide to cease treatment.
What happens if I miss a dose?
If you are on a frequent injection schedule (e.g., EOD or 3x week), missing one dose is negligible.
Simply take it as soon as you remember or wait for the next scheduled time. Do not double dose.
Stability is the goal, but minor deviations are not catastrophic.
Find the Protocol That Works For You
There is no “one size fits all” in hormone health. Our doctors specialize in tailoring
protocols to your specific biochemistry, lifestyle, and goals.
Telehealth across Australia • AHPRA-registered doctors • Evidence-based care