Protocols

TRT Protocols Explained

A clear breakdown of how testosterone replacement therapy actually works — dosing, injection frequency, ancillary medications, and how protocols are optimized over time.

Last updated May 2026

Standard TRT Protocol

The most common online TRT protocol involves testosterone cypionate injected 1-2 times per week. Here's what a typical protocol looks like:

Component	Typical Range	Frequency	Purpose
Testosterone Cypionate	100-200mg/week	1-2x weekly	Primary hormone replacement
Anastrozole (AI)	0.25-0.5mg	2-3x weekly (if needed)	Estrogen management
HCG	250-500 IU	2-3x weekly	Testicular function / fertility

Injection Frequency: Why More is Better

The old-school protocol of one injection every 2 weeks creates dramatic hormonal fluctuations. Modern protocols favor more frequent, smaller injections:

Every 2 weeks (outdated) — Large peaks and valleys, mood swings, energy crashes before next injection
Once weekly — Good balance of convenience and stability for most men
Twice weekly (optimal) — Most stable blood levels, fewest side effects, best for estrogen-sensitive men
Every other day (EOD) — Maximum stability, typically for those with high aromatization or hematocrit concerns

Pro tip: If you're experiencing estrogen-related side effects (water retention, nipple sensitivity, mood issues) on once-weekly injections, switching to 2x/week at the same total dose often resolves these without needing an AI.

Ancillary Medications

Anastrozole (Aromatase Inhibitor)

Blocks the conversion of testosterone to estrogen. Not everyone needs it — only use if bloodwork shows elevated estradiol (typically >40-50 pg/mL) with symptoms. Over-use crashes estrogen, which is worse than slightly elevated E2.

HCG (Human Chorionic Gonadotropin)

Mimics LH, keeping testicles functioning. Benefits: maintains testicular size, preserves fertility potential, may improve mood and libido beyond testosterone alone. Downside: adds cost and injection frequency.

DHEA

Some clinics add DHEA (25-50mg oral daily) as TRT can suppress adrenal androgens. Benefits are modest but may help with overall well-being and skin health.

Protocol Optimization Timeline

Weeks 1-6: Start at conservative dose (typically 120-150mg/week). Assess initial response.
Week 6-8: First follow-up bloodwork. Adjust dose based on trough levels (target: 700-1000 ng/dL total T).
Weeks 8-16: Fine-tune. Add AI only if estradiol is problematic. Adjust frequency if needed.
Week 16+: Maintenance phase. Bloodwork every 3-6 months. Protocol should feel dialed in.

Injection Method: IM vs. SubQ

Method	Needle	Location	Pros	Cons
Intramuscular (IM)	25g 1"	Glutes, delts, quads	Proven absorption, larger volumes	Slightly more pain, potential for scar tissue
Subcutaneous (SubQ)	27-30g 1/2"	Abdomen, love handles	Less pain, easy self-injection	Limited to smaller volumes, some absorption variability

Signs Your Protocol Needs Adjustment

Fatigue returning — Dose may be too low, or injection frequency too infrequent
Acne/oily skin — Dose may be too high, or DHT conversion elevated
Water retention/bloating — Estrogen elevated; try splitting dose before adding AI
Mood swings — Check injection timing; peaks/valleys from infrequent dosing
High hematocrit (>52%) — Donate blood, consider lower dose or more frequent injections

Provider matters: Good clinics like FYRE Body adjust protocols based on both labs AND symptoms. If your provider only looks at numbers and won't listen to how you feel, consider switching.

This information is educational only. TRT protocols should only be initiated and adjusted by a licensed physician based on individual bloodwork and health history. Never self-prescribe or adjust doses without medical guidance.