TRT

Testosterone Replacement Therapy (TRT) is FDA-approved for treating male hypogonadism (low testosterone) caused by testicular failure or hypothalamic-pituitary dysfunction. Testosterone cypionate and enanthate are the most commonly prescribed injectable esters, providing sustained testosterone levels with weekly or bi-weekly dosing. The TRAVERSE trial (5,200+ participants) confirmed cardiovascular safety in high-risk men when used as indicated.

• Hypogonadism Treatment
• Symptom Resolution
• Quality of Life

Most effective TRT delivery method with predictable testosterone levels. Intramuscular or subcutaneous administration provides sustained release over 7-8 days. Significantly improves energy, libido, mood, muscle mass, and bone density in hypogonadal men.

Testosterone esters (cypionate/enanthate) are dissolved in oil and injected, where they slowly release testosterone as the ester bond is cleaved. Cypionate has ~8-day half-life, enanthate ~7 days. Testosterone then binds to androgen receptors, modulating gene expression for anabolic and androgenic effects.

Peak plasma concentration: 2 days. Elimination half-life: 5 days – 8 days. Largely cleared by: 25 days – 40 days.

Research protocols from published literature — not dosing recommendations.

• hCG — Synergistic: hCG maintains testicular function and fertility during TRT by mimicking LH. Commonly dosed at 250-500 IU 2-3x weekly.
• Anastrozole — Supportive: Aromatase inhibitor that prevents testosterone-to-estrogen conversion. Used at 0.5-1mg weekly if estradiol elevates.
• Growth Hormone Peptides — Synergistic: GH secretagogues (Ipamorelin, CJC-1295) may enhance body composition effects when combined with TRT.
• Insulin — Monitor Combination: TRT may improve insulin sensitivity and reduce blood glucose; diabetics may need medication dose adjustments.
• Blood Thinners — Monitor Combination: TRT can increase hematocrit and hemoglobin. Monitor closely if on anticoagulants due to altered blood viscosity.
• Clomiphene — Alternative: SERM used as alternative to TRT or for PCT. Not typically combined during active TRT as they work through opposing mechanisms.

Supplies:

• Testosterone cypionate or enanthate vial (pre-mixed oil, typically 200mg/mL)
• 3mL syringe for drawing
• 18-21G needle for drawing (1-1.5 inch)
• 25-27G needle for injection (0.5-1 inch for SubQ, 1-1.5 inch for IM)
• Alcohol swabs
• Sharps container

1. 1No reconstitution needed - testosterone comes as ready-to-use oil solution
2. 2Warm vial briefly in hands if oil is thick (do not heat excessively)
3. 3Clean vial stopper with alcohol swab
4. 4Draw air equal to dose volume, inject into vial to ease drawing
5. 5Invert vial and draw prescribed dose slowly (oil is viscous)
6. 6Switch to injection needle if using separate draw needle
7. 7Clean injection site, insert needle, aspirate briefly, inject slowly
8. 8Dispose of needles in sharps container

Week 1-3: Initial adjustment, possible mood fluctuations as levels stabilize. Week 3-6: Improved energy, mood, mental clarity, and libido typically begin. Month 2-3: Enhanced recovery from exercise, improved sleep quality. Month 3-6: Body composition changes become noticeable (muscle gain, fat loss). Month 6-12: Bone density improvements, sustained metabolic benefits. Ongoing: Continued benefits require continued treatment; cessation reverses effects.

Requires diagnosis of hypogonadism with documented low testosterone (54% requires intervention (dose reduction, therapeutic phlebotomy). Not for use by women (especially pregnant), children, or men with prostate/breast cancer. May cause testicular atrophy and infertility - discuss hCG if fertility desired. FDA black box warning: possible increased risk of heart attack and stroke.

Requires diagnosis of hypogonadism with documented low testosterone (54% requires intervention (dose reduction, therapeutic phlebotomy). Not for use by women (especially pregnant), children, or men with prostate/breast cancer. May cause testicular atrophy and infertility - discuss hCG if fertility desired. FDA black box warning: possible increased risk of heart attack and stroke.

TRT should be stored at Room temperature 20-25°C (68-77°F). Do not refrigerate or freeze..