My TRT Protocol, Month by Month

This is a first-person walkthrough of the first nine months of my TRT protocol. The labs, the doses, the adjustments, what I felt, and what I would do differently if I were starting again today. It is not medical advice. It is one man’s experience with one protocol, against one baseline, under one provider’s guidance. Your situation will be different and your protocol should be built by you and your provider, not copied from anyone on the internet including me.

If you want the framework for what TRT is and how to think about the decision, start with What TRT Actually Is and You’re in Range. You’re Not Fine.. If you want the broader context for how I got here, What Is OPTN is the founder story.

The starting point

By the time I started TRT, I had already spent about six months on the lifestyle foundation. Sleep was locked at 7.5-8 hours with consistent timing. Alcohol was down to maybe one drink a week. Nutrition was dialed in. Training was consistent, four days a week, strength plus mobility. Body fat was at a reasonable range for my age and build. The boring things were in place.

My pre-TRT labs, after six months of foundation work:

• Total testosterone: 480 ng/dL (up from 380 at baseline)
• Free testosterone: 9.2 pg/mL
• SHBG: 38 nmol/L
• Sensitive estradiol: 22 pg/mL
• LH: 4.1 mIU/mL
• FSH: 3.8 mIU/mL
• Hematocrit: 44%
• Thyroid, metabolic, and inflammatory markers unremarkable

The lifestyle work had moved my total T from 380 to 480, which was real but not enough to resolve the symptoms. Energy was better than at baseline but still not where I remembered it being in my twenties. Libido was improved but still intermittent. Morning erections were inconsistent. Recovery from workouts was slower than it should have been. The panel looked reasonable on paper. The experience did not match.

This is the “in range but not fine” territory that the first Fundamentals article is about. I knew what the gap was, I had done the work to rule out lifestyle confounds, and I had a provider willing to think with me about whether TRT was the next move. The decision was not about crisis symptoms. It was about a clear gap between where I was and where I wanted to be, and a judgment call that TRT was the right lever against a solid foundation.

The protocol

My starting protocol, settled with my DPC physician:

• Testosterone cypionate, 100mg once weekly, subcutaneous injection
• No anastrozole (no symptomatic need, estradiol not crashed, no high-aromatization baseline)
• No HCG (not trying to preserve fertility, no testicular atrophy concern at this dose)
• Follow-up labs at 6 weeks and 12 weeks, then quarterly
• Compounded from a PCAB-accredited 503A pharmacy shipped to Maine

Total out-of-pocket cost, including the medication, the DPC fee averaged across the year, and the labs, worked out to about $200 a month. For the breakdown of how that number lands, see The Real Cost of Men’s Health Optimization.

A note on the “once weekly” decision. The literature and clinical experience both suggest that twice-weekly or every-other-day injections produce a flatter hormonal curve and fewer symptoms from the trough. I started once weekly anyway because my provider wanted to see the response curve at a simpler frequency before introducing more variables. That turned out to matter.

Month one

The first shot was on a Sunday night. Subcutaneous injection into the upper glute with a 27-gauge half-inch needle. The actual injection was easier than the anticipation. If you are squeamish about needles, the upper glute is the least uncomfortable site I have tried and the technique takes about a week of practice to feel routine.

The first week, I felt nothing I could attribute to TRT. I expected this. The literature is clear that most men see no meaningful subjective change in the first 2-4 weeks, because it takes that long for serum levels to stabilize at the new baseline and for the downstream effects to show up.

By the end of week two, I noticed better sleep. Specifically, I was waking up less often in the second half of the night and feeling more recovered in the morning. This was the first thing I noticed. It was also not on the list of things I had expected TRT to affect. I had been focused on energy and libido. The first change was in sleep quality.

By the end of week three, morning energy was different. Not higher, exactly. More stable. The difference between “I need coffee to be a person” and “I am a person who also likes coffee” is subtle but real, and it landed during week three.

Libido did not move in month one. If anything, it was slightly worse, which I now suspect was a coincidence of timing rather than a TRT effect. Patience turned out to be the right answer.

Month two

The second month was where the signal started to separate from the noise. The sleep improvement held. The morning energy stabilization held. Recovery from workouts improved in a way I could point to: DOMS from heavy leg days resolved in two days instead of three or four. Mood was more even, with a specific improvement in the mid-afternoon flatness I had gotten used to.

Libido started to return in the second half of month two, and the pattern was interesting. Not a general “rising tide” improvement, but a return of the spontaneous baseline I had forgotten existed. Morning erections became consistent again. The background awareness of being attracted to my wife came back, which sounds obvious but was not something I had realized had dimmed until it came back.

Injection day discomfort at the site was minimal. Once or twice I had a small area of tenderness for a day. Nothing that suggested I needed to change technique or equipment.

Month three and the six-week labs

Six-week labs came back at week seven:

• Total testosterone: 720 ng/dL (trough, drawn just before the next injection)
• Free testosterone: 14.8 pg/mL
• SHBG: 34 nmol/L
• Sensitive estradiol: 31 pg/mL
• Hematocrit: 46%

The trough total T of 720 was a solid response to 100mg weekly. It meant my peak was probably somewhere in the 950-1050 range mid-week. The sensitive estradiol at 31 was inside my personal range for feeling good. Hematocrit had risen from 44 to 46, which was expected and well within the safe range.

I reviewed these with my provider. Her read was that the numbers looked good and the symptoms were pointing in the right direction. We held the protocol steady and waited for the 12-week labs.

Month three was the best month of the early protocol. Sleep, energy, libido, recovery, and mood were all in a better place than they had been for years. I noted this in a journal and also noted that I should be careful not to project forward, because early-protocol improvement often settles into a new baseline that is not as dramatic as month three feels.

Month four and the first adjustment

Month four brought a subtle regression. Not a disappearance of the improvements, but a flattening. Mid-week was still good. The 48 hours before the next injection were noticeably less good, with more fatigue, worse sleep, and a return of some of the pre-TRT symptoms. This was the classic once-weekly trough pattern that the literature describes.

I talked to my provider about splitting the dose. We agreed to move to 50mg twice weekly (Sunday and Wednesday), same total dose, with the expectation that the flatter curve would reduce the trough symptoms without changing the overall response.

The adjustment worked within two weeks. The late-week trough pattern disappeared. Day-to-day felt more consistent. No worse on peak days, noticeably better on the days that had been troughs. I wish I had started twice-weekly from the beginning, but the journey through once-weekly was informative because it made the trough pattern visible in a way that going straight to twice-weekly would not have.

Month six and the second adjustment

The 12-week labs at month three had looked good. The 24-week labs at month six looked mostly good with one question mark.

• Total testosterone (measured between injections): 780 ng/dL
• Free testosterone: 15.6 pg/mL
• SHBG: 32 nmol/L
• Sensitive estradiol: 33 pg/mL
• Hematocrit: 47%

The numbers were still solid. Estradiol was stable. Hematocrit had risen another point but was still well within safe range. What the labs did not show was a subtle regression in energy and libido that had started in month five and held through month six. Nothing dramatic. Enough to notice.

My provider’s read was that the numbers suggested I was responding well but that the specific dose might be on the low end of my personal optimal range. She offered two options: hold the dose steady and see if the regression resolved, or bump the dose to 120mg weekly (60mg twice weekly) and reassess in 6 weeks.

I chose the dose bump. The regression had been slow but clear, and I wanted to know whether a modest increase would move the symptoms. We adjusted to 60mg twice weekly and scheduled follow-up labs for week 30.

By week 28, the regression had resolved. Energy was back to the month three baseline. Libido was consistent. Sleep and recovery stayed stable. The 30-week labs confirmed the numbers had moved up appropriately:

• Total testosterone: 880 ng/dL
• Free testosterone: 18.1 pg/mL
• SHBG: 31 nmol/L
• Sensitive estradiol: 36 pg/mL
• Hematocrit: 48%

The sensitive estradiol moved from 33 to 36, which was still inside my range for feeling good. The hematocrit moved to 48, which was the number I was watching most carefully. My provider and I agreed that if it crossed 52, we would either donate blood or consider reducing the dose.

Month nine

As of the 36-week mark, the protocol has been stable on 60mg twice weekly for about three months. Subjective wellbeing is consistent with the post-adjustment baseline. Labs have been stable within normal variation. Hematocrit is hovering at 48. No need for anastrozole, no need for HCG, no side effects that require intervention.

This is where the protocol lives right now. Not permanent. Not optimized. Just working. My next labs are at month 12, and the plan is to hold the current protocol unless something changes.

What I would do differently

Looking back on the nine months, a few things I would change if I were starting again today.

Start twice-weekly from the beginning. The once-weekly trough pattern was informative but I spent a month feeling less good than I needed to. Twice-weekly is the better default for most men on TRT, and the flatter curve is worth the extra needle.

Order a wider initial panel. My initial panel covered the basics. It did not include inflammatory markers, a sensitive DHT, IGF-1, or a full thyroid workup. These would not have changed the decision to start TRT but would have given me a better baseline to compare against at follow-up. If I were starting over, I would pay for the deeper panel even though the DPC path did not require it.

Keep a more structured symptom journal. I kept notes but they were loose. A structured daily or weekly rating of energy, sleep, libido, recovery, and mood would have made the month-four regression visible earlier and the month-five regression obvious before the labs were due. Subjective data is real data, and a structured format captures signal a loose journal misses.

Take the monthly cost down by a bit. My monthly cost is reasonable but there is room to optimize. Buying labs through DTC rather than through a clinic route for the follow-ups would save $30-50 per round. I left that on the table because the DPC-routed workflow was easier.

Introduce peptides or other adjuncts more slowly. I did not add peptides in the first nine months, which turned out to be the right call. If I had added them in month two alongside the TRT, I would not have been able to separate the signals. Adding one variable at a time and giving each enough time to show its effect is the right framework, and it is the opposite of the temptation to stack everything at once for faster improvement.

The disclaimer I would give myself

If you are reading this and you are considering TRT, do not use this article as a protocol template. Use it as an example of what one man’s nine months looked like and what one provider recommended against one baseline. The right protocol for you depends on your labs, your symptoms, your response to a starting dose, and your provider’s judgment. The right provider is one who will think with you about the data rather than push you toward a standard prescription.

What I would take from this if I were on the outside looking in: starting TRT is less dramatic than the internet suggests, the early weeks are informational rather than optimized, the first protocol is almost certainly not the final protocol, the symptoms and the labs do not always agree, and the sleep you do not think to look for is often the first thing that gets better.

The boring things matter. The labs matter. The symptoms matter. The provider relationship matters. The specific dose and frequency matter less than people think, as long as you are paying attention and willing to adjust.