TRT in the UK and EU   |
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By Mike Kocsis | 7 minutes read |
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  • Medically Reviewed by Dr. George Touliatos

    trt-testosterone-dosages

    Testosterone replacement therapy (TRT) replaces normal endogenous tesosterone levels with exogenous sources. These different types of TRT doses aim at mimicking the normal levels of testosterone and it’s metabolites. It is a recognised principal in treatment of low testosterone that the physiological state should be mimicked as close as possible.

    What is the best dose for TRT?

    The best dose is the treatment that will improve your symptoms with the least amount of side effects.

    Traditionally doses were prescribed according to the licence for the product as determined by the manufacturer and medicines regulator. They were dreadful recommendations often leaving a patient to be supraphysiological and in a steroid abuser state during the first few days. After which they would decline to hypogonadal states or even lower than before they started TRT. This yo-yo treatment was cruel and unfair but unfortunately many men are still suffering with a sub-optimal TRT dosage from the NHS and not so experienced private consultants.

    Optimal Male Hormone Levels

    Take Hormone Quiz

    Fortunately Balance My Hormones are able to offer modern testosterone optimisation techniques that will provide optimal male hormone levels using international or ‘American Style’ TRT with British sensibilities to our patients across the UK and EU.

    Testosterone Sustanon Dosages for TRT

    This testosterone is a blend of short, medium, and longer chain fatty acids.

    It theoretically should lead to long lasting and sustained levels over 3 weeks. In practice it falls far short and usually needs to be injected weekly or twice per week.

    The dosage is key, as a smaller more frequent dose can maintain stable levels in the blood and stable moods. Sustanon can be misunderstood by some who without looking at the blood test data will say that it may be unstable due to all the different esters, but blood tests have demonstrated time and again very predictable and optimised testosterone blood test levels on that TRT dose.

    What level of Testosterone can you expect on 125mg of Sustanon dosed every 5 days on the 5th day or trough day?

    Our doctor’s have seen levels normally around 30-35nmol/L on the trough day, or the day of the next injection. This has been shown consistently time and again despite several esters being in the mix. When this testosterone preparation is prescribed at the optimal dose then optimal levels and minimal side effects have been seen.

    Testosterone Cypionate Dosages for TRT

    This is a single medium length fatty acid testosterone ester.

    It can be dosed every 3-7 days depending on the initial dose used. It traditionally was dosed at 200mg every 2 weeks which was unfortunate as large supraphysiological levels were followed by low hypogonadal levels for several days to a week before the next injection. Testosterone Cypionate is available in North America and parts of Europe. Balance My Hormones has been able to procure Testosterone Cypionate for import to our pharmacy in the UK. This is a good option when Sustanon cannot be tolerated by some due to allergies, or post injection pain which may occur in a small percentage of patients.

    The best TRT dosing on Cypionate is one that is specific to you and your physiology, lifestyle, SHGB, and ability to inject more frequently. Many people do well with 80-100mg every 4-6 days, and others with 100mg every 4-7. It really depends on many factors including adherence to the doctor’s treatment plan.

    Testosterone Enanthate/Enantate Dosages for TRT

    Enantate is easily interchangeable with Cypionate. In the UK it is very costly, and limited in supply. In Europe it’s more reasonably priced and available.

    The pharmacokinetics are similar to Testosterone Cypionate and can be dosed in a similar fashion to described above. The constraints with testosterone enanthate is the single use ampoule and cost as frequent smaller doses can increase the cost.

    Testosterone Propionate Dosages for TRT

    This is a short length fatty acid testosterone ester.

    It needs to be dosed every day or every other day. The official recommendation is 50mg 2- 3 times per week. The testosterone propionate is available exclusive to BALANCE MY HORMONES patients is 25mg of Testosterone Propionate in a single use ampoule. Blood levels with 20mg daily injections have been 40nmo/L on the trough day or the next morning before the next injection. For those who do not wish to apply cream daily or twice daily, or for those who prefer daily or alternate day injections, testosterone propionate may be a good alternative. It come in a single ampoule and enough ampoules are supplied as an economical way to do more frequent injections. It provides stable levels so long as you inject frequently.

    Lower trough levels could be achieved with 25mg every other day and would more closely result in levels near 20-25 nmol/L on trough days or right before the next injection.

    Testosterone Cream Dosages for TRT

    If injecting is not for you and you’ve heard stories about gels not working then you may want to consider bespoke specialist manufactured cream. In the USA they call this testo-cream, or testosterone cream or compounded testosterone cream.

    The cream has various absorption enhancers and is able to hold a large concentration of testosterone. The skin or dermis layer can act as a reservoir and slowly release the bio-identical non esterified testosterone into the capillaries.

    Through normal skin you can expect around 10% absorption but through scrotal skin absorption could be close to 50% in some men. The cream also produces more of the metabolite DHT or dihydrotestosterone which may be responsible for restoring libido in men who have been refractive to injectable testosterone therapy.

    We’ve had reports from patients who have switched to the cream from injections and said it was nothing like what they have tried before and it improved their libido more than injections.

    The dose for cream is either one pump once per day or one pump twice per day. Blood tests should be done no more than 24 hours after the last dose and before applying the next dose. The timing window for blood testing is rather small so it’s important to arrange your blood test within 1-2 hours of your next dose either at the 12 hour or 24 hours after last application depending on how the doctor has dosed you.

    If you have low or very low SHBG you may tend to excrete testosterone at a higher rate and actually end up with lower levels, so smaller and more frequent dosing may be required. Testosterone cream can be formulated to meet your individual requirements so your testosterone dose will be just right for you.

    Testosterone Dosage Chart / Calculator for TRT

    This dosage chart illustrates the most common testosterone preparations available in the UK.

    Not all options are available everywhere and those with a * denote they are mostly exclusive to Balance My Hormones.

     

    PreparationRoute of ApplicationHistoric TRT DoseModern Optimal TRT Dose
     

    Testosterone Enanthate (Enantate)

    Intramuscular injection200-250mg every 2-3 weeks125mg every 5-7days

     

    250mg every 7-10 days

     

    Testosterone Cypionate*Intramuscular injection200-250mg every 2-3 weeks75mg every 3 days

     

    80mg every 3-4  days

    100mg every 4-7 days

    250mg every 7-10 days

    Sustanon®

    Each 1 mL dose of testosterone Sustanon 250 solution for injection contains 100 mg testosterone decanoate, 60 mg testosterone iso-caproate, 60 mg testosterone phenylpropionate and 30 mg testosterone propionate

     

    Intramuscular injection250mg every 3 weeks adjusted according to response.

     

    100-125mg every 4-5 days

    125mg every 5-7 days

    250mg every 7 -10 days

    Testosterone Propionate*Intramuscular injection50 mg 2–3 times a week.

     

    20-25mg daily, or 25-50mg  alternate days.
    Testosterone Undecanoate, Nebido®Intramuscular injection1000mg every 8-10 weeksNot recommended, in rare cases more frequent dosing every 4-6 weeks
    Specials Manufactured Trans-scrotal Testosterone Cream 100mg-200mg per dose.

    Available in 30,50,100ml in various pumps, dispensing volume, and base creams.

    Topical Scrotal application, Rib cage, or forearms100mg -200mg per dose applied once or twice per day100mg -200mg per dose applied once or twice per day
    Licenced Transdermal Testosterone Gel 16-50mg per 1-5g of gel

    Testim®, Testavan®, Tetogel®

    Topical/Transdermal Application Apply and rub in to the shoulders and/or upper arms.

     

    5 grams once daily

    Apply 60 mg once daily, subsequent application adjusted according to response; maximum 80 mg per day.

     

    Not normally recommended at modern TRT clinics.

     

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    About the Author: Mike Kocsis

    Mike Kocsis has an MBA with a focus on healthcare administration and is an entrepreneur and medical case manager for Balance My Hormones Ltd which offers medical services in the UK and Europe. Mike has over 20 years of experience in the healthcare sector, much of that working with people who have hormone imbalances. Mike has appeared on podcasts and radio and is an expert speaker on the subject of hormone imbalance. He specialises in Testosterone Replacement Therapy (TRT) and Hormone Replacement Therapy (HRT) and has helped thousands of people suffering from hormone imbalances recover and regain control of their lives. You can follow him on LinkedIn and on the Balance My Hormones YouTube Channel.

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    Last update: March 15th, 2021

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