Start with a blood test
By Mike Kocsis | 14 minutes read | Last updated: November 30, 2024
Medically Reviewed by Dr. George Touliatos
How much testosterone should you take to get optimal results? Determining the best TRT dosage for you can be challenging. The goal is to alleviate symptoms with the fewest side effects. Historically, TRT dosages were based on manufacturer guidelines, often leading to fluctuating testosterone levels and inconsistent results. Many men still endure sub-optimal treatments from the NHS and inexperienced private consultants.
At Balance My Hormones, we utilise modern testosterone optimisation techniques to provide stable hormone levels. This article explores various TRT dosages, including Testosterone Sustanon, Cypionate, Enanthate, Propionate, and Testosterone Cream, and offers guidance on finding the ideal dose tailored to your specific needs.
What is TRT?
Testosterone Replacement Therapy (TRT) is a medical treatment designed to address low testosterone levels, often due to conditions like male hypogonadism. Testosterone is a crucial hormone for men, influencing sexual function, muscle mass, mood, and energy. When the body cannot produce testosterone naturally (either due to aging or issues with the pituitary gland) TRT can help restore hormonal balance. It works by increasing the levels of bioavailable testosterone (including free testosterone, the active form) to alleviate symptoms associated with testosterone deficiency, such as chronic fatigue and reduced libido.
Symptoms TRT May Relieve:
- Low energy and fatigue
- Decreased muscle mass and strength
- Reduced libido and sexual function issues
- Erectile dysfunction
- Depressed mood or irritability
- Difficulty concentrating
- Decrease in bone density
Determining the right testosterone treatment requires understanding how your body responds to therapy and achieving a balance that mimics natural hormone levels. Finding the optimal dosage is essential for maximising benefits while minimising potential side effects.
What is the best dose for Testosterone replacement therapy?
The best dose is the treatment that will improve your testosterone levels and 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 testosterone replacement therapy. 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 Testosterone Levels
Fortunately, Balance My Hormones can offer modern testosterone optimisation techniques that will provide optimal testosterone levels using international or ‘American Style’ TRT with British sensibilities to our patients across the UK and EU.
Find out more about TRT UK
How to use a Syringe with TRT (Animated Guide)
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 serum testosterone 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 doctors have seen testosterone 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.
Testosterone Cypionate 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 testosterone replacement therapy 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/Enanthate Dosages for TRT
Testosterone enanthate 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 similarly to those described above. The constraints with testosterone enanthate are 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 exclusively 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 the cream daily or twice daily, or for those who prefer daily or alternate-day injections, testosterone propionate may be a good alternative. It comes 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 testosterone 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 can 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 minimum effective dose dose for cream is either one pump 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 the 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 end up with lower levels, so smaller and more frequent dosing may be required. Testosterone cream can be formulated to meet your requirements so your testosterone dose will be just right for you.
Testosterone Injection Dosage Chart / Calculator for TRT
This testosterone injection dosage chart illustrates the most common testosterone preparations available in the UK.
| Preparation | Route of Application | Historic TRT Dose | Modern Optimal TRT Dose |
| Testosterone Enanthate (Enanthate) | Intramuscular injection | 200-250mg every 2-3 weeks | 125mg every 5-7days
250mg every 7-10 days
|
| Testosterone Cypionate* | Intramuscular injection | 200-250mg every 2-3 weeks | 75mg 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 injection | 250mg 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 injection | 50 mg 2–3 times a week.
| 20-25mg daily, or 25-50mg alternate days. |
| Testosterone Undecanoate, Nebido® | Intramuscular injection | 1000mg every 8-10 weeks | Not 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 volumes, and base creams. | Topical Scrotal application, Rib cage, or forearms | 100mg -200mg per dose applied once or twice per day | 100mg -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. |
Microdosing TRT
What is microdosing?
In the past, testosterone replacement therapy (TRT) was often administered in biweekly injections, with large doses designed to sustain testosterone levels over time. However, this approach frequently led to fluctuations in hormone levels, causing peaks and troughs that could result in mood swings, energy dips, or other unwanted side effects. Today, there is a growing preference for “microdosing” TRT, where smaller, more frequent doses are given to maintain steadier testosterone levels. This method aims to mimic the body’s natural rhythm, reduce side effects, and improve overall patient outcomes, aligning with modern personalised approaches to hormone therapy.
What are the issues with large dosing in TRT?
When a large dose of testosterone is administered every two weeks, testosterone levels often spike significantly in the initial days, reaching excessively high levels. Subsequently, these levels start to decline, reaching optimal levels around the fifth day and persisting until they return to baseline by the fourteenth day. This injection pattern often leads to challenges for patients, including a surge in energy, heightened sexuality, and sometimes anxiety, followed by a recurrence of testosterone deficiency symptoms. Described as a cycle of high peaks followed by low troughs, this fluctuation contributes to a suboptimal experience for individuals and gave rise to the popular TRT term of feeling ‘unstable’.
Studies on microdosing
A PK study (Nankin HR 1987) evaluated serum levels of testosterone periodically for 14 days after administration of TC 200 mg IM in 11 hypogonadal men (Reference). The mean Cmax was supratherapeutic (1,112±297 ng/dL) and occurred between days four and five post-injection. After day 5, testosterone levels declined and by day 14 the mean Cavg approached 400 ng/dL. These large fluctuations in serum testosterone over a 2-week period illustrate the less-than-ideal kinetics of TC IM injections.
When working with a doctor to determine a suitable TRT protocol, it’s essential to recognise that each individual responds differently. Factors such as sex hormone-binding globulin (SHBG) levels can guide a doctor, but optimal dosing varies from daily to weekly. Patients with similar dosing and blood levels may still experience different outcomes. Beware of clinics, doctors, coaches, or social media influencers claiming a one-sise-fits-all treatment protocol; this is likely a sales technique rather than an accurate representation of the individualised nature of TRT.
hCG and Microdosing
Human Chorionic Gonadotropin (hCG) plays a pivotal role in Testosterone Replacement Therapy (TRT), particularly for those practising microdosing. hCG is often included to maintain natural testosterone production and prevent testicular shrinkage, which can occur when exogenous testosterone suppresses the body’s natural hormonal pathways. When paired with microdosing—where smaller, more frequent doses of testosterone are administered—hCG complements the steady hormonal levels by stimulating the testes to continue producing testosterone and supporting fertility. This approach helps mitigate the peaks and troughs commonly associated with larger, less frequent testosterone injections while providing a more physiological and balanced hormonal environment.
Final Thought
Finding the right testosterone replacement therapy is crucial for achieving optimal results with minimal side effects. Different forms of testosterone, such as Sustanon, Cypionate, Enanthate, Propionate, and Testosterone Cream, offer various benefits and challenges. The key is to tailor the dosage to your unique physiology, lifestyle, and treatment goals.
If you have any questions or would like more information about testosterone replacement therapy preparations for you, please contact Balance My Hormones. Our experts are here to help you achieve optimal hormone levels and improve your quality of life.
How can Balance My Hormones help?
Here at Balance My Hormones, we have extensive experience with testosterone replacement therapy (TRT). We work to ensure that all our patients receive the best possible dosages and treatments for their bodies.
If you have any questions or would like more information about TRT, please click the contact button above. Our experts are here to help you achieve optimal hormone levels and improve your quality of life.
References/Bibliography/Scientific studies/Further reading
Nankin HR. Hormone kinetics after intramuscular testosterone cypionate. Fertil Steril 1987;47:1004-9. 10.1016/S0015-0282(16)59237-1 [PubMed Reference] [Cross Reference]
Ramasamy R, Armstrong JM, Lipshultz LI. Preserving fertility in the hypogonadal patient: an update. Asian J Androl2015;17:197-200. 10.4103/1008-682X.142772 [PMC free article] [PubMed] [CrossRef]
Evidence Based Research
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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.
Last update: November 30th, 2024
