T Nation

Help with Current TRT Dosage, Possible Side Effects

I have been living with low test for over 20 years and I am now 44 years old ( my labs over the years have all been under 200 ng/dL at my highest so I think it’s genetic) I have always made due with the aches and pains, low libido, depression, and settled with just getting by. My quality of life has been horrible to say the least.

7 weeks ago I finally took the plunge, and decided to start testosterone replacement therapy after years of trying every way to naturally raise my testosterone. Needless to say my intermittent fasting, keto diet, heavy deadlifts ect. have all been unsuccessful, but have gotten me to this point… My Dr started me at @ 200mg test cyp every 2 weeks to take an aggressive approach to correct my issues… My energy did increase in the first few weeks, and my depression lessened, but I started experiencing soreness in my nipples that started at about week 2. The soreness has diminished some, but is still noticeable at my current week 7.

I feel as if my estrogen may be very high, and I have been feeling very lethargic to top things off.
At about week 5 I almost felt as bad as when I had low testosterone, but I no longer have the body aches.

Now at week 7 I am very tired most of my day, and just feel like I want to sleep, or rest. I am very unmotivated.

Sexually I feel very high desire most of the time, but when I am close to climax I start to get loss of sensation, and a discomfort in my penis testicles and can feel my prostate is irritated… Almost like a warm burning, or tingling feeling, that makes me lose my erection. It is very uncomfortable, and it is very hard to continue after this point. If I am able to re gain my erection in the hopes to continue. My ejaculation is uncomfortable and the pain lingers throughout most of the day afterwards. Too much prolactin perhaps?

I brought these issues up to my DR, and he tested me for bladder and prostate infection which came up negative. He did a full blood work panel “other then” Estrogen of all things that I am reading should have been tested. I had an abdominal, and pelvic CT scan with contrast and everything was fine, so I am lost.

My testosterone at week 5 on 200mg test cyp a week was 1300 which yes is high, and free test was very high as well. He has advised me to lower my dosage, and I am thinking about skipping this weeks shot, and continuing my testosterone next week at 100mg a week from then on out. At least until I understand what these issues are caused from to see if the testosterone is the reason. My Dr hasn’t prescribed me any HCG or any aromatase inhibitor. My basic blood work looked great by the way. My estrogen panel was not requested with my testosterone blood work for whatever reason??? This is my 3rd urologist in the past few months, and I feel as if I need to know exactly what to say, and ask for when I see him next, or he will push me on to the next Dr…

I want to request the particular blood work for estrogen, and I am wondering if too much estrogen may be the cause of my discomfort, and low energy.??? I am praying it’s something simple because I appear to be in perfect health… I need to know what exact blood test to ask for as I feel that I need to know to get these Dr’s on track with me. Is it really necessary in the beginning of TRT to start HCG? What do I ask my Dr for as far as dosage on a script if so? I do have noticeable testicle shrinkage as well.

Could I be having an allergic reaction to the test Cypionate? The injectable form is all that my insurance covers. I am scared to think about going back to having low testosterone if I need to come off of TRT due to an allergic reaction to the test cyp
Could I be experiencing issues do to too much prolactin, or estrogen? Yes I know this is a lot and I appreciate your time, and patience reading all of this to get on track with me. Thank you in advance…

This isn’t aggressive, it’s stupid and it tells me your doctor doesn’t usually prescribe TRT. Most managed healthcare doctors are operating in the dark and only have outdated guidelines (200mg every 2 weeks) to follow, managed health care isn’t where you should be looking for treatment.

SHBG should have been tested, SHBG binds sex hormones, you will need two or more injections per week and lower values means you will likely have to inject more frequently. My SHBG is low and feel best injecting daily.

You would know if you were having an allergic reaction, it would be at the injection site shortly after your injection. Skin would turn red and itch or burn.

This could have many causes like excesse RBC or iron deficiency and even low potassium can cause burning sensation.

It’s time to start looking for a doctor that specializes in his area of medicine and it most likely will not be a urologist or endocrinologist or any managed healthcare doctor. You need extensive lab work and your doctors are unlikely to be able to interpret the labs values.

Most of us have either had to figure out our own cases or seek out private doctors who specialize in this area of medicine in anti-aging and sports medicine, the home to TRT for 7 decades. You can keep changing doctors, it will more than likely net you the same results as before.

  • Total T
  • Free T
  • SHBG
  • Estradiol Sensitive (E2)
  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel
  • CBC-complete blood count
  • Comprehensive Metabolic Panel
  • Lipid profile/panel

Thank you for the quick response. This is why I have waited so long to start TRT, and now it seems that I am in an even worse situation then when I started. I have access with my insurance to my family care physician, my urologist, and possibly an endocrinologist if need be. My primary care Dr will work with me on pretty much whatever I need or ask for including labs, but none of my Dr’s follow an updated regimen on TRT. They all recommend 200mg every 2 weeks, other then my prescribing primary care physician who gave me 200mg a week, and surprisingly it was covered by my insurance. I asked for this dosage to be able to increase, or decrease according to how I felt or blood work results. He said it may be an aggressive approach to be exact… I combed the forums of guys running 200mg a week that say they have great success, while just taking a little arimidex at .25 every few days while at 200mg a week. This is why I started here and didn’t think I would need an anti estrogen this early on. I know that without knowing all my labs treating my condition at this point is probably impossible, but I am going to make an appointment to get them done as soon as I can get in.

I could always go down from here with my dosage. There are no TRT specialists in my insurance plan so if this is my only hope for normal levels then it will need to wait until I come up with the funds for this.

In the meantime would you suggest that I skip my next dosage and continue at 100mg a week there after? Or should I ask for arimidex and try this approach to see how I feel while I wait for my next labs which take a few weeks with my Dr. I am reading that I am going to probably feel like crap now for another 6 weeks adjusting any dosage. :frowning:

I am about ready to come off of this all together and just deal with the having a shitty life again. I thought I did my research and was ready for this but obviously I am not ready and another story of TRT gone wrong. All of the 3 urologists that I have seen have no idea of TRT therapy and just want to push me off saying that I need to do their 200mg every 2 weeks or they wont help me. Even asking how they support this protocol when the halflife is 7 to 8 daysd and it is proven that numbers fall to below normal towards the end of week 2. It is ridiculous that all they care about is liability, and not how they’re patients feel.

I can have my primary care Dr give me arimidex or maybe some cabergoline or perhaps something that I may need while I await my next labs if it may help with my energy levels, and fatigue.

I hope this helps anyone reading this that thinks they can just start TRT and coast or whatever bullshit that is circulating the net that makes people like myself think TRT is an easy solution to feeling better. Thank you again for your help, and I look forward to your next response or anyone that wants to share a similar experience.

Are you allowed to self inject, or do you have to go to the Dr’s office to get your injection?

If you can get the prescription and they allow you to do your own injections, then just smile and let them believe their bullshit protocol is working while you choose your own injection protocol for yourself. No harm no foul. You need to be injecting more than once per week in smaller doses to minimize E2 spikes.

If I were you, knowing what I know now, I would start TRT over going with 60mg injected twice weekly for starters for at least 6-10weeks with no AI or any other compounds at all. After that get labs at your trough period to see where your levels are at and assess how you feel. Small adjustments up or down can be made from there.

Thank you for your time, and response. Yes I self administer my test shots, but they only allow me one needle and syringe to draw, and one needle to inject per 200mg vial. That is 1 shot and vial per week to do whatever I want with. I am going to have to order some needles online it seems. Would you say that my symptoms sound estrogen or prolactin related? I know it’s not a good idea to give advice without labs, so I am just asking for opinions here. If I can get on an anti estrogen, and taper down slowly I would like to minimize any more negative side effects and the potential of feeling crashed out for up to 6 more weeks… I can ask my Dr for cabergoline, or arimidex. Perhaps HCG if it is needed but I need to know what MG to ask for so he can write the script accordingly… He has been helpful so far other then our shared ignorance of proper TRT protocol. All of these Dr’s treat trt as a liability, and don’t want to get involved. I could only imagine how 200mg every 2 weeks would feel if twice a week or more injections are necessary for proper estrogen control. Even with my current issues it’s still better then living with 180ish test level, but I just want to feel good for what may be the first time since my early teen years.
Thank you again.

Order yourself some needles and syringes online. You’re asking for trouble trying to introduce an AI at these doses. Your symptoms do sound E2 related, but it’s only out of whack because of your protocol. Fix the problem, not the temporary symptom. Follow a more frequent injection schedule and if you still have issues after 6-8 weeks, or if you are just hell bent on trying to control E2 and can’t bear the stabilization period, you should try something like DIM. Try to leave AI’s out of the equation if at all possible.

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Really appreciate the quick response… So at this point with my next injection coming up in 3 days should I just skip the next dosage? Or should I just drop it down to 100mg and continue injecting twice a week @ 100mg every 3.5 days to see if that helps?
I just looked up this DIM supplement, and I was not familiar with it. I will be sure to go pick up a bottle at my local health food store… I am willing to try anything at this point… Do you have a dosage recommendation for the DIM to give it a try? Thank you agian. I did have labs done at 5 weeks and my RBC cholesterol, basic labs were all very good ranges, so I am healthy at least.

He speaks the truth. Get some needles online. They are super cheap. Then up the frequency of your injections. Every other day, or every day injections will help a lot. I too reached high e2 symptoms (backed up by blood work), around week 8 of my original trt program (200mg once a week). I went on an ai and it crashed my e2, which was almost worse than high e2. Thanks to this forum I got on an eod injection schedule, and things got better. I dropped the ai months ago, and eventually went to every day injections, and e2 has been in the sweet spot ever since. It does take time to balance out. I was ready to drop it after the high e2 symptoms, which created some very serious anxiety and panic attacks. But I’m glad I stuck with it. I haven’t felt this good since I can’t remember.


I would drop the Test dose to 120 - 150mg per week split into 2 - 3 injections.

For DIM, 100mg per day seems to work just fine for a lot of guys. I would start with 100mg EOD and then go up to ED if you think you need it, but I would wait a while after dropping test dose to see if I thought I still needed DIM, and even then I would verify it with blood-work before I started trying to do anything about it.


I take one dim tablet every other day. Fyi. You might take one every day until your high e2 goes away. And then stick to an eod tablet. Its different for everyone, so you really need to learn your high and low e2 symptoms. Pay attention to what your body tells you and take note of it. Don’t do too much guessing, and change things too rapidly. Once you make a change stick with it for 4-6 weeks to give it a chance. Changes in hormones take time.


Ah man after reading this I don’t understand how Dr’s are perscribing 200mg every 2 weeks. That’s just insane. Thank you for saving me from getting an A.I. and going through what you did as well… I think I am going to try injecting twice a week to start. I do have a few extra needles here because I waited a few weeks to start my protocol to keep a few extra vials just in case I needed to travel. I am going to go buy this DIM stuff today if I can find it locally otherwise I will order it on Amazon Prime. Got a favorite DIM brand? Any particular thing to look for when buying this stuff? I usually order the NOW sports supplements they have always been really good in my opinion. Looks as if they have a Now DIM 200 90 vcaps which is 200mg and has some other crap in it.
Serving Size: 1 vcap
Servings Per Container: 90
Ingredient Amount % Daily Value**
Calcium (from Calcium D-Glucarate) 12mg 1
DIM (3,3’-Diindolylmethane) 200mg †
Calcium D-Glucarate (Tetrahydrate Form) 100mg †
Sodium Copper Chlorophyllin (Chlorophyll) 20mg †

Would this suffice?

Ok we are getting somewhere, and I am feeling a little more hopeful!
What protocol, and what injection site are you guys pinning every other day or more frequently?
IM or sub Q? I am just doing glutes switching sides once a week.

I inject 25mg of test cypionate ed. I take 100 mg of dim every other day. I use 1 ml insulin syringes with 1/2" 30 gauge needles to inject. When injecting such small dosages, you need a small syringe. I inject into my belly fat. It takes a while to fill the syringe with such a small needle, but you almost dont even feel the injection.

I have read about the sub Q injections but traveling with needles without a script might pose a problem for me. The injection frequency might be a problem due to travel but I can get away with twice a week for now so I pray that will be good enough to get things under control.

So where I am at now with my current protocol… Would it be safe to start injecting 100mg at the end of this week aprox. 7 days after my last shot of 200mg? Then starting 100mg every 3.5 days here after? Or should I skip this weeks shot and pick it up 3.5 days after when I was supposed to inject this week to let things settle down a bit? My current schedule is 200mg every Thursday morning.

If I can get away with staying at my current dosage at least till the end of summer that would be great, and especially if any changes may very well cause more issues with energy or libido ect.

Do you guys have a favorite DIM brand or is there anything to look out for when buying DIM? So something like 100mg every day for a week then 100mg every other day there after? How long does this stuff take to work? Again I greatly appreciate the advice.
Thank you for baring with me here. I know I have a lot of questions, and I am having some major anxiety over correcting these issues.

The reason is doctors that stray from guidelines can get in trouble in something were to go wrong, they are covering their own ass. TRT is not easy, it is as complicated as F*** and isn’t taught in medical school.

Standard of care for TRT in managed healthcare is basically 200mg every 2 weeks, my endo still prescribes this protocol and I told him I’ve been doing daily before joining this healthcare group and my levels have never been above mid-range, so he says nothing.

Maybe someday the guidelines will be update to allow for more frequent smaller injections, but for right now men are suffering needlessly. If you’re looking to struggle and have a difficult time on TRT, go to a managed healthcare doctor.

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I’d hardly call it complicated, it isn’t exactly brain surgery to tell someone to inject test every day and to treat symptoms more than lab values.

The problem is they aren’t taught to do this so they stick with guidelines that are outdated at best

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Hello again guys.
Here’s an update. I ended up going with the DIM plus supplement 100mg before bed for about 4 days and it helped very quickly with my issues. The nipple sensitivity went away in about 2 days. I took it off and on as needed and now haven’t taken it at all in a few weeks. I also divided my testosterone cypionate dosage to 100mg 2x a week which helped with my mood and energy level.
At my last blood work my test level was off the charts at over 1500 and my Dr advised me to drop to 60mg 2x a week which I have been doing for about a week now. He also advised me to give blood as soon as possible. Here are my blood levels that were in the high area. Everything else was good.
Rbc 4.30-5.90 =6.27
Hemoglobin 13.0-17 =18.4
HCT 39-51 =54.8
For the record.
He tested me a day after my shot of 100mg as well. Does that make a big difference?

My question is now that I have lowered my testosterone to 60mg 2x a week will these numbers go down themselves? Or do I really need to give blood? I did notice that I would have random heart palpations at night or when resting with the higher dosage. It has pretty much went away at 60mg 2x a week. I need to get my numbers down in a month or my Dr has threatened to cancel my testosterone prescription although I’ve followed his instruction to a T so far other then my pleading with him that I wanted to try the 2x a week divided dosage… Now because my blood levels are high and I am a liability to him he is being a prick about this therapy. I don’t have a lot of options where I am at so this guy has to work for now I know I need another Dr. I need help fast with this as my natural levels are below 190 and the thought of going back to that life is more scary then facing a stroke or heart attack. Yes I understand that 200mg a week was a high dosage but I wanted to try to put some muscle on this summer and get out of my rut. It was only for 12 weeks.
And as for the issues I was having it turned out I had a hernia that was strangulating my left testicle and was giving me a painful erection,amd loss of sensation. I just had surgery yesterday to fix and I’m laying here feeling like hell so I decided to say hello… . So it’s been a fun time since we chatted to say the least. Also need to know if I should skip an injection before the next blood work to be safe and insure my number is below 800. So how close to the next blood work should I wait to give blood? I’m probably going to need at least a week to donate seeing as I just had surgery. Appreciate your time and help… Have a great day today guys.

Your numbers will drop within a week.

Thank you for your response. Would you advise still giving blood to be withing my limits and to lower my hemoglobin and rbc for my next blood test in a month? I’d like to keep my testosterone level on the high side of the safe area. I’m finally starting to feel really good so I’m reluctant to lower my dosage especially after getting my libido back and meeting my girlfriend. Forgive me for all the questions I want to do this right without crashing or putting myself at any more risk. Would you say the 60mg 2x a week would produce a safe result? I know it varies from individual, so thoughts for this dosage? What is the feel good number range for test level?

A lot of guys fall for this trap, took me 2 years to figure out my libido is higher around 400-500 with Free T midrange but once I hit high normal testosterone libido takes a hit, sometimes less is more.

Remember more T means more E2 and excess of either can kill libido.

My total T is 1999 and E2 is 77 and I have super libido. At 600 T it wasn’t super. I like mine higher and thus I recommend higher. Systemlord feels best lower than my pre-trt level and that’s what he recommends. The one thing for certain is you won’t be exactly the same as anyone else here so don’t take anyone’s advice as gospel. Use it as a guide to figuring out you.

Why did he say you need to donate blood? Am I missing something? Your hematocrit is 39. Mine was 38 when I had iron deficiency anemia. Make sure you find out why before giving blood as it could cause issues if not needed.