T Nation

Starting TRT Over 40, Have a Few Questions


I’m a 42 male about to start TRT. Over the past couple of years I’ve been gradually feeling my energy and libido going down. Significantly more so this year. I’ve went through some personal issues with my marriage and work which had me very stressed and slightly depressed, so I’m sure that had something to do with it. Along with my age of course - that I’m no longer 25.

Anyways I went to my family doctor in Toronto, did some blood tests, and these were my results:

Total T levels: 18.9 nmol/L Reference range 8.4 - 28.8
Free Testosterone 321 pmol/L Reference range 196 - 636

I discussed my options with my doctor, and TRT was one of them. After a few months of thinking it over and not feeling any better, I decided to go for it.

He prescribed Delatestryl 200mg/ml every 3 weeks.

My questions are:

1- Is this a good dosage to start with?
2- Is once every 3 weeks a good break down of the my dosage? Because from what I’ve read most people seem to be breaking their dosage to weekly or bi-weekly injections, some twice a week. If I take the shot every 3 weeks, by the 3rd week will I be experiencing more negative symptoms?
3- Is TRT enough or should I be taking something else with it? I read some people take clomid to fight some side effects? Or should I wait and see if I have any first?
4- I understand that taking TRT will kill my normal sperm production, but lets say in a year if my wife and I decide to have one more child, will going on HCG help restart my sperm production or will it be too late?
5- My job requires me to travel a lot, is it easy to travel with TRT and what happens if you miss a shot? Can you make up for it a week later?
6- How long after starting TRT can one expect to start feeling a difference?

I apologize if some of my questions are redundant or have been answered in the forum before, but as you can imagine like everyone starting this for the first time, something that will be a life long commitment - I’m a bit nervous.

I appreciate any advice or feedback I can get.


No, no, and no! I’m afraid your doctor isn’t up to speed on TRT at all and is incompetent. There was a clinical study published back in 2005 where men were injected with 200mg every 2 weeks and 6 days after each injection, levels were below the therapeutic ranges. The guidelines doctors follow are outdated if this 2005 study has anything to say about it.

An experience TRT doctor would know full well these protocols don’t show favorable results, in fact it’s worse than pre-TRT and if this doctor actually had clinical experience, he would know firsthand because patients would be complaining.

A lot of men inject T two or more times per week, examples are 100mg weekly, 50mg twice weekly, 20-25mg EOD or 10-15mg daily. These are just starting points and further tweaking is almost always needed.

I’m not surprised to see you experiencing symptoms with Free T midrange, I see a lot of this on T-nation, when my Free T is midrange, I experience all low T symptoms. Beware, low thyroid function has similar symptoms as low T, often doctors follow outdated lab ranges that included those with thyroid dysfunction in determining the lab ranges.

HCG can help in the fertility department, FSH injections is king in the fertility department, but is expensive. Stopping TRT to become infertile is completely unnecessary, you can even micro doses of clomid to help regain fertility. Stopping TRT will cause your natural production to start back up after a time.

Your estrogen will be managed by increasing injection frequencies if proving difficult to manage where lowering the dosage isn’t enough, estrogen blockers are over prescribed and unnecessary in most cases. These estrogen blockers (AI’s) screw with estrogen metabolism, but in rare cases they are needed for a short amount of time until the situation is under control. [fat loss]

If you are carrying around extra weight in the mid-section, you may have high estrogen symptoms until weight is lost. Nothing daily injections cannot fix if you dose it smartly.

Most men who wish to work with competent doctors pay for treatment out of pocket in private practices in anti-aging and wellness which is preventative medicine, not managed healthcare.

Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism

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These numbers are not of the charts.
Are you obese?

Did they check prolactin, lh, fsh,cbc, metabolic panel, lipids, iron?

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Do NOT take shot every 3 weeks!!!

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Correct do it twice weekly Adamo77 your TEST enanthate okay, do 50mg twice weekly to start off for a total of 100mg TEST E per week, if that doesn’t give you your old youth back and fully optimal wellbeing feeling, which is Libido, Erection Strength, Mental energ/muscular strength & endurance, then you can go up to 65mg per shot which will be 130mg per week of TEST e. Myself i used to do 60MG twice a week of Test E (total 120mg week) every 4 days i would inject 60mg it was ideal and i had zero E2 Estro issues, didn’t have to reach for Anastrozole Adex once. i am Slim 160lbs 5foot 9 tall, and lower body fat now.

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Also run a blood panel about 8 weeks after twice weekly at 50mg that is more than enough time for it to stablize and for a real base line result from running your Delatestryl (Enanthate).

Hope my answers clear anything up, Oh and for the Blood Labs run Total T, Free T, Sensitive (E2) Regular (E2) and SHBG. All Thyroids & Thyroid antibodies, Run PSA if you worried about prostate.

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Thanks @systemlord. This is very helpful. Yeah its seems from what you are saying and what I’ve been reading that my family doc isn’t very versed in TRT. But he was willing to prescribe it and I guess thats a good thing from what I’ve heard of other family doctors.

So my issue now would be that I’m going back to him this week so he can administer my first shot and to show me how to do it. Should I just tell him don’t give me the full dose and split it? I’m just not sure how he’d take it?! lol Doctors can get touchy about patients thinking they know better. My other option is to just administer that first shot on my own but honestly I would be worried about doing that since I never gave myself or anyone else a shot before, I need a professional to show me how to do it.

What do you think is the best way to approach this with my doctor? Also, how about 100mg once a week for started? The prospect of injecting myself once a week sounds better to me than twice a week, at least as I begin.

What do you think?

Thanks dannybrouk! I’m actually about your height and weight. Slightly heavier though.

What do you think about starting off with 100mg a week, once a week? Instead of 2 shots weekly? Could that work. I think I need to ease myself into taking shots regularly.

Also still figuring out how to argue this point with my doctor, who will administer my first dosage to show me how it done.

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Hi Charlie12,

Thanks for your reply. No I’m not obese. I’m in decent shape for 42 I think. I work out about 3 times a week, not too intense, but I’m in decent shape. I have a decent “dad bod”. Just very low energy for about 9 month and very low libido.

And no, I’m not sure if all that stuff you mentioned was checked. He just told me to do a blood test, and then we discussed TRT. I’m thinking if I had other problems he would have told me

What would you recommend golfbear? May I ask what dosage has worked for you?

Show your doctor something he will understand, show him the study provided, this should alleviate any concern. I use 29 gauge insulin syringes in the shoulders and quads.

Once weekly will likely not be sufficient enough prolonging the dialing in process to several months or longer, note progress halts when not in a stable state.

Almost everyone pushes back at the idea of multiple injections a week, in the end they always realize it after several months than more frequent injection is better.

I would say 100mg is typical dose regardless to what other men do. 100mg will get your testosterone to 1000 ng/DL but if you’re a Hyper Metabolizer with a Normal SHBG like me will need more than 100mg a week. I am on higher dose Sustanon though which is totally different to Enanthate. But need to do it twice weekly my Brother Adamo keep (Estrogen levels in check) Most men split their 100mg dose by 2 shots of 50mg which works for many guys that Protocol. Hope that helps

Also ask him if you can take your 5ML or 10ML Vial home. i guess that u wont be going to him for every shot right? and you can take the script to your local Pharmacy/drug store for the bottle to take home.

Best place Intramuscular is DELTS (shoulders) by far for me anyways. avoids you bending around to your ass cheeks and sticking that, it’s more simple when done with I.M use a 27g needle too. this video will help you very much https://www.youtube.com/watch?v=0uXoBb6mkys for doing injections. But it’s preference if you want to do your Thighs (Quads) or Glutes you can.

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Even easier to INJECT is Subcanteously into your belly or Hip fat. But that is something you do when you’re more confident in doing your treatment injections. But many many guys have switched to SubQ. I am still on old fashioned way I.M yep.

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Hey bro I’m in Toronto too. You’re gonna love Delatestryl. I see you did you tests with LifeLabs right? Same ranges as mine. I started at 12.1 TT. 100 mg once weekly brought me to 42.8 on peak.

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IM shots in quads are so easy. I use a 25 gauge 7/8" needle and I can’t even feel the needle going in. Zero pain. Shallow IM is the best of both worlds. And numbers show it works.


Thank you so much dannybrouk! All this info is great and the video is very helpful.
Cheers brother.

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NELSON VERGEL is an expert i guess in lots about T.R.T the man has his own website. Blood testing company and he’s been on T.R.T about 20 years. So i definitely like his Injection Technique : D

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Hey Sublimeprince32! Thanks for your reply. That’s great that you are in Toronto, cause I have some specific questions for you.

1- Where do you get your Testosterone vial from? I have my prescription, my doctor is in North York and I live downtown. Can I get the prescription filled at any Shoppers pharmacy or do you get it from specific pharmacies?

2- How much should I expect the 200ml to cost? I know OHIP probably doesn’t cover this but I’ll check if my Manulife insurance does.

3- Also for syringes and wipes, do you get them online or at Shoppers Pharmacy?

4- Is 100ml once a week working for you? Have you felt you need to break it down to 2 dosages a week?

5- Do you take anything else with TRT for side effects or TRT is enough? Also if you don’t mind me asking, how long have you been on TRT and any thing you think I should be aware of?

Thanks brother.

Yes he seems like it. I can’t imagine how things will be for me 20 years from now if I’m still on TRT, but right now I just wanna live my good life while I still can. 40’s is the new 30! lol

Dannybrouk, do you feel you take anything with TRT to combat side effects or you find that TRT alone is enough as long as you are within a reasonable range?