Standard Starting Doses
Testosterone cypionate is the most commonly prescribed form of TRT in the United States. It is an oil-based injectable with a half-life of approximately 8 days, making it suitable for once or twice-weekly injection protocols.
Most providers start patients at 100-200 mg per week, with the typical starting dose being 100-150 mg/week. This conservative starting point allows your provider to assess your response, monitor lab markers, and titrate upward if needed.
| Starting Dose | Typical Use Case |
|---|---|
| 80-100 mg/week | Conservative start for older patients, those with cardiovascular risk, or borderline-low levels |
| 100-150 mg/week | Standard starting dose for most hypogonadal men |
| 150-200 mg/week | Higher starting dose for significantly low levels (under 200 ng/dL) or larger body mass |
Your dose is not determined by symptoms alone. It is based on your baseline testosterone levels, SHBG (which affects how much free testosterone you have), body weight, age, and overall health profile. Two men with the same total testosterone can require very different doses because their SHBG levels differ.
Do not increase your dose without lab confirmation and provider approval. More testosterone is not always better — supraphysiological levels increase estradiol conversion, hematocrit, and side effect risk without proportional benefit.
Injection Frequency: Once vs Twice Weekly
Testosterone cypionate can be injected once per week or split into two smaller doses per week. The total weekly amount is the same — the difference is in how stable your blood levels stay.
Once weekly (e.g., 150 mg every Monday): simpler, fewer injections, but produces more pronounced peaks and troughs. Some men feel great for the first few days then experience fatigue or mood dips before the next injection.
Twice weekly (e.g., 75 mg Monday and Thursday): produces more stable blood levels with less peak-to-trough variation. Many men report feeling more consistently good throughout the week. This is the preferred protocol for most modern TRT providers.
Some men inject every other day or even daily with microdoses. These protocols produce the most stable levels but are less common and require more commitment. Your provider will recommend a frequency based on how your body responds and your preference.
Subcutaneous vs Intramuscular Injection
Traditionally, testosterone cypionate was injected intramuscularly (IM) — typically in the gluteus or quadriceps using a 22-25 gauge, 1-1.5 inch needle. This remains a common and effective method.
Subcutaneous injection (SubQ) has gained popularity in recent years. This involves injecting into the fatty tissue of the abdomen or thigh using a smaller needle (27-30 gauge, 0.5 inch). Research shows subcutaneous injection produces equivalent testosterone levels to intramuscular injection.
Advantages of subcutaneous: smaller needle (less intimidating for first-timers), less injection site soreness, more injection site options, and studies suggest slightly more stable absorption. The main limitation is that high-volume injections (over 0.5-0.7 mL) are more comfortable intramuscularly.
Your provider will teach you the proper technique for your chosen method. Most Heyday patients use subcutaneous injection with an insulin-type needle.
How Dose Adjustments Work
Your starting dose is exactly that — a starting point. Optimization happens through a feedback loop of labs and symptoms:
First labs at 6 weeks: drawn at the trough (the day before or morning of your next injection). Your provider is looking at total testosterone (target: 500-900 ng/dL at trough), free testosterone, estradiol, hematocrit, and PSA.
If total T is below target: dose increases by 10-25 mg/week. Re-check labs in 6-8 weeks.
If total T is above target or estradiol is elevated: dose decreases or injection frequency changes. Re-check labs in 6-8 weeks.
If hematocrit is elevated (above 52-54%): your provider may reduce dose, increase injection frequency, recommend blood donation, or initiate other interventions.
Labs at 3 months: confirms stabilization. Most men are at their optimized dose by this point.
Ongoing labs every 6 months: monitors long-term safety markers and ensures the protocol remains effective. Your needs can change over time — SHBG levels shift, body composition changes, and aging affects metabolism. Regular labs catch these shifts.
Always draw labs at trough — the lowest point in your cycle (morning of injection day). This gives your provider the most accurate picture of your minimum testosterone level. Peak measurements overestimate your effective levels.
What to Expect at Each Dose Range
Individual response varies, but generally:
At 100 mg/week: most men achieve trough levels of 400-600 ng/dL. Sufficient for symptom relief in many cases. Lower estradiol conversion risk.
At 150 mg/week: most men achieve trough levels of 550-800 ng/dL. The sweet spot for most patients — strong symptom resolution with manageable side effects.
At 200 mg/week: trough levels of 700-1000+ ng/dL. Higher symptom resolution but increased monitoring needed for hematocrit and estradiol. Not necessary for most men.
The goal is not the highest possible testosterone level. The goal is the lowest effective dose that resolves your symptoms while keeping safety markers in range. More is not better in TRT — it is a balance.
Medications That May Accompany TRT
Depending on your labs and response, your provider may add supporting medications:
Anastrozole (aromatase inhibitor): prescribed if estradiol rises too high. Blocks conversion of testosterone to estrogen. Used at low doses (0.25-0.5 mg, 1-2x per week). Not everyone needs this — many men do fine without it.
HCG (human chorionic gonadotropin): stimulates the testes to maintain natural testosterone production and preserve testicular size. Important for fertility preservation. Typically 500-1000 IU, 2-3x per week.
Enclomiphene: a selective estrogen receptor modulator that can be used as a TRT alternative or adjunct to maintain LH/FSH signaling. Growing in popularity for younger men concerned about fertility.
Your Heyday provider discusses all options during your consultation and prescribes based on your specific needs and goals.