TRT Cheat Sheet 2026
· DoseRoutine Editorial Team
Researched by DoseRoutine Research TeamReviewed for accuracy by Nicholas Alexander, RSE, SO, PMPLast updated Educational reference only — not medical advice. Always confirm dosing and safety decisions with a licensed clinician.
A TRT cheat sheet covers four things: which testosterone ester you are on and how often it needs redosing, the labs that get checked before and during treatment, what a reasonable dose looks like, and the side effects that mean you call your prescriber. Testosterone replacement is a prescription medical treatment — this is a reference for people already working with a clinician, not a protocol to self-start.
Testosterone replacement gets discussed as though it were a supplement stack. It isn't. It's a long-term prescription therapy that changes fertility, blood counts and cardiovascular risk profile, and the difference between people who do well on it and people who don't is usually monitoring rather than dose. This page is the reference sheet — esters, timing, labs, and the things that actually go wrong.
Esters and how often they need redosing
The hormone is the same molecule in every case. The ester attached to it changes how quickly it releases, which is the only reason dosing schedules differ.
| Ester / form | Approximate half-life | Typical schedule | Notes |
|---|---|---|---|
| Testosterone cypionate | ~8 days | Weekly or twice weekly | Most common injectable in North America |
| Testosterone enanthate | ~7 days | Weekly or twice weekly | Near-interchangeable with cypionate in practice |
| Testosterone propionate | ~20 hours | Every other day | Sharp peaks, more injections |
| Testosterone undecanoate (injection) | ~34 days | Every 10–14 weeks | Clinic-administered, pulmonary oil embolism warning |
| Transdermal gel | Hours | Daily | Transfer risk to partners and children |
| Subcutaneous pellets | Months | Every 3–6 months | No dose adjustment once implanted |
Splitting a weekly injectable dose into two smaller doses is the single most common adjustment clinics make, because it flattens the peak-to-trough swing that drives mood and water-retention complaints. It does not change the weekly total.
What a typical dose looks like
Replacement dosing is aimed at restoring a normal physiological range, not exceeding it. In most guidelines that means something in the region of 100–200 mg per week of cypionate or enanthate for injectables, adjusted against trough labs and symptoms rather than against a target number someone read online. Doses meaningfully above that range stop being replacement and start being performance dosing, with a different risk profile and, in most places, a different legal status.
Dose changes should be one variable at a time with at least six weeks between adjustments, because the ester needs roughly five half-lives to reach a steady state before a trough level means anything.
The labs that matter
Baseline, before starting:
- Total testosterone, measured on two separate early-morning fasted draws
- Free testosterone and SHBG, which explain most cases where symptoms and total T disagree
- LH and FSH, to separate primary from secondary hypogonadism
- Haematocrit and haemoglobin
- PSA if you are over 40, plus a prostate discussion
- Oestradiol, prolactin, thyroid panel, lipids, HbA1c
- Semen analysis if fertility matters to you now or later
On treatment, most clinics recheck at six to twelve weeks, again at six months, then annually: total and free testosterone at trough, haematocrit, oestradiol if symptomatic, PSA, and lipids.
Haematocrit is the number to actually watch. Rising haematocrit is the most common reason a dose gets reduced or an injection frequency gets split, and it is silent until it isn't.
Side effects worth acting on
- Rising haematocrit or thick-blood symptoms — headaches, flushing, unusual clot risk. Call your prescriber, don't wait for the annual.
- Fertility suppression. TRT shuts down the natural signal. If children are on the table, that conversation happens before the first injection, not after.
- Oestradiol swings in either direction — nipple sensitivity and water retention at the high end, joint pain, low libido and low mood at the aggressively-crushed end. Aromatase inhibitors are over-used in the self-directed crowd.
- Sleep apnoea worsening, especially with weight gain.
- Injection-site issues. Rotate sites, log which one you used, and treat persistent hot swelling as an infection until proven otherwise.
Things the forums get wrong
"Test your levels at any time of day." No — timing changes the result. Trough draws immediately before the next dose are what your clinician is interpreting against.
"Every man on TRT needs an AI." Most don't. Oestradiol is required for bone density, libido and mood in men, and reflexively suppressing it causes its own set of symptoms.
"More is more." Above physiological replacement, the symptom benefit plateaus while haematocrit, blood pressure and lipid changes keep climbing.
"Once you start you can never stop." You can stop, but recovery of natural production is variable and can take months, and it should be planned with a prescriber rather than by abruptly quitting.
Where tracking earns its keep
TRT is a long game measured in years, and the useful record is boring: injection date, dose, site, ester, and the lab values with the date they were drawn. When a symptom shows up eighteen months in, the question is always "what changed" — and a written history answers it in thirty seconds. DoseRoutine keeps the injection schedule, the site rotation and the lab markers in the same timeline, and if you also run peptides alongside, the peptide cheat sheet covers how those are dosed and where they clash.
For anything involving prescribing, dose changes or symptom management, work with your clinician. This page is a reference sheet, not medical advice.
FAQs
- What is a normal testosterone level on TRT?
- Most clinics aim to keep trough total testosterone within the normal reference range, commonly quoted as roughly 300–1000 ng/dL, with the target set by symptom response rather than by hitting the top of the range. Free testosterone and SHBG often explain why two people at the same total level feel completely different.
- Is weekly or twice-weekly injection better?
- Twice weekly splits the same weekly dose into smaller amounts and produces a flatter level, which many people find helps with mood swings, water retention and haematocrit. Weekly is simpler and works well for plenty of patients. It is a preference-and-labs decision, not a rule.
- Does TRT cause hair loss?
- It can accelerate male pattern hair loss in people genetically predisposed to it, because testosterone converts to DHT. It does not create the predisposition.
- Can you take peptides while on TRT?
- People commonly do, but the interaction that matters is monitoring: adding a growth hormone secretagogue or a GLP-1 while adjusting testosterone makes it impossible to attribute a change to either. Change one thing at a time and tell your prescriber what else you are running.
- How long until TRT starts working?
- Libido and mood often shift within three to six weeks. Body composition, red blood cell changes and bone density take months, and levels themselves need about five half-lives — roughly six weeks on cypionate — to stabilise before a trough lab is meaningful.
This article is for informational purposes only and does not replace professional medical advice. Always consult your healthcare provider before changing medications or supplements.