If I could go back to day one before starting Testosterone Replacement Therapy (TRT), I wouldn’t start with motivation, gym results, or libido improvements.

I’d start with proper injections and protocols — because that’s where everything begins.

TRT isn’t just “take testosterone and feel amazing.” It’s a structured medical therapy. The difference between feeling stable and feeling like you’re on a hormonal rollercoaster usually comes down to how well your protocol is set up from the start.

Here’s what I wish I knew.

1. Proper Injections: Frequency Matters More Than Dose

Most beginners focus on the number — 100 mg, 150 mg, 200 mg per week.
What I didn’t realize is that injection frequency often matters more than the total weekly dose.

Large, once-weekly injections can cause:

• Big hormonal spikes

• Estrogen swings

• Mood fluctuations

• Energy crashes before the next shot

Splitting your weekly dose into 2–3 injections per week often creates:

• More stable testosterone levels

• Better mood consistency

• Fewer estrogen issues

• Less water retention

Stable levels = stable life.

2. Injection Technique: Simple, But Important

This part sounds basic — but doing it correctly makes a difference.

Key considerations:

• Intramuscular (IM) or subcutaneous (SubQ), depending on provider guidance

• Rotate injection sites (glutes, ventrogluteal, delts, quads)

• Use appropriate needle size

• Maintain sterile technique

Poor technique can lead to:

• Scar tissue buildup

• Irritation

• Inconsistent absorption

The smoother the injections, the smoother the therapy.

3. Start Moderate — Not Aggressive

One of the biggest mistakes I see is starting too high.

High starting doses can:

• Spike estradiol

• Raise hematocrit quickly

• Increase blood pressure

• Cause anxiety or irritability

A moderate starting range (determined by your provider and labs) allows your body to adjust. You can always increase if necessary. It’s much harder to manage side effects after overshooting.

TRT is about optimization, not chasing supraphysiological levels.

4. Estrogen Is Not the Enemy

When testosterone rises, some of it converts to estradiol (E2). This is normal and healthy.

Estradiol supports:

• Libido

• Joint health

• Cardiovascular protection

• Mood stability

Crashing estrogen with an aromatase inhibitor too early can make you feel worse than low testosterone ever did.

Instead of panicking over lab numbers:

• Assess symptoms

• Adjust testosterone dose first

• Add medications only if truly necessary

Balance beats suppression.

5. Bloodwork Is Your Roadmap

TRT without bloodwork is guesswork.

Before starting, you should evaluate:

• Total testosterone

• Free testosterone

• SHBG

• LH & FSH

• Estradiol (sensitive assay)

• CBC (hematocrit/hemoglobin)

• Lipids

• PSA

After starting, labs should be repeated regularly to monitor trends.

Elevated hematocrit, for example, can increase cardiovascular risk if ignored. Lipid changes matter. 

6. Fertility Considerations: Think Ahead

This is something I wish more people emphasized.

TRT suppresses natural testosterone production, which can significantly reduce sperm production.

If you plan to have children:

• Discuss hCG alongside TRT

• Consider fertility-preserving strategies

• Freeze sperm beforehand if necessary

Don’t assume fertility automatically rebounds.

7. The First 8–12 Weeks Are an Adjustment Phase

Early TRT can feel like:

• Increased energy

• Higher libido

• Improved mood

But it can also bring:

• Water retention

• Sleep changes

• Emotional fluctuations

Your body is adapting to new hormone levels. Resist the urge to constantly tweak your protocol during this phase unless side effects are severe.

8. TRT Doesn’t Replace Discipline

TRT amplifies your habits.

If you:

• Train consistently

• Eat well

• Sleep properly

• Manage stress

You’ll likely see incredible improvements in body composition, strength, and vitality.

If you neglect those areas, TRT won’t compensate for them.

Hormones optimize effort — they don’t replace it.

Final Thoughts

If I could summarize the TRT starter pack in one sentence:

Start conservatively, inject consistently, monitor intelligently, and think long term.

TRT can be life-changing for the right candidate — restoring energy, drive, confidence, and physical vitality. But success isn’t about chasing the highest numbers.

It’s about building a stable, sustainable protocol that supports your health for years to come.