How Much Testosterone Should I Take?

Evidence-Based TRT Dosing Guide (Updated Jan 2026)

Testosterone replacement therapy (TRT) is not a "one number fits all" treatment. The right dose depends on why testosterone is low, how it's delivered (injections vs gel vs other forms), and how your body responds over time. A dose that's perfect for one person can be too high - or ineffective - for another.

This guide explains how clinicians typically determine a testosterone dose, what current evidence says about "safe" dosing targets, how injection frequency affects peaks and troughs, and which labs matter most - so you can have an informed, practical conversation with your provider.

What "Testosterone Dose" Really Means

When people ask "How much testosterone should I take?", they usually mean one of three things:

• How many milligrams (mg) per injection or per week?
• How often should I dose (weekly, twice weekly, every 2 weeks)?
• What blood level should we aim for?

Clinically, the goal of TRT is generally to restore testosterone into a physiologic range and improve symptoms while minimizing adverse effects. Evidence-based guidance emphasizes monitoring and aiming for a mid-normal range rather than chasing extreme highs.

What Clinicians Consider When Choosing a TRT Dose

A responsible dosing decision starts with confirming that TRT is appropriate. Most evidence-based approaches include:

• Symptoms consistent with testosterone deficiency, AND
• Repeated low testosterone measurements (often morning testing), plus clinical context.

Then dose and schedule are individualized using factors like the following.

Clinical Factors

• Likely cause of low testosterone (primary vs secondary hypogonadism, medication effects, etc.)
• Age and comorbidities (sleep apnea risk, cardiovascular risk, clot history, kidney disease, etc.)
• Fertility goals (TRT can suppress sperm production; this is a major decision point)
• Baseline hematocrit/hemoglobin (tendency toward erythrocytosis)
• Prostate risk and screening preferences (shared decision-making)

Practical Factors

• Formulation choice (IM/SC injections vs gel/patch vs longer-acting options)
• Adherence and lifestyle (some people do better with fewer dosing days; others prefer more frequent smaller doses)
• Tolerance of peaks/troughs (energy, mood, libido swings can correlate with fluctuations in some patients)

What Is the Safest Testosterone Dosage?

"Safest" is less about a single number and more about a safe outcome:

• testosterone levels maintained in a physiologic range,
• symptom improvement,
• and safety markers staying in acceptable limits (especially hematocrit and blood pressure).

What Dosing Ranges Show Up in Labeling and Guidelines?

You may see different ranges depending on whether you're looking at product labeling or clinical guideline examples.

• FDA labeling for injectable testosterone (example: testosterone cypionate) lists a broad dosing range and stresses that dosing must be individualized based on response and adverse reactions.
• Clinical guidance commonly discusses starting strategies such as 75–100 mg weekly or 150–200 mg every two weeks for cypionate/enanthate as typical example regimens (not universal instructions).

Important Safety Update That Matters in 2026

In 2025, the FDA announced class-wide labeling updates for testosterone products after reviewing TRAVERSE and other data. The update emphasized increased blood pressure across testosterone products and revised cardiovascular language accordingly. In practical terms, "safe dosing" in 2026 must include attention to blood pressure trends, not only testosterone numbers.

How Often Should Testosterone Be Injected?

Injection frequency is one of the biggest drivers of:

• symptom stability,
• side effects,
• and how "smooth" your lab curve looks.

Why Frequency Matters: Peaks and Troughs

With some intramuscular (IM) regimens, testosterone can spike high after the injection and then gradually drift down before the next dose. Longer intervals can create larger fluctuations ("peaks and valleys"), which some people feel as inconsistent symptom control. Pharmacokinetic discussions also note that every-other-week IM dosing can produce larger swings than more frequent dosing. That's one reason many modern protocols favor weekly dosing or splitting the weekly amount into two injections for certain patients.

Weekly vs Twice-Weekly Injections: Why Frequency Matters

Many clinicians start with weekly dosing, then adjust based on labs and how the patient feels. In some cases, splitting the same total weekly dose into two smaller injections can help:

• reduce peak-related side effects (acne, irritability, sleep disruption),
• improve end-of-week symptom "drop-off,"
• provide more stable levels for some individuals.

Subcutaneous (SC) injections are also used in certain settings. Published studies describe SC administration achieving target testosterone ranges for many patients when properly monitored. The best option depends on individual response, comfort, and clinician guidance.

TRT Delivery Options at a Glance

Signs Your Testosterone Dose May Be Too High or Too Low

Symptoms alone aren't enough—labs matter—but these patterns are commonly discussed in practice.

Possible Signs Your Dose Is Too High (or Peaks Are Too High)

• Acne or oily skin
• Hair shedding changes
• Irritability, anxiety, sleep disturbance
• Swelling or fluid retention (needs medical evaluation)
• New/worse snoring or sleep apnea symptoms (needs evaluation)
• Rising hematocrit/hemoglobin (lab-confirmed)

Possible Signs Your Dose Is Too Low (or Troughs Are Too Low)

• Symptoms return before the next dose
• Energy and libido improve briefly then fade
• Labs show low trough or low mid-interval levels despite adherence

Safety Red Flags That Deserve Prompt Clinical Attention

• Blood pressure rising or difficult-to-control hypertension (especially relevant after FDA's 2025 labeling update)
• Chest pain, shortness of breath, fainting, severe headache, leg swelling, or other concerning symptoms that could signal urgent problems (seek medical evaluation immediately)

Cardiovascular Outcomes Context

Large trial data (TRAVERSE) found TRT was noninferior to placebo for major adverse cardiac events in a specific population of men with confirmed hypogonadism and elevated cardiovascular risk. However, careful monitoring remains important, and some analyses discussed signals for certain events, reinforcing the need for individualized risk review and follow-up.

When a Dosage Change Is Needed

Dose changes are usually driven by one or more of the following:

• Lab targets not met (testosterone not in the intended range for the chosen regimen)
• Adverse effects (hematocrit rising, blood pressure trending up, intolerable side effects)
• Symptom pattern suggests peaks/troughs (timing-related ups and downs)
• Life changes (weight changes, new medications, new diagnoses, fertility plans)

A key evidence-based principle is structured monitoring that includes symptoms, adverse effects, testosterone levels timed appropriately for the chosen formulation, and hematocrit. Prostate-related monitoring is typically addressed through shared decision-making and individualized follow-up, especially early in therapy.

Monitoring Plan (Labs and Timing)

Below is a practical monitoring framework consistent with guideline-based approaches. Exact tests and timing vary by individual risk and the formulation used.

Baseline (Before Starting TRT)

• Total testosterone (often repeated if needed), plus clinical evaluation
• CBC (hematocrit/hemoglobin)
• Blood pressure assessment
• Prostate screening discussion (shared decision-making based on age/risk and patient preferences)

First Follow-up (Commonly Around 3–6 Months)

• Testosterone level (timed correctly for the formulation and dosing schedule)
• CBC (hematocrit)
• Blood pressure trend review
• Symptom review and side effect check

Early-Year Follow-up (Commonly Within 3–12 Months if Prostate Screening Is Chosen)

• PSA/prostate evaluation per shared decision-making and risk profile

Ongoing (Often Yearly, Sometimes More Frequently)

• CBC (hematocrit)
• Blood pressure and cardiovascular risk review
• Symptoms and adverse effects
• Testosterone level as needed to keep dosing appropriate

How Timing Works for Injections (Important Detail)

For injectable cypionate/enanthate, some guideline tables recommend measuring testosterone midway between injections and adjusting dose/frequency based on that value (and the overall clinical picture). Your clinician may also target trough or other timing depending on your protocol and symptoms.

Monitoring Checklist

FAQ

Advanced Vitality Closing

At Advanced Vitality Hormone Replacement Therapy, TRT dosing is guided by confirmed labs and symptoms, individualized risk review, and scheduled monitoring with dose and frequency adjustments when needed. If you're considering TRT—or you're already on therapy and want a second opinion on dosing stability—our team can review your history and labs and discuss options aligned with current evidence and FDA labeling.

References

• Endocrine Society Clinical Practice Guideline (2018): Testosterone Therapy in Men With Hypogonadism (JCEM)
• Endocrine Society teaching/monitoring materials (testosterone therapy)
• FDA (Feb 28, 2025): Class-wide labeling changes for testosterone products (blood pressure warning and TRAVERSE review)
• NEJM (2023): Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE)
• American College of Cardiology summary: TRAVERSE trial context and signals discussed
• Mayo Clinic: Testosterone injection (IM/SC) overview
• Drugs@FDA label example: testosterone cypionate injection (label dosing range and safety information)
• NCBI Bookshelf table (monitoring timing considerations by formulation; clinical reference)