Troubleshooting My TRT Protocol (What You Need to Know)

Starting TRT

After training naturally my entire life, I began TRT 12 weeks ago. At age 35, I had hoped to delay this another 5-10 years, but it became medically necessary after surgery fell short in restoring optimal testosterone levels due to a varicocele I’ve been dealing with for a few years now.

Though I’ve always prided myself on accomplishing what I did in the gym completely naturally, I’d be lying if I said it hasn’t been incredible experiencing the biggest strength gains and best recovery ability I’ve had since my mid-20s, with my physique beginning to catch up as well (and fast).

After starting TRT with a Herculean first couple of months in the gym, I suddenly noticed that I was beginning to feel a bit tired around week 9, which was in stark contrast to the transient insomnia I had been experiencing during the first several weeks while I was adjusting.

By the end of week 10, I began to hit the wall. I started waking up feeling unrefreshed, all of the same weights I had smoked just a week prior in the gym suddenly felt extremely heavy, and my mood began to drop. It felt like the testosterone wasn’t even working anymore and I was back to my pre-TRT state of feeling just “blah” all the time.

While I was aware that the honeymoon phase was beginning to wear off, something was definitely wrong, so I was eager to see the results of the labs I was waiting on after having them drawn the week prior.

Whatever the issue turned out to be, I knew that I’d have to apply what I know and approach myself the same way I’d troubleshoot things with a client. This, however, always seems to come in the form of a mini-ego death, despite the number of times in the past that I’ve ended up having to come to terms with the fact that I, too, am mortal.

Given the effects of the honeymoon phase and my newfound vitality, I had been pushing the intensity in the gym more than I have in some years, but I was still keeping my volume down, training 3 full-body sessions per week and always staying a rep shy of failure, as per my usual approach for the majority of my lifting career (I practice what I preach here, simply because it works).

That being said, I had been enjoying the gains so much that I hadn’t really stopped to comprehend just how much my strength and overall work capacity had increased in 10 weeks. Anyone who has been training consistently for a long time knows that, short of artificially enhancing yourself, progressive overload week-in and week-out is essentially impossible after the newbie-gain phase of your first year or two (if you’re doing everything right) wears off.

After coming to my senses, I figured it was well-past time for a deload, so I took 5 days off - only to come back and find things feeling even worse.

Around the same time, my labs came back, and my total testosterone was in the mid-900s at near-trough, with free testosterone at 23, sensitive E2 at 37, and hematocrit at 46. Though only 10 weeks into just starting TRT and still on the original dose I had estimated for myself, I was sitting at effectively ideal numbers, while keeping in mind that numbers don’t always tell the whole story.

So what the hell was going on?

Well, it turned out to be the combination of several things, as it typically always is, all working in tandem with one another:

Ferritin/Iron Deficiency

In my labs, I also noticed that my ferritin level had fallen to 35 from 75 just one year ago, and I was now borderline low.

Most patients and providers alike are unaware of TRT’s hidden kryptonite effect on iron. Due to the increase of erythropoiesis (the production of red blood cells), TRT can absolutely tank ferritin, and thus, iron level (you can read about ferritin and how it relates to iron here) - and mine tanked fast.

Some guys on TRT still experience symptoms such as fatigue and low mood and have no idea that their ferritin/iron levels are in the toilet, because for some reason, their providers usually never even check. I’ve seen this occur repeatedly with clients and it’s well-studied mechanistically, as well as discussed anecdotally in TRT forums, so I was keen to keep an eye on my levels.

I began supplementing with iron bisglycinate, which I knew wasn’t the most absorbable form, but I figured if I paired it with vitamin C on an empty stomach to increase absorption and took it every other day, I could dose it high enough to get my level up quickly.

(Pro-tip: Always take iron every other day, as this allows you to actually absorb ~50% more by way of working around a hormone called hepcidin, which rises for ~24 hours after ingesting iron to prevent you from absorbing too much.)

This turned out to be a mistake, because within a week, my gut was wrecked. I’ve always dealt with transient GI issues, so when I ended up taking constant trips to the bathroom in conjunction with experiencing even more fatigue and lower mood, I knew bisglycinate wasn’t for me.

I ended up swapping it out in favor of heme iron, which is the bioavailable and better-absorbed form found only in animal foods, and I felt the difference almost immediately. Within a few days, my gut was back to normal and my energy began to pick up, which was also a result of addressing the other factors on this list.

(For anyone looking for the best heme iron supplement I've come across, I highly recommend Proferrin.)

Lack/Quality of Sleep

For about the first 8 weeks or so on TRT, I experienced an insane increase in energy while dealing with some insomnia, which isn’t uncommon when initiating and adapting to TRT.

It’s important to note that for some guys, TRT worsens or even unmasks sleep apnea, so if you’re snoring heavily or choking in your sleep, waking up several times throughout the night, and/or just waking up unrefreshed and you’ve never been screened for sleep apnea, it’s worth looking into. Undiagnosed sleep apnea will destroy your gains and your TRT results, as well as your overall quality of life.

While my insomnia turned out to be at least partially due to my initial dosing schedule (more about this in the next section), even once I started being able to fall asleep reliably again, I was still waking up feeling unrefreshed.

After reevaluating everything from my TRT to pregnenolone replacement dosing, the immediate remedy turned out to be related to something I had known about myself for a long time but had simply overlooked, with an added new twist.

Years ago, I had some genetic testing done, which revealed that I have a genetic mutation of the CYP1A2 liver enzyme and am what’s known as an ultra-rapid metabolizer of compounds broken down by this gene, which includes melatonin.

I have experienced very irregular circadian rhythm patterns for most of my life, realizing very young that I am a night owl and a late-riser by nature. After learning about my CYP1A2 genetic mutation, however, I theorized that my nocturnal tendencies must have something to do with a lack of melatonin signaling from it effectively being broken down by my body too quickly.

Being the pivotal hormone involved in the sleep-wake cycle, I researched a bit further into the “Miracle Molecule", especially after repeatedly hearing the great Dave Lee tout its benefits. Low and behold, it turns out that DHT (testosterone's even more anabolic metabolic byproduct) inhibits melatonin's synthesis and signaling by decreasing its overall production and expression at receptor sites.

The light bulb went off for me, and the “cracked out” feeling I was experiencing suddenly felt familiar to something I had experienced several years prior and previously remedied with melatonin.

I began supplementing melatonin again, but not with the conventional stuff from the drug store, which hardly ever worked for me. Most people are unaware that melatonin can literally feel like an entirely different substance when formulated and administered in the following ways:

• Micronized (superior bioavailability and absorption)

• Sustained-Release (assists with sleep duration)

• Sublingual (bypasses the digestive system and liver to assist with sleep onset)

I paired a micronized SR formulation with a sublingual formulation just before bed, and the very first night, the difference was incredible. I fell asleep faster and slept much more deeply, waking up feeling refreshed for the first time in weeks.

(Shout-out, once again, to Dave Lee for the information about micronized SR + sublingual melatonin - an absolute game-changer. He is truly the GOAT when it comes to neuroendocrinology, so all credit where credit is due.)

Splitting the TRT Dose (Even More)

If you’re still injecting TRT once per week (or God forbid biweekly), I’m here to tell you that you’re doing it completely wrong and leaving so many benefits on the table (and making things even worse if you’re using an AI as a result of this schedule).

While many (most) providers with seemingly zero understanding of pharmacokinetics will insist that weekly injections are sufficient due to testosterone cypionate or enanthate’s 4-7 day half-life (a heavily debated subject), this completely ignores the fact that it takes 24-48 hours after injecting to gradually reach peak effects, with levels declining again thereafter.

A classic example that many people are more familiar with when it comes to half-life vs. peak effects is how some metabolites of marijuana can be found on a drug test several days to weeks after last ingestion due to its long half-life, but (I’d hope) one certainly isn’t high that entire time.

On a TRT protocol with weekly injections, many guys will assume or be told that their side effects are either due to their testosterone and/or estradiol levels being too high, when in actuality, it’s due to the swings of the roller coaster-like peak and trough of both from such infrequent dosing. These same guys then either lower their dose and end up with a suboptimal testosterone level, or end up crushing their E2 with an AI, which is a huge mistake for the vast majority of men that I'm not even going to get into in this article.

If you ever want to watch this roller coaster play out from the sidelines, simply observe your girlfriend’s mood from week-to-week over the course of a month’s menstrual cycle and how it fluctuates with the relative swinging of her E2 levels.

When beginning my own TRT protocol, I initially settled on injecting twice per week, which is a reasonable baseline for the minimum frequency anyone should start on. After the first month of poor sleep and mood swings, it was clear that I needed to split the dose up even more and move to 3 days per week.

I maintained injections 3 days per week until the issues crept in around week 10, and by this point, I had become even more observant of the remaining, more subtle swings I was still experiencing after getting used to TRT’s effects.

Beginning at week 11, I switched to EOD (every other day) injections, and the difference was almost immediate, with side effects finally disappearing in conjunction with the other interventions on this list.

Given how powerful splitting injections up as frequently as possible can be, I eventually may move to daily shots (which isn’t difficult at all if you use a 27-29g ½” insulin needle). Daily injections most closely mimic how the body naturally produces testosterone, which occurs in small pulses each day rather than in massive floods every few days.

While dosing this frequently won't be necessary for all guys, if you’re experiencing prominent or lasting side effects beyond 8-12 weeks of starting TRT, splitting injections more frequently should be the first troubleshooting step you take before moving onto other interventions, especially messing with the dose or adding an AI.

Overtraining/Need for a Deload

As I mentioned earlier, overtraining and the need for a deload absolutely played a part in me hitting the wall, especially when combined with poor sleep and suboptimal ferritin/iron status. Adding an extra 2-3 days to the original 5 days I took off turned out to be extremely helpful, and I came back just as strong as I was before the crash.

The learning lesson in this is that becoming more anabolic and increasing muscle tissue recovery doesn’t mean that the nervous system can recover proportionally from the increased neural demand of moving heavier weights week after week - especially at 35 years old, already previously having been very strong for my size and genetics, running a business while running on suboptimal sleep, and lacking in iron.

Since I no longer train competitively as a powerlifter, I usually prefer to just take time off for my deloads, but if you're training for maximum numbers or competition, cutting your big lifts down to 80% of your working weight and/or doing 30-50% less volume in your training sessions overall is a good strategy for preserving the “groove” and keeping the nervous system adaptations for optimal mechanics fresh, while allowing 5-7 days for recovery.

A deloading week is also a great time to focus on mobility, single-limb exercises and stability training (even though you should be doing all of these anyway), as well as any accessory movements to bring up weaknesses. For strength work during this phase, single-limb stuff is king, because it’s not nearly as CNS- or joint-taxing as a result of being able to use considerably lighter loads to achieve the same (or even greater) training effect.

Now that I'm back with it and feeling good, I’m also going to resume practicing what I preach and not just throwing around 5RMs every week, in favor of actually using what I know to periodize volume and intensity.

Again, since I'm not training competitively anymore, I prefer to simply auto-regulate my periodization by simply starting with, for example, a weight I can hit for 2 top sets of 6-8 reps on an exercise, aiming to add a rep or two each week until I’m at 3 sets of 10, then possibly add another set. Once I can hit 3 sets of 10 with the same weight, I increase in weight and begin with 2 top sets of 6-8 reps again, automatically wavering volume and intensity over time.

When it comes to big lifts, I still like to utilize 5-rep sets (especially on more technical/taxing movements like deadlifts), so I usually like to work with ~85% of my 5RM for 3 sets of 5 reps, either adding 5-10 lbs to the bar each week, or keeping the same starting weight and adding a 4th set the following week and a 5th set the week after that before cycling back down to 3 sets of 5 reps and increasing the weight.

On these bigger lifts, deloading every 6-8 weeks is usually optimal for me, but some people can get away with deloading every 8-12 weeks, depending on individual capacity in conjunction with factors such as age/training age, strength levels, and motor recruitment capacity.

The point is, it can’t just be balls-to-the-wall all the time, and while you don't have to use strict percentages (especially if you're not competing), you DO have to auto-regulate volume and intensity to preserve your CNS as well as your joints.

Key Takeaways (“TL;DR”)

• After starting TRT, “dialing in” often requires troubleshooting, and it isn’t a guessing game. Many factors need to be taken into consideration that are best left to a qualified professional (which, unfortunately, likely isn’t your current provider).

• Numbers on labs often do NOT tell the whole story, even if everything looks perfect.

• TRT can and often does decrease ferritin/iron levels, and if you end up deficient or even borderline-deficient, it can keep you feeling fatigued and low, despite having optimal testosterone levels. Be sure to monitor these carefully, since your provider probably won’t.

• When supplementing iron, some people will only tolerate and be able to absorb heme iron.

• While adjusting or dialing in your protocol, TRT can interfere with falling asleep and/or sleep quality. This can be due to several different reasons (proper investigation is crucial), with altered melatonin synthesis and signaling being one of them as a result of increased DHT levels.

• Not all melatonin supplements are created even close to equal. Micronized, sustained-release + sublingual forms are highly superior.

• Inject TRT twice per week, at minimum. If you’re experiencing side effects, it probably has little to do with testosterone or estradiol being too high (despite what you’ve heard), and usually to do with the fluctuation of levels between injections. The solution is to split up the injections more frequently. The more frequently you can inject, the more stable your levels will be, and the smoother things will feel.

• TRT is NOT a panacea for allowing you to train balls-to-the-wall all the time. While your muscle output and recovery capacity will increase greatly, your nervous system and joints don’t follow the same trajectory. Honor proper training protocols, periodization methods, and the need for deload weeks.

• Proper deloading protocol: 5-7 days training at 80% of your usual working weights and/or 30-50% less total volume.