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/ / How do you take TRT?

How do you take TRT?

26 March 2025 | 

For an of the full treatment approach and benefits, please refer to our treatment page.

Historical Context of Testosterone and TRT

Historically testosterone was associated with bodybuilders abusing vast of anabolic substances often injected through large bore into muscle. Abuse of these drugs and without proper monitoring can result in life changing complications. It is no surprise therefore that the stigma associated with injecting Testosterone Replacement Therapy (TRT) into muscles remains, albeit to a lesser degree as we are starting to shift the connotations towards the health and wellbeing benefits of TRT.

Methods of Administering TRT

There are different ways of administering from infrequent intramuscular injections to frequent injections using fine needles to oral preparations.

The goal for most people is to find a treatment plan that provides them with stability in how they feel. Whilst an injection into muscle, like nebido, every 8 to 12 weeks is certainly more convenient it has it’s drawbacks, primarily in that it does generate somewhat of a peak and a trough between injections. The ultimate route to stability of levels is injections of fast but long acting testosterone esters like cypionate or implantable pellets that slowly release testosterone, though there are also some practical difficulties with this method. Testosterone cypionate is suspended in low enough viscosity diluents to be injected and drawn up using fine needles and because of the lower viscosity it tends to be well tolerated when injected into the fat beneath the skin (not dissimilar to the way insulin is taken by patients with diabetes). This is often favoured by patients as they can use fine needles and inject in the abdomen quickly, safely and in a fairly pain free way. Whenever you inject there will be a degree of scarring and this applies to both muscle and fat. Scar tissue tends to be broken down and absorbed by the body, though this will happen at different rates from one person to another, as will the severity of scar that forms vary. What’s important is that when injecting into the fat, to give the body ample opportunity to clear the micro scar, rotating your injection site prevents repetitive trauma to the same piece of tissue. If the same tissue is repeatedly injected into scarring of the fat cells can become so marked that you can feel an area of hardness in your abdomen called lipohypertrophy. Subsequent into such an area would result in very little of the medication being absorbed by the body as it tends to remain in this walled off ball of hardened fat.

As injecting is the most effective means of taking TRT, avoiding forming scar tissue is a key consideration. It’s not uncommon for patients who solely inject subcutaneously to develop some areas of scarring that they can feel; it can feel like areas of hard or lumpy tissue. My advice is to rotate as much as possible, not just between different sites for subcutaneous injecting but also between subcutaneous and intramuscular injecting. Injecting using fine needles into the muscle, whether the thigh or the glutes, is an entirely different to the relatively barbaric large bore needle used by those abusing steroids.

For further guidance on alternative approaches and optimising your injection technique, you might find our page useful.

Shelf Life and Sterility of Multi-Use Vials

Testosterone cypionate is most often in a multi-use vial that tends to last around 3 months. Questions have been raised about the sterility of a vial from which medication is drawn up repeatedly over a 3 month period. Whilst some guidelines state a 28 day use of multi-use vials, this is a fairly arbitrary shelf life as there are studies that have found multi-use vials to be safe for at least 6 months when being drawn from twice daily.

For insights into the , please refer to our dedicated page.

Alternative Formulations of TRT

Other formulations include creams, which are absorbed to a greater degree than gels. They can either be applied directly to the skin or via a patch. These are largish molecules that need to navigate the fairly robust barrier, the skin. The skin’s permeability also changes significantly on temperature, skin hydration, age, skin damage etc. Aside from absorption being an unpredictable variable, of the drug from the patient to family and through direct or indirect contact is another problem. I particularly advise patients with children in the household of this risk as it’s not uncommon for testosterone cream or gel to be found on surfaces or even from shared towels.

The next area of interest is without a doubt testosterone in tablet form. Testosterone undecanoate has been developed as an oral version of TRT over many years, initially with liver issues when the drug would be metabolised. This has now been overcome and there are numerous branded agents available and whilst they’ve been used in the US for a few years, they are still fairly new to the UK market. The little research that’s been done shows good results with the oral forms, albeit they can take around a week to reach a stable level in the blood. Risk profiles of the oral forms are similar to that of injectables and creams. The main with the oral formulations has been how well they can be absorbed by the gut and the individual in the extent to which they get broken down by the liver when they pass through.

For more on alternative approaches, our page provides additional context.

Finally, pellets might be the most fuss-free option on a day to day basis, where a small pellet that slowly releases testosterone constantly is implanted just under the skin. It’s much more difficult with these to tweak protocols and if there are any concerns, whereas with the other forms you can simply pause treatment, it’s more of an to have to remove a pellet and then re-insert it.

For more detailed discussions on treatment options, including when coming off TRT, please visit our page.

Additional Resources

For further and to expand your understanding of TRT and its benefits:

Learn more about the .

For a comprehensive overview of what TRT is, visit our page.

Dr Aman Chungh is a highly regarded men’s health physician and medical author whose work the gap between clinical expertise and health education. With over a decade of experience in practice, he has refined an approach that seamlessly integrates insights from medicine, surgery and holistic health. His clinical journey has deepened his understanding of the complex interplay between hormones, mental well‐being and physical vitality - a perspective that enriches his written contributions to the field.

A proud alumnus of the University of Southampton, Dr Chungh obtained his Bachelor of Medicine and Bachelor of Surgery degree in 2014, his success in both a Bachelor of Science and a Bachelor of Medical Sciences. This robust academic foundation, with years of hands‐on patient care, fuels his commitment to remaining at the forefront of medicine. As an author, he skilfully translates intricate medical principles into engaging, reader???friendly content, enabling both professionals and the general public to appreciate the nuances of modern men’s health.

Dr Chungh is by a compassionate, patient???centred philosophy. He champions the dismantling of traditional barriers to care, believing that an informed patient is an one. His work not only reflects his diagnostic and therapeutic but also his unwavering dedication to collaborative care, treating every individual with the same empathy and respect he would offer his own family.

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 | 26 March 2025

 | 26 March 2025

 | 26 March 2025

/ / How do you take TRT?