How to Get Started on TRT: 11 Things I Wish I’d Known

Has a doctor ever told you your labs are “normal” while everything in your body is screaming that something’s wrong?

That was my experience for longer than I care to admit. About five years ago, I started noticing symptoms I didn’t even want to talk about: sexual dysfunction and a constant, low-level depression. It stuck with me all day, even when nothing seemed wrong. I did what you’re supposed to do and went to the best urology clinic in my city.

They never looked for a cause. Not once.

Now I believe celiac disease was the real cause. Once I diagnosed and got healed by God, I might not have needed testosterone replacement therapy at all. But nobody was asking about that — they only wanted to know if my number was low enough to treat.

If I could tell my past self one thing, it would be this: how you feel matters more than what the old-school model measures. It took me five years and visits to three of the “best” urologists in my city to finally believe that.

Before I go on, I want to be clear: I’m not a doctor, and this isn’t medical advice. This is just my own experience and what I’d share with a friend over coffee. Please talk to a qualified doctor before you start, stop, or change anything related to hormone therapy. I’ll mention this again at the end.

Maybe you’re trying to figure out how to get started on TRT. Or you’re already on it but something still feels off. Either way, here’s what I wish someone had told me from the beginning.

Find the Root Cause Before You Start

1. Look for what’s actually causing your symptoms — don’t skip straight to TRT.

My first stop was a respected urology clinic. They ran a testosterone test, didn’t like the result, and immediately started talking about treatment. Nobody asked why my hormones might be off in the first place.

Looking back, I wish I had seen an endocrinologist and someone in functional medicine before starting any prescription. My real problem was undiagnosed celiac disease. Once I got healed, many of the symptoms labeled “low T” might have gone away on their own.

There’s real research on this. A case-control study on low testosterone in non-responsive celiac disease found much lower testosterone in men whose celiac symptoms didn’t improve on a gluten-free diet, compared to those who did heal. If you haven’t ruled out your gut, thyroid, or another systemic issue, check those first.

2. Understand that this isn’t something you casually try and walk away from.

TRT isn’t like a supplement you can just stop taking whenever you want. Once you start taking testosterone, your body reduces its own production. Stopping means your system needs time to adjust and start making testosterone again. This doesn’t mean you shouldn’t do it. Just know it’s a real, ongoing commitment, not something to try for a couple of weeks.

Picking How You’ll Actually Take It

3. Skip the gel. Injections are the gold standard.

My first prescription was a topical gel. I wouldn’t recommend it. The absorption is inconsistent. It’s easy to accidentally transfer to others too — anyone you hug or sleep next to — and you can’t really fine-tune your dose. Injections are the best option, and it’s easy to adjust the dosage as you figure out what works for you. Oral testosterone therapy has improved a lot and might be worth considering later, but I wouldn’t start with it today.

4. You can train yourself to give the injections — even if you’re needle-phobic.

I used to be afraid of needles — really afraid, with sweaty palms and needing to look away. But by God’s grace, I got past it, and now giving myself injections is just part of my routine. There are self-injector devices you can use. Either way, I suggest having a medical professional show you how to do your first injection before you go it alone. Then practice until you’re comfortable doing it yourself. If you absolutely can’t handle needles, your spouse or someone you trust can learn to do it for you.

Pro tip: use a small-gauge needle. I use a 28-gauge for testosterone and a 30-gauge for HCG. These are thinner than most people expect and make the shots almost painless.

The Old Model vs. the New Model

5. Total testosterone isn’t the whole story — insist on Free T.

This is the biggest thing I wish I’d known, and it’s why three different urologists in my city couldn’t help me. There are two ways to measure testosterone: Total T and Free T. The old approach only looks at Total T, and for some men, that’s enough. It wasn’t for me. When I finally stopped seeing local doctors, a urologist at the main hospital told me, “Testosterone isn’t your problem,” because my Total T looked fine. She wouldn’t even order a Free T test.

Free testosterone is the part your body can actually use; the rest is bound up and not available. A protein called SHBG controls how much of your Total T is “free.” My SHBG was too high, probably because of celiac disease, so my Total T looked normal but my Free T was much too low. If your doctor won’t test Free T along with Total T, that’s a warning sign.

6. The old dosing schedule is built around insurance and convenience — not your biology.

Here’s the second big realization I had. The traditional approach follows what insurance will pay for, which usually means an injection every one or two weeks. But your body normally makes this hormone all the time, not in big bursts. That’s why you feel sharp highs right after the shot and lows before the next one. The American Urological Association’s guidelines allow for more personalized dosing based on your symptoms, not just what’s convenient. When I switched to a telemedicine provider, the first thing they did was split my weekly shot into three smaller ones. That one change made a real difference.

I chose Defy Medical, a national telemedicine TRT provider, after looking into several options and getting helpful recommendations from a Facebook group. Honestly, that group gave me better advice than any of the three local specialists I saw. I don’t say that to criticize all traditional doctors — the usual system just focuses more on avoiding risk and following insurance rules than on helping you actually feel better.

Getting Dialed In Takes Time

7. Give it six to twelve months, not six to twelve days.

From my experience, it really takes six to twelve months to get your treatment plan just right. If you expect to feel perfect after your first round of bloodwork, you’ll probably end up frustrated. This process takes time and adjustments, so approach it that way from the beginning.

8. It might take more than testosterone.

There are at least six hormones that need to be in balance, and for many men, testosterone alone isn’t enough. For me, the real turning point — when my sexual dysfunction stopped and my mood improved — was adding HCG to my treatment. Most traditional doctors won’t talk about HCG unless you’re trying to have more children, but it actually helps your body keep making its own testosterone, not just with fertility. There’s strong research supporting HCG as a co-therapy with TRT, including studies showing that low-dose HCG can help preserve natural testicular function in men on testosterone replacement. My current routine is three testosterone injections (about 100 mg a week) and three HCG injections (about 150 IU a week). I split them between Tuesday, Friday, and Sunday mornings around 7 a.m. — not perfectly spaced, but a balance I can stick to.

Pro tip: injections can sometimes cause small lumps or scar tissue at the injection site over time. For me, cold plunges and using a massage gun on the area have helped prevent this.

9. Change one thing at a time, then retest.

Make changes to your dosage and treatment plan based on real lab results, and don’t hesitate to adjust when the data supports it. But only change one thing at a time — your testosterone dose, then whether to add something, then that new dose. Retest after about six weeks before making another change. If you change too many things at once, you won’t know what actually made a difference.

The Real Finish Line

10. How you feel outranks the number on the lab report.

Lab results are important, but they’re just a tool — not the end goal. Keep making adjustments, even if your numbers look “fine,” until your libido is good and you feel like yourself most days. I feel good now. My sexual symptoms are mostly gone, my body is where I want it, and my mood is good most of the time. That’s the real finish line, not just a number on a report.

11. ED and low T are related — but they’re not the same problem.

Erectile dysfunction and low testosterone often happen together, so it’s easy to think one causes the other. But they’re actually separate issues with different causes — vascular, psychological, and hormonal factors can all play a role. Getting my hormones balanced helped a lot, but it didn’t completely solve my ED. I also take a fast-dissolving sildenafil tablet — a 38 mg dose that dissolves under the tongue — which works in about fifteen minutes and has really helped. Don’t assume fixing your testosterone will solve everything. Sometimes you need both treatments.

How to Get Started on TRT, If I Were Doing It Today

Here’s the quick-start version — what I’d actually do if I were starting from scratch, knowing everything I know now:

1. Start with a trusted TRT telemedicine provider (I use Defy Medical) rather than a local urologist — unless yours already tests Free T and doses flexibly.
2. Start with testosterone alone and get that dialed in first — don’t add anything else yet.
3. Change one thing at a time. Do labs roughly every six weeks and adjust based on the results.
4. Once you’ve dialed in testosterone, if you still don’t feel right (you probably won’t yet), consider adding something like HCG — one variable at a time, same as before.
5. Keep adjusting until your libido is good and you feel like yourself most days. Don’t stop at “technically normal.”
6. Expect this whole process to take six to twelve months. That’s normal, not a sign something’s wrong.

Those are my best TRT tips, learned from five years of trial and error before I finally got it right.

Bottom Line

If there’s one thing I hope you remember, it’s this: how you feel matters more than what an old-school lab report says. It’s worth spending months to figure out what works for you. That’s how to get started on TRT without wasting five years and seeing three urologists in a system built for caution, not for your well-being.

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What’s your experience with TRT, or with getting a doctor to really listen to you? I’d truly love to hear your story.

A Note on All of This

I’m not a physician, and nothing in this post is medical advice. TRT is a serious, ongoing medical intervention. It changes how your body produces its own hormones, and stopping it isn’t as simple as stopping a vitamin. Everyone’s labs, health history, and risk factors are different, and what worked for me won’t be right for everyone. Please work with a licensed physician who’s willing to look past a single number on a page, before you start, adjust, or stop any hormone therapy. Don’t take anything here — including the specific providers, medications, or dosages I’ve mentioned — as a personal recommendation for your own body.

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