Testosterone is a naturally occurring hormone that plays a significant role in male development and health, affecting muscle mass, bone density, mood, and sexual function. Hypogonadism occurs when the body does not produce enough of this hormone, leading to symptoms like fatigue, reduced libido, and decreased physical strength. Testosterone Replacement Therapy (TRT) is a medically supervised treatment designed to restore these hormone levels to a normal, healthy range.
Testosterone is classified as a Schedule III controlled substance, meaning it requires a prescription and must be managed by a qualified healthcare provider. The amount of testosterone administered for TRT is highly individualized, and a physician determines the appropriate dose based on a patient’s specific health profile and symptoms.
Forms of Testosterone Administration
The question of “mg per week” most directly applies to injectable forms of testosterone, though several different methods of administration exist. Intramuscular injections, typically utilizing testosterone cypionate or enanthate, are a common and cost-effective method that allows for controlled dosing. These injections are often given once or twice a week to maintain stable hormone concentrations.
Other delivery systems, such as topical gels and creams, are measured differently and are not typically quantified in weekly milligrams. A common topical gel might be dosed as 50 to 100 milligrams of testosterone applied daily to the skin. Patches are another transdermal option, delivering a smaller daily amount, often between 2 and 6 milligrams.
Subdermal pellets are another option, which involve a minor procedure to implant solid testosterone pellets under the skin, usually in the hip area. These pellets slowly release testosterone over a period of three to six months, with total implanted doses ranging from 150 to 450 milligrams. Because of their differing absorption rates and schedules, the dosing for these non-injectable forms cannot be simply converted into a weekly milligram total comparable to injections.
Standard Therapeutic Ranges for Injectable Testosterone
For the most common injectable forms used in TRT, such as Testosterone Cypionate and Testosterone Enanthate, the typical dosage range is between 75 mg and 200 mg per week. Many physicians start patients on a conservative dose, such as 100 mg per week, and then adjust based on subsequent blood work and symptom response. The goal of therapy is to achieve a serum total testosterone level in the mid-to-high normal physiological range, generally considered to be between 400 and 700 ng/dL.
Injectable testosterone is formulated as an ester, which allows for a slower release of the hormone once injected into the muscle. This slow release prevents the need for daily injections, with the ester side chain determining the half-life of the compound. For instance, a dose of 200 mg injected every two weeks can lead to a peak level that is initially high, sometimes exceeding 1,200 ng/dL, before levels decline near the end of the dosing period.
To mitigate these wide fluctuations between doses, a more frequent injection schedule is often preferred, with smaller amounts administered weekly or even twice weekly. A regimen of 75 to 100 mg injected weekly can help maintain more stable levels and prevent the symptomatic peaks and troughs that can occur with less frequent dosing. The specific weekly dose is a starting point that is refined over time to keep the patient’s testosterone concentration within the targeted therapeutic window.
Determining the Optimal Individual Dose
The selection of a starting dose for TRT is a highly personalized process that relies on a thorough diagnostic evaluation. Before starting therapy, a physician assesses the patient’s baseline blood markers, including total and free testosterone, and Sex Hormone Binding Globulin (SHBG). The severity and persistence of hypogonadal symptoms, such as fatigue, depressed mood, and reduced libido, are weighed alongside these objective laboratory findings.
A patient’s age, body weight, and overall health status are also factors that influence the initial dosing calculation. For example, a person with a larger body mass index may require a slightly higher dose to achieve therapeutic levels compared to a smaller individual. The initial dose is often a conservative estimate, designed to gently elevate testosterone levels without causing an immediate adverse reaction.
The goal is not simply to reach a number on a lab report but to achieve resolution of the patient’s symptoms while normalizing the hormonal profile. A physician will use the initial dose as a trial, understanding that the patient’s unique metabolism and response to the medication will necessitate future adjustments. This initial calculated dose is the beginning of a dynamic and monitored treatment process.
Monitoring and Long-Term Management
Once a patient begins TRT, the weekly milligram dosage is not fixed and requires regular monitoring to ensure both safety and efficacy. The first formal laboratory testing is typically performed two to three months after initiating therapy or following any dose change. For injectable testosterone, blood samples are drawn midway between injections, usually five to seven days after a weekly dose, to accurately assess the average therapeutic level.
Beyond testosterone levels, physicians monitor several other health markers to manage potential side effects. Hematocrit and hemoglobin levels are closely tracked because testosterone can stimulate red blood cell production. An excessively high hematocrit (above 54%) may require a dose reduction. Prostate-Specific Antigen (PSA) is also monitored, particularly in men over 40, to screen for prostate health changes.
After the initial adjustment period, monitoring frequency typically shifts to every three to six months during the first year, and then annually once the dose is stable. Dose adjustments, either up or down, are made based on a combination of persistent symptoms, lab results outside the target range, or the development of adverse effects. This continuous feedback loop ensures that the weekly testosterone dose remains therapeutic and safe for the patient long-term.