Your TRT
Starter Guide
Everything you need to start and manage testosterone replacement therapy safely, confidently, and effectively.
After hours by text/call (slower reply)
Giving Your Injection
Your testosterone is given as a small subcutaneous injection (just under the skin). It's quick, nearly painless, and easy to learn. Here's exactly how.
100-unit (1 mL) syringe · 27-gauge
For subcutaneous injections, doses are measured in units, not milliliters. The 27-gauge needle has a larger bore, so the oil draws up and injects more easily.
100-unit (1 mL) syringe · 31-gauge
A thin 31-gauge needle. HCG is also dosed in units.
If you use intramuscular dosing, the pharmacy provides an IM kit with a longer needle that attaches to a syringe. IM doses are measured in milliliters (mL), not units.
Before you start
- Wash your hands thoroughly with soap and water.
- Gather your supplies: medication vial, syringe, and alcohol wipes.
- Clean the top of the vial with an alcohol wipe.
- Remove the syringe from its packaging.
Drawing up your dose
- Pull the plunger back to fill the syringe with air equal to your dose.
- Insert the needle into the vial and push the air in.
- Turn the vial upside down, keeping the needle tip in the liquid.
- Pull the plunger to draw up your prescribed dose in units.
- Remove the needle and check for air bubbles.
- Tap gently and nudge the plunger to clear any bubbles.
Injecting
- Clean the site with an alcohol wipe; let it dry 10–15 seconds.
- Pinch the skin to create a fold.
- Insert the needle at a 45–90° angle with a quick, dart-like motion.
- Release the pinched skin.
- Push the plunger slowly to inject over 5–10 seconds.
- Remove the needle, apply gentle pressure, and dispose in a sharps container.
Abdomen: stay at least 2 inches away from your belly button, and rotate to a new spot each time. Thigh: use the front or outer thigh — avoid the inner thigh — and rotate sites. Rotating prevents lumps and soreness.
Storing Your Medications
Room temperature
Store at 68–77°F. Do not refrigerate. Keep away from light and moisture. Good for 28 days after the first puncture.
Refrigerate after mixing
Must be kept refrigerated once mixed.
Room temperature
Clomiphene (Clomid), enclomiphene, and anastrozole are stored at room temperature.
Room temp, then refrigerate
Store at room temperature before use; refrigerate after opening.
Always check expiration dates before every use, and keep all medications out of reach of children and pets.
Adjunct Medications
Not every patient needs these. We add medications only when your labs and goals call for them — not by default. Your provider will tell you which, if any, belong in your plan.
HCG — Human Chorionic Gonadotropin
HCG mimics luteinizing hormone (LH), signaling the testes to keep producing testosterone and sperm. This preserves fertility and prevents testicular atrophy (shrinkage) while on TRT.
Benefits
- Maintains testicular size and function
- Preserves fertility potential
- Supports natural intratesticular testosterone production
- May improve overall sense of well-being
How to reconstitute
- Clean the tops of both the HCG powder vial and the bacteriostatic water vial with alcohol wipes.
- Using the 10 mL syringe provided, draw up 6 mL of bacteriostatic water.
- Inject the 6 mL of water into the HCG powder vial.
- Gently swirl to mix. Do not shake vigorously.
- Refrigerate immediately after mixing or when not in use.
Label the vial with the reconstitution date.
Dosing
Typically twice weekly, and can be given on the same days as your testosterone for convenience. Some patients do best dosing the day before or after testosterone. Measured in units using the 31-gauge syringe.
Clomiphene (Clomid)
Blocks estrogen receptors in the hypothalamus and pituitary, raising FSH and LH to support fertility and testicular function.
- Helps maintain sperm production on TRT
- Prevents or reduces testicular atrophy
- An alternative or addition to HCG
Dosing: oral, typically twice weekly as prescribed.
Anastrozole (Arimidex)
Reduces conversion of testosterone to estradiol. Only for patients with symptoms of high estrogen or significantly elevated labs — many men have mildly high estradiol without symptoms and need nothing.
Dosing: typically once weekly — sometimes twice weekly at a smaller dose — adjusted to your symptoms and labs.
Some estrogen is essential — for bone health, cardiovascular function, brain health, and libido. The goal is balance, not elimination. Here's what an imbalance in either direction can look like.
- Water retention and bloating
- Breast tissue tenderness or swelling (gynecomastia)
- Decreased libido or erectile difficulty
- Mood swings or heightened emotions
- Stubborn fat, especially lower belly and chest
- Fatigue despite adequate testosterone
- Joint pain, aches, or stiffness
- Low libido or erectile difficulty
- Fatigue and low energy
- Irritability, anxiety, or low mood
- Poor sleep
- Dry skin and, over time, reduced bone density
Your Symptom Timeline
Everyone responds differently, but here's the arc most patients follow. Consistency and patience are what get you there.
Early lifts in mood, motivation, and mental clarity. Some patients notice better sleep quality.
Energy and stamina climb. You may notice improvements in libido and erections.
Clearer gains in sexual function and libido. Better gym performance and recovery, more visible body-composition change, and sharper focus.
Meaningful gains in muscle mass and strength with proper training and nutrition. Fat loss becomes apparent, mood stabilizes, and bone density begins to improve.
Maximum benefit in most areas: optimal body composition, fully stabilized symptoms, and continued bone-density improvement.
Individual results vary with age, baseline health, diet, exercise, sleep, and stress. This timeline is typical — not a guarantee of results.
Laboratory Monitoring
Labs keep your treatment safe and dialed in. Your first follow-up labs are recommended 6–8 weeks after starting or changing your dose.
Standard panel — $60
- Total Testosterone
- Free Testosterone
- Sex Hormone Binding Globulin (SHBG)
- Estradiol (E2)
- Complete Blood Count (CBC) — red blood cells
- Comprehensive Metabolic Panel (CMP) — liver & kidney
- Lipid Panel — cholesterol (not always checked)
Additional tests may be added if clinically indicated, with cost discussed first.
Booking your lab monitoring follow-up visits
We'll send you a text-message reminder when your labs are due. Please schedule within one to two weeks of receiving that message.
Schedule a lab follow-up →
Follow-ups are always complimentary.
Reference ranges differ between laboratories and testing methods, so the "normal" numbers can vary from one lab report to the next. Always read your results against the reference range printed on your own lab report — and your provider will interpret them in the context of how you're feeling, not just the number.
Side Effects & Management
Most side effects are mild and manageable, especially with good technique and monitoring. Here's what to watch for.
- Acne / oily skin — increased oil production; manage with skincare, topicals, or dosing adjustments.
- Androgenic hair changes — some men see male-pattern thinning or increased body hair.
- Fluid retention — mild, usually early, and typically resolves as your body adjusts.
- Higher red blood cell production — requires monitoring (see below).
- Testicular atrophy — a natural response to external testosterone; can be mitigated with HCG.
- Mood changes — sometimes tied to estrogen imbalance.
- Sleep changes — can worsen sleep apnea in predisposed individuals.
- Injection-site reactions — mild redness or soreness; minimal with good technique.
Testosterone stimulates red blood cell production, which can thicken your blood. Hematocrit is the percentage of your blood made up of red blood cells — a commonly cited male range is about 38–50%, though this varies by lab (see note below).
Managing it: donate blood every 8–12 weeks, reduce your dose, switch to smaller more-frequent injections (daily or every other day), and stay well hydrated — dehydration falsely elevates hematocrit.
Symptoms of very high hematocrit: headaches, dizziness, blurred vision, fatigue, shortness of breath. Contact your provider if these occur. These thresholds are general guides — your lab's reference range and your provider's judgment come first.
Supportive Supplements
Not required, but these may support your results and overall health. Always tell us what you're taking, especially alongside other medications.
Supplements support but do not replace proper TRT management.
When to Reach Out
- Persistent or severe headaches, or vision changes
- Severe mood changes, depression, or anxiety
- Signs of a blood clot: leg pain, swelling, warmth, or redness
- Excessive fatigue or weakness
- Significant breast tenderness or enlargement
- Difficulty urinating or changes in urinary frequency
- Unusual bleeding or bruising, or yellowing of skin/eyes (jaundice)
- Persistent nausea or vomiting, or facial/lip/tongue swelling
- Any concerning symptom or question about your treatment
- Chest pain or pressure, or severe shortness of breath
- Sudden severe headache — the worst of your life
- Slurred speech, facial drooping, or sudden vision loss
- Signs of stroke: sudden weakness, numbness, confusion, trouble speaking or walking
- Calf pain with swelling, warmth, and redness (possible clot)
- Severe allergic reaction: trouble breathing, throat swelling, severe rash
- A painful erection lasting more than 4 hours (priapism)
Important Treatment Information
Medical necessity & treatment guidelines
Insurance guidelines don't consider TRT "medically necessary" when testosterone is within the normal reference range, even with symptoms. Per the Endocrine Society and American Urological Association, TRT is typically indicated for men with:
- Total testosterone consistently below 300 ng/dL, and
- Signs and symptoms of testosterone deficiency
That said, response varies — some men with "normal-low" levels still have real symptoms. ZYP takes an individualized approach, weighing both your labs and how you feel. Our goal is optimizing your health and quality of life, not just treating a number.
Compounded medications
ZYP Medical may prescribe compounded medications — customized preparations made by state-licensed compounding pharmacies following USP standards.
- Compounded medications are not FDA-approved and have not undergone FDA review for safety, efficacy, or quality.
- We use them when they offer advantages such as customized dosing, cost savings, or better tolerability.
- All compounded prescriptions are considered off-label use.
- Quality can vary between pharmacies — we work only with reputable, accredited facilities.
By proceeding with treatment, you acknowledge understanding that compounded medications are not FDA-approved and accept the associated risks and benefits.
- Active or prior prostate or breast cancer
- Uncontrolled heart failure
- Recent heart attack or stroke
- Untreated severe sleep apnea
- Hematocrit above 54% before starting
- Trying to conceive soon (without fertility preservation)
- Severe lower urinary tract symptoms
Tell us immediately if your medical status changes.
Provider discretion
ZYP Medical may stop, modify, or hold treatment at any time if we determine that:
- Continued treatment isn't clinically safe
- Treatment isn't medically warranted or beneficial
- Labs indicate increased risk (e.g., hematocrit >54%, adverse lipids)
- You develop a contraindication
We'll always discuss any change and explain our reasoning. Treatment does not guarantee any specific health result.
Controlled Substance Agreement
Federal and state laws strictly regulate testosterone. Violation of these policies will result in immediate discharge from our practice and reporting to the appropriate authorities.
By starting treatment, you agree to the following:
- Single provider. ZYP Medical will be your only provider of TRT. Obtaining testosterone or related medications from other sources is prohibited.
- Proper use. Use medications only as prescribed. Dose changes must be approved by your provider.
- No diversion. Never sell, share, trade, or give your medications to anyone. This is a federal crime.
- Secure storage. Keep all medications in a secure location, away from others and especially children.
- Lost or stolen medications. File a police report and notify ZYP immediately. Replacements are at provider discretion and may not be provided.
- Honest communication. Be honest about your medication use, symptoms, and any other substances (supplements, OTC, or recreational).
- Random testing. You may be asked to submit to random drug testing or pill/vial counts. Refusing may result in discharge.
- Prescription monitoring. Your prescriptions are reported to and monitored through the PDMP as required by Nebraska, Iowa, and Arizona law.
- No doctor shopping. Seeking these controlled substances from multiple providers is illegal and results in immediate discharge.
- Keep appointments. Attend follow-ups and complete required labs on time. Failure to do so may end treatment for safety reasons.
- Terminate treatment and discharge you from the practice
- Report findings to the PDMP as required in Nebraska, Iowa, and Arizona
- Report to the U.S. Drug Enforcement Administration (DEA) if appropriate
- Report to state medical boards and law enforcement if diversion or illegal activity is suspected
- Document non-compliance in your medical record
By starting treatment with ZYP Medical, you acknowledge that you have read, understand, and agree to these terms.