You started TRT 12 months ago. You were told your testosterone was low. You were put on 200mg of testosterone cypionate per week. Maybe they added anastrozole to 'control your estrogen.' Maybe they threw in HCG. You felt better for about six weeks. Then you went back to feeling exactly the same as before. Maybe worse.
Mistake #1: The Cookie-Cutter Starting Dose
200mg per week is the default starting dose at most TRT clinics. It's not based on your labs. It's not based on your SHBG. It's not based on your body weight, your lifestyle, your stress levels, or your goals. It's the dose that's easy to prescribe and easy to bill for. For some men, 200mg is too much. For others, it's not enough. For almost everyone, it's the wrong place to start without a comprehensive baseline.
Mistake #2: Anastrozole You Don't Need
Anastrozole is an aromatase inhibitor — it blocks the conversion of testosterone to estrogen. TRT clinics prescribe it reflexively because 'high estrogen causes side effects.' What they don't tell you is that estrogen is critical for bone density, cardiovascular health, libido, mood, and cognitive function in men. Crushing your estrogen with anastrozole because your clinic is scared of gynecomastia is one of the most common and most damaging mistakes in TRT.
Mistake #3: Ignoring SHBG
SHBG — Sex Hormone Binding Globulin — is the protein that binds testosterone and makes it unavailable for use. A man with high SHBG can have a total testosterone of 900 ng/dL and a free testosterone that's functionally low. Most TRT clinics don't run SHBG before starting a protocol. They look at total T, see it's low, and prescribe. The result: you're on TRT, your total T looks great on paper, and you still feel terrible because your free T is still low.
Mistake #4: Ignoring Thyroid
Testosterone and thyroid are not separate conversations. They are deeply interconnected. A man with suboptimal thyroid function will not respond well to TRT — because thyroid hormones regulate the sensitivity of testosterone receptors. If your T3 is low, your cells can't properly use the testosterone you're giving them. Most TRT clinics don't run a comprehensive thyroid panel. They run TSH, see it's in range, and move on.
Mistake #5: No Nutrition or Training Protocol
TRT is not a standalone solution. It is one input in a system. If you're on TRT and you're still eating the way you've always eaten, training the way you've always trained (or not training at all), and sleeping four to five hours a night on red-eyes — the TRT will not save you. Testosterone optimization requires a training protocol that's calibrated to your hormone levels. It requires a nutrition approach that supports body recomposition, not just weight loss. It requires sleep optimization because 80% of your testosterone is produced during deep sleep.
What a Real TRT Protocol Looks Like
It starts with comprehensive labs — not just total T. Free T, SHBG, free T3, free T4, DHEA, pregnenolone, cortisol, GGT, A1C, full lipid panel, CBC, comprehensive metabolic panel. The protocol is built from the data. The dose is calibrated to your SHBG and your free T target, not a default starting point. Anastrozole is only used if estrogen is actually elevated and causing symptoms. Thyroid is addressed if it's suboptimal. And the hormone protocol is integrated with a training and nutrition system that's built around your actual life.
If you've been on TRT for more than six months and you don't feel dramatically better than you did before you started, something is wrong with your protocol. Not with you. With the protocol.