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By Dr. Meyer Schoeman, MD — Precision Sexual Health Clinic, Calgary
If you’ve been prescribed testosterone by a urologist, endocrinologist, or GP in Canada to treat testosterone deficiency, there’s a reasonable chance you’re on a depot injection — typically testosterone cypionate or enanthate — given every two to three weeks. This is the standard approach in most general practice settings.
It’s also, for many men, the reason TRT gets a bad reputation.
A standard depot injection delivers a large bolus of testosterone into the intramuscular depot, from which it’s absorbed over time. The pharmacokinetic profile of this approach produces a sharp peak in the first two to four days post-injection, followed by a gradual decline back toward — and sometimes below — baseline by the time the next injection is due.
What this means in practice: you feel best in the first few days after your injection. By week two, you’re declining. By the time you’re due for your next shot, some men are symptomatic again — low energy, mood dips, reduced libido. Then the cycle repeats.
This is not a side effect of testosterone therapy. It’s a side effect of that particular dosing strategy.
The high serum testosterone levels in the days immediately following a depot injection create a secondary problem: excess aromatization. Testosterone converts to estradiol via the aromatase enzyme, primarily in adipose tissue and the liver. When testosterone spikes acutely, so does estradiol — sometimes to levels that produce symptoms of their own: water retention, breast tissue sensitivity, mood instability, and in some men, worsening of erectile function rather than improvement.
The conventional response to high estradiol on TRT is to add an aromatase inhibitor. This approach has its place, but it’s partly treating a problem that the dosing schedule created. Blunt the peak, and you blunt much of the estradiol issue along with it.
Subcutaneous microdosing — small volume injections administered daily or every other day — produces a fundamentally different pharmacokinetic profile. Rather than a sharp peak and a long trough, you get stable serum testosterone levels that stay within a consistent physiological range throughout the week. This isn’t just anecdotal; it is backed by clinical data. A landmark study in The Journal of Sexual Medicine demonstrated that subcutaneous administration achieves a steady pharmacokinetic profile, significantly reducing the hormonal fluctuations that cause the ‘rollercoaster’ effect.
The clinical advantages are straightforward. Symptom stability improves because the hormonal environment is stable. Estradiol excursions are smaller because you’re not flooding the system with a single large dose. Testicular atrophy is less pronounced because the suppressive stimulus is lower and more consistent rather than periodically intense. And patient-reported wellbeing is generally better — men don’t feel the roller-coaster.
Subcutaneous administration also has practical advantages over intramuscular. The injections are smaller gauge, less painful, and manageable for self-administration at home. Insulin syringes work well. Most men adapt quickly and find the daily routine far less burdensome than the intermittent IM injection once they’ve done it a few times.
Honest answer: because the depot injection model is familiar, established, and logistically simple for a busy general practice. It requires fewer patient interactions and less monitoring. The limitations are real but they tend to emerge gradually — and many men are told the mood swings and energy crashes are just how TRT works, or that they need to adjust their expectations.
They don’t. The variability is a dosing problem, not an inherent feature of testosterone therapy.
If you’re evaluating a TRT program — whether you’re starting for the first time or reconsidering an existing prescription — ask specifically about the dosing frequency and route of administration. Ask what monitoring is in place for estradiol and haematocrit. Ask whether the program adjusts based on symptom response or purely on total testosterone levels.
A protocol that accounts for the actual pharmacokinetics of testosterone delivery isn’t more complicated — it’s just more thoughtful. And the difference in how you feel is often significant.
Don’t settle for an outdated protocol that ignores your body’s pharmacokinetics. Join the men in Calgary who have switched to a more thoughtful, individualized TRT experience. Schedule a private assessment at Precision Clinic to see if our microdosing approach is right for you. Book a consultation in Calgary today.