Do most doctors actually know nothing about TRT?

What did @otmenshealth actually say?

The creator argues that weekly or biweekly testosterone injections cause testosterone to peak, then crash, while estrogen climbs in the opposite direction, leaving men with "high estrogen and low tests" by the end of the cycle. His fix: daily injections, which he says produce stable hormone levels, lower cortisol, better recovery, and more muscle. He also claims doctors are essentially guessing on TRT protocols, and that anyone below a testosterone level of 500 should "just get on" TRT without much deliberation.

He frames all of this as suppressed knowledge that mainstream medicine won't acknowledge. That framing is worth examining separately from the actual pharmacology, because some of what he says about half-lives and injection frequency is grounded in real science, while other parts of his argument run ahead of the evidence.

Does the science back this up?

The pharmacokinetics argument is mostly correct. Testosterone cypionate has a half-life of approximately 8 days, and enanthate sits around 4-5 days. That sounds longer than the creator implies, but the peak-and-trough pattern he describes is real and well-documented.

A 2017 study by Kaminetsky et al. in the Journal of Sexual Medicine found that subcutaneous testosterone enanthate administered weekly produced significantly more stable serum testosterone levels compared to standard biweekly intramuscular injections. The hormone fluctuation problem is not invented. Research from Snyder et al. (2016, New England Journal of Medicine) on the Testosterone Trials also documented how variable testosterone levels affect symptom burden. Whether daily injections are definitively superior to weekly injections for most patients is less settled. Most clinical protocols use weekly or twice-weekly dosing as the practical standard, and some endocrinologists argue that the clinical difference for average patients is modest. The creator presents daily injections as obvious and settled. The literature treats it as one reasonable option among several.

What did they get wrong (or right)?

Credit where it is due: the basic hormone fluctuation argument is legitimate. Biweekly injections, as commonly prescribed at VA facilities and some primary care settings, do produce wider swings in testosterone and can elevate estradiol during the peak phase. That is not a fringe claim.

Where he goes wrong is the threshold claim. Saying anyone below 500 ng/dL should be a "no-brainer" for TRT is not supported by clinical guidelines. The Endocrine Society (Bhasin et al., 2018, Journal of Clinical Endocrinology and Metabolism) recommends initiating TRT only in men with consistently low testosterone confirmed on at least two morning measurements, combined with symptoms of hypogonadism. A number alone does not qualify someone for hormone replacement. Many men with testosterone in the 400-500 range are asymptomatic. Treating them introduces real risks, including suppression of natural production, fertility impact, and polycythemia, with no documented benefit. The creator also overstates the cortisol and muscle-building claims for daily TRT. Those outcomes have not been demonstrated in controlled trials comparing injection frequencies.

What should you actually know?

The injection frequency debate is real and ongoing in clinical TRT practice. Twice-weekly or weekly injections have largely replaced biweekly protocols in evidence-informed settings, precisely because of the fluctuation problem the creator describes. Daily subcutaneous injections are used by some practitioners and do produce very stable levels, but they have not been proven in randomized trials to produce better long-term outcomes than optimized weekly dosing.

The 500 ng/dL threshold claim is the most dangerous thing in this video. It could push men toward TRT who do not need it, based on a single lab value and an influencer's confidence. The Endocrine Society guideline is clear: diagnosis requires symptoms plus biochemical confirmation. The American Urological Association (Mulhall et al., 2018, Journal of Urology) similarly requires documented symptoms alongside low lab values before initiating therapy. If your doctor is not asking about symptoms, sleep, weight, and doing at least two morning draws, find a different doctor. But the answer is not to self-direct TRT because a podcast told you 500 is the line.