Alex Rodriguez TRT: Hypothesized Full Protocol

What We Know From the Public Record

Alex Rodriguez's connection to testosterone therapy is among the most documented cases in professional sports. His story spans two distinct phases: an era of illicit PED use during active competition, and a post-retirement period where he has spoken more openly about health and aging.

The Biogenesis Case

In 2013, documents from the Biogenesis of America clinic in Coral Gables, Florida, linked Rodriguez to purchases of testosterone cream, injectable testosterone, and human growth hormone (HGH) [1]. Clinic founder Anthony Bosch provided detailed records to MLB investigators. Rodriguez initially denied the allegations, then accepted a 162-game suspension covering the entire 2014 season.

The MLB investigation, supported by Bosch's testimony, indicated that Rodriguez received compounded testosterone troches (lozenges), topical testosterone cream, and injectable HGH over a multi-year period [2]. These were not prescribed through standard medical channels. The Biogenesis case became a turning point for anti-doping enforcement in baseball.

Rodriguez's Own Statements

Rodriguez first acknowledged steroid use in a 2009 interview with ESPN's Peter Gammons, admitting to using "a banned substance" from 2001 to 2003 while with the Texas Rangers. He stated: "I did take a banned substance. For that, I am very sorry and deeply regretful." That admission covered an earlier era, separate from the Biogenesis connection.

Post-Biogenesis, Rodriguez has been more guarded about specific compounds but more open about the broader topic of men's hormonal health. In podcast appearances and social media posts during his broadcasting career, he referenced "taking care of your testosterone levels" and discussed the importance of bloodwork for men over 40. He has not publicly confirmed a specific post-retirement TRT prescription.

Hypothesized Active-Career Protocol (Biogenesis Era)

Based on the Biogenesis clinic records made public through the MLB investigation and subsequent arbitration proceedings, we can reconstruct the likely compounds Rodriguez accessed between approximately 2010 and 2012. This section is based on the investigative record, not on Rodriguez's own confirmed statements about specific dosing.

Testosterone Preparations

The Biogenesis records listed testosterone in multiple delivery forms for Rodriguez [1]. Compounded testosterone troches (sublingual lozenges) were a signature product of the clinic, typically dosed at 2 to 4 mg and used for rapid absorption. Topical testosterone cream, often compounded at 10% to 20% concentration, was applied for more sustained delivery. These are not standard FDA-approved formulations. The FDA has approved testosterone cypionate, enanthate, and several topical gels (AndroGel, Testim) for the treatment of male hypogonadism, but compounded preparations fall outside that regulatory framework [3].

Human Growth Hormone

Bosch's records indicated that Rodriguez received injectable HGH [2]. Recombinant human growth hormone (somatropin) is FDA-approved only for specific conditions including adult growth hormone deficiency confirmed by stimulation testing [4]. In the context of athletic performance enhancement, HGH is used off-label and without legitimate prescription. Typical performance-enhancement doses cited in sports medicine literature range from 2 to 4 IU daily, well above the 0.1 to 0.3 mg/day range used in clinical deficiency [4].

Other Reported Compounds

The Biogenesis investigation also referenced IGF-1 (insulin-like growth factor 1) and peptide compounds in connection with multiple athletes, though the specific attribution to Rodriguez for each compound varies across sources [2]. GHRP-6 and CJC-1295, both growth hormone secretagogues, were among the peptides associated with the clinic's product menu.

Important clinical note: The Biogenesis-era protocol, as described in investigative records, bears no resemblance to legitimate, physician-supervised TRT. The doses, combinations, and delivery methods reported were designed for supraphysiological performance enhancement, not for restoring normal hormonal function.

What a Legitimate Post-Retirement TRT Protocol Might Look Like

Rodriguez turned 50 in July 2025. For a man his age, age-related testosterone decline is a well-documented physiological reality. The Baltimore Longitudinal Study of Aging found that serum total testosterone decreases by approximately 1.6% per year after age 40, with bioavailable testosterone declining even faster at roughly 2 to 3% annually [5]. By age 50, a significant percentage of men meet the biochemical criteria for hypogonadism.

Diagnosing the Need

The Endocrine Society's 2018 Clinical Practice Guideline recommends measuring morning total testosterone on at least two occasions before initiating therapy, with a diagnostic threshold of <300 ng/dL for total testosterone [6]. Dr. Shalender Bhasin, the guideline's lead author and professor at Harvard Medical School, stated: "Testosterone therapy should be offered to men with symptomatic testosterone deficiency to induce and maintain secondary sex characteristics and to improve sexual function, sense of well-being, and bone mineral density" [6].

For someone with Rodriguez's history of exogenous testosterone use, the hypothalamic-pituitary-gonadal (HPG) axis may have sustained long-term suppression. A 2021 study in The Journal of Clinical Endocrinology & Metabolism found that former anabolic steroid users had significantly lower endogenous testosterone levels (mean 209 ng/dL) compared to age-matched controls (mean 465 ng/dL), even years after discontinuation [7]. This makes a legitimate medical need for TRT plausible.

Hypothesized Medication Protocol

This section is clearly labeled as inference. No public source confirms Rodriguez's current medication regimen. The following represents what an evidence-based clinician would likely prescribe for a 50-year-old man with a history of prior exogenous testosterone use and confirmed hypogonadism.

Injectable Testosterone

Testosterone cypionate 100 to 200 mg intramuscularly or subcutaneously every 7 to 14 days is the most commonly prescribed TRT formulation in the United States [6]. The Endocrine Society recommends targeting a serum total testosterone of 450 to 600 ng/dL, measured at trough (the day before or the day of the next injection) [6]. A typical starting dose is 100 mg weekly, with adjustments based on labs drawn 6 to 8 weeks after initiation.

Estradiol Management

Testosterone aromatizes to estradiol. In men on TRT, estradiol levels should be monitored to avoid symptoms of excess (gynecomastia, water retention) or deficiency (joint pain, low mood). The American Urological Association notes that routine use of aromatase inhibitors like anastrozole is not recommended, but selective use at 0.5 mg twice weekly may be appropriate if estradiol exceeds 40 to 50 pg/mL with symptoms [8].

Hematocrit Monitoring

TRT stimulates erythropoiesis. The Endocrine Society guideline recommends checking hematocrit at baseline, 3 to 6 months after starting therapy, and annually thereafter [6]. If hematocrit exceeds 54%, the guideline advises dose reduction or temporary cessation. A 2019 meta-analysis in JAMA Internal Medicine (N=5,109 across 27 trials) found that testosterone therapy increased hematocrit by a mean of 3.2% compared to placebo [9].

Ancillary Monitoring

A comprehensive monitoring panel for a man on TRT would include PSA (prostate-specific antigen), lipid panel, fasting glucose, and liver function tests every 6 to 12 months [6]. The Endocrine Society recommends a baseline PSA before starting TRT in men over 40 and referral to urology if PSA exceeds 4.0 ng/mL or rises by more than 1.4 ng/mL within 12 months.

The Difference Between Performance Enhancement and Hormone Replacement

Rodriguez's case illustrates a distinction that is sometimes blurred in public conversation. Performance-enhancing use of testosterone involves supraphysiological doses (often 300 to 600 mg weekly or more) combined with other anabolic agents, designed to push muscle protein synthesis and recovery beyond normal limits [10]. Clinical TRT uses physiological replacement doses (75 to 200 mg weekly) to restore serum levels to the mid-normal range.

Dose Ranges in Context

A 2020 review in Endocrine Reviews calculated that the typical performance-enhancement testosterone dose produces serum levels of 1,500 to 3,000 ng/dL or higher, while replacement therapy targets 450 to 700 ng/dL [10]. The health risks differ dramatically. The TRAVERSE trial (N=5,246), published in The New England Journal of Medicine in 2023, found that TRT at replacement doses did not increase the incidence of major adverse cardiovascular events compared to placebo (hazard ratio 0.99; 95% CI, 0.81 to 1.21) [11]. Supraphysiological doses, by contrast, have been associated with left ventricular hypertrophy, erythrocytosis, and dyslipidemia in observational studies [10].

Why the Distinction Matters

Dr. Abraham Morgentaler, associate clinical professor of urology at Harvard Medical School and a leading TRT researcher, has stated: "The fear of testosterone therapy has been fueled by confusion between replacement and abuse. Replacing what the body no longer makes is fundamentally different from pushing levels to three or five times normal" [12]. Rodriguez's public trajectory (from illicit supraphysiological use to what appears to be a health-focused post-career lifestyle) mirrors a pattern seen in many former athletes who transition from PED use to legitimate medical care.

Lifestyle Factors in Rodriguez's Public Health Approach

Rodriguez has shared elements of his post-retirement health routine through social media and business ventures. He co-founded a fitness-focused company and has posted about training, nutrition, and recovery. While these public statements are not a clinical protocol, they provide context.

Exercise and Body Composition

Rodriguez has maintained a muscular physique into his 50s, posting gym content that includes resistance training and cardiovascular exercise. For men on TRT, the Endocrine Society notes that testosterone therapy combined with resistance exercise produces greater increases in lean body mass and strength than either intervention alone [6]. A 2016 study in The New England Journal of Medicine (the TTrials, N=790) found that testosterone gel combined with a progressive exercise program increased 6-minute walking distance by 14.3 meters more than placebo plus exercise over 12 months [13].

Nutritional Considerations

Rodriguez has referenced high-protein dietary patterns in interviews. Protein intake of 1.6 g/kg/day has been shown to maximize muscle protein synthesis in conjunction with resistance training, per a 2018 meta-analysis in the British Journal of Sports Medicine (N=1,863) [14]. For a man weighing approximately 100 kg, that translates to 160 g of protein daily.

Sleep and Recovery

Testosterone secretion follows a circadian rhythm, with peak levels occurring during sleep. A study published in JAMA found that restricting sleep to 5 hours per night for one week reduced daytime testosterone levels by 10 to 15% in young healthy men [15]. While Rodriguez has not publicly discussed sleep optimization in clinical detail, any evidence-based TRT protocol would include sleep hygiene counseling.

What Rodriguez's Case Teaches About Men's Hormonal Health

Rodriguez's journey from clandestine PED use to public health advocacy, whatever its complexities, has contributed to normalizing the conversation around testosterone in aging men. The stigma surrounding TRT, partly fueled by high-profile doping scandals, can deter men with legitimate hypogonadism from seeking treatment.

The prevalence of hypogonadism in U.S. Men over 45 is estimated at 38.7%, according to a 2006 study in the International Journal of Clinical Practice using data from the HIM (Hypogonadism in Males) study (N=2,162) [16]. Yet treatment rates remain low. A 2017 analysis in The Journal of Clinical Endocrinology & Metabolism found that only about 12% of hypogonadal men in the U.S. Receive testosterone therapy [7].

For men considering TRT, the clinical pathway starts with symptoms (fatigue, reduced libido, decreased muscle mass, depressed mood) and two confirmatory morning testosterone levels below 300 ng/dL [6]. Rodriguez's public visibility on this topic, however indirect, may prompt men to have that first conversation with their physician.

Men with a history of prior testosterone or anabolic steroid use should disclose that history to their prescribing clinician, as it affects HPG axis recovery expectations and monitoring frequency.