26 Year Old, Extremely Low TT. Help with TRT

Hello everyone, I hope that someone can help me with my situation, as my endo seems to not be knowledgeable, and she’s supposedly the best one in my country.

Male
26 years old
185 cm / 6" 1’
130 kg / 287 lb
Waist 125 cm/49.2 inch

My blood results:
• Testosterone : 188 ng/dl
• Free testosterone : 8.43 pg/ml (1-28.28)
• SHBG : 19.6 nmol/L (11.2-78.1)
• E2 (not sensitive, we don’t have that here) : 73 pg/ml (10.7-39.8)
• Cortisol: 284.29 nmol/L (111.6-618)
• ACTH 40.3 og/ml (7.2-63.3)
• I tested T3 and T4 twice in the last two years, can’t remember results but they were in normal range

My symptoms:
• Low energy all day long
• Can’t ever sleep enough, even if I sleep for 14 hours
• Low libido
• ED
• Fogged mind
• Almost no body hair, no beard at all
• Low muscle mass
• Kinda manboobs, not too much
• Very dry skin, especially on the face
• Very hard to lose weight
• Lots of fat around waist, disproportionate

My lifestyle:
• Mostly eat home cooked meals, lots of meat, carbs like rice, potato etc, I used to eat a lot of sweets, but in the past couple of moths I avoid them, on and off trying to have healthy diet in the past 5 years
• Competing amateur weightlifter, training since 6 years old judo, switched to Olympic weightlifting in high school, trained for 4 days a week for the last 10 years, heavy lifting but no muscle mass, only quads
• Taking no medications
• Never used hair loss drugs, sleep drugs, any drugs
• Salt is iodized by default here
• Drinking protein, occasionally kreatin, here and there magnesium
• Drinking coffee 2-7 times a day
• Working for 8-10 hours a day
• Married, one child

I had these symptoms for the last 10ish years, but it never occurred to me to test hormones, my wife brought in up recently, along with my lack of body hair, and ED, so I tested it at last. My biggest problem is the lack of energy and lethargy.

After seeing these blood results and hearing my symptoms, my endocrinologist gave me the teraphy of 250 mg of testosterone enanthate ONCE A MONTH for 4 months and then to see her again with new blood tests, if necessary she would increase the dosage to 250 mg twice a month.
She didn’t order to test SHBG and E2, I did that on my own.

I already injected 250 mg 8 days ago, yesterday I injected 125 mg after deciding on my own to go with 125 mg a week.
I wanted to split it into smaller doses and do EOD or twice a week, but it’s impossible with this type ampule that we can buy here.

Testosterone is only available in glass ampule that you have to break and it’s 250mg/ml, ampule is 1ml=250mg.
It’s very dense, I can hardly draw it in the syringe and I’m using 2ml syringe with needles 0.8mmx44mm , I tried to split ampule in 4 syringes, but it’s impossible…

Now I was thinking of drawing entire ampule of 1ml in one syringe, then inject 0.25 ml or 62.5mg every 4 days from that syringe, changing the needles of course. What do you think?

When I inject, I only go 2 cm deep, the needle is 4.4 cm and I feel that’s too long?
I bought smaller needles, but they can’t draw this dense fluid, it makes vacuum in syringe.

My main question is what my dosage should be, how often should I inject, in quads or glutes, and should I take any estrogen blockage, as my endo didn’t mention that at all?

Even the wiki on test E says inject at least every week bec the half life is 4.5 days. If you dont get onto a better schedule you are in for a world of hurt.

Im not sure regarding the syringe for multiple uses. Its seems fine to me as its enclosed and you are changing out the part that interacts.

Low SHBG men should inject testosterone multiple times per week, preferable EOD given your current levels. The only really good TRT doctors are those that have been doing it for decades, the guidelines are horribly outdated and doctors have nowhere to turn to for advice, it’s why each doctors does things radically different than the last one.

Experience, trial and error is how a doctors gets good at TRT. I recommend ethanate 20-25mg EOD for you, this will maintain stable levels with as little fluctuations as possible and will help keep levels from fluctuating and you will feel better for it.

My SHBG is within a few points of yours and I do well injecting cypionate 20mg EOD, cypionate is very similar to ethanate and only the half life is 2 days shorter. Your protocol of 250mg ethanate is an insane protocol for a hormone with a half life of on average 8 days, less because of your lower SHBG.

Lower SHBG men excrete testosterone quickly and also metabolize free testosterone faster, more more frequent smaller injections is best. It will go along way in managing hematocrit, RBC and hemoglobin and will lower estrogen as well. This is important for low SHBG men do to the abundance of free hormones.

A lot of us guys inject using 27-29 gauge insulin syringes in the shoulders and outer quads, otherwise known as shallow IM. Some guys do well on Sub-Q into the love handles, some find this lowers estrogen too much.