From the labs, nothing stands out as something that needs to be fixed, so TRT is a good option. Did doc examine your testes? Testes ache?
Thyroid:
TSH (IU/mL) - 1.39 (0.27 - 4.2)
T4, free (ng/dL) - 1.39 (0.93 - 1.7)
T3, free (pg/mL) - 2.9 (2.0 - 4.4)
fT3 is the active hormone and is significantly below mid-range. fT4 is good, fT4–>fT3 conversion could be suboptimal. TSH better closer to 1.0
How much iodized salt to you consume?
Using a vitamin that lists iodine+selenium?
Your lab units are mixed. Where are you located? Affects diagnostic and treatment options.
I agree with your comments re protocol. Anastrozole can be adjusted based on next labs. hCG is indeed higher than needed to preserver testes and fertility. 250iu SC EOD is effective and cheaper. Higher doses can create high E2 levels from LH receptor overload and we often see docs that do not understand this.
Injecting T twice a week and anastrozole once a week is a disaster. You should take anastrozole at time of injections. If you can’t split the pills, dissolve 1mg/ml in vodka and dispense by volume or by drops. Understand from the stickies what anastrozole over-responder means.
Always do labs halfway between injections, at time of office visit will be mostly wrong. Need to avoid lab timing artifacts.
Your case is not well defined. Might be a combination of some primary and secondary. No expected issues from your prolactin or E2 levels.
If this works right, you and the wife will be very busy.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- advice for new guys
- things that damage your hormones
- protocol for injections
- finding a TRT doc
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.