Many issues here.
Injections every two weeks will leave you crashing and as SHBG and E2 increases, many will feel worse than before TRT [as the T levels drop, with the now increase E2 levels, you will feel worse]. You have been prescribed 100mg/wk, you are in control and can inject with whatever feels best to you. You can load and inject with 1.5" #23 in the gluts and 1.0" #25 in the vastus lateralis. For every other day injections (EOD) you can use 1/2" #29 .5ml [50 unit] insulin syringes.
The 200mg every two weeks is something that comes out of a practice where the patient goes to the doctors office every two weeks. For self injections that is totally inappropriate.
More frequent injections of lesser amounts that add up to 100mg/wk will lower T spikes, and that will reduce E2, reduced E2 leads to less SHBG which leads to more free T. SHBG bound T does not do the work, only free T (FT) or weakly bound T.
You need to control E levels. You cannot expect to get significant changes to %BF and fat distribution patterns if your E2 is elevated. The range of 0-53, but that ‘normal’ lab statistic also includes men that have serious untreated hormone problems. Normal lab range does not in this case imply proper body functioning or health. Many doctors do not understand this. They will let a guy with E2=50 suffer, as they just do not understand the issues at all.
E2 blocks the action of T at T receptors and many parts of your body want to develop female characteristics or a lack of male characteristics. Elevated E2 can block your libido. In some cases, E2 in the 35-40 range can kill libido, create brain fog, lack of energy and all of the symptoms of low T, WHILE your total T (TT) is high [even at 1000pg/ml] and FT is good or above normal range. You need to be testing for E2 and should have E2 results from your pre TRT lab work as well. You need to get your E2 down into the lower 20’s for TRT to work best. It is thought that E2=17-20 provides optimal libido.
Elevated E2 levels can also block the sensitivity of your penis. It is possible for the penis to be numb with high T levels if E2 is elevated.
Libido can be the first thing to respond and can change quickly. You should use libido to act as your barometer of what works and what does not. Other changes do not have anything that you can sense and can be slow and progressive… difficult to use as a guide to wellness. If E2 is blocking libido, starting with Arimidex at 1mg/week can create a huge boost in libido in 7-10 days.
Elevated E2 is perhaps the biggest cause of prostate enlargement. Keeping E2 low is protective. In most cases, higher DHT levels are not a concern if E2 is low. But cancers can respond to T and DHT. You need to check PSA once or twice a year. And have a PSA number from before starting TRT. PSA should be checked at the first TRT lab work at 2 or 3 months.
Arimidex [aromatase inhibitor] interferes with T–>E aromatization. 1mg/wk is a typical starting dose. Originally developed to treat female E sensitive cancers [breast]. Some docs do not understand its use and will not prescribe or will read about its use for female cancers and will prescribe 1mg/day which will take E2 too low in some cases and otherwise is a waste of an expensive drug.
When E2 is reduced, libido will pick up. Other changes in thinking and attitude will be mostly in place in two months, and will be completed by 3 months.
When starting TRT without AI or HCG, things can feel great at first, but E2 and SHBG levels are increasing and FT is reduced. The down time before your next injection can become longer and longer until you are down all the time an feel nothing from your injections at all. Part of this are changes in the brain caused by E2. Those changes take time and your though patterns slowly adjust in a negative way. Libido, initially very strong, goes away. Some of the increase in libido in the beginning is not from the absolute level of T, but from the transient increase. That cannot be sustained and the long term effects often do not feel as good as when you started TRT.
If your doc is not testing for E2 or DHT, you have someone who really does not understand the issues and success factors.
TRT will shut down your HPTA and LH production will stop. You testes will shutdown and shrink in time. The scrotum will pull up tight like a little boy’s. The testes produce things other than T that are important. Much of the pregnenolone in the body is produced there. Injecting 250iu HCG SC EOD will keep the testes working near baseline. That will work if the testes are not damaged and are LH/HCG responsive. Pregnenolone is critical for for the nervous system and brain and is the starting point for neural steroids. Many note a improvement in mood with HCG. If you doc does not understand the HCG connection, you have a problem! There is also an issue of sexual self image and how ones mate sees you, a strong quality of life (QOL)issue.
You need TRT+HCG+AI, that is simply best practice. All are critical and not doing all of these will often lead to marginal results. Without AI, TRT often simply will not work. I strongly believe that HCG and AI should be started with TRT and not be added one at a time as symptoms develop. Younger men should not let their testes atrophy. Some older men will not care and some will have testes that will not respond to LH or HCG. If the testes are allowed to atrophy, in the long term, irreversible tissue changes will occur and the state cannot be reversed at a later date.
The big success factors in TRT seem to be gaining knowledge and finding the right doctor or educating your current doctor if [his/her] ego will allow that.
One can also have thyroid level problems and if TRT does not seem to be working right, low energy and mood, thyroid levels can be checked, TSH, FT3, FT4. If the thyroid levels are good, then one should consider depression as a factor. Some men get into a depressed state that does not have a factor of profound sadness or gloom, but a lack of energy, initiative, passiveness, apathy etc. That situation presents some difficulty in recognition.
TRT can greatly decrease total cholesterol while leaving HDL unchanged. In some cases statin drugs can be avoided, discontinued or reduced. Statin drugs can kill libido as well.
The odd thing is that so many men who have signs of hypogonadism do not seem to care and if you talk to an older friend about TRT/HRT they think that you are crazy or a drug addict or steroid junkie.
Your weight suggests a possible case of metabolic disorder aka syndrome X. That is a prediabetic state associated with low T, elevated E and fat patterns that create an apple shape in the long run. You need to have your fasting serum glucose levels checked and this should be part of your basic CBC panels. This prediabetic state is characterized by insulin resistance. That can be partly driven by dietary factors that reduce cell wall permeability. The reduces many aspects of cellular functioning. Improving that condition by diet and supplements can improve many aspects of health/aging. Adding TRT/HRT to a bad situation will alone not fix everything.
Fat gain and low energy are also signs of possible hypothyroidism. It is not a surprise when an overweight guy with a need for TRT also has thyroid issues. One needs to be open minded to this possibility if TRT does not seem to work mentally or lead to fat loss and reapportionment when E2 levels are optimal.
Get copies of and retain all lab results. You need to have these for yourself. Do not simply leave these in your doctors hands. Understand whats there and demand that some things be added to lab work if needed. You cannot be passive about this.
There are a lot of things that need to stated about diet and supplements. These things can be found elsewhere and everything that has been discussed in this thread has been stated many times before. Use the search functions of this website and spend a few weeks or months educating yourself. You need to do some things on your own. Facts can be consolidated in this thread, but this thread will become history as they all do.
