Target on TRT is 22pg/ml which seems optimal for almost all guys [a few are different] with regards to mood, libido, energy and fat loss/patterns. You are at E2=20 with low T, you will need anastrozole for sure. But your doc might easily have no concept of optimal and may only react to high levels. Doctors are THE problem.
Other health issues?
Are you using a statin drug or any other medications?
For your body weight, you may need 140mg/week to get high end TT and FT.
Diet should have lots of proteins as TRT will drive a need for more and you might otherwise get a hunger that will not go away. Whey shakes can quench that hunger and keep you away from other inappropriate foods and eating.
Thyroid problems can drive fat gain by lowering metabolic rate.
TSH should be closer to 1.0, 1.9 is a problem.
Thyroid lab ranges are stupid and doctor follow like zombies.
Your problem might be caused by not using iodized salt, and doctors never ask about that.
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.
Cortisol lab done at 8AM or 1 hour after waking? Otherwise sort of unusable. Cortisol affects energy levels in short term, thyroid longer term.
Starvation diets can be quite harmful to sex hormones and to thyroid function by increasing rT3 that interferes with the active hormone fT3.
Have you tested A1C?
Most guys injecting T once a week do not do well with T peaking and crashing and E2 goes up and as T levels drop into a cesspool of E2 they flounder. Please inject T twice a week. You will get steadier T levels. Better injected subq and not IM for smoother release and no IM muscle damage.
pinch up skin over upper leg, inject into end of the fold with needle parallel to muscles. #29 1/2" 0.5ml [not 1.0ml]
If/when you get anastrozole, take 1/2mg at time of T injections. If you have a sudden crash, you are an anastrozole over-responder, stop for 5-6 days and resume at 1/8th mg at time of injections. Adjust dose after later labs to get near E2=22pg/ml. If you get E2=30, new dose = old dose x 30/22
Your testes will mostly likely shrink and pull uptight. on TRT as LH/FSH-->zero. Can effect ones sense of sexual identity and many wives care too. Testes may ache 24x7. 250iu hCG subq EOD prevents that and many find a mood improvement too.
Great work on the weight loss!
Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
- advice for new guys - need more info about you
- things that damage your hormones
- protocol for injections
- finding a TRT doc