If have Hemolytic Anemia, your doctors should have prescribed TRT years ago. I was anemic when I was diagnosed with a testosterone deficiency at 225 ng/dL, no longer. My hematocrit was 41% and is 50% when Total T is 500 ng/dL and hemoglobin is 17.0, closer to the top of the ranges. You deserve better care than you are receiving.
Correcting the testosterone deficiency is associated with increased hemoglobin levels and tends to correct hemolytic anemia! Studies are showing a cardiovascular disease is associated with testosterone levels below 440, you are scoring lower than healthy 70 year old men including our current president (446 ng/dL).
Do not let your doctor to tell you that you’re levels are normal, a common tactic sick care doctors use to deny TRT because the organisations behind these reference ranges and the endocrine society have a bias toward TRT and will make it difficult to get approved for treatment even though the clinical studies show the cut off point for experiencing low testosterone to be much higher than what the Endocrine Society states in the guidelines that all doctors follow.
We see a lot of men complaining of low testosterone symptoms when dropping below 500 ng/dL, I myself am on TRT and recently scored a Total T of 406 and Free T 16.0 (ranges 6.8-21.5) had every symptoms of low testosterone, poor sleep, weak infrequent erections, low energy. A simple dosage increase fix that little problem.
According to the average 36 year old healthy male, you are significantly lower than the average male your age. Your Free T is at the bottom of the ranges where most would have symptoms, some men have symptoms with Free T midrange, everyone is different.
You will find little to no help going through insurance as they are very few doctors who specializes in this area of medicine, most of the experts in this field of medicine can be found privately in anti-aging or sports medicine.
TRT will lower SHBG a little, low SHBG guys tend to do better on multiple injections per week using insulin syringes in the shoulders and quads. If your doctor prescribes 200mg every two weeks, suffering will continue or get worse.
I would like to see thyroid panel, ferritin and cortisol levels.
Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:
These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction.