Don't bother with the total E lab work. Test for serum E2 0-53 pg/ml. The other estrogens are metabolites of E2. Get E2 down and the metabolites will fall. After you get E2 corrected for a while, you could do a total E test to see if you are having an unusual amount of estrogen metabolites. Total E without E2 does not allow one to determine if metabolites are an issue.
E2 should be in the low 20's. Some sources suggest 17-20 for optimal libido.
Start with 1.5mg* arimidex/anastrozole every week in divided doses. The liquid anastrozole is very cheap from research chem sites, $50 for 60mg. Arimidex from a pharmacy can cost 9$ for one 1mg tablet ;( You could get a script then follow that with the liquid. Liquid also allows for flexibility of dosing that you can't get with tablets.
- The typical starting/trial dose for guys with E2 in the 30 - 50\ range is 1mg/week. You might need more than that.
You can get E2 tests (and others) via lef.org to guide dosing changes if your med plan will not cover what needs to be done.
Arimidex/anastrozole can create a huge increase in libido, sometimes in 10-14 days. As this is a fast acting response, this is your best barometer for what is happening. There also will be improved mood, elimination of brain fog, more energy and personality changes as your brain gets testosterone dominated instead of estrogen-progesterone effects. These changes can take 2-3 months to fully complete. You might also get what I term as "dryer emotions".
As those brain changes and habits of thought are changing, be positive about things and you might shape positive habits of thought while things are changing.
AI can change everything! Your T levels may improve as less T is lost to T-->E conversion. High E can block the effects of high TT, even at TT=1000. You have a lot to gain by doing this. If your doc will not do all required, you can do this on your own as the doctor's standard of care is not acceptable. Many doctors do not understand all of the issues.
The foundation of TRT/HRT [according to me]is testosterone, HCG and AI [anastrozole]. It is like a tripod. Without all three, the result is less than optimal. HCG keeps the testicles working and healthy. The testes make most of the pregnenolone in the body. When T shuts down the HPTA, that stops as well. Pregnenolone is more than a raw material for sex steroid and DHEA. It is converted in the brain (locally, not systemic) to produce neural steroids. Low levels of pregnenolone can lead to memory and other cognitive deficits.
A good dose for HCG is 250iu SC EOD. Very inexpensive at Sam's Club with a business membership, $16.25 for 10,000iu. This will also improve your T levels.