KNB, good catch on the Queast lab!
He will have to switch once on anastrozole.
Derf, you doc seems to know what he is doing. I would have started anastrozole from day one as E2=34 is enough to affect mood, energy, fat and libido. Your levels are consistent with your age. But still good to review drugs, Rx and OTC for endocrine distruption side effects.
You really do need the DHEA and low DHEA may have had an effect as a rate limiter on T production levels.
LH release is pulsatile [less so with age] and has a short half life. So a single lab make catch a peak or valley - you can’t tell. But that number is consistent with your TT. FSH levels are steadier and are useful. But, once you start to inject, your HPTA is shutdown and LH/FSH will track towards zero. Thus such labs have no further use in TRT, except that that a FSH level that does not drop can indicate testicular cancer… which tends to affect younger men.
hCG 250iu SC EOD maintains baseline testosterone production in the [health] testes. 500iu increased levels by 17%, diminishing returns. Learn to understand dose as iu’s not mls! I assume that your T is 200mg/ml, not 100mg/ml.
Test cyp and eth are completely interchangeable!
Some inject T and hCG EOD, every other day. With the then small volumes, you can inject that with #29 .5ml .5" insulin syringes in the vastus lateralis [front outer quadrant of the quads]. You do not need to use huge needles. Some is 1ml #25 1" and insert 3/4". Some of this depends on how much fat you need to get through to get into the muscle. Canadian clinical results show that SC injections provide steadier levels.
You do not need to inject hCG IM, SC works perfectly well, as shown in the 250iu SC EOD research.
Best testing accuracy is 1/2 way between injections. Some will test before their injection due the day of the tests so the numbers will be less high… seeking a higher dose.
This all sounds expensive! What kind of doc/clinic?
I can help you as well with injection Q’s etc.
DHEA is made mostly in your adrenals from pregnenolone. Pregnenolone is made in your testes. Either your adrenals are DHEA insufficient or they are rate limited by low pregnenolone levels. If the testes are not producing much pregnenolone, you might feel that your testes are smaller or soft now. Start feeling them now and try to note size changes and firmness from the hCG. If they get bigger and firmer, they are LH responsive and pregnenolone may increase. Some who supplement with pregnenolone capsules or transdermals find that that increases DHEA. DHEA oral absorption varies greatly. Some are poor absorbers… such as myself. I take a measure of bulk DHEA powder to get my levels up. DHEA is not water soluble, as with all of the typical steroid hormones. DHEA oil caps absorb better and best to take with an oil meal. DHEA in alcohol, dispensed into water than drank is way better than any powder.
Get “The Testosterone Syndrome” - Eugene Shippen from Amazon.com or elsewhere. Note that it is way off re injections and predates Arimidex for men, but still the best read if you are only going to read one book.
You need a DRE before starting TRT and PSA [done] a repeat PSA at month 3 and a repeat DRE at 6 months then once a year thereafter.
Your higher albumin level is good. Most T is going to be SHBG or albumin bound. Albumin bound T is the largest component of bio-T.
When is you next lab? If libido peaks then drops, along with energy etc, then your E2 is probably to blame. I would push for an early lab to resolve that and ask for an Arimidex script right away with labs to follow for confirmation. Elevated E2 can spoil everything and you E2 is already too high now. I would like to see you on 1mg/week in divided doses now.
It sounds very expensive to get DHEA and supplements as medical supplies. You can shop around for those.