Any doctor you have access to will not be of much help, you need to educate yourself because none of your doctors will be educated in TRT. Most men inject two or more time per week to keep levels in the therapeutic ranges. If levels are swing from high to low range between injections, I expect you will have no symptom resolution.
Men with high normal testosterone live longer and have the least cardiovascular events than those in the mid normal ranges, men with testosterone lower than 350 are at high risk for all the diseases of aging (heart attacks) and your doctor should be targeting 800-1000 Total T, his complete lack of knowledge is responsible for your suffering.
Managed health care will unfortunately be unable to manage your TRT protocol because the way it operates which focuses reference ranges where in range is normal, so when you scored the 322 it was in range (264-916) and no more thought went into it.
The endocrinology department won’t be much help either, endocrinologist isn’t the type of doctor you want managing your TRT, they are every bit as clueless. You need to seek private care for your TRT or expect to figure out everything on your own.
SHBG levels should dictate injection frequencies, the lower this value, the more frequent injections should be. My SHBG fluctuates between 16-22 and feel best injecting 25mg every other day and feel even better on 10mg daily dosing.
This may be the only bit of good news you have mentioned so far, see if you can’t get this doctor to order more labs recommended by hardartery and see if your doctor could write your script for 100mg weekly which would allow you to split up how ever many ways you prefer and base this decision on your SHBG value.
Show him these studies I’m providing below and maybe he will listen. You should also consider 1/2" 27-29 gauge insulin syringes and inject in shoulders and quads, no need for large needles in the glutes.
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.
Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism
Skip to figure 1 graph B, 6 days after a 200mg injection levels are below the therapeutic ranges while estrogen remains very high creating estrogen dominance in men. We men excrete testosterone a lot faster than we excrete estrogen which must be cleared by the liver which takes longer.