Optimizing TRT (6-Weeks In)

I recently began TRT about six weeks ago. I am at biweekly injections of 0.40ml totaling 0.80ml weekly as well as anastrozole. Taking DIM/I3C to metabolize estrogen. We are waiting on bloodwork to see how much to increase if at all.

Over the past three years my T went from 900+, to 700+, to low 500. In that time, I began med school, I’m 40 years old, a father of twin eight year olds, and a husband. It took its tole on me, I started gaining weight regardless of how healthy and active I was. Eventually, just driving home in traffic was an energy suck. I was burned out, easy to trigger, I’d lash out at my kids for just kid stuff. I was stretched so thin.

I went in to figure out what was going on. The first thing the Dr. said was “talk to me about your T” (I had sent him the past 3-years’ worth of bloodwork before meeting him). Not a single previous doctor either noticed it or cared enough to address it thinking it was not the underlying issue. Low and behold, it was the only underlying issue.

After two weeks on TRT, my sleep was regulated. My energy skyrocketed and my stress level plummeted. I started lifting again because the energy was through the roof. Libido is unmatched, morning wood and hardons like I’m 18 again.

Quick stats in case you can relate:

  • T was low (low 500’s)
  • Estrogen was high
  • Sex-binding globulin was high (increases in concentration relative to estrogen), so it was binding free T making it useless.

I want to make the most of TRT. I am in the process of losing weight. The Dr. said I should be able to reach my body comp goals within a year on TRT. I have a significant background in strength training so picking that back up was a breeze, but my body is responding better now than it ever has before.

I am taking 2g of L-Carnitine L-Tartrate/day to increase androgen receptors (based on the below research: Androgenic responses to resistance exercise: effects of feeding and L-carnitine - PubMed

I’m lifting on days closest to my peak (12-24 hours from injection) recommended by the doctor.

My Question: are there any other ways you have found to maximize TRT? Simple lifestyle changes or supplements (like Carnitine) that might have some impact?

If there are posts already addressing this I’ll check those out too. Haven’t found too many.


I have been on TRT for over 22 years. There is no way to “maximize” it.

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If you are supplementing oral Carnitine you should also consider supplementing with garlic to minimize production of TMAO. If you switch to injectable carnitine you do not need to supplement with garlic. I used injectable carnitine BEFORE starting TRT and had no noticeable benefits that were worth the hassle of daily carnitine injections. I have not resumed carnitine since beginning TRT but my body comp is improving rapidly due to dialing in my diet and dosage and I see no reason to start try carnitine again yet. That’s my personal experience.

I think you will find a MUCH bigger benefit in perfecting your diet. I recently started following Justin Harris and Paul Barnett to learn about carb cycling and I’m getting good results.

Other small recommendations would be to research DHEA, Pregnenolone and other neurosteroids for which supplementation can be beneficial on TRT by helping with sleep quality and things like that. Vigorous Steve is a good resource for those types of ancillaries and uses during different cycles.

TT doesn’t mean a ton on its own although you are clearly on a descending path. 500s TT is adequate on its own metric for your age, it’s midrange. However…

With high SHBG you will have lower FT as you stated. What was your FT prior to TRT?

This is horseshit. Workout when it suits your schedule. No magic timing here will actually yield better results.

Take it slow be steady. I don’t like your protocol at all. You still haven’t stated your dose. You gave volumes. We need to know your dose in Mg or the concentration of your testosterone vial. Why are you on anything other than solo T to start. My recommendation is to start over with solo T and take labs after 4-6 weeks. See how you feel and where you are at. Take them on your trough day and aim to have FT in mid to 2/3 range on that day. You can titrate up or down to achieve this and retest again.

IMO you only add an AI or DIM if you need it after your initial try with solo T.


2021 Bloodwork:

Testosterone, Total: 676.4 (range: 264-916 ng/dl)

Free Testosterone: 9.2 (range 8.7-25.1 pg/ml)

DHEA-Sulfate: 226 (range 102.6-416.3)

Estrone: 80 (range 15-65)

Estradiol: 44.4 (range 7.6-42.6)

SHBG: 69.3 (range 16.5-55.9)

Hematocrit: 42.9 (range 37.5-51)

2022 Bloodwork:

Testosterone, Total: 571.4 (range: 264-916 ng/dl)

Free Testosterone: 7.9 (range 8.7-25.1 pg/ml)

Estrone: 109 (range 15-65)

Estradiol: 29.3 (range 7.6-42.6)

SHBG: 70.5 (range 16.5-55.9)

2023 Bloodwork (began TRT six weeks ago):

Hematocrit: 45.1 (range 37.5-51)

Waiting on hormone panel

TRT info:

Testosterone Cypionate 200 mg/mL intramuscular solution

  • 0.4 ml 2 times a week in the evening, subcutaneous route
  • this translates to 80mg/0.40mL injected twice weekly; 160mg weekly.

anastrozole 1 mg oral tablet

1/2 tablet(s) 2 times a week, oral route on testosterone injection days

It is believed I have an upregulated gene for aromatase enzyme so the doctor started me on anastrozole to lower estrogen production and DIM/I3C to metabolize it. Once estrogen is in a good place, I think we are going to stop it, but waiting on hormone panel to discuss. It was only temporary, but I see what you’re saying.

This should be everything you’re asking. Thank you for your time.

May I ask why that is believed? Because of high estrone? Your labs look very similar to mine before TRT. Estradiol is the only estrogen you need to worry about. I had high SHBG, low FT, high estrone, etc very similar. I was also started on a similar protocol and struggled to dial in until I did my own research and asked to be put on solo T. Lo and behold that all I needed and it makes perfect sense. Low T, treat with T. If follow up labs and or symptoms show adjunct meds are necessary you treat them at that time.

I believe they (my former doctor and current doctor) came to this conclusion because of the high estrogen marker and because of where I put the body fat on during the period I gained. They came to this conclusion independently of each other and it seemed like a logical conclusion at the time. The stress of pre-med did a number on my thyroid hormones, RT3 was high, metabolism dropped. Started putting weight on. Unbeknownst to me, because it was never a focus of my doctors, T was dropping as well jus making it all worse.

I will be getting blood drawn next week and then within two weeks the hormone panel will be back. I can give you more info then, but I do remember that the AI was only temporary (he wanted to lower estrogen and therefore indirectly lower SHBG. He wanted to get estrogen back down and then see if it climbs again on its own if I remember correctly.

Received my hormone panel results: