After years of messing around with every variable I could think of, I found a protocol that works very well.
Two of my battles have been with low SHBG and poor tolerance to Anastrozole.
I endured a whole lot of deadened libido, depression, ED, etc., for the first couple years of TRT. Here's what finally did the trick:
1) Allowed myself to crash to around baseline T levels (after 2 years on TRT, this was probably below 200 ng/dl).
2) Frontload 50mg of Testosterone Cypionate, injected subcutaneously
3) Starting 24 hours later, inject 20mg of T-Cyp EVERY NIGHT before bed (rotate injection sites between obliques and upper glutes on either side)
4) Take 25mg of research-chemical Exemestane every night before bed
5) Take another 25mg of research-chemical Exemestane every morning before leaving for work about 12 hours later
This puts my total T in the 800-900 range and bioavailable T in a proportionately high-normal range.
Taking that much Exemestane seems like it should crash my E2 through the floor. I actually haven't gotten an E2 lab since starting this protocol, and I really don't care what that number is at this point. (I once got near the Holy Grail E2 reading of 22, and I still was not feeling great).
I feel good, my mood is stable, it's easy to lose bodyfat, workouts are good, sexual function is good...even morning/nocturnal wood is much more consistent and vigorous than it's been in many years. This has been the story for about 5-6 months now. No looking back, as far as I'm concerned.
The daily injections are a hassle, and yes, I'm sure I'm building up some considerable scar tissue. But that's a small price to pay, in my opinion.
I hope this helps someone. Life was pretty bad before getting the hormones stabilized. I'm glad I didn't quit.