My Bloodwork and Dr.'s treatment

I am 41 (6' 3.5" tall and 265 lbs) and have been on Cypionate 100mg once per week for about 4 weeks now. Seems to be working. My question is, given my bloodwork prior to treatment, did i need T or could the Dr. have just lowered my E2? I assume lowering my E would have increased my T, which would have lowered my SHBG, which would have increased my Free T (which i believe was the initial issue)???

Here is my pre treatment bloodwork, any opinions? I dont have post treatment BW yet.

SHBG = 41 (10-50 nmol/L)
Hematocrit = 48 (38.5-50%
Testosterone Free = 1.15 (.95-4.3 ng/dL)
Estradiol = 38.3 (20-75 pg/ml)
Prolactin = 4.4 (3.3-20.8 ng/ml)
TSH = 2.2 (0.5-6.0 uIU/ml)
Progesterone = 0.4 (0.0-0.6 ng/ml)
HBA1C = 4.9 (3.8-6.0%)
PSA = 1.1 (0.0-4.0 ng/ml)
Total Testosterone = 447 (300-1000 ng/dl)
LH = 2.5 (1.7-11.2 mIU/ml)
FSH = 3.5 (1.7-11.2 mIU/ml)

Also, i am not taking any HCG or an AI.

Well, your levels are low and that includes your LH and FSH. Doing what you suggested would work to a point. Whether it would be enough to "feel" how you like is totally subjective. Many people at 447 TT would be just fine, probably most would. What symptoms did you present that made you take the leap into TRT?

Consider supplementing with D3 which will help lower your shbg thus increase free T. Also look into micronized DHEA and pregnenelone. There are many threads here on D and a sticky on DHEA. Be sure to test your D (25-Hydroxy) and DHEA-S during your next BW. Actually, in the Finding A Doc Sticky there is an example of BW you can use as a guide.

Symptons? I had many. Started with some Ed issues that i was noticing. More tired, not as motivated, irritable, weight gain, harder time pushing myself physically, tough time recovering from physical activity, etc.

The T seems to be helping as of now. I have just been curious if there were other options that were not explored by the Dr. at the time TRT was choosen. I have read more on this now and understand it is for life. Is there something that would be better for my body long term given my bloodwork?

I am concerned that TRT shuts down some of the hormone pathways as the body will not need to make its own T anymore. When on this stuff long term should the Dr. be considering filling in those pathways as there may be other things in my body that will now go without?

If you have full blood work pre-TRT post it up for us to review. Many things can cause the symptoms you described. Test is not always the culprit. TRT does shut down your endogenous production as your body senses that it doesn't need to produce any more due to the exogenous T introduced. You have much to consider with HRT therapy. It's not just take a shot and forget it as you know. HCG should be a part of your protocol as well as possibly an AI if BW indicates it. Although every effort should be made to not have to use one.

Back-filling pathways? Well, consider supplementing with DHEA and pregnenolone in micronized forms. These will help with your chol pathways. First, though I would test your DHEA-S to get a baseline. Testing for preg is not really worthwhile as most is in tissue. Also consider vit D3. It's probably the most important vitamin (hormone actually) you can take for many reasons and most everyone is low. D is in literally every cell in your body so make sure it's in good shape. Take some time and read the stickies at the top of this forum.

When it comes to other options. TRT should be a last resort in my opinion. Every effort should be made to find the cause and correct it first. Be it medically or lifestyle related. And no, it's not too late to come off of TRT if other options present themselves to you. You just need a knowledgeable doctor to help you along the way. Think about it, people cycle "massive" amounts of AAS and restart all the time.

Well i agree it should be a last resort but did not know enough a month ago when i started. Yes i can stop as you say. Looking at the BW i posted pre-treatment am i primary or secondary? Also, does the approach of adding T to lower SHBG which inturn will increase Free T a reasonable approach in your opinon? It makes sense to me just dont quite understand why a DR. would not concentrate more on the SHBG without adding T. Would getting my E2 to about 20 with an AI increase my total T enough to lower SHBG. Would SHBG get low enough to increase free T. Of course everyone is different and there probably isnt an answer but these are general questions.

Thanks for you help.

Why should HCG always be included? If HCG is included would backfilling be unnecessary?