Starting TRT and severly obese

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New Member
I'm a 52 year old male, 320 Lbs, 6'1 (wasnt really overweight until I got into my late 30 and just get heavier each year). I recently requested that my doctor test my testosterone level and it came back at 194 (280-800)
Test,Free 21.9 (35.0-155)
FSH 6.2 (1.5-12.4)
LH 5.8 (1.7-8.6)

Glucose 95 (65-99) fasting
PSA 0.5 (<=4.0)
BUN/Creatinine ratio 8.9(10.0-28.0)
Cholesterol 237 (<=199)
Triglycerides 237 (<=149)
Cholesterol/HDL ratio 5.5 (<=4.9)
HDL Cholesterol 43 (>=40)
Non-HDL Cholesterol 194 (<=159)
LDL Cholesterol, Calculated 147 (<=129)
VLDL Cholesterol 47 (<-29)

blood pressure is in the good range and I've had 2 sleep apnea tests that came up negative

I took additional tests this past Friday for E2, TSH, fT3, fT4, IGF-1, and DHEA-S and awaiting the results.
Next Thursday, I go into my doctors office for training on self-inject Testosterone. I do not know the dose yet and if my doctor will prescribe anything else such as hcg or anastrozole but the new test results will shed more light on that subject.

This is all new to me and I'm trying to educate myself as much as I can and reading through all the threads, I also ordered Nelson's book as well and should get that in a week.

My question is, with my weight, what should I look out for and what can I expect being so heavy. I'm reading some guys gain weight and some guys lose weight. Right now I just dont have any energy to even start an exercise regime and being a trucker do not have access to a gym(I can start a walking program though) I dont know how knowledgeable my doctor is in TRT but he seems to be the kind that is willing to work with patients.
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Defy Medical TRT clinic doctor


Azbri - welcome to the forum. Get off your butt my friend and start walking. I lost 110 pounds (300 down to 190), by doing absolutely no exercising other than walking. I would fast walk 45 minutes every day. Maybe start with 15 minutes and work your way up. If you're a trucker, the bigger challenge I see for you would be eating correctly. Consistent walking and a significant change in diet, will do the trick.

Nelson Vergel


Welcome to

Testosterone replacement will help you lose weight faster as long as you get on a good diet and exercise.

Weight loss increases testosterone blood levels. You may start TRT now and then explore getting off of it after you have reached your weight goal (your axis now is not that bad and I predict your total testosterone can increase to at least 400-500 ng/dL when you lose weight if you do not suppress your hormone axis with TRT).

You may want to consider TRT+ HCG. Although no one has studied if men on this combo have a shorter recovery time of their hormone axis when they stop TRT after weight loss, it would be an interesting thing to explore. Or you can chose to stay on TRT for life.

I would read this information and watch some of these videos:
Nelson's Top Tricks for Fat Loss
Overcoming Challenges in Weight Management
The Science of Healthy Eating
Exercise Tips to Lose Fat and Gain Muscle


New Member
My new blood lab results came today(pre-trt) and my estradiol is in the normal range but my total estrogen is really high. The doc put me on Anastrozole 1mg tablet per day. Based on what I'm reading that is way too high of a dosage and that I should be taking 1/4 that amount. I also got my first shot of 200mg/ml of test cyp(prescribed as one shot every 4 weeks) today. I know that is a really low dose but my doc is willing to adjust it after after new blood tests in 4 weeks and said that we will probably have to go to every 2 weeks injections at that point.
Here are my lab results for the 10/22 test draw
DHEA-S 141(70-310)
Estradiol 12(8-43)
Estrogen Total 194(130 or less)
IGF-1 188(50-317)
Z-Score Male 0.6(-2.0 - +2.0)
T3 Free 2.8 (2.0-4.8)
T4 Free 1.4 (0.8-1.7)
TSH High Sensitivity 0.96 (0.45-4.50)

Why would the estrogen be high but the estradiol be in the low to normal range?

Nelson Vergel

I agree wit James. That testosterone dose and frequency is not effective. In fact, it will make you more hypogonadal. The anastrozole dose is crazy high also. Your doctor does not seem to have a good grasp at dosing.

100-200 mg per week of testosterone cypionate or enanthate brings up most men's total T above 500 ng/dL.

Anastrozole should never be prescribed unless someone uses the sensitive E2 test at week 6 after starting TRT. A value under 45 pg/mL does not justify anastrozole. For men with higher E2 values at week 6, starting with 0.5 mg per week of anastrozole is suggested. The dose can be increased if needed after another follow up test 2-4 weeks.

I am so tired of how badly some physicians are managing their TRT patients. No wonder there is such bad publicity in the past few months from badly managed studies that pretty much made men more hypogonadal than when before their started testosterone therapy.


New Member
After I got home from the doc office, I took my first 1mg anastrozole and thought that seemed quite high and searched for other guys doses. I think I should drastically reduce my dose or eliminate anastrozole altogether based on my current e2 level. I just dont understand how the "Estrogen Total" number plays into this. Is it important too as the information I seem to read only talks about e2/estradiol

Since my doc seems to be willing to increase my test after the next blood test, I will stick it out otherwise I will look for another trt doc
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