Unfortunately your doctor is caught up on that TT only matters syndrome!
Although TT is important to know FT is what truly matters as its the active unbound fraction of T is responsible for the positive effects.
* the symptoms follow free testosterone they do not follow total testosterone
With a robust TT 622 ng/dL and high SHBG your cFT would be sub-par
SHBG inflating your TT.
Even than would not fret over driving down SHBG let alone anyone making claims that you need to start on a higher dose of T!
It is far from a given that you will need a high dose to achieve a healthy FT even with having high SHBG.
Increasing your TT will increase your FT.
You would need to have your FT tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG to know where it truly sits.
Also keep in mind as of now cFTV tends to overestimate when compared to a standardized gold standard ED assay.
If you had your FT tested using Quests ED assay (most accurate) it may very well come back the same or slightly lower.
If you decide to hop on TTh start low and go slow.
Patience is key!
Have realistic expectations.
Do not get caught up on that more T is better mentality!
Common starting dose regardless of where your SHBG sits (low/normal/high) is 100 mg T/week or better yet 50 mg T split twice-weekly (every 3.5 days).
Most men can easily achieve a healthy let alone high or in some cases absurdly high trough FT on 100-150 mg T/week especially when split into more frequent injections as in twice weekly (every 3.5 days), M/W/F, EOD let alone daily.
Most would never need the higher-end dose of 200 mg T/week to achieve a healthy let alone high FT and yes even men with highish/high SHBG.
Pay close attention (36:29-41:47)
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