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Obese insulin resistant men do not do as well on TRT and are liable to suffer more estrogenic sides.
I’m the exception. I had an SHBG at 11 pre-TRT, so profoundly insulin resistant that I’m resistant to all type 2 diabetes drugs. I have no issues with high estrogen at all on TRT.

I however don’t have low SHBG anymore, 24 last time I checked, more than double my baseline level. I think it’s both, the low SHBG is a consequence of some other disease process -> obesity.

One wouldn’t be insulin resistant with low body fat percentage. I do recall a member having an SHBG, as low as 10 and very lean and doing very well on TRT.
 
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Defy Medical TRT clinic

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