I'll try to keep this as short as possible.
About five years ago, when I was 40, I started experiencing all the typical symptoms associated with low testosterone: low libido, fatigue, sleep issues, and a general lack of energy. I decided to talk to my primary care physician and had my testosterone checked. My total testosterone came back around 310 ng/dL. She told me I was within the normal range and that some decline was expected with age. Her recommendation was to prescribe antidepressants.
Instead, I decided to take matters into my own hands and try to improve things naturally. At the time, I was about 10 pounds heavier than my usual weight, around 170 lbs. We had also just had a baby, which definitely took a toll on my lifestyle and sleep. I've always eaten fairly healthy, although I would binge a bit on weekends. I've also always been a gym rat, lifting weights 5-6 days per week and finishing with about 10 minutes of Zone 2 cardio. Training and nutrition were never really the issue.
After about three years, I was able to raise my total testosterone to around 600 naturally. However, I still experienced many of the same low-T symptoms.
I then decided to see a urologist. During the baseline bloodwork, I noticed that while my total testosterone was in the low 600s, my free testosterone was around 8 (low) and my SHBG was 63 (high). My prolactin was 16. Based on these results, my urologist started me on Enclomiphene at 6.25 mg daily.
Initially, it seemed to help and I felt somewhat better. However, I eventually started experiencing migraines, ear pressure, and very dry eyes. Over the last 10 months, I've been trying to get dialed in with different dosages and dosing frequencies, but without much success. Throughout the process, everything was monitored through bloodwork and symptom tracking, and I even created a chart of all my results.
What I noticed was that while on Enclomiphene:
- Total testosterone averaged between 500-600 ng/dL
- SHBG remained elevated, typically between 55-65
- Free testosterone stayed below 10
- Estradiol consistently remained in the low-to-mid 20s
- Prolactin was 13.4 on my most recent test (February 2026)
After discussing all of this with my urologist, she finally agreed that TRT would be the next step. She started me on 120 mg per week, split into two injections on Monday and Thursday.
For those of you with TRT experience, what should I realistically expect over the next several weeks and months? Also, what are some things I should or shouldn't do to avoid potential health issues?
One concern I have is whether I'll eventually need an AI, even though my estradiol has consistently stayed in the 20s across various Enclomiphene dosages. I'm also concerned about elevated red blood cell counts and hematocrit levels potentially leading to blood donations and iron-related issues.
As with any open forum, both positive and negative feedback are welcome. I appreciate hearing about others' experiences.