I'm trying to settle an internal debate that I've got going about whether TRT would truly help to solve my issues or if it would cause more headaches than other therapies. I had been set on starting TRT because of my symptoms: sleep, lethargy, fogginess even on my ADHD meds that have worked great for 20 years, weight gain, and my fasting glucose keeps hovering around 105. However, my IGF-1 came back low at 99, I do have stage 2/3 hypertension that I've struggled to control, and my Estradiol seems pretty high at 33.1 (I do have gyno on the left, confirmed with mammogram). So prior to this week my doc had suggested I try peptides and I had been dismissive of them. Of course things have changed drastically in that arena as of late and he can no longer recommend the course that he would have 2 weeks ago. But now I am kinda torn and almost leaning toward the peptide therapy. More deets -> 46M, 6'0", 240lbs and climbing regardless of what I do/try. Test is 555, Free Test has gone up over the last year from 6.7 to now 9.1, SHBG 45, LH 2.0, and DHEA 85.8. Eighteen months ago my test was 683, free was 16.1. I've put on 30 pounds in that time. I have done Enanthate and Sustanon 250 recreationally way back in the late 90's, so I am somewhat familiar with taking test. How does TRT look for helping with my issues?

While starting TRT would certainly increase your IGF-1, which would increase muscle mass over time, starting TRT is not always the answer.

To be honest, it’s not clear that TRT would be the fix for you. While your T level has dropped from what your normal baseline is, your current level is not terrible. That would suggest that you may be able to recover your normal function with some lifestyle changes first.

Undoubtedly increasing your testosterone level would give you better recovery from workouts and maybe help with energy and motivation, but you haven’t exhausted all your options yet.

Peptides certainly can help give you “an edge”, but they are not typically as potent as the effect you might expect from androgens.

You might notice that if you are able to lose those 30 lbs you gained, you may very well feel back to your normal self again.

That said, if you did choose TRT, you would need to account for your gyno/higher Estrogen concerns. This may mean you might need to use an AI.

Since you're at 555 or and were higher at your baseline, you may be experiencing a case of relative hypogonadism, which means that you would need a slightly higher dose of Testosterone than someone who is lower, certainly meaning that you would need the AI mentioned above.

Hypertension tends to not be negatively impacted by TRT, overall health tends to improve. Some rare cases find that RHR & BP increase on TRT, but it does tend to be transient in most. These are not reasons to avoid TRT, though.

This would be a slightly complicated case, but not anticipated to be problematic. If you ever do decide to give TRT a shot a proper consult with your doctor would go a long way.