So, regardless of what my test comes back at, what can I do to deal with the high E2? Is it just time at this point waiting for the fat to come off? 22 pounds down in under a month, cholesterol, LDL, and triglycerides all down... so health is moving in the right direction. Is there anything else meaningful that I can do? Or just fat loss and other meds?
Overweight TRT Considerations
- Thread starter msyntakz
- Start date
woundcarping
GLP-1 Specialist
Forgive me if I missed it… aside from the lab results, what symptoms are you having?
Turbo-Farmer
GLP-1 Enthusiast
Insulin resistance and testosterone
1. The Direct Hit to the Testes
Research shows that insulin resistance directly impairs the Leydig cells in the testes. These are the cells responsible for churning out testosterone. When your body is resistant to insulin:
• The Leydig cells become less responsive to Luteinizing Hormone (LH)—the "start engine" signal from your brain.
• Even if your brain is screaming for more testosterone, the testes don't "hear" the signal as clearly, leading to lower output.
2. The "Belly Fat" Factor (Aromatization)
Insulin resistance is almost always tied to increased visceral (belly) fat. This fat isn't just storage; it’s metabolically active and contains an enzyme called aromatase.
• Aromatase takes the testosterone you do have and converts it into estrogen.
• Higher estrogen levels then tell your brain, "We have plenty of hormones," which causes the brain to slow down the signal to produce more testosterone.
3. SHBG Suppression
Insulin levels significantly influence Sex Hormone Binding Globulin (SHBG), a protein that carries testosterone through your blood.
• High insulin levels signal the liver to produce less SHBG.
• While this might sounds like it would leave more "free" testosterone, low SHBG is often a marker of metabolic dysfunction and is consistently linked to lower total testosterone levels over time.
4. Inflammation and the Brain
Chronic insulin resistance creates a low-grade inflammatory state. This inflammation can disrupt the Hypothalamic-Pituitary-Gonadal (HPG) axis. Essentially, the "command center" in your brain becomes less efficient at monitoring and regulating your hormone levels, leading to a drop in production.
The Silver Lining: Reversibility
The good news is that because this relationship is bidirectional, fixing one often helps the other. Improving insulin sensitivity—is one of the most effective "natural" ways to boost testosterone.
1. The Direct Hit to the Testes
Research shows that insulin resistance directly impairs the Leydig cells in the testes. These are the cells responsible for churning out testosterone. When your body is resistant to insulin:
• The Leydig cells become less responsive to Luteinizing Hormone (LH)—the "start engine" signal from your brain.
• Even if your brain is screaming for more testosterone, the testes don't "hear" the signal as clearly, leading to lower output.
2. The "Belly Fat" Factor (Aromatization)
Insulin resistance is almost always tied to increased visceral (belly) fat. This fat isn't just storage; it’s metabolically active and contains an enzyme called aromatase.
• Aromatase takes the testosterone you do have and converts it into estrogen.
• Higher estrogen levels then tell your brain, "We have plenty of hormones," which causes the brain to slow down the signal to produce more testosterone.
3. SHBG Suppression
Insulin levels significantly influence Sex Hormone Binding Globulin (SHBG), a protein that carries testosterone through your blood.
• High insulin levels signal the liver to produce less SHBG.
• While this might sounds like it would leave more "free" testosterone, low SHBG is often a marker of metabolic dysfunction and is consistently linked to lower total testosterone levels over time.
4. Inflammation and the Brain
Chronic insulin resistance creates a low-grade inflammatory state. This inflammation can disrupt the Hypothalamic-Pituitary-Gonadal (HPG) axis. Essentially, the "command center" in your brain becomes less efficient at monitoring and regulating your hormone levels, leading to a drop in production.
The Silver Lining: Reversibility
The good news is that because this relationship is bidirectional, fixing one often helps the other. Improving insulin sensitivity—is one of the most effective "natural" ways to boost testosterone.
So, I've been over 300 lbs since '09 and got my biggest (390) in '22. So, I've been dealing with this stuff for a while, but general depressive issues, irritability, on top of the bipolar, low motivation, low libido/ED issues, hair loss on and off when I was at my heaviest, sleep... holy hell, the elusive sleep. Been consistent 7.5-8.5 hours since getting some weight off and being on GLP, so that's better. That's the gist of it, though.
I mean, I definitely am the walking definition of insulin-resistant. I have belly fat, but my fat is very evenly distributed all over. Not a giant gut, but I'm sure I have plenty of visceral fat to deal with. My HbA1c has never been bad, though, 5.1 for the past six years, and it just came back at 5 even on Sunday. So, not sure how much that (A1c) reflects insulin resistance, but it's never been high. So, it sounds like it's in the right direction.
woundcarping
GLP-1 Specialist
Most of those sound like low T symptoms too.
In theory the main sides I look for with elevated E2 while on TRT is fluid retention/puffy and sensitive nips.
I have been back and forth on so many TRT forums/sites, and what I consistently am seeing for overweight guys is pin often at low dose and subQ, all to keep spikes low and mimic natural production for the least aromatization. It seems to be a polarizing subject, to say the least.
Turbo-Farmer
GLP-1 Enthusiast
It’s not the sugar that’s the problem, it’s the insulin required to keep the sugar low. Insulin is a powerful hormone and it effects other hormones.
You can calculate your
HOMA-IR (Homeostatic Model Assessment for Insulin Resistance)
By testing your fasting insulin and fasting glucose
I am currently using the ss31 /mots-c / NAD+ protocol for mitochondrial function, because at my last physical my fasting blood sugar was low, however my insulin levels were high.
Tbagger
GLP-1 Enthusiast
My personal advice would be to wait until you lose some fat. I haven't noticed anyone mention it, but your blood pressure is also a factor. Test can dramatically raise your hematocrit and increase the chance of a heart attack or stroke. And as with all the other side effects of TRT, it increases with your bodyfat %.
I was 300lbs at over 40%BF. I decided to wait to start TRT due to high e2, insulin resistance, and high blood pressure. Spent a year working hard to drop the fat. Good diet and weight training 5 days a week. I started Reta, and tesa/ipa for the fat loss. Then cycled NAD+, SS31, and Mots-c to increase my insulin sensitivity. After I got under 20%BF I felt safe to start TRT. Now I'm on 150mg test-c a week, total T is 1200, e2 is 50, and hematocrit is 47. Never felt better in my life! It wasn't the fastest way to get here, but I felt it was the right way. But my way was just that, my way. You'll have to make your own risk analysis and choose the path that's right for you
I was 300lbs at over 40%BF. I decided to wait to start TRT due to high e2, insulin resistance, and high blood pressure. Spent a year working hard to drop the fat. Good diet and weight training 5 days a week. I started Reta, and tesa/ipa for the fat loss. Then cycled NAD+, SS31, and Mots-c to increase my insulin sensitivity. After I got under 20%BF I felt safe to start TRT. Now I'm on 150mg test-c a week, total T is 1200, e2 is 50, and hematocrit is 47. Never felt better in my life! It wasn't the fastest way to get here, but I felt it was the right way. But my way was just that, my way. You'll have to make your own risk analysis and choose the path that's right for you
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I appreciate the breakdown from a similar side of the coin. That is all very much necessary to consider. I’m on a good track for weight loss, so patience may be needed. I know I’ll get there physically, the thing I’m really impatient about is feeling better mentally. All of the success stories of night and day improvements mentally is so hard to ignore. It will be interesting to see what the rest of the tests come back as.
woundcarping
GLP-1 Specialist
I think you’re overthinking it.., you’re big but you’re not that much different than where I started in December (6’1-2” 282lb, 304lb ath). I knew I had low T from a dx in 2021.
I started TRT in January. The reason for the delay was wanting to see how I would handle SQ injections of GLP, I didn’t handle the harpoons back in 2021.
I started at 120mg/weekly SQ, split 3x. My 8 week labs were great, aside from DHT being low. I bumped my dose to 180mg/week. My labs Monday showed my hematocrit is up to 51.1, I didn’t do a hormone panel, that’ll be next month.
Aside from helping low t symptoms, which sounded similar to your current issues, I wanted TRT for the lean mass preservation. My January to March DEXA scans showed I lost ~19lb in that time only losing ~.5lb of lean mass.
I haven’t done anything to control estrogen although I have AI on hand. Unless I find symptoms, I’m not particularly worried about my E2. The only current symptom I’m have, in the last couple weeks, is my Oura ring being tighter when I sleep. Same thing happened when I started, gained 3lb overnight, classic signs of water retention. It resolved in early March, as expected. I’ll have a hormone panel done next month at 8 weeks at this dose and see how I’m doing.
Caught me. Yeah, that's a classic me thing. Over-analyse and then in hindsight: "Oh, no big deal."
I really do appreciate the reassurance and detail of your own situation. Helps build confidence for this process as it continues forward. The saving of lean mass would be a massive positive, and that's amazing preservation per your DEXA.
Also the symptoms to watch for regarding E2 is helpful to know, and watching for water weight swings. Appreciate all that!
BlueDog55
GLP-1 Apprentice
Ulta Labs it's on line. I have been using them for 10+ years and way way cheaper than a doc.
BlueDog55
GLP-1 Apprentice
Man, I wish I could pin anywhere but my glut, I have tried quad and delt both hurt so bad I couldn't take it. I have been on TRT for 15+ years and I have so much scar tissue I have to jab it in sometimes...
charliebrown1
GLP-1 Novice
🚫No Source Discussion🚫
I tried TRT for the 4th time but can’t live with the excess glyogen and water with 25 pound scale gain after 4 weeks. Actually lasted longer than in past and love extra energy libido muscle fillness etc but after dropping from 325 to 165 I can’t live with weight gain as much as I tell myself it’s not fat. Starting PCT and discontinuing—might retry at 150mg (currently 300 mg) after weight comes off.
BlueDog55
GLP-1 Apprentice
That is because the Labs use averages like 18 to 80... what a joke. I been on TRT for over 15 yrs and have read the subject to death. What I have decided is every one is different so the avg is BS. Do you think a 20yr old collage athlete (test 1800) has the same test as a normal 20yr old guy?(test 800) So when they are both 45 the ex-athlete could be 600 and the avg dude 350 and the athlete would be effected a lot more than the avg dude. This is just my Hypothesis but i have talked to several TRT doctors and they agree. I always tell people if they feel bad, feel weak so on they should try it. Also in this case for the OP he's young and rightfully so doesn't want to get on TRT for life if he doesn't need to, he should if he decides to start TRT also run HCG to keep his natural production going.
BlueDog55
GLP-1 Apprentice
Hi man see post #46 I posted to Latviantower but it should be info that might help you out.
Ok... I had a feeling making that last post would get me movement, lol.
Here are my relevant numbers -
Free Testosterone: 9.44 ng/dL
Total Testosterone: 285 ng/dL
E2: 54 pg/mL
SHBG: 20 nmol/L
IGF-1: 199 ng/mL
Hematocrit: 46.6%
So, to all my TRT folks out there, what are your takes on my situation as it sits?
Funny enough, for the testosterone levels, I am still in range for this lab that did the testing. Free test range was noted as 240 - 950 ng/dL, and free is 4.65 - 18.1 ng/dL. It seems like the reference ranges just keep getting lower and lower, which makes sense given the general population continuing to decline.
Anyway, that's where I stand in regard to the TRT conversation.
Here are my relevant numbers -
Free Testosterone: 9.44 ng/dL
Total Testosterone: 285 ng/dL
E2: 54 pg/mL
SHBG: 20 nmol/L
IGF-1: 199 ng/mL
Hematocrit: 46.6%
So, to all my TRT folks out there, what are your takes on my situation as it sits?
Funny enough, for the testosterone levels, I am still in range for this lab that did the testing. Free test range was noted as 240 - 950 ng/dL, and free is 4.65 - 18.1 ng/dL. It seems like the reference ranges just keep getting lower and lower, which makes sense given the general population continuing to decline.
Anyway, that's where I stand in regard to the TRT conversation.
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woundcarping
GLP-1 Specialist
Are you in the US?
Yes, michigan.
woundcarping
GLP-1 Specialist
That’s right, I think I saw that elsewhere.
You’re low enough to have labs plus symptoms to get a legal Rx.
Your E2 is high, relatively, that’ll be worth watching for symptoms and having a management plan ahead of time.
I’d get a legal script and inject it SQ 3x a week to reduce your spikes. TRT should generally help mentally as well as physically preserving lean mass while you cut. Losing fat should help reduce E2 also.
(This is more or less what I’ve done 3 months and 35lb ago.)
I appreciate the specific input from you. I like the idea of SQ and split dosing, no harpooning, steady release.
Thanks again!
I have almost the exact same issue as you do, of course, with the exception of the bipolar disorder, but yes, the low T and obesity and the desire to lose weight but preserve lean muscle mass, yes, I'm on the same boat. This is what I would recommend. The high estrogen activity due to aromatase from the visceral fat is definitely a contributor to low T, which is why I would look towards preserving whatever muscle mass I had while I lost weight and then measure my testosterone after that, because if one were to look at this logically, any testosterone level in the blood right now would be the result after estrogen activity due to aromatase. Your high estrogen amount seems to indicate as much. So you would not know how much actual testosterone is produced by your own body. Thus, once you lose all your weight and the fat, or at least as much as is possible, you would get a more reliable measurement of your actual testosterone production when you look at your blood testosterone levels. That is why , if I were in your shoes, I would focus on losing as much weight as possible, at least weight in terms of fat, and then measure the testosterone, and only then decide if I should go on TRT, because you can also try to boost your normal testosterone production by using things like enclomiphene or even HCG, even growth hormone can have an effect on the normal testosterone production of your body. The risks associated with testosterone replacement therapy is the fact that it could permanently mess up the natural production of testosterone in your body. And given your relatively young age, I think that that risk might be a little too much to indulge in right now. Therefore, unless you lose all that excess fat, it might not be prudent to go on TRT now. Instead, you could actually focus on exercising and doing strength training that would ensure that even if you were to lose muscle volume, you would retain those extremely invaluable myonuclei that is a result of strength training, specifically myofibrillar hypertrophy. So, that way, even when you do end up losing a bunch of muscle, it would be easy for you to regain it back. Muscle memory is a real thing.
rettta
GLP-1 Novice
🚫No Source Discussion🚫
I have been using one GLP1 or another on and off for 3 years. I added body weight fitness and reta around december. I started TRT about 8 montha ago. I take 10 units daily, no spikes, improved mood and motivation. I am eating at a much smaller calorie deficit and watching my protein intake. Weight loss has slowed from the first strict calorie deficit and walking routine but it so much more enjoyable and sustainable this time.
If I could go back I would have started TRT and resistance training from day 1. It is so much more sustainable , you need to retain your muscle! It is harder to keep your muscle than lose fat in my opinion. Eat your protein , keep doing your workouts add TRT ( in my untrained no medical background) opinion and and the results will come.
Such1943
GLP-1 Apprentice
I started TRT midway through a year long cut in which I lost over 100 lbs. I had both the symptoms and the bloodwork to justify starting. While I may have started at a higher bodyfat % than optimal, it provided the necessary motivation to become active again. Many simply start pinning GPL-1s, stop eating, remaining sedentary, then wonder why they plateau or why am I loosing all my muscle. The TRT will do a 180 on mood and motivation. RETA will do a 180 of your food intake. You need to use these tools to start a new life style plan to get the most out of your limited time left on this earth. It's time to take back the second half of your life.
rettta
GLP-1 Novice
🚫No Source Discussion🚫
100% agree
This is where I'm at, really looking for the sustainability of it. I am getting out and walking at least 5 miles a day, and training 3 times per week, and I would like to do more, but recovery seems tough right now. Likely also contributing from the calorie deficit, though I am hitting my protein really well. Anything to help would be nice.
Yes, the mood and motivation is so huge for me right now. Currently, life is just so overwhelming, and though there are troubles, it's not more than the average person. It feels unreasonably overwhelming and tiring. I am sleeping, I am on antidepressants, I eat well, I move well, I weight train... something is missing. Good to hear this!
rettta
GLP-1 Novice
🚫No Source Discussion🚫
Mood and motivation is a big desire for me too. I used modafi for it. I do have clenb. I also have bemethyl, and methylene blue which I just started taking 5 minutes ago. Let's see if it works. What I will say about fatigue, mood, motivation is the following. Hormones play a massive role in this. If the hormonal interplay of our body is messed up, as is the case in obesity, it's guaranteed to have a negative effect in the long term. That said, the main reason why I didn't recommend going on TRT straight away is that if supplements taken are not synergistic, we would need to go out of our way to derive two vastly diverse effects. While it is theoretically possible to gain muscle and lose fat at the same time, with TRT and Reta, it is mighty difficult, if not impossible. Even more so, when we are already obese, with a maladjusted hormonal profile. On the other hand, with natural production enhancers like enclomiphene, it's now worth trying to keep off TRT until we can gain full effect from it. Like secretagogues and GH.
