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MaxP

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Hi all, 60 male here and I have been dealing with depression, anxiety, fatigue, lack of motivation, focus, concentration etc for a long time. Depression and anxiety have gotten better with therapy and spravato treatment (now stopped) but the rest of the issues still continue and so I have my 1st consult with Defy this week.
I have tried TRT through my pcp but didn't see any results and was pcp was not that knowledgeable about TRT imo.
What questions should I ask and if other meds besides the testosterone are recommended, how do I decide which to go with initially or just do as recommended.
My lab results are below.
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Defy Medical TRT clinic doctor
My testosterone panel is exactly identical to yours, right up to the TT and SHBG. I feel fine with regards to the hormone panel.

As far as other meds with your TRT protocol, aside from daily Cialis, keep it simple, testosterone in isolation.

What was the TRT protocol with your PCP?
 
My testosterone panel is exactly identical to yours, right up to the TT and SHBG. I feel fine with regards to the hormone panel.

As far as other meds with your TRT protocol, aside from daily Cialis, keep it simple, testosterone in isolation.

What was the TRT protocol with your PCP?
Thank you for the response, I appreciate it.
My PCP had me start at 100mg a week Cypionate then dropped me to 50mg weekly because testosterone was around 1200 which then dropped to around 635 but nothing else was done.
So, just having the testosterone alone may not be enough for me to help my symptoms.
Not sure I need daily Cialis as libido and ED isn't an issue.
Since you panel is identical (I assume with TRT), what has been your TRT regimen and did it work for whatever issues you were having?
*I forgot to mention I stopped my Cypionate shots around 3-4 months ago in order to restart fresh with Defy .......but surprisingly my testosterone level was still in the 400's.
 
Hi all, 60 male here and I have been dealing with depression, anxiety, fatigue, lack of motivation, focus, concentration etc for a long time.
Your PCP wasted your time with the 50 mg weekly protocol and I wouldn't take your lack of response to that as indicative of what TRT can do for you. I would get back on the 100 mg weekly, see how that treats you longer-term and adjust from there.

At the same time, many of your symptoms are non-specific for testosterone deficiency, so I would be looking at everything else that can cause those symptoms: metabolic health / insulin resistance, sleep quality / apnea, micronutrient deficiencies (B12, iron, etc), thyroid, etc.
 
Your PCP wasted your time with the 50 mg weekly protocol and I wouldn't take your lack of response to that as indicative of what TRT can do for you. I would get back on the 100 mg weekly, see how that treats you longer-term and adjust from there.

At the same time, many of your symptoms are non-specific for testosterone deficiency, so I would be looking at everything else that can cause those symptoms: metabolic health / insulin resistance, sleep quality / apnea, micronutrient deficiencies (B12, iron, etc), thyroid, etc.
Your PCP wasted your time with the 50 mg weekly protocol and I wouldn't take your lack of response to that as indicative of what TRT can do for you. I would get back on the 100 mg weekly, see how that treats you longer-term and adjust from there.
I'm not sure why you would make that statement. The original poster clearly is a good responder to T; at 100mg weekly and with the resultant TT of 1200, he's placing his 60 year old self at risk for the various issues that older patients can have. There's nothing so wrong with the TT of 635 that he ended up at with the lower dose. I would think Defy could learn from this experience and start him at a lower dose than the normal 100mg weekly.

At the same time, many of your symptoms are non-specific for testosterone deficiency, so I would be looking at everything else that can cause those symptoms: metabolic health / insulin resistance, sleep quality / apnea, micronutrient deficiencies (B12, iron, etc), thyroid, etc.

I agree with your statement. Too many people hope that T will be the panacea to all their aches and pains; in my experience that's most often not the case.
 
I'm not sure why you would make that statement. The original poster clearly is a good responder to T; at 100mg weekly and with the resultant TT of 1200, he's placing his 60 year old self at risk for the various issues that older patients can have. There's nothing so wrong with the TT of 635 that he ended up at with the lower dose.
If his SHBG didn't move very much, and it probably didn't, he had a free T around 13 ng/dL at 635 total. I define that as a waste of time, and I don't have time to debate the point. We'll have to agree to disagree.
 
Thank you for the response, I appreciate it.
My PCP had me start at 100mg a week Cypionate then dropped me to 50mg weekly because testosterone was around 1200 which then dropped to around 635 but nothing else was done.
So, just having the testosterone alone may not be enough for me to help my symptoms.
Not sure I need daily Cialis as libido and ED isn't an issue.
Since you panel is identical (I assume with TRT), what has been your TRT regimen and did it work for whatever issues you were having?
*I forgot to mention I stopped my Cypionate shots around 3-4 months ago in order to restart fresh with Defy .......but surprisingly my testosterone level was still in the 400's.

Again although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Top it off that we always need to test at the true trough lowest point before your next injection.

You were hitting a whopping TT 1200 ng/dL (100 mgT/week) and robust TT 635 ng/dL (50 mg T/week) and you have normalish SHBG but not sure where it sat on your 100 mg/week protocol.

How many days post-injection on both protocols 50/100 mg T were labs done?

Going to be a big difference in peak--->trough when injecting once weekly.

Need to know what trough FT level you were truly hitting before jumping to any conclusions as to whether your dose of T is possibly too high or too low!

Common starting dose is 100 mg T/week.

Yes some may start on <100 mg/week but it is far from common.

Rare that anyone would be started on 50 mg T injected once weekly and even if the starting dose 100 mg is eventually titrated down most are still injecting more than 50 mg T/week.




 
Again although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Top it off that we always need to test at the true trough lowest point before your next injection.

You were hitting a whopping TT 1200 ng/dL (100 mgT/week) and robust TT 635 ng/dL (50 mg T/week) and you have normalish SHBG but not sure where it sat on your 100 mg/week protocol.

How many days post-injection on both protocols 50/100 mg T were labs done?

Going to be a big difference in peak--->trough when injecting once weekly.

Need to know what trough FT level you were truly hitting before jumping to any conclusions as to whether your dose of T is possibly too high or too low!

Common starting dose is 100 mg T/week.

Yes some may start on <100 mg/week but it is far from common.

Rare that anyone would be started on 50 mg T injected once weekly and even if the starting dose 100 mg is eventually titrated down most are still injecting more than 50 mg T/week.




At 100mg weekly I was injecting 4 times a week and at 50mg 2x a week........I would get lab work done before my next shot, so as close trough as possible.
 
At 100mg weekly I was injecting 4 times a week and at 50mg 2x a week........I would get lab work done before my next shot, so as close trough as possible.

Not sure how many months you followed each protocol?

On the 100 mg T/week split into 4 injections protocol you were hitting a very high trough TT 1200 ng/dL and with normalish SHBG (will use your pre-TTh 37.5 nmol/L) your trough cFTV 28.6 ng/dL would have been very high.

Always need to keep in mind that your peak TT, FT and estradiol will be higher!

Again have no clue where your SHBG truly sat as it was 37.5 nmol/L pre-TTh and may have dropped further when you went on TTh (100 mg T/week).

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If you were on such protocol for at least 3 months and you felt great overall minus any sides and blood markers were healthy than I see no issue here if that is where you felt best.

Not sure where your RBCs, hemoglobin and hematocrit sat or how you were truly feeling overall but keep in mind that your hemoglobin and hematocrit were already closer to the top-end pre-TTh.

Chances are that you may have been dealing with elevated hematocrit and even then where your level sat 4 weeks in let alone 3 months in is not where it would have ended up 6-9 months down the road.

As I stated previously when using exogenous T hematocrit will start rising within the 1st month of starting therapy and will take anywhere from 6-9 months or in some cases up to a year to reach peak levels.

On the 50 mg T/week split into twice-weekly injections (every 3.5 days) you were hitting a robust trough TT 635 ng/dL and with normalish SHBG (will use your pre-TTh 37.5 nmol/L) your trough calculated cFTV 12.9 ng/dL would be descent but may have been too low for you!

Always need to keep in mind that your peak TT, FT and estradiol will be higher.

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Just to put this in perspective most healthy young males would be hitting a peak cFTV 13-15 ng/dL and this is a daily short-lived peak too boot!

Yes many tend to aim for a higher-end trough but this is not a given that most need to be hitting a higher-end/high trough in order to experience relief/improvement of low-T symptoms.

Many will do well with a trough FT 15-25 ng/dL.

Yes some men may run levels much higher!

Comes down to the individual.

Even then need to keep in mind that there is a big difference between one hitting a high trough FT 20-25 ng/dL injecting daily vs every 3.5 days vs once weekly!

Always need to pay attention to your injection frequency when speaking on trough FT!

What needs to be stressed here is running too high a trough/steady-state FT can be just as bad in many ways as running too low a FT especially when it comes to libido and erectile function.

Tread lightly when it comes to that more T is better mentality myth being pushed by all those sheep stinking up the so called men's health/HRT forums!
 
Beyond Testosterone Book by Nelson Vergel
Not sure I need daily Cialis as libido and ED isn't an issue.
It doesn’t appear that your issues are being caused by lack of sex hormones.

TRT isn’t a panacea.

I wonder if your symptoms could be related to the treatment you’re currently on for depression, as these treatments aren’t without side effects.
 
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