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  1. Dr Justin Saya MD

    HCG Cream

    Convenient for them, but concerning not knowing what is going into your body (or in this case of transdermal hCG, what is NOT going into your body...but draining your wallet nonetheless).
  2. Dr Justin Saya MD

    Question, backfilling the pathways?

    Everyone is unique and I believe there is a role, however limited it may be, for HCG from an upstream perspective. However, I’ve seen guys with a strong case of primary hypogonadism and with LH levels >40 (the biological equivalent of a very high HCG dosage) still have low DHEA/pregnenolone...
  3. Dr Justin Saya MD

    How to adjust dose for daily injections?

    Daily injections, though not always *necessary*, will always give more stability (invariably) than less frequent injection schedules. See my automobile analogy from a couple years back in post 36: Some insight on T cyp injection frequency and SC vs IM)
  4. Dr Justin Saya MD

    HCG 1 week on, 3 weeks off ~ Dr. West Conner

    Suffice? For fertility - No For testicular atrophy - not likely (or partially) For the subjective benefits some patients feel with HCG (libido, etc) - well for 1 week
  5. Dr Justin Saya MD

    HCG 1 week on, 3 weeks off ~ Dr. West Conner

    For transparency, he is a pharmacist not a medical doctor. His reasoning suggests he is concerned with the (often discussed yet never proven) notion of desensitization of the leydig cells - which wouldn’t be and isn’t a concern with the modest doses of hCG used for TRT purposes.
  6. Dr Justin Saya MD

    Whether to go on TRT or not while obese

    Indeed a night and day difference for many guys.
  7. Dr Justin Saya MD

    What blood tests have reference ranges that depend on age?

    Those are the big ones for our purposes. Add SHBG although (for LabCorp) only divided into 2 reference ranges: Age 20-49: 16.5 - 55.9 nmol/L Age > 49: 19.3 - 76.4 nmol/L This is indicative of the age-related increase in SHBG.
  8. Dr Justin Saya MD

    Degree of Inaccuracy of Standard Estradiol Tests Vs Sensitive Estradiol Test

    The most significant cross-reactant with the immunoassay is CRP. However, let’s not forget about biotin. The LC-MS/MS is quite a bit more expensive (though the negotiated price is much lower for our patients/discounted labs). In order to accurately calibrate the standard estradiol RIA one would...
  9. Dr Justin Saya MD

    Hematocrit levels

    True, though it’s not clotting that is the concern with higher hematocrit (erythrocytosis). Unfortunately many get lost in the weeds debating about clotting when this isn’t the reason to be cautious about higher hematocrit. There are other reasons...
  10. Dr Justin Saya MD

    Going on TRT AI Question

    Riptide - Dr Calkins trained with me and has worked by my side for several years. Although every patient is unique, he doesn’t often steer patients wrong.
  11. Dr Justin Saya MD

    Going on TRT AI Question

    Bingo! I can’t tell you how MANY times I’ve consulted with a patient I’ve known to have been a forum member and heard “haven’t been on the forums in a long time. Not having any problems...doing well and just enjoying life”.
  12. Dr Justin Saya MD

    Treatment of Micropenis with Combined GH and Testosterone

    Quick comment and then going to steer clear of this thread as it will likely take quite a few tangents :-) “GH treatments increase AR (androgen receptor) expression” is the best pearl from this publication.
  13. Dr Justin Saya MD

    Testosterone plus Clomid Combination

    Correct that clomid (or any SERM) is typically not effective at raising LH/FSH for most men on *adequate* TRT doses. However, still can have an impact on SHBG and also the interactions with E2 receptors (agonist and antagonist) doesn’t show on blood work, but certainly CAN impact how one feels...
  14. Dr Justin Saya MD

    Stopped TRT , on restart protocol , feeling good so far

    It’s not an irresponsible dose for a RESTART...Which is a shorter course of treatment and a different animal than Clomid monotherapy as we are kickstarting a completely suppressed HPTA. Vince Carter is a pal, but for some reason periodically makes similar antagonist comments. Antcon - This may...
  15. Dr Justin Saya MD

    25 Y/O Male blood work and suggested treatment options

    I can endorse Dr Crisler (Lansing, MI) and Dr Rand McClain (Santa Monica) as colleagues and friends I have personal experience working with.
  16. Dr Justin Saya MD

    Problems with LabCorp Sensitive Estradiol Machine

    A headache for everyone involved...from LabCorp to physicians/clinics to patients. Resolution is near.
  17. Dr Justin Saya MD

    HCG Cream

    I would encourage you to order a quantitative serum beta hCG lab test to be drawn a couple hours after applying the cream to assess if you are absorbing any actual hCG. This can be ordered through my staff. Would be interesting for everyone if you shared your results.
  18. Dr Justin Saya MD

    HCG Cream

    Unfortunately, as others have stated, other formulations of HCG (transdermal, oral, sublingual) have proven to be ineffective. Try if you wish, but don’t have high expectations.
  19. Dr Justin Saya MD

    What is the best dose of HCG? Dr Saya presents two case studies.

    There are other variables that also contribute to whether or not a specific patient will need an AI beyond HCG dosage. The higher the dosage of HCG there can be further increase in estradiol, but often this is clinically relevant and more pronounced at much higher HCG doses than we use (eg...
  20. Dr Justin Saya MD

    Results of Bloodwork - Help Me Make Sense of Them

    Indeed sleep apnea trashes neurotransmitters which can diminish just about every subjective “feeling” (including libido).
  21. Dr Justin Saya MD

    Professor wont start thyroid medication until TSH reaches 10!

    The key to Bernie’s post above is that he specifies “without symptoms” and “asymptomatic”. In Dr McClain’s defense, most on this site would routinely state “only treat high E2 levels if there ARE SYMPTOMS”, yet are disagreeing with Dr McClain’s decision here to NOT treat Bernie’s thyroid when...
  22. Dr Justin Saya MD

    Testicle atrophy even with HCG.

    Oh boy...I would bet you wouldn’t like the side effects of THAT regimen...women with breast cancer (whom are the only ones where that regimen would be appropriate) don’t like the side effects either!
  23. Dr Justin Saya MD

    My progress with "Defy Medical"

    Welcome to the team!
  24. Dr Justin Saya MD

    Almost one year on TRT... struggling to find balance

    A trial of stopping HCG and then labs and subjective assessment at time of consult would be of clinical value.
  25. Dr Justin Saya MD

    Walk me through Defy Medical

    Indeed...and it is a delicate balance. Especially considering the cost vs necessity ratio may be different for each individual case. Kudos for your proactive approach!
  26. Dr Justin Saya MD

    Almost one year on TRT... struggling to find balance

    If you haven’t spoken to me yet, please do schedule your next consultation with me for review. You mentioned in a previous post that through your experience HCG may have provoked anxiety and rapid heart rate symptoms. Here’s a pearl of wisdom for the community and a less known fact - HCG is...
  27. Dr Justin Saya MD

    Started TRT .... Looking forward (updated w 8/20/18 Labs)

    Yes that’s okay assuming site was sterilized properly.
  28. Dr Justin Saya MD

    Clomiphene and Anxiety / Negative Thoughts

    Lol. I was just was over on PeakT and posted an additional response to your thread...then hopped over to EM and ran across this one. I’ll paste response below for the sake of continuity. Good work making use of both resources. Both forums present thoughtful, educated, and sometimes differing...
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