1st Defy Consult & Recommended Protocol

[MikeP]

60 year old male in California and have tried TRT in the past with just Testosterone prescribed by PCP which I stopped 3-4 months ago.
Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3



Follow Up in 3 months with same full labs and adding FT3 & RT3
I can request a consult after a month if nothing changes or I have any issues with new protocol.

My PCP prescribes my Cypionate 200 mg/ml and hopefully she will prescribe the HCG so my insurance can fill it.

1. The DHEA 25mg is OTC or from Defy's pharmacy (APS)........I would appreciate any recommendations for best OTC brand etc for this.

2. I thought he wanted me to start the Anastrozole now but consultation summary states "Begin Anastrozole 0.125mg IF high Estrogen symptoms present" so I probably have clarify with Defy.
What symptoms should I watch out for if they only want me to take it then?
If I need to take it I will have to get from Defy's pharmacy (APS) as local pharmacy's here in SoCal only carry 1mg........Any other options?

I started today with the first 70mg Cypionate dose and will start the other meds as soon as I get them.
Feel pretty good with how the consult went and have no issues trying this protocol and working with Defy.
i've attached my lab work from last month.

 

[Phil Goodman]

My initial thoughts would be


1.) you may be able to get by with less than 140 weekly, but that’s a pretty reasonable starting dose. If you do decide to take less than that it would result in slow buildup of an emergency supply, which imo everyone should have an emergency supply of all medications.

2.) I recommend waiting at least six weeks to start HCG. For one your body is still producing testosterone and will for at least a little while. Might as well get the honeymoon phase with just testosterone before adding anything else. Secondly, it’s easier to dial in one thing at a time, so getting settled with test before adding HCG would be ideal. And again, if your protocol ends up being less than 1,000/week you could build up an emergency supply

3.) it’s very unlikely that you’ll need an AI. And don’t be tempted to attribute every negative side effect to high E2. It may take a while for your body adjust, so let it settle in for quite a while before considering the AI.

4.) I just order my DHEA directly from Life Extension. And like with others above, I’d hold off on adding it. Wait until you’re settled in with others. For example I’m pretty sensitive to DHEA and it amps me up at just moderate doses(even my Dr. at Defy who is awesome says it’s a strange case with me in that regard). If I’d started that right out the gate with test I would’ve almost certainly attributed those side effects to the test because it would seem much more likely. But since I dialed in one thing at a time I know for sure how the DHEA affects me at various doses. FYI I ended up settling at 1/4 of a 25 mg pill daily, so that saves money and is a much lower effective dose than most.




But again that’s just my take on it, and how you approach your health is completely up to you.

 

[MikeP]

My initial thoughts would be


1.) you may be able to get by with less than 140 weekly, but that’s a pretty reasonable starting dose. If you do decide to take less than that it would result in slow buildup of an emergency supply, which imo everyone should have an emergency supply of all medications.

2.) I recommend waiting at least six weeks to start HCG. For one your body is still producing testosterone and will for at least a little while. Might as well get the honeymoon phase with just testosterone before adding anything else. Secondly, it’s easier to dial in one thing at a time, so getting settled with test before adding HCG would be ideal. And again, if your protocol ends up being less than 1,000/week you could build up an emergency supply

3.) it’s very unlikely that you’ll need an AI. And don’t be tempted to attribute every negative side effect to high E2. It may take a while for your body adjust, so let it settle in for quite a while before considering the AI.

4.) I just order my DHEA directly from Life Extension. And like with others above, I’d hold off on adding it. Wait until you’re settled in with others. For example I’m pretty sensitive to DHEA and it amps me up at just moderate doses(even my Dr. at Defy who is awesome says it’s a strange case with me in that regard). If I’d started that right out the gate with test I would’ve almost certainly attributed those side effects to the test because it would seem much more likely. But since I dialed in one thing at a time I know for sure how the DHEA affects me at various doses. FYI I ended up settling at 1/4 of a 25 mg pill daily, so that saves money and is a much lower effective dose than most.




But again that’s just my take on it, and how you approach your health is completely up to you.

Thank you for your response and I will look into your suggestions.
I added the following to my post:
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3

As I mentioned I have been on TRT before for about 1.5 years (During this time I had no benefit at all ) and I stopped it 3-4 months ago in order to start fresh with Defy. I was initially on 100mg weekly but my PCP was not happy with a TT of 1200 and dropped my dose to 50mg weekly which put me in the 635 for TT.
So I assume my body already stopped producing it's own testosterone and from my understanding it does not start producing it if I stop TRT.

As a general I need higher doses of even regular meds (metabolism or something) for example 1 Vicodin will not work for me i'd need 2-3 for it to start to take effect same with Advil need 4x 200mg to even make a dent.

Since just testosterone alone did nothing for me I feel I should follow the recommended protocol and deal with issues/side effects if I get any and then adjust after another consult.

 

[madman]

60 year old male in California and have tried TRT in the past with just Testosterone prescribed by PCP which I stopped 3-4 months ago.
Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3



Follow Up in 3 months with same full labs and adding FT3 & RT3
I can request a consult after a month if nothing changes or I have any issues with new protocol.

My PCP prescribes my Cypionate 200 mg/ml and hopefully she will prescribe the HCG so my insurance can fill it.

1. The DHEA 25mg is OTC or from Defy's pharmacy (APS)........I would appreciate any recommendations for best OTC brand etc for this.

2. I thought he wanted me to start the Anastrozole now but consultation summary states "Begin Anastrozole 0.125mg IF high Estrogen symptoms present" so I probably have clarify with Defy.
What symptoms should I watch out for if they only want me to take it then?
If I need to take it I will have to get from Defy's pharmacy (APS) as local pharmacy's here in SoCal only carry 1mg........Any other options?

I started today with the first 70mg Cypionate dose and will start the other meds as soon as I get them.
Feel pretty good with how the consult went and have no issues trying this protocol and working with Defy.
i've attached my lab work from last month.

The starting protocol 140 mg T split into twice-weekly injections let alone with hCG thrown in to boot is overkill from the get go as again in your previous thread which I replied to pointing out that on your 100 mg T/week protocol (50 mg T every 3.5 days) your were hitting a whopping trough TT 1200 ng/dL and more importantly with normalish SHBG (will use your pre-TTh 37.5 nmol/L) your trough cFTV 28.6 ng/dL would have been very high.

You should have pointed this out to your doctor at Defy!

If those labs were accurate on the 100 mg T/week (split 4X weekly) protocol than 140 mg T (70 mg every 3.5 days) is going to have your trough TT and more importantly FT way too high let alone throw in the hCG to boot and you will be driving up your TT, FT and estradiol further!

Ridiculous starting you on such!

Standard starting protocol is 100 mg T/week or better yet 50 mg T every 3.5 days.

Again you already tried 100 mg T/week (split 4X weekly) and your trough TT 1200 ng/dL and more importantly cFTV 28.6 ng/dL was very high!

Surefire way to end up dealing with elevated hematocrit!

Again running too high a trough/steady-state FT can be just as bad as running too low a FT especially when it comes to libido and erectile function.

Need to think this one through!

This is going to be a mess!

Should have posted this under your previous thread (link below) instead of starting a new one again as you are just going to confuse everyone here.

M

Thread 'Initial Consult with Defy'

Jan 20, 2025

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...

• MikeP
• Replies: 10
• Forum: Introductions

Your reply from post #3:

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.




Your reply from post #8:

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.




My reply from post #9:

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).

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.

 

[madman]

My initial thoughts would be


1.) you may be able to get by with less than 140 weekly, but that’s a pretty reasonable starting dose. If you do decide to take less than that it would result in slow buildup of an emergency supply, which imo everyone should have an emergency supply of all medications.

2.) I recommend waiting at least six weeks to start HCG. For one your body is still producing testosterone and will for at least a little while. Might as well get the honeymoon phase with just testosterone before adding anything else. Secondly, it’s easier to dial in one thing at a time, so getting settled with test before adding HCG would be ideal. And again, if your protocol ends up being less than 1,000/week you could build up an emergency supply

3.) it’s very unlikely that you’ll need an AI. And don’t be tempted to attribute every negative side effect to high E2. It may take a while for your body adjust, so let it settle in for quite a while before considering the AI.

4.) I just order my DHEA directly from Life Extension. And like with others above, I’d hold off on adding it. Wait until you’re settled in with others. For example I’m pretty sensitive to DHEA and it amps me up at just moderate doses(even my Dr. at Defy who is awesome says it’s a strange case with me in that regard). If I’d started that right out the gate with test I would’ve almost certainly attributed those side effects to the test because it would seem much more likely. But since I dialed in one thing at a time I know for sure how the DHEA affects me at various doses. FYI I ended up settling at 1/4 of a 25 mg pill daily, so that saves money and is a much lower effective dose than most.




But again that’s just my take on it, and how you approach your health is completely up to you.

Might want to read over his previous threads before jumping to any conclusions here!

Based off his replies if labs were accurate and tested at the true trough as he stated than he was already hitting a whopping TT 1200 ng/dL and more importantly high cFTV 28.6 ng/dL on 100mg T (split 4X weekly)!

 

[madman]

60 year old male in California and have tried TRT in the past with just Testosterone prescribed by PCP which I stopped 3-4 months ago.
Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3



Follow Up in 3 months with same full labs and adding FT3 & RT3
I can request a consult after a month if nothing changes or I have any issues with new protocol.

My PCP prescribes my Cypionate 200 mg/ml and hopefully she will prescribe the HCG so my insurance can fill it.

1. The DHEA 25mg is OTC or from Defy's pharmacy (APS)........I would appreciate any recommendations for best OTC brand etc for this.

2. I thought he wanted me to start the Anastrozole now but consultation summary states "Begin Anastrozole 0.125mg IF high Estrogen symptoms present" so I probably have clarify with Defy.
What symptoms should I watch out for if they only want me to take it then?
If I need to take it I will have to get from Defy's pharmacy (APS) as local pharmacy's here in SoCal only carry 1mg........Any other options?

I started today with the first 70mg Cypionate dose and will start the other meds as soon as I get them.
Feel pretty good with how the consult went and have no issues trying this protocol and working with Defy.
i've attached my lab work from last month.

Some of these doctors working for Defy are clearly out to lunch especially when it comes to testing FT!

Again pre-TTh your RBCs, hemoglobin and hematocrit are already close to the upper-end so it is a given driving up your trough/steady-state FT will increase these markers to the point where they may end up too high!



Natty labs!

Again the direct immunoassay is the wrong FT testing method which is known to be inaccurate and should not be used/relied upon!


Natty labs!

You need to have your FT tested using the most accurate assay the gold standard Equilibrium Dialysis in order to know where your FT level truly sits!

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

If you do not have access to such (highly doubtful) if you reside in the US than you would need to use/rely upon the calculated linear law-of-mass action Vermeulen (cFTV).

Free & Bioavailable Testosterone calculator

 

[madman]

60 year old male in California and have tried TRT in the past with just Testosterone prescribed by PCP which I stopped 3-4 months ago.
Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3



Follow Up in 3 months with same full labs and adding FT3 & RT3
I can request a consult after a month if nothing changes or I have any issues with new protocol.

My PCP prescribes my Cypionate 200 mg/ml and hopefully she will prescribe the HCG so my insurance can fill it.

1. The DHEA 25mg is OTC or from Defy's pharmacy (APS)........I would appreciate any recommendations for best OTC brand etc for this.

2. I thought he wanted me to start the Anastrozole now but consultation summary states "Begin Anastrozole 0.125mg IF high Estrogen symptoms present" so I probably have clarify with Defy.
What symptoms should I watch out for if they only want me to take it then?
If I need to take it I will have to get from Defy's pharmacy (APS) as local pharmacy's here in SoCal only carry 1mg........Any other options?

I started today with the first 70mg Cypionate dose and will start the other meds as soon as I get them.
Feel pretty good with how the consult went and have no issues trying this protocol and working with Defy.
i've attached my lab work from last month.

Again tread lightly when it comes to who is treating you!

If we are speaking in terms of trough FT here than driving up your dismal trough FT 7.9 ng/dL--->25 ng/dL (high) off the hop is piss poor advice!

Again it is the wrong FT testing method to boot!

Not everyone will need to achieve a high trough FT in order to experience relief/improvement of low-T symptoms let alone it is pretty much a given that you will be dealing with elevated hematocrit, may end up feeling worse off in the long-run running too high a trough/steady-state FT level let alone put yourself in a position where the doctor prescribes an AI to control the elevated estradiol which for most is not needed!

Always best to start low and slow on a T-only protocol as we want to see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) will have your trough TT and more importantly FT, estradiol let alone other critical blood markers RBCs, hemoglobin and hematocrit.

There will always be time to increase the dose of T or add in hCG if need be!

Last thing you want to do is drive your trough FT too high off the hop!

Patience is key here!




Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3

Post in thread 'Defy recommended Dr, PA or NP from your experience'

Dec 31, 2024

Hello, I am a 60 year old male and in the process of scheduling my consultation for TRT with Defy and was given a choice from different Dr's, PA's or NP's to choose from. I want to get the best consultation and treatment plan so figured I would ask in this forum for reccomendations of who to see or not from their experiance.
I was on Cypionate 50mg weekly earlier this year through my pcp but stopped around 3 month or more ago due to not feeling any different and my pcp's knowledge with TRT. I stopped as I figured I would start fresh with Defy after a few months.
My testosterone level...

• madman

• 

My reply:

Although you will find many on the forum who use Defy that have positive experiences you still need to tread lightly as the downfall here is from what I have seen on the forum over the years is that some of the doctors tend to overmedicate (150-200 mg T/week) from the get-go let alone they are still clueless when it comes to testing one of the most important blood markers free testosterone as they are still using/relying upon a known to be inaccurate assay the direct immunoassay!

 

[MikeP]

The starting protocol 140 mg T split into twice-weekly injections let alone with hCG thrown in to boot is overkill from the get go as again in your previous thread which I replied to pointing out that on your 100 mg T/week protocol (50 mg T every 3.5 days) your were hitting a whopping trough TT 1200 ng/dL and more importantly with normalish SHBG (will use your pre-TTh 37.5 nmol/L) your trough cFTV 28.6 ng/dL would have been very high.

You should have pointed this out to your doctor at Defy!

If those labs were accurate on the 100 mg T/week (split 4X weekly) protocol than 140 mg T (70 mg every 3.5 days) is going to have your trough TT and more importantly FT way too high let alone throw in the hCG to boot and you will be driving up your TT, FT and estradiol further!

Ridiculous starting you on such!

Standard starting protocol is 100 mg T/week or better yet 50 mg T every 3.5 days.

Again you already tried 100 mg T/week (split 4X weekly) and your trough TT 1200 ng/dL and more importantly cFTV 28.6 ng/dL was very high!

Surefire way to end up dealing with elevated hematocrit!

Again running too high a trough/steady-state FT can be just as bad as running too low a FT especially when it comes to libido and erectile function.

Need to think this one through!

This is going to be a mess!

Should have posted this under your previous thread (link below) instead of starting a new one again as you are just going to confuse everyone here.

M

Thread 'Initial Consult with Defy'

Jan 20, 2025

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...

• MikeP
• Replies: 10
• Forum: Introductions

Your reply from post #3:

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.




Your reply from post #8:

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.




My reply from post #9:

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).

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.

Apologies for new post but after seeing the "Testosterone Basics & Questions" forum I realized this is where I should have posted my original thread instead of "Introductions" and so posted new here.

I did let the Dr know of my previous dosage and T level but he wanted to start me at 2x 70mg weekly to bring up my Free T Direct.
At this point I feel Defy has an overall great rep for TRT and have heard good results for same symptoms as myself from people I know and trying to work on my it with my PCP & Endinocrologist has got me nowhere due to their lack of current TRT knowledge. So, I feel I should follow the recommended protocol and be very vigilant and effects on me.
I will send an email with previous lab results/numbers while on 100mg to Defy and ask them to double check with the Dr if he would still want me to restart at 140mg.
I haven't had a chance to go through the responses on this thread but will do tonight when I have more time and give everything some thought and respond back.
I appreciate everyone's responses and advice/opinions, thank you

 

[madman]

Apologies for new post but after seeing the "Testosterone Basics & Questions" forum I realized this is where I should have posted my original thread instead of "Introductions" and so posted new here.

I did let the Dr know of my previous dosage and T level but he wanted to start me at 2x 70mg weekly to bring up my Free T Direct.
At this point I feel Defy has an overall great rep for TRT and have heard good results for same symptoms as myself from people I know and trying to work on my it with my PCP & Endinocrologist has got me nowhere due to their lack of current TRT knowledge. So, I feel I should follow the recommended protocol and be very vigilant and effects on me.
I will send an email with previous lab results/numbers while on 100mg to Defy and ask them to double check with the Dr if he would still want me to restart at 140mg.
I haven't had a chance to go through the responses on this thread but will do tonight when I have more time and give everything some thought and respond back.
I appreciate everyone's responses and advice/opinions, thank you

He is clearly confused here because if you were already hitting a whopping trough TT 1200 ng/dL on the 100 mg T/week (split 4X weekly) protocol than using your pre-TTh SHBG 37.5 nmol/L you would have been hitting a very high trough cFTV 28.6 ng/dL.

Even than it is a given with a whopping trough TT 1200 ng/dL and normalish SHBG 37.5 nmol/L your trough FT will be high even if it were tested using the most accurate assay the gold standard Equilibrium Dialysis.

He is jacking up your dose to 140 mg/week split into twice-weekly injections (70 mg every 3.5 days) which will easily have your trough TT and more importantly FT sky-high!

Gets even nuttier as he also wants you to throw in hCG (500 IU 2x/week) to boot which will drive up your TT, FT and estradiol even further!

Common starting dose across the board for the majority is 100 mg T/week or better yet 50 mg every 3.5 days.

Your starting protocol is overkill!

Regardless if you want to jump into this head first go nuts!

Makes no sense starting one out on a higher dose let alone hCG thrown in to boot when you were already hitting a high trough TT and more importantly FT injecting 100 mg T/week (split 4X weekly).

Do not be surprised if you end up with elevated RBCs,hemoglobin and hematocrit!

You were already running around with a high trough TT and more importantly FT so what makes you think driving it even higher will put you in a better place.

Your previous doctor should have been paying attention not only to your trough TT but more importantly trough FT let alone where your RBCs, hemoglobin and hematocrit sat and even more concerning is how you felt overall on such protocol (dose of T/injection frequency) mind you one would have needed 3 months to truly assess before claiming success or failure.

Way too big of a decrease in dose of T (100 mg--->50 mg/week) off the hop!

Bad move starting over again on a higher dose of T (140 mg/week) with hCG thrown in to boot!

Most likely going to end up with sky-high FT off the hop which can easily open up a can of worms for many!

 

[Phil Goodman]

Thank you for your response and I will look into your suggestions.
I added the following to my post:
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3

As I mentioned I have been on TRT before for about 1.5 years (During this time I had no benefit at all ) and I stopped it 3-4 months ago in order to start fresh with Defy. I was initially on 100mg weekly but my PCP was not happy with a TT of 1200 and dropped my dose to 50mg weekly which put me in the 635 for TT.
So I assume my body already stopped producing it's own testosterone and from my understanding it does not start producing it if I stop TRT.

As a general I need higher doses of even regular meds (metabolism or something) for example 1 Vicodin will not work for me i'd need 2-3 for it to start to take effect same with Advil need 4x 200mg to even make a dent.

Since just testosterone alone did nothing for me I feel I should follow the recommended protocol and deal with issues/side effects if I get any and then adjust after another consult.

Since 50 mg test/week didn’t work your plan is to almost triple the dose, add in HCG, pop AIs as necessary, and start DHEA all at the same time? When you say “deal with side effects as they arise”, how will you know which medication is causing which side effect? I’m not saying you won’t need or benefit from more than just testosterone, I’m just saying it’s easier to dial in one thing at a time.

But either way, I wish you luck and will be interested to hear how your journey goes.

 

[Phil Goodman]

@madman you often bring up hematocrit so I’d be interested to see what studies you have available that compare men on trt who maintain high hematocrit vs men on trt who keep it under the top end of the range.

 

[Vince]

60 year old male in California and have tried TRT in the past with just Testosterone prescribed by PCP which I stopped 3-4 months ago.
Today I had my Initial consult with Defy and was recommended the following protocol for the next 3 months.
My primary concerns atm is lack of sleep and quality of sleep, focus, concentration, motivation, fatigue etc

1. Testosterone Cypionate 200 mg/ml – Inject 0.35ml IM/SQ (70mg) twice weekly
2. HCG (Pregnyl) - Inject 500iu (0.50ml) SQ twice weekly to reverse/prevent testicular atrophy.
3. Begin Anastrozole 0.125mg - Take 1 by mouth twice weekly IF high Estrogen symptoms present.
3. DHEA 25mg - Take 1 by mouth every night.

He would like to see:
Free T (Direct) at around 25 vs the current 7.9
DHEA at 250+ vs current 86.
Estradial at 30-40 vs current 28.3



Follow Up in 3 months with same full labs and adding FT3 & RT3
I can request a consult after a month if nothing changes or I have any issues with new protocol.

My PCP prescribes my Cypionate 200 mg/ml and hopefully she will prescribe the HCG so my insurance can fill it.

1. The DHEA 25mg is OTC or from Defy's pharmacy (APS)........I would appreciate any recommendations for best OTC brand etc for this.

2. I thought he wanted me to start the Anastrozole now but consultation summary states "Begin Anastrozole 0.125mg IF high Estrogen symptoms present" so I probably have clarify with Defy.
What symptoms should I watch out for if they only want me to take it then?
If I need to take it I will have to get from Defy's pharmacy (APS) as local pharmacy's here in SoCal only carry 1mg........Any other options?

I started today with the first 70mg Cypionate dose and will start the other meds as soon as I get them.
Feel pretty good with how the consult went and have no issues trying this protocol and working with Defy.
i've attached my lab work from last month.

That's the exact protocol I started a little over 10 years ago on my 60th birthday. I felt amazing and still do. I'm presently injecting 16 mg of Testosterone Cypionate daily and 500 IU of HCG every third day. I've never used an AI.

 

[madman]

@madman you often bring up hematocrit so I’d be interested to see what studies you have available that compare men on trt who maintain high hematocrit vs men on trt who keep it under the top end of the range.

What studies!

*There is no evidence that an increase of haematocrit up to and including 54% causes any adverse effects. If the haematocrit exceeds 54% there is a testosterone independent, but weak associated rise in CV events and mortality [79, 177-179]. Any relationship is complex as these studies were based on patients with any cause of secondary polycythaemia, which included smoking and respiratory diseases. There have been no specific studies in men with only testosterone-induced erythrocytosis




Needs to be pointed out to the OP that his hematocrit is on the higher-end pre-TTh and seeing as he will most likely end up with a very high trough/steady-state FT his hematocrit may end up being a lot higher.

His starting Defy protocol is overkill from the get-go!

One needs to keep mind some men do not feel well with high hematocrit especially if they have any underlying health issues.

You already know where I stand on hematocrit!

Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Yes some will be more cautious and take measures once hematocrit hits 52%.

Most of the endos are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

• 

* With testosterone therapy elevated haematocrit levels are more likely to occur if the baseline level is toward the upper limit of normal prior to initiation. Added risks for raised haematocrit on testosterone therapy include smoking or respiratory conditions at baseline. Higher haematocrit is more common with parenteral rather than topical formulations. Accordingly, a large retrospective two-arm open registry, comparing the effects of long-acting testosterone undecanoate and testosterone gels showed that the former preparation was associated with a higher risk of haematocrit levels > 50%, when compared to testosterone gels [185]. In men with pre-existing CVD extra caution is advised with a definitive diagnosis of hypogonadism before initiating testosterone therapy and monitoring of testosterone as well as haematocrit during treatment.

* Elevated haematocrit in the absence of comorbidity or acute CV or venous thromboembolism can be managed by a reduction in testosterone dose, change in formulation or if the elevated haematocrit is very high by venesection (500 mL), even repeated if necessary, with usually no need to stop the testosterone therapy.

 

[madman]

That's the exact protocol I started a little over 10 years ago on my 60th birthday. I felt amazing and still do. I'm presently injecting 16 mg of Testosterone Cypionate daily and 500 IU of HCG every third day. I've never used an AI.

Yet you were not the one hitting a whopping trough TT 1200 ng/dL and more importantly very high trough FT on 100 mg T/week and this is without the addition of hCG!

His SHBG is lower than yours to boot!

Defy wants to restart him on 140 mg T/week split twice-weekly (70mg every 3.5 days) with hCG (500 IU 2x/week) to boot!

Even recommended low dose AI if need be!

Pre-TTh he is already hitting a higher-end RBC, hemoglobin and hematocrit!

Let's just go and jack up his trough FT from the get-go!

Go figure!

M

Thread 'Initial Consult with Defy'

Jan 20, 2025

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...

• MikeP
• Replies: 10
• Forum: Introductions

Better yet did you miss that part in his previous thread where he stated:


I have tried TRT through my pcp but didn't see any results and was pcp was not that knowledgeable about TRT imo.

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.

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.

 

[Phil Goodman]

What studies!

*There is no evidence that an increase of haematocrit up to and including 54% causes any adverse effects. If the haematocrit exceeds 54% there is a testosterone independent, but weak associated rise in CV events and mortality [79, 177-179]. Any relationship is complex as these studies were based on patients with any cause of secondary polycythaemia, which included smoking and respiratory diseases. There have been no specific studies in men with only testosterone-induced erythrocytosis




Needs to be pointed out to the OP that his hematocrit is on the higher-end pre-TTh and seeing as he will most likely end up with a very high trough/steady-state FT his hematocrit may end up being a lot higher.

His starting Defy protocol is overkill from the get-go!

One needs to keep mind some men do not feel well with high hematocrit especially if they have any underlying health issues.

You already know where I stand on hematocrit!

Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Yes some will be more cautious and take measures once hematocrit hits 52%.

Most of the endos are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.

Post in thread 'High Testosterone on only 80mg/week'

Jun 22, 2024

Based on the comments you made here about a hematocrit of below 54 being safe are you willing to stand liable for giving out this false information if the OP has a stroke or heart attack?

Also please enlighten us on where you attended medical school and where you got your degree in endocrinology?

If you are having to give blood to reduce the hematocrit, you are not on "TRT" you are taking a small steroid cycle and calling it TRT.

As for my advice to the poster, I know personally of two people I have given similar advice to, both had strokes under the age of fifty. One with a...

• madman

• 

* With testosterone therapy elevated haematocrit levels are more likely to occur if the baseline level is toward the upper limit of normal prior to initiation. Added risks for raised haematocrit on testosterone therapy include smoking or respiratory conditions at baseline. Higher haematocrit is more common with parenteral rather than topical formulations. Accordingly, a large retrospective two-arm open registry, comparing the effects of long-acting testosterone undecanoate and testosterone gels showed that the former preparation was associated with a higher risk of haematocrit levels > 50%, when compared to testosterone gels [185]. In men with pre-existing CVD extra caution is advised with a definitive diagnosis of hypogonadism before initiating testosterone therapy and monitoring of testosterone as well as haematocrit during treatment.

* Elevated haematocrit in the absence of comorbidity or acute CV or venous thromboembolism can be managed by a reduction in testosterone dose, change in formulation or if the elevated haematocrit is very high by venesection (500 mL), even repeated if necessary, with usually no need to stop the testosterone therapy.

Right, relationships are complex and it’s difficult to parse out a lot of the nuances with this kind of stuff. That’s why I was asking. You’re referring to studies that lump in all causes…so from their perspective elevated hematocrit from smoking or respiratory disease is equal to higher hematocrit from testosterone replacement therapy, and I’d argue those things are not equal. Not saying there isn’t a risk, but it is likely dependent on the individual and if you are using data that includes all of those causes then you are probably over-estimating the risk.

And I agreed with you that his starting protocol was overkill, which is why I made the recommendations I did in my first post in this thread….which was that he can likely get away with a lower dose and should start one thing at a time. I’m just not as fixated on lab numbers as you are.

 

[madman]

Right, relationships are complex and it’s difficult to parse out a lot of the nuances with this kind of stuff. That’s why I was asking. You’re referring to studies that lump in all causes…so from their perspective elevated hematocrit from smoking or respiratory disease is equal to higher hematocrit from testosterone replacement therapy, and I’d argue those things are not equal. Not saying there isn’t a risk, but it is likely dependent on the individual and if you are using data that includes all of those causes then you are probably over-estimating the risk.

And I agreed with you that his starting protocol was overkill, which is why I made the recommendations I did in my first post in this thread….which was that he can likely get away with a lower dose and should start one thing at a time. I’m just not as fixated on lab numbers as you are.

What studies!

*There is no evidence that an increase of haematocrit up to and including 54% causes any adverse effects. If the haematocrit exceeds 54% there is a testosterone independent, but weak associated rise in CV events and mortality [79, 177-179]. Any relationship is complex as these studies were based on patients with any cause of secondary polycythaemia, which included smoking and respiratory diseases. There have been no specific studies in men with only testosterone-induced erythrocytosis



Again!

One needs to keep mind some men do not feel well with high hematocrit especially if they have any underlying health issues.

You already know where I stand on hematocrit!

Again if one has no underlying health issues and is not experiencing any negative sides most in the know specializing in testosterone therapy would not fret if the patient's hematocrit falls within 50-54%.

Yes some will be more cautious and take measures once hematocrit hits 52%.

Most of the endos are sticklers and hesitate once your hematocrit gets over the top end and prefer to keep patients levels no higher than 50%.

 

[madman]

Right, relationships are complex and it’s difficult to parse out a lot of the nuances with this kind of stuff. That’s why I was asking. You’re referring to studies that lump in all causes…so from their perspective elevated hematocrit from smoking or respiratory disease is equal to higher hematocrit from testosterone replacement therapy, and I’d argue those things are not equal. Not saying there isn’t a risk, but it is likely dependent on the individual and if you are using data that includes all of those causes then you are probably over-estimating the risk.

And I agreed with you that his starting protocol was overkill, which is why I made the recommendations I did in my first post in this thread….which was that he can likely get away with a lower dose and should start one thing at a time. I’m just not as fixated on lab numbers as you are.

Your reply from post #2.

My initial thoughts would be


1.) you may be able to get by with less than 140 weekly, but that’s a pretty reasonable starting dose. If you do decide to take less than that it would result in slow buildup of an emergency supply, which imo everyone should have an emergency supply of all medications.


I already stated that he was hitting a whopping trough TT 1200 ng/dL and more importantly high trough FT when his previous doctor started him on 100 mgT/week split (4X weekly) no hCG to boot!

140 mg T/week split (70 mg every 3.5 days) let alone with hCG thrown in to boot is not a reasonable starting dose for him let alone the standard starting protocol across the board for most in the know is 100 mg T/week or 50 mg every 3.5 days!

Again most men can easily achieve a healthy, high or in some cases very high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Common sense here is starting low and going slow on a T only protocol so we can see how the body reacts to testosterone and where said protocol (dose of T/injection frequency) will have their trough TT and more importantly trough FT, estradiol let alone critical blood markers RBCs, hemoglobin and hematocrit.

There will always be time to increase the dose if need be!

 

[Phil Goodman]

Your reply from post #2.

My initial thoughts would be


1.) you may be able to get by with less than 140 weekly, but that’s a pretty reasonable starting dose. If you do decide to take less than that it would result in slow buildup of an emergency supply, which imo everyone should have an emergency supply of all medications.


I already stated that he was hitting a whopping trough TT 1200 ng/dL and more importantly high trough FT when his previous doctor started him on 100 mgT/week split (4X weekly) no hCG to boot!

140 mg T/week split (70 mg every 3.5 days) + hCG to boot is not a reasonable starting dose for him let alone the standard starting protocol across the board for most in the know is 100 mg T/week or 50 mg every 3.5 days!

Again most men can easily achieve a healthy, high or in some cases very high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Common sense here is starting low and going slow on a T only protocol so we can see how the body reacts to testosterone and where said protocol (dose of T/injection frequency) will have their trough TT and more importantly trough FT, estradiol let alone critical blood markers RBCs, hemoglobin and hematocrit.

There will always be time to increase the dose if need be!

We both agree that it’s better to start lower than higher.

We both agree that it’s better to dial one component in at a time.



I didn’t know his previous results, thus I said 140 is a pretty reasonable starting dose. If someone just came up and said “my doc started me on 140/week” would you say that’s reasonable? If not we’ll just have to disagree. Also, despite his levels previously he found no symptom resolution. Perhaps that’s because his doc saw them and cut his dose in half before he could start to see the benefits(which also likely means he didn’t see any of the negative side effects). Either way, I’ve given my thoughts on what his approach should be, which is to start lower than 140 and just take test by itself before adding other components and adding them one at a time when he does. So really we are both recommending a very similar approach for him. It looks like he is going to disregard our advice, so we’ll just have to see how it works out for him. Obviously I think you and I will probably be correct and he will encounter more issues because of how he proceeds.