22 Years Old - Starting TRT - HELP ME NOT **** MY LIFE

[PAUL-E]

Thanks man My parents are really against working with online clinics. Hopefully, Defy will offer a better treatment protocol. I'll keep you updated

This is how I look at it Defy medical has a actual office that you can go to and a very good reputation, we are just lucky we are able to get that kind of care over the phone VS traveling there for it.

 

[PAUL-E]

You're 22 years old.

IMHO there's nothing wrong with seeking advice from someone with more life experience who truly cares about your well being

 

[tarnation]

Quick Update for everyone:

Update on Defy Medical: I decided to get all my work done for a consult with Defy. The staff at Defy has been extremely helpful, patient, and very responsive. So far, I'm very impressed with the customer service over there. They wrote me a prescription for all the blood work they wanted me to get done, so I didn't have to pay a single penny out of my pocket. I am waiting on Defy to receive my lab results so that I can get a consultation with a Dr. So far, my only concern is that the wait time to actually speak to a dr at Defy will be too long (based on the experiences of others). However, that is complete speculation at this point and I'm hoping I'll get to speak to a dr pretty soon.

Update on my Endo's protocol: I decided to hold off on taking the 25mg per week injections as instructed by my endo. She is now refusing to give me HCG to take along with the test injections.

Question for you guys and Dr. Saya, should I start taking IM test-cyp 100mg injections weekly in order to keep me sane until I see Dr. Saya? The thought of living with these symptoms for 3-4 weeks (how long I believe it will take to get an appointment) is not something I want to do. I have 1,000mg/ml test cyp on hand which will keep me going for 10 weeks, and then I can switch to the protocol that Dr. Saya suggests. If I do decide to do this, should I purchase some non-presc. HCG to include with the weekly injections?

Thanks!

 

[Dr Justin Saya MD]

Quick Update for everyone:

Update on Defy Medical: I decided to get all my work done for a consult with Defy. The staff at Defy has been extremely helpful, patient, and very responsive. So far, I'm very impressed with the customer service over there. They wrote me a prescription for all the blood work they wanted me to get done, so I didn't have to pay a single penny out of my pocket. I am waiting on Defy to receive my lab results so that I can get a consultation with a Dr. So far, my only concern is that the wait time to actually speak to a dr at Defy will be too long (based on the experiences of others). However, that is complete speculation at this point and I'm hoping I'll get to speak to a dr pretty soon.

Update on my Endo's protocol: I decided to hold off on taking the 25mg per week injections as instructed by my endo. She is now refusing to give me HCG to take along with the test injections.

Question for you guys and Dr. Saya, should I start taking IM test-cyp 100mg injections weekly in order to keep me sane until I see Dr. Saya? The thought of living with these symptoms for 3-4 weeks (how long I believe it will take to get an appointment) is not something I want to do. I have 1,000mg/ml test cyp on hand which will keep me going for 10 weeks, and then I can switch to the protocol that Dr. Saya suggests. If I do decide to do this, should I purchase some non-presc. HCG to include with the weekly injections?

Thanks!

Neither myself nor anyone else could (or should) recommend a treatment plan at this point as we simply don't have enough information, especially given your very young age. I will need to look at ALL of your previous labs and ALSO the additional labs I am ordering for you in order to accurately assess your case and determine all relevant factors of your case including primary vs secondary Hypogonadism AND any possible causative factors (i.e. thyroid). Your treatment approach and plan can vary SIGNIFICANTLY dependent on these factors.

 

[tarnation]

Neither myself nor anyone else could (or should) recommend a treatment plan at this point as we simply don't have enough information, especially given your very young age. I will need to look at ALL of your previous labs and ALSO the additional labs I am ordering for you in order to accurately assess your case and determine all relevant factors of your case including primary vs secondary Hypogonadism AND any possible causative factors (i.e. thyroid). Your treatment approach and plan can vary SIGNIFICANTLY dependent on these factors.

Thanks, I'll stick with the protocol my endo gave me until our consult.

 

[Dr Justin Saya MD]

Thanks, I'll stick with the protocol my endo gave me until our consult.

That's not exactly where I was heading, as THAT protocol is worthless and potentially harmful by just further shutting down your natural production and only replacing with a very small amount of testosterone.

I was heading more towards HOLDING EVERYTHING until I can accurately and appropriately diagnose you correctly from the start. You may just need thyroid treatment and an HPTA restart, in which case starting TRT right now would be counterproductive. Again, don't have all the necessary info yet.

 

[CSI007]

Thanks, I'll stick with the protocol my endo gave me until our consult.

I know you feel like crap. I have been there. I know exactly how you feel. But it's probably best to just keep the status quo until you can get treatment from a trusted source. Adding something externally can screw up many things in your body. Just my opinion but I would drag my butt along until you talk to a good Doctor that is willing to explore all alternatives especially at your age. Some times we look for the easy fix or band-aide but that might be very counter productive.

Good luck to you and I am very glad you are taking charge of your health here.

 

[tarnation]

I know you feel like crap. I have been there. I know exactly how you feel. But it's probably best to just keep the status quo until you can get treatment from a trusted source. Adding something externally can screw up many things in your body. Just my opinion but I would drag my butt along until you talk to a good Doctor that is willing to explore all alternatives especially at your age. Some times we look for the easy fix or band-aide but that might be very counter productive.


Good luck to you and I am very glad you are taking charge of your health here.

Thanks for the response brother. I'll definitely try to wait it out, but it's a lot easier said than done lol. I'm hoping i'll get lucky and won't have too long of a wait time for my consult with Defy. These are some of my most recent lab results (just so you guys can get a better understanding of how terrible I feel right now):

E2: 5L (8-43) Test Total: 127L (280-800) Free Test: 2.43 (3.7-14.7) LH: .8L (1.5-12.4) FSH: 3.2 (1.5-12.4) Prolactin: 5.4 (4.0-15.2) Cortisol Level: 18.6 ACTH: 20 Estrone: 13 SHBG: 34.5 (10-57) IGF-1:127

 

[tarnation]

That's not exactly where I was heading, as THAT protocol is worthless and potentially harmful by just further shutting down your natural production and only replacing with a very small amount of testosterone.

I was heading more towards HOLDING EVERYTHING until I can accurately and appropriately diagnose you correctly from the start. You may just need thyroid treatment and an HPTA restart, in which case starting TRT right now would be counterproductive. Again, don't have all the necessary info yet.

Makes sense - I'll try waiting it out until our consult. Thanks for taking the time out of your weekend for the guidance, I appreciate it.

 

[CSI007]

Trust me when I tell you. Once you get this stuff figured out you will feel much better again. The bottom line is there is a chance you may not need to be on meds forever. That is worth it's weight in gold!!!

 

[johndoesmith]

Makes sense - I'll try waiting it out until our consult. Thanks for taking the time out of your weekend for the guidance, I appreciate it.

Hey brother, I just want to say I've been in your position only 6 months ago. I'm close to your age, had low e2 as well as low test symptoms pretty badly. I also was so anxious to get started, although in my case it was a bit more clear that I was primary so I kinda knew I was going to be on trt. I would highly highly recommend you do wait the 3 or 4 weeks until your defy consult, the patience is needed for trt. There's very little about trt that is quick so the patience will be needed.

I am a patient of Dr saya and I will tell you he will treat you well, medically and in terms of respect. My first consult with him I think I spent more time with him than all the doctors I've seen combined.It's not like going to your primary, getting told everything is "normal" and the doctor is out of the room so quick you can't even remember his name!

Defy and Dr saya have changed my life absolutely, without them I honestly don't even want to think about how angry and frustrated with doctors I'd be. I went to 3 urologists, and my primary, all of them agreed I was low, and TRT would help, but won't prescribe because it's "malpractice". So you can imagine how that kind of anger and depression can build, on top of all the low E and test symptoms.

 

[tarnation]

Hey brother, I just want to say I've been in your position only 6 months ago. I'm close to your age, had low e2 as well as low test symptoms pretty badly. I also was so anxious to get started, although in my case it was a bit more clear that I was primary so I kinda knew I was going to be on trt. I would highly highly recommend you do wait the 3 or 4 weeks until your defy consult, the patience is needed for trt. There's very little about trt that is quick so the patience will be needed.

I am a patient of Dr saya and I will tell you he will treat you well, medically and in terms of respect. My first consult with him I think I spent more time with him than all the doctors I've seen combined.It's not like going to your primary, getting told everything is "normal" and the doctor is out of the room so quick you can't even remember his name!

Defy and Dr saya have changed my life absolutely, without them I honestly don't even want to think about how angry and frustrated with doctors I'd be. I went to 3 urologists, and my primary, all of them agreed I was low, and TRT would help, but won't prescribe because it's "malpractice". So you can imagine how that kind of anger and depression can build, on top of all the low E and test symptoms.

That's so awesome to hear man - glad it is working for you. I have been through 3 doctors as well, tried Clomid once, and now i have to deal with this idiotic protocol with my current endo. I've done a ton of research on Dr. Saya and he seems like he's the best in this field. I'm really looking forward to my consult with him. What kind of treatment plan are you on currently if you don't mind me asking?

 

[johndoesmith]

That's so awesome to hear man - glad it is working for you. I have been through 3 doctors as well, tried Clomid once, and now i have to deal with this idiotic protocol with my current endo. I've done a ton of research on Dr. Saya and he seems like he's the best in this field. I'm really looking forward to my consult with him. What kind of treatment plan are you on currently if you don't mind me asking?

Yeah don't do 25mg a week. Do EXACTLY what Dr Saya said here. Even if you started TRT right now, you won't feel almost anything in 4 weeks. Honestly, I think it took about 2 months for me to notice anything. After one month I pulled labs on my own, levels were great 860 trough, 25 free, sensitive E2 27. I felt nothing at that time and called defy, spoke to one of the medical assistants there and complained.

Looking back, I probably had some effects at 6 weeks, but they're so subtle it's easy to miss them. I had other people point them out to me, like my family and even my therapist. I had to make a pretty difficult financial decision at about 2 months in, still not "feeling" anything, and I didn't even think about it, just did some research and made a decision. I didn't even realize that this was an improvement, only after I remembered a similar issue I had to deal with before TRT, then it was so clear.

I am on 60mg E3D test cyp, 420 IU HCG E3D. Originally 70mg E3.5D and 500 IU E3.5D but I had to adjust it(with Dr saya's approval) due to me and mornings not agreeing.

I still don't know if Dr saya used skill to arrive at that dose, or experience, some kind of formula, or a lot of luck but there wasn't any adjusting or high E2 problems and it seems like I am right on his and my targets for upper end total, free, and E2. I think it's mostly skill and experience with some luck too.

 

[Dr Justin Saya MD]

You know what they say, johndoesmith, sometimes it's better to be lucky than to be good ;-) ...but yeah, I guess treating over 10,000 HRT/TRT patients helped a bit too.

Tarnation - I look forward to helping you. Hang in there bud!

 

[johndoesmith]

You know what they say, johndoesmith, sometimes it's better to be lucky than to be good ;-) ...but yeah, I guess treating over 10,000 HRT/TRT patients helped a bit too.

Tarnation - I look forward to helping you. Hang in there bud!

Haha yeah that's true. So was it a calculation, or a gut feeling that made you choose 140mg per week for me? Either way I'm still impressed, I don't think you took it as me doubting your experience but if you did I apologize

 

[Dr Justin Saya MD]

Haha yeah that's true. So was it a calculation, or a gut feeling that made you choose 140mg per week for me? Either way I'm still impressed, I don't think you took it as me doubting your experience but if you did I apologize

Oh absolutely not, johndoesmith - didn't take it that way at all!

In fact, you're rather accurate. Experience + skill + knowledge and pattern recognition + a little luck to account for the "we're all unique/different" aspect and...voila - there ya go!

 

[johndoesmith]

Oh absolutely not, johndoesmith - didn't take it that way at all!

In fact, you're rather accurate. Experience + skill + knowledge and pattern recognition + a little luck to account for the "we're all unique/different" aspect and...voila - there ya go!

Haha good. Human communication was never intended to take place in a text only environment, so a lot of tone and such is lost!

I imagine T/E2 ratio on pre-trt labs, SHBG, maybe even baseline HCT, HGB, and RBC are taken into account? I'm curious what the "clues" are so to speak that guide your decision on a starting dose, seeing as some guys simply metabolize faster than others.

Really I guess there's no way to predict the trough levels based on mg per week. right?

 

[Dr Justin Saya MD]

Haha good. Human communication was never intended to take place in a text only environment, so a lot of tone and such is lost!

I imagine T/E2 ratio on pre-trt labs, SHBG, maybe even baseline HCT, HGB, and RBC are taken into account? I'm curious what the "clues" are so to speak that guide your decision on a starting dose, seeing as some guys simply metabolize faster than others.

Really I guess there's no way to predict the trough levels based on mg per week. right?

You're right, there is absolutely no way to fully/accurately predict. However, there is a lot to be said about pattern recognition after seeing soooo many cases. Have seen just about every possible combo of symptoms/labs/dosages...and most multiple times. This all assists in taking ALL of the parameters you listed into consideration. In fact, that's where the "art" of this medicine (as opposed to the science) begins to shine through!

 

[johndoesmith]

You're right, there is absolutely no way to fully/accurately predict. However, there is a lot to be said about pattern recognition after seeing soooo many cases. Have seen just about every possible combo of symptoms/labs/dosages...and most multiple times. This all assists in taking ALL of the parameters you listed into consideration. In fact, that's where the "art" of this medicine (as opposed to the science) begins to shine through!

I don't know if this is too much, but are there any interesting patterns that stick out in your mind? Like patterns that really stick out lol. I am curious about this, just for knowledge.

Well, I am thinking of this more and more since you mentioned to me the possibility about being a mid level provider.

I imagine if you were able to write up a guide much like Dr. Crisler did for other providers it could potentially change a lot of men and women's lives by educating their providers!

 

[Dr Justin Saya MD]

I don't know if this is too much, but are there any interesting patterns that stick out in your mind? Like patterns that really stick out lol. I am curious about this, just for knowledge.

Well, I am thinking of this more and more since you mentioned to me the possibility about being a mid level provider.

I imagine if you were able to write up a guide much like Dr. Crisler did for other providers it could potentially change a lot of men and women's lives by educating their providers!

I would delight in training you if you decide to pursue the PA/NP pathway. It would be a decision I doubt you would regret! In fact, I am currently training a PA and a local urologist and soon, if things fall in place, potentially training and sharing protocols with a major university urology department and medical school. The knowledge is spreading and growing for the benefit of all!