Defy Consultation Today-Conclusion/Protocol

[Jason Sypolt]

What was your E2 that was preventing you from feeling a total of 1000, and what did you need to adjust it to?

When you had it fixed, did you feel all of your symptoms resolve?

It was 42.7 taking DIM 200mg daily, and then 38 taking 0.25mg liquid Anastrozole every 3 days. Who knows if the liquid stuff was really any good. That was a stupid thing to do, but I felt like I had no choice at the time until I was able to get the initial consult with Defy.


I felt completely wretched. My symptoms were:
- Severe back and shoulder acne. It was down to my elbows.
- Severe ED. When 100mg of Viagra or 25mg of Cialis has no effect then something is very wrong.
- Tired and unmotivated.

- Nipples puffy and bright red.

- Really emotional. I would actually tear up if some dramatic stunt came on TV like in a car commercial.



I was on T-Cypionate 60mg every 3 days. The urologist I was seeing finally told me to go seek a second opinion and maybe try a hormone clinic. He wasn't comfortable prescribing anything for TRT other than testosterone itself because he had no data to base his decisions off of. So I got started with Defy at that point.


Dr Crisler said it was probably hyperestrogenism. I tried to look into this further and it usually means that to feel well, one with this problem needs to be at the top of the range. The Anastrozole/DIM combination I'm on now seems to be working. Plus I can be sure it's real Anastrozole. I'll find out what the latest results are in a few weeks when I get follow up labs. I'm expecting the Total T to be even higher since my dose was increased and HCG was added. And the E2 should be lower because I feel better, but I'm not so sure that it will be drastically lower because HCG also increases E2. Having that much testosterone has made me look more muscular with only moderate exercise (60 minutes indoor rowing each day). But I only feel just above normal and I don't have a lot of muscular strength.


That said, I do feel like the symptoms are at least for now resolved. I think it's important for anyone on TRT (and their Dr.) to take into account how you are feeling as a big factor. The numbers are only part of the story. Being in or out of a range doesn't really mean anything if you aren't feeling well.

 

[busa2009]

Well I ordered my supplies Thursday from defy got overnight. I haven't received any tracking numbers yet so once I start I will update maybe could of saved on overnight since I haven't received tracking figured they would have it to me by Saturday or on Saturday.

 

[ERO]

I have had that happen as well. Usually it is an issue where the lab is waiting on something to complete your order, then it goes out overnight.

 

[Speed]

My last LH reading was 0.1 - basically shut down since I've been on TRT over a year. I'm expecting that to increase for the followup labs since I'm taking HCG now. LH is important because there are receptors not only in the testicles, but over the rest of the body as well.

Just to point on this. HCG is LH mimicker (almost same as LH). That means that HCG also supress your LH So, don't waste money on LH testing. It will be always ZERO on TRT or HCG

 

[busa2009]

Still havent received my supplies just yet...Im going back over this protocol getting the abbreviations down and just noticed HCG every morning? thats a lot of sticking..Whats the shelf life of HCG in your system? I read that it takes 14 days for a 10,000iu dose to leave...Is there anyway i could cut down on the amount of injections once i start this? Havent started just yet due to not having supplies just yet..should be here soon though I ordered 6/30

]Protocol:

1. Increase hydration

2. Pt advised to establish relationship with local PCP

3. DHEA 25mg Troche SL BID

4. HCG 100iu SQ QAM *(thats 700iu/wk)

5. Test cyp 200mg/mL 0.4mL SQ BIW

6. F/U labs 6 weeks per Pt: Full TRT, Vit D

7. Anastrazole 0.5mg w/ DIM 200mg PO BIW on shot days

8. Vit D 5000iu PO QD

 

[ERO]

HCG has a very short half-life so the best TRT docs typically prescribe either a small dose daily or a larger dose every 3.5 days at most.

I would give Defy a call or send an email about your supplies, they are normally very prompt but weird stuff happens.

 

[PAUL-E]

Well I ordered my supplies Thursday from defy got overnight. I haven't received any tracking numbers yet so once I start I will update maybe could of saved on overnight since I haven't received tracking figured they would have it to me by Saturday or on Saturday.

it wouldn't hurt to give them a call and ask for an update as you paid for overnight shipping but even with overnight delivery they still have to wait for the compounding pharmacy I know waiting sucks but I hope you get your supply's soon!

 

[busa2009]

it wouldn't hurt to give them a call and ask for an update as you paid for overnight shipping but even with overnight delivery they still have to wait for the compounding pharmacy I know waiting sucks but I hope you get your supply's soon!

Yes thinking I wasted money on overnight shipping. What I ordered didn't seem to be something special I'm assuming it should of been on shelf. Lol. Calling now

 

[bako]

I ordered a new shipment of med yesterday. Shipper says it will be here by 8pm today. I live in California. Go figure.

 

[busa2009]

I ordered a new shipment of med yesterday. Shipper says it will be here by 8pm today. I live in California. Go figure.

Wtf? Lmao. I just called they said it should be on the way

 

[Tom Larabee]

Did you get an email with tracking information, I know Defy has to wait for it from the Compounding Pharmacy but you should have gotten it once it was shipped?

 

[busa2009]

Wtf? Lmao. I just called they said it should be on the way

they just called me and said it should be here today, while i was on the phone i got the fed ex email..so I guess I will start tomorrow...Should I call about the every day HCG? does anyone inject every single day? Any way around that? Im assuming not because he would have mentioned it..Im prepared mentally to do what i have to do..
Protocol:

1. Increase hydration

2. Pt advised to establish relationship with local PCP

3. DHEA 25mg Troche SL BID

4. HCG 100iu SQ QAM *(thats 700iu/wk)

5. Test cyp 200mg/mL 0.4mL SQ BIW

6. F/U labs 6 weeks per Pt: Full TRT, Vit D

7. Anastrazole 0.5mg w/ DIM 200mg PO BIW on shot days

8. Vit D 5000iu PO QD

 

[CoastWatcher]

they just called me and said it should be here today, while i was on the phone i got the fed ex email..so I guess I will start tomorrow...Should I call about the every day HCG? does anyone inject every single day? Any way around that? Im assuming not because he would have mentioned it..Im prepared mentally to do what i have to do..
Protocol:

1. Increase hydration

2. Pt advised to establish relationship with local PCP

3. DHEA 25mg Troche SL BID

4. HCG 100iu SQ QAM *(thats 700iu/wk)

5. Test cyp 200mg/mL 0.4mL SQ BIW

6. F/U labs 6 weeks per Pt: Full TRT, Vit D

7. Anastrazole 0.5mg w/ DIM 200mg PO BIW on shot days

8. Vit D 5000iu PO QD

Some do, indeed, inject HCG on a daily basis. I inject testosterone every morning - you will soon have the mechanics of the injection process down to a well-managed few minutes.

 

[Jackie Treehorn]

they just called me and said it should be here today, while i was on the phone i got the fed ex email..so I guess I will start tomorrow...Should I call about the every day HCG? does anyone inject every single day? Any way around that? Im assuming not because he would have mentioned it..Im prepared mentally to do what i have to do..

When I first started TRT, I was injecting HCG daily (150IUs). That quickly got old, as I am also pinning Sermorelin every night in my abdomen. I switched to an EOD schedule for the HCG (300IUs), after about a month an a half, and have been doing that ever since. Not having to pin HCG daily just makes my day a whole lot easier. You wouldn't think it's that big of a deal, but having that day off in-between injections does make a difference.

During a follow up consultation, I mentioned it to Dr. Crisler, who didn't have a problem with it. The smaller, daily injections of HCG are definitely better for someone concerned with E2 issues, but it's not going to kill you to go to an EOD schedule.

 

[Dr Justin Saya MD]

^^^ Agree with this ^^^

 

[a_crossfitter]

Im 41 African American(if that matters?) work out 4xweek. Been having tons of sympotoms. Im scheduled for Dr Crisler June 30(your thoughts on that as well)Dr Saya was booked to far out everyone here seems to praise him a lot..From my readings i see about 4 red flags Hematocrit,ldl,estradol,luetinizing harmones, now what that means not for sure


Protocol:

1. Increase hydration

2. Pt advised to establish relationship with local PCP

3. DHEA 25mg Troche SL BID

4. HCG 100iu SQ QAM

5. Test cyp 200mg/mL 0.4mL SQ BIW

6. F/U labs 6 weeks per Pt: Full TRT, Vit D

7. Anastrazole 0.5mg w/ DIM 200mg PO BIW on shot days

8. Vit D 5000iu PO QD

Question/s
since my Test is already 461 will/can that decrease since TRT shuts down your production?
Will the Anastrazole stop production or bind Estrogen?
Whats a good product for Vitamin D?
CBC With Differential/Platelet
WBC 6.7 3.4 - 10.8 01
RBC 5.05 4.14 - 5.80 01
Hemoglobin 15.8 12.6 - 17.7 01
Hematocrit 47.9 37.5 - 51.0 01
MCV 95 79 - 97 01
MCH 31.3 26.6 - 33.0 01
MCHC 33.0 31.5 - 35.7 01
RDW 13.8 12.3 - 15.4 01
Platelets 198 150 - 379 01
Neutrophils 56
Lymphs 36
Monocytes 6
Eos 1
Basos 1
Neutrophils (Absolute) 3.7 1.4 - 7.0 01
Lymphs (Absolute) 2.4 0.7 - 3.1 01
Monocytes(Absolute) 0.4 0.1 - 0.9 01
Eos (Absolute) 0.1 0.0 - 0.4 01
Baso (Absolute) 0.1 0.0 - 0.2 01
Immature Granulocytes 0
Immature Grans (Abs) 0.1 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 95 65 - 99 01
BUN 15 6 - 24 01
Creatinine, Serum 1.24 0.76 - 1.27 01
eGFR If NonAfricn Am 71 >59
eGFR If Africn Am 82 >59

BUN/Creatinine Ratio 12 9 - 20
Sodium, Serum 139 134 - 144 01
Potassium, Serum 4.1 3.5 - 5.2 01
Chloride, Serum 102 97 - 108 01
Carbon Dioxide, Total 24 18 - 29 01
Calcium, Serum 9.0 8.7 - 10.2 01
Protein, Total, Serum 7.6 6.0 - 8.5 01
Albumin, Serum 3.9 3.5 - 5.5 01
Globulin, Total 3.7 1.5 - 4.5
A/G Ratio 1.1 1.1 - 2.5
Bilirubin, Total 0.8 0.0 - 1.2 01
Alkaline Phosphatase, S 66 39 - 117 01
AST (SGOT) 28 0 - 40 01
ALT (SGPT) 40 0 - 44 01
Lipid Panel w/ Chol/HDL Ratio
Cholesterol, Total 157 100 - 199 01
Triglycerides 54 0 - 149 01
HDL Cholesterol 44 >39 01
VLDL Cholesterol Cal 11 5 - 40
LDL Cholesterol Calc 102 0 - 99
T. Chol/HDL Ratio 3.6 ratio units 0.0 - 5.0
Testosterone,Free and Total Testosterone, Serum 461 ng/dL 348 - 1197 01 Comment: Adult male reference interval is based on a population of lean males up to 40 years old.
Free Testosterone(Direct) 9.7 6.8 - 21.5 02
DHEA-Sulfate 272.1 102.6 - 416.3 01
TSH 1.760 0.450 - 4.500 01
Luteinizing Hormone(LH), S LH 10.4 High mIU/mL 1.7 - 8.6 01

INTERVAL LAB
Prostate-Specific Ag, Serum Prostate Specific Ag, Serum 0.7 ng/mL 0.0 - 4.0 01 Roche ECLIA methodology. According to the American Urological Association, Serum PSA should decrease and remain at undetectable levels after radical prostatectomy. The AUA defines biochemical recurrence as an initial PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory PSA value 0.2 ng/mL or greater. Values obtained with different assay methods or kits cannot be used interchangeably. Results cannot be interpreted as absolute evidence of the presence or absence of malignant disease.
Estradiol, Sensitive 45.5 High pg/mL 8.0 - 35.0 02
This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration. Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)
Progesterone 0.7 ng/mL 0.2 - 1.

Can you post your protocols decoder ring for the acronyms? Haha please.

 

[busa2009]

a_crossfitter Im assuming your asking how i figured what the acronyms was saying in my protocol?
1. Increase hydration

2. Pt advised to establish relationship with local PCP

BID =2xday

SQ QAM =subcutaneous every morning
SQ=subcutaneous
QAM=Every morning
SQ BIW subcutaneous =2 a week
6. F/U labs 6 weeks per Pt: Full TRT, Vit D
PO BIW on shot days= PO(orally)BIW 2 times week
8. Vit D 5000iu PO QD= PO(orally) QD(every day)

 

[a_crossfitter]

Thanks.

 

[TexasTea]

a_crossfitter Im assuming your asking how i figured what the acronyms was saying in my protocol?
1. Increase hydration

2. Pt advised to establish relationship with local PCP

BID =2xday

SQ QAM =subcutaneous every morning
SQ=subcutaneous
QAM=Every morning
SQ BIW subcutaneous =2 a week
6. F/U labs 6 weeks per Pt: Full TRT, Vit D
PO BIW on shot days= PO(orally)BIW 2 times week
8. Vit D 5000iu PO QD= PO(orally) QD(every day)

It seems that Defy didn't provide any explanation of the terms used in their protocol. If they insist on communicating with abbreviations, it seems simple enough for them to provide a glossary. Did you have to figure out the abbreviations on your own?

 

[Dr Justin Saya MD]

It seems that Defy didn't provide any explanation of the terms used in their protocol. If they insist on communicating with abbreviations, it seems simple enough for them to provide a glossary. Did you have to figure out the abbreviations on your own?

All RXs come with clear instructions of exactly how and when (how frequent) to take the prescribed medications.

The "protocol" in question appears to be a copy/paste of Dr Crisler's "plan" section of his patient chart note from his initial consult...not the details from the medication RXs which should state clearly the details mentioned above (i.e. we send RX to pharmacy stating "BIW"...pharmacist is trained to know "BIW" means "twice weekly"....pharmacist states "twice weekly" on the RX to the patient.

Hope that makes sense.