Just Started Defy protocol

[maxadvance]

So thanks to this community and Nelson, I have started with Defy. I began with an hour consult with Nelson, highly recommended since he has a wealth of experience and he's a pretty smart guy. And the following day I had my 1 hour consult with Dr. Saya, he is very straightforward, very calm in his delivery, and very patient with his patient and their stupid questions . I was concerned that with the TRT and HCG treatment, how that could negatively affect any future aspirations of starting a family. Specifically, does the treatment affect the sperm, its' strength, it's DNA, and whatever else to the point that your offspring could be deformed, retarded or whatever. Short answer no, check.

So I started 16 months ago with 10% compounded cream, 4 clicks per day, 1 gram total, which was upped a few months later to 15%. Baselines as follows:
T-334
T Free-7.5
PSA-0.9
Hemoglobin-17.5
Hematocrit-49.4
eGfr-non afr amer-79
chol-265

Now, over 24 hours beyond last cream application

T-199
T Free-12.7
PSA-0.9
hemoglobin-16.2
hematocrit-47.1
eGfr non afr amer-100
chol-224(triglycerides went from 246 to 142)
DHEA-307 (71-375)
IGF-1-150 (61-200)
Estradiol(sensitive)- 21(8-35)


So as you can see, some good some bad. The new reading of T was really low because Dr Saya said my body metabolizes the T cream super fast and rec'd a switch to Cypionate. I supplement with Keto-7, pharm grade fish oil w 500 g of EPA and 0 DHA, and 5k iu of D3. Hence I had some good measurements of DHEA and IGF-1.

My main complaint was erection quality went down when I started T cream. There were good days, and there were wtf days, and I was frustrated. So I read about HCG, mostly here, and became hopeful.

So my protocol is as follows:

40mg cyp twice per week, 35 insulin units HCG twice per week, and .25 anastrazole twice per week.

First shots were Saturday, no pills. Felt good, refreshed. Second shots were Tuesday(T in the glute, HCG in the belly), and took the first Anastr. pill. Wednesday morning was good, the afternoon and into today Thursday I feel like a truck ran me over. Lower back is killing me, muscle aches, headaches. Libido was good til tuesday, now not so much lol.

Nelson forewarned that the Anastrozole scrip would be recommended , and he was telling me it was likely a cya scrip to protect them against any gyno claims in the future. I'm tempted to dump this Anastrazole in the trash, it just seems like it was prescribed for something that may be needed in the future but just as likely may not.

What do you guys think?

 

[CoastWatcher]

It sounds as if you may be the victim of low E2. It is easy enough to set aside and see how you feel. It's just as easy to resume it again if needed. Many of us have never needed an AI, and others have adjusted their protocol to avoid one. You are injecting 80mg of testosterone per week, not a large amount. I would see how you do w/out the Anastozole.

 

[ERO]

My 2-cents, keep the AI, but stop using it. as CoastWatcher says, many of us here don't use it and don't need it. I have personally been on as much as 200 mg/week of T (broken into twice weekly injections) and still not needed an AI.

 

[Robertmicheal]

What do you guys think?

Maxadvance,

Good choice of Defy and Dr Saya, I also live in LA and have been under his care since June. For the first month or so I had some weird ups and downs, one issue was libido quality, which I have never had issues in my life, but I stuck with it and after that first month I am more than happy with energy, strength and my libido is better than ever.

Test Cyp 200 mg/ml, 40 insulin units x twice a week, SC injections.
hCG 11,000 U, 50 units x twice a week.
Anas .25/200 mg twice a week.

Pre-TRT labs
Test total 204 ng/dL (range 212-835)
Free test 3.86 pg/mL (4.25-30.37)
Estradiol 23 pg/mL (0-39.8)

Current labs
Test 1145 ng/dL (348-1197)
Free T 39.39 ng/dL (5-21)
Estradiol 25.5 pg/mL (8-35)
DHEA 227.8 ug/dL (71.6-375.4)
Hematocrit 49 % (37-51)

Hope this helps and let me know if I can help with any advice or questions.

Robert

 

[Vitamin_C]

An rx for E2 when its 21? yikes...

 

[Vince Carter]

I echo the don't get rid of it recommendations. While many of us don't take it, many take much less than .25mg. I for instance have .15mg compounded capsules, I use 1 per week right now, that's a really small amount. IMHO .25mg 2x per week is much to much and shouldn't be taken as a requirement on T.

 

[Jasen Bruce]

Dr Saya is taking into consideration the T:E ratios and how it offers predictive value for subsequent E2 levels after initiating TRT. For example, maxadvance initial T 199with E 21 (approx 10:1 ratio), now if that ratio holds (and it often does fairly closely), if his T increases to let's say 700-1100 range, that correlates with E of 70-110. Thus the anastrozole to corral some of the aromatization.
The second case (Robertmichael) illustrates a perfect case in point. Initial T 204 with E 23 (very similar to maxadvance),anastrozole 0.25mg BIW. Follow up labs T 1145 with E 25.5 (he also had a 10:1ratio of T:E and without the 0.25 of anastrozole would have likely had VERY high E2 on follow-up (10:1 ratio - T 1145 = E 114...now it likely wouldn't have gone THAT high, but very high nonetheless). Most importantly, he is feeling great now.

Some fail to consider taking the entire picture into context and completely neglecting the predictive value of the T:E ratio

Remember, Dr Saya and his collegues (Dr Crisler, Dr Mcclain, Dr Lawson, etc etc) have treated hundreds of patients over the years therefore their data and experience comes from real observation of trends and outcomes.

 

[maxadvance]

You are correct Jasen, ratio was the determining factor in the scrip. It's just that 199 T reading was 36 hours after the cream application, the free T was 12.7, so hopefully it's not unreasonable to think my T after 12 hours after application would be in the 600-650 range. The question I should have asked is "Does the estradiol reading dip as quickly as the T reading when the cream wears off? " I really wasn't forewarned by the office of the possible side effects of the Anastrole, eg feeling like I was run over by a truck.

That being said, thanks everyone for the replies, I value all of them.

 

[ERO]

To be sure, that is not a side effect that typically happens that quickly. Tanking your E2 definitely does feel like sh*t, (I have done it) but it doesn't typically happen within 24 hours after taking one dose of AI.

I don't mean to minimize your symptoms at all, but could you be getting the flu or something?

 

[maxadvance]

no chance on the flu, it's 3 days since the dose and I've felt progressively better, no congestion, no fever, just felt wiped out with headaches. I think I'll do the T and HCG for a few weeks and then resume the Anastrozole

 

[MarkLA]

I supplement with Keto-7, pharm grade fish oil w 500 g of EPA and 0 DHA
...
My main complaint was erection quality went down when I started T cream. There were good days, and there were wtf days, and I was frustrated. So I read about HCG, mostly here, and became hopeful.

First shots were Saturday, no pills. Felt good, refreshed. Second shots were Tuesday(T in the glute, HCG in the belly), and took the first Anastr. pill. Wednesday morning was good, the afternoon and into today Thursday I feel like a truck ran me over. Lower back is killing me, muscle aches, headaches. Libido was good til tuesday, now not so much lol.

What do you guys think?

Question:

Why EPA only and no DHA?

Comment:

On E2 - You should be retesting after x weeks on the new protocol. IMO, those results and how you feel should guide the Dr. on whether the AI is needed. Then repeat testing would dial in what dose is right for you.

Edit: Not sure how I missed Jasen's post, but it makes total sense to use the T:E ratio to try to predict where E2 will end up after start of therapy based on Dr Saya's experience with previous patients. I'm sure that Defy will retest some time after and adjust if necessary.

IANAD...

 

[Vitamin_C]

Not all men aromatize the same though. If I were a prescriber (applying for my PNP) I would be hesitant to give a script for Adex until I saw a definite need for estrogen control. It is a delicate balance.

 

[MarkLA]

Dr Saya is taking into consideration the T:E ratios and how it offers predictive value for subsequent E2 levels after initiating TRT. For example, maxadvance initial T 199with E 21 (approx 10:1 ratio), now if that ratio holds (and it often does fairly closely), if his T increases to let's say 700-1100 range, that correlates with E of 70-110. Thus the anastrozole to corral some of the aromatization.
The second case (Robertmichael) illustrates a perfect case in point. Initial T 204 with E 23 (very similar to maxadvance),anastrozole 0.25mg BIW. Follow up labs T 1145 with E 25.5 (he also had a 10:1ratio of T:E and without the 0.25 of anastrozole would have likely had VERY high E2 on follow-up (10:1 ratio - T 1145 = E 114...now it likely wouldn't have gone THAT high, but very high nonetheless). Most importantly, he is feeling great now.

Some fail to consider taking the entire picture into context and completely neglecting the predictive value of the T:E ratio

Remember, Dr Saya and his collegues (Dr Crisler, Dr Mcclain, Dr Lawson, etc etc) have treated hundreds of patients over the years therefore their data and experience comes from real observation of trends and outcomes.

That's really interesting.

Thanks for posting the logic behind the protocol. It makes total sense.

 

[maxadvance]

Question:

Why EPA only and no DHA?

Comment:

On E2 - You should be retesting after x weeks on the new protocol. IMO, those results and how you feel should guide the Dr. on whether the AI is needed. Then repeat testing would dial in what dose is right for you.

Edit: Not sure how I missed Jasen's post, but it makes total sense to use the T:E ratio to try to predict where E2 will end up after start of therapy based on Dr Saya's experience with previous patients. I'm sure that Defy will retest some time after and adjust if necessary.

IANAD...

EPA and DHA compete for absorption and actually can cancel out eachother. DHA is critical early and late in life, EPA is critical and the more beneficial of the 2 during adulthood, and clearly the better of the 2 for inflammation. DHA is cheaper to make, hence some manufacturers push the benefits of DHA heavily. I use Omegavia brand EPA, 120 capsules for $28 on Amazon.
http://www.amazon.com/gp/product/B00D37S0HC?psc=1&redirect=true&ref_=oh_aui_detailpage_o07_s00

Here's a link for some differences.
https://igennus.com/nutrition/omega-3-science/epa-vs-dha/

 

[Vince Carter]

Not all men aromatize the same though. If I were a prescriber (applying for my PNP) I would be hesitant to give a script for Adex until I saw a definite need for estrogen control. It is a delicate balance.

I think you nailed it. Prescribing an AI and taking it as part of the routine isn't wise. I get most Drs want to take a little bit until you can get to the 90 day point and do labs its just that they put a guy on too much AI....25mg twice a week (or more), is A LOT when not supported by testing. Yet.