Starting the process. Labs and advice requested.

[finkelet]

Hi all.


So I am a 38yo man. 5'11 255lbs. Over the last few years I've had increasing abdominal fat, poor libido, difficulty maintaining an erection, mild depression, poor motivation, irritability ect. No drugs, mild drinking, no smoking. I lift weights (heavy) 3 times a week, and am generally active. I do work rotating shifts, high stress working in transplant surgery. I live in the LA/OC area.


PMH: Medical history of hypertension, hi cholesterol, and obstructive sleep apnea (well controlled with CPAP).


Meds: Losartan 100mg, Metformin 500mg, Lipitor 10mg


My PCP doesn't think TRT is needed as my levels "aren't that low". So I decided to look for a specialist. I can afford to self pay for proper care alothough like most budget is a concern.


I'm starting the process with Defy. I've done the labs and the intake paperwork. I have the physical and consult to do. I am starting to have a few second thoughts about telemedicine. I wonder if using somebody local like Dr McLain in Santa Monica or Dr Sean Breen in Irvine would be a good idea as I'd like to integrate my TRT with my HTN, elevated blood sugar, cholesterol and maybe thyroid (if needed).


What are your thoughts?

 

[CoastWatcher]

Welcome to Excelmale. You are wise to seek treatment with a TRT specialist; your bloodwork is a portrait of a man dealing with hypogonadism. As to your question about care, and I should point out that I am not a Defy patient, it's up to you, but the telemed works. EM has scores of satisfied Defy patients as members. Dr. McLain is certainly an excellent doctor. You have the resources of Prime Body, a site sponsor, to consider. In short, unlike so many men who arrive here, your moving in the right direction. Why second thoughts about a process that has proven successful?

 

[finkelet]

Thank you for the reply. No second thoughts about Defy necessarily.

More curious if I can find somebody to look at and manage the TRT, BP, blood sugar, and cholesterol at the same time. A holistic (I usually hate that word) approach to my overell wellness picture.

 

[CoastWatcher]

https://www.excelmale.com/forum/sho...About-Testosterone-and-More&highlight=McClain

A video interview with Dr. McClain you should find interesting.

 

[johndoesmith]

Not that low?!?!?

My jaw literally dropped when I saw your levels, I honestly was thinking "Oh here's someone around 400 or something". Nope. I cannot wrap my head around how your levels aren't that low. Free is significantly below range as well. I wouldn't ever be able to go back to that PCP again. In fact, I doubt his competency, even if TRT isn't his thing, no one should disregard a lab level that low without at LEAST referring it. How can you trust him or her to look into things in the future that you may not know about?

I use defy. If you'd like my experience I will provide it. If you want to get things done right the first time, use defy. If you wanna try 200mg E14D, or being told you're fine or perfect, or wanna get androgel, then try some local doctors. It's possible you may get a good TRT doctor locally first time, but the chances of that are almost zero.

 

[trt4me]

Telemedicine is totally fine and a lot of trt is based on symtoms and labs.
Just about everyone is pleased with defy. I'm sure defy would be open to all approaches including anything natural or more conservative. Since your LH is low it's no surprise your test level is low and also your e2 ( not much testosterone to convert to e2 I guess?) don't be surprised if defy wants to work on that before jumping into trt.
What is your body fat like overall?

 

[finkelet]

I was curious about the LH as well. BF is around 30%.

I had a vasectomy about 4 years ago. Could that have any impact?

 

[Deleted member 14271]

Your labs mirror mine pre-TRT, similar age when I started, same height... you got me on weight

If you and your doctor decide to pursue treatment via TRT - my advice since you asked...

1. Never change but one variable at a time!!! I do not recommend jumping into TRT with T, HCG and an AI. Start first with T and with a modest dose (something like 50mg E3.5 days). This will establish a good baseline from which to make adjustments or add adjuncts. If at some point you add something... add it but don't tweak anything else and don't add anything else. What you don't want to do is muddy the waters and make it difficult to isolate the variable responsible for whatever symptoms your dealing with down the road.

2. Pick a protocol and stick with it for at least 6-8 weeks!!! Some argue 4 to 6 is sufficient to reach steady state but there are a number of ways the body adapts to exogenous T in an effort to reach what your individual body considers homeostasis, it doesn't happen overnight.

3. Not sure where you are fitness/nutrition wise but this is a great time to clean up your diet and commit to regular exercise. Reducing your percent body fat will help to reduce conversion of T to E. Try to shoot for 15% or below.

Getting off the soapbox now. Best of luck to you! If you go with Defy... I think you'll be very happy with Dr. Saya. He's very knowledgable and thorough!

 

[CSI007]

Those labs look a lot like mine do/did except for the cholesterol - which for me is normal. But while overweight, I do eat low carb and it has helped an incredible amount.

In addition to what others have pointed out, you are definitely also hypothyroid with a TSH like that. Ideal is between .1 and 1.5 (lower the better).

It seems that many of us with these problems have High blood glucose, elevated TSH, low testosterone/estrogen etc. etc. On what I have been reading, The culprit is probably something wrong with the pituitary gland. Either a tumor or something else going wrong with it. The pituitary controls many of these hormonal functions. Once its screwed up everything seems to head south.

You might want to check and see if you have auto-immune problems going on as well like Hashimoto's.

I bet that HCG alone would be a good possibility for you since your LH is so low. I am still trying to get that dialed in for myself. I might be switching to T at some point if my next set of labs don't turn out so well.

Good luck to you! And stay on top of your health and don't let doctors push you around!!!

 

[Pranayama]

You would be hard pressed to find a Doctor locally who will give you a consult and follow ups as thorough and comprehensive as Defy. I used to go to a Low t center in my area and it is night and day by comparison. The Dr. At the Low t center spent about 3 minutes with me and would not offer HCG. In contrast, Dr. Saya spent 45 minutes covering all bases and answering questions I had. The labs and ancillary med are comprehensive for trt: HCG, Arimidex, Testosterone, plus the correct labs. He has also helped me with my cholesterol by suggesting dietary changes and supplements otc, and your heart will automatically benefit from TRT at your low level. I was at 225 ng/ml when I started TRT a few years ago at Low t center.

 

[finkelet]

Thanks guys for the replys. I decided to continue the process with Dr Saya. A large part of me wanted more immediate gratification but this is too important to make decisions like that.

So I have an appointment with him on 11/16. On the standby list if anything opens.

 

[CSI007]

Thanks guys for the replys. I decided to continue the process with Dr Saya. A large part of me wanted more immediate gratification but this is too important to make decisions like that.

So I have an appointment with him on 11/16. On the standby list if anything opens.

Don't rush it! I have been trying to get this all figured out for almost a year now. Had ups and downs...mostly downs and sadly I am moving on from HCG mono to TRT but I wanted to exhaust every avenue I could. This is not a decision to take lightly for sure! Hopefully it won't take another year to get the TRT dialed in although from what I am reading, it might.

I think you are in good hands and hopefully you can get it resolved and feeling better quickly.

 

[johndoesmith]

Thanks guys for the replys. I decided to continue the process with Dr Saya. A large part of me wanted more immediate gratification but this is too important to make decisions like that.

So I have an appointment with him on 11/16. On the standby list if anything opens.

I was on the standby list and got moved up 2 weeks. Doctor's offices always have cancellations.

Not saying it will definitely work just that it's a possibility.

 

[finkelet]

Following up. So I had my consult with Dr Saya today and to echo the previous sentiments he was great. The thoroughness about my entire health picture was fantastic. So here are his recommendations which I will follow.

35 day Clomid stim test.
Complete thyroid panel.
Start DHEA 200mg/day
CoQ10 60mg day
Fish oil 4G day.

Reassess in 30 days.

Dr Saya thinks that with my Low T, elevated TSH and Low LH that this may all be related to Low pituitary gland function. So before starting Test and shutting down my axis he wants to see if we can increase LH and Test.

Thoughts?

 

[Dr Justin Saya MD]

Following up. So I had my consult with Dr Saya today and to echo the previous sentiments he was great. The thoroughness about my entire health picture was fantastic. So here are his recommendations which I will follow.

35 day Clomid stim test.
Complete thyroid panel.
Start DHEA 200mg/day
CoQ10 60mg day
Fish oil 4G day.

Reassess in 30 days.

Dr Saya thinks that with my Low T, elevated TSH and Low LH that this may all be related to Low pituitary gland function. So before starting Test and shutting down my axis he wants to see if we can increase LH and Test.

Thoughts?

Finkelet -

Want to make sure, in case you get the supplements OTC, that the dosages are correct in case of typo. Should be:

CoQ10 - 200mg daily
DHEA - 30mg daily

**You may have the DHEA dosage confused with DIM 200mg - which is compounded into the same capsule as your Clomid.

 

[finkelet]

Thank you! That is exactly what I did.