Starting TRT with Defy

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EhEhRon

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Feel free to move this post if needed. I didn’t see a place for logs and this seemed to be the best place.

Yesterday I had my new-patient consult with Dr Calkins of Defy Medical. Man, Defy is great and Dr Calkins was awesome. He took the time to answer all of my questions and I felt like he actually wanted to help me get healthy again. He called about 15 minutes late because he was late with his previous patient, but he still didn’t seem rushed and made up the time so I got my full hour.

I’ll post my latest bloods below. The only thing that needs to be noted is that the levels are not as accurate in these bloods because I made a poor decision and tried the SARM Ostarine for a little less than a month, and I stopped taking it the day before the blood test below. This caused some issues with my results, like my SHBG and HDL being much lower than normal, and my triglycerides being higher than normal.

My SHBG was at 7 this time, but my previous two tests the last two months showed it at 23 and 31. That’s low, but not nearly a single digit low. Ostarine is well known to lower SHBG and HDL. My HDL has been right in the middle of healthy for years now, including my physical three months ago. My triglycerides were a wee bit high, but it’s never been close to high before Ostarine. All in all, Ostarine was a mistake and bad idea on my part.

My previous results showed my SHBG at 23, and my TT at 76 (280-1,100) and my FT at 1.68 (1.9-27).

Dr Calkins listened to this when I told him on our call, and he took this info into account when creating a plan for me. So here is that plan:

150mg test cypionate weekly, divided into 50mg M-W-F.

1,050iu HCG is weekly at 350iu M-W-F.

.125 anastrozole M-W-F.

Then he’s got me taking 25-50mg DHEA before bed nightly. Also 5,000iu vitamin D, and 3-4,000 omega 3.

I like the idea of splitting the dose to M-W-F because of my naturally low SHBG. From my “research” this seems to be an ideal protocol. The HCG is because I’m 29 without children and wanted to leave open the option for a later time, even though we don’t want kids now.

I do have some results that aren’t pictured below, but the Dr did see them in the consultation:

LH 2.7 range of 1.7-8.6

FSH 3.5 range of 1.5-12.4

Estradiol 16.7 range of 11.3-43.2

Prolactin 7.7 range of 4.1-18.4

TSH 2.63 range of 0.27-4.2

My thyroid is a bit off so we are going to test the T3 in 3 months to see if the TRT helps.

I’ve ordered all of the stuff and paid to get it express, so hopefully by early to mid next week I can begin. I’m pretty excited and I know it can take some time to see reliable, consistent results. I have a lot of faith that Defy and Dr Calkins are with me and we are going to get me back on track. They couldn’t have been better to work with throughout this entire process.
 

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Defy Medical TRT clinic doctor
That all sounds great I hope your #'s improve soon and you start feeling better. Dr. Calkins is my doc too, awesome dude...
 
I could not get dialed in at all at my local T clinic. Im so glad I switched over to defy. Im just a little past my 13 week with them and felt the best I have in 15 years. I love the freedom that injecting from home gives me. No more rollercoaster of a big T shot when I can get to the clinic. My insurance did cover the local clinic but going with Defy out of pocket cost me about the same price per year. No brainer for me.
 
What was his rationale for starting you on anastrazole from day one?

Because of my low SHBG, which is low even at levels of 23, my E2 may shoot right up with the injections. It’s a pretty low dose so it shouldn’t keep it too low, I assume.

I was curious too why I am starting with that right off the bat when it’s already low.
 
Because of my low SHBG, which is low even at levels of 23, my E2 may shoot right up with the injections. It’s a pretty low dose so it shouldn’t keep it too low, I assume.

I was curious too why I am starting with that right off the bat when it’s already low.
No worse feeling than crashing your E2. Are you carrying a lot of fat? Just really be on high alert for low E2 symptoms so you can stop the anastrazole quickly if necessary.
 
No worse feeling than crashing your E2. Are you carrying a lot of fat? Just really be on high alert for low E2 symptoms so you can stop the anastrazole quickly if necessary.

I appreciate that. I am carrying more fat than I’ve ever carried, yes. Luckily Dr Calkins did mention that I can use my judgement on that, if I notice a lot of low E2 symptoms. I’ve certainly had plenty of symptoms lately, so if those get worse I should know why.
 
What kind of fees does Defy charge? I looked on their website and couldn't figure it out.

You should give them a call. They’re really easy to work with and don’t pressure you at all, so there’s not really any risk in calling or emailing.

The way it goes is:

1) Call them to discuss if they’re right for you.
2) Get your blood drawn. If you can get your doctor to draw the necessary bloods (you can ask what they need when you first call Defy) then you can use those results for Defy. If not, the cost of the initial labs are $279, I believe.
3) Schedule a consultation with the Doc. The unfortunate thing about this for some is that you have to pay for the visit when you schedule. I booked my appointment with Dr Calkins 8 days out. I hear it takes up to a month or more sometimes, but can take less if you are willing to have a nurse practitioner see you for your first visit. The cost for this consultation is $250.
4) Order meds. My particular protocol cost me $300. That was Test Cyp, HCG, Anastrozole and all the tools to administer. This will last me three months and change.

Once again, reach out to Defy, don’t just take my word for it. I worked with Jesse and he was very helpful.
 
At that SHBG its likely you'll have an E problem, too much Testosterone, 150mg is too much in this SHBG condition. And, M-W-F is not ideal, makes for a very low point you have to get thru on Sun/Sun night, EOD would be a better option.
The AI is prescribed but you should not use it, it will be tough to gauge physically how you feel from one-day to the next and everything will be in flux, it's a terrible thing to use because you feel this or that on any given day. Put the AI on the shelf.
When you have your 90 days followup labs that is the time to discuss the AI though if it were necessary, a T dose reduction is the first course of action. With 150mg and low SHBG your Free T is going to be astronomical and need reduced, FT for SHBG probably should not exceed the lab range in your trough.
 
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