Tracking T and E2 Levels Over an Injection Cycle

[johndoesmith]

You probably know, I did finally had my shbg tested. 38.1 range 19.3-76.4

Heh. I forget what my original reason was to ask you that, probably had to do with Jill predicting your levels or something. Dunno. Thanks for the update though.

 

[CoastWatcher]

You probably know, I did finally had my shbg tested. 38.1 range 19.3-76.4

It still startles me that you never knew your SHBG value. Just an observation, certainly not a criticism!

 

[Vince Carter]

It still startles me that you never knew your SHBG value. Just an observation, certainly not a criticism!

That's another one of those oddities from our favorite clinic, never having tested some one's SHBG.

 

[johndoesmith]

That's another one of those oddities from our favorite clinic, never having tested some one's SHBG.

Not sure who you're referring to, but all the guys online that I talk to, and are starting with Defy have SHBG on their initial panel.

 

[Dr Justin Saya MD]

That's another one of those oddities from our favorite clinic, never having tested some one's SHBG.

It's a delicate dance with trying to balance costs for cash paying patients when it comes to required labs (I know you are VERY fortunate to have your insurance cover every penny of your labs, but the vast majority are not so lucky).

I'd personally love to have EVERY lab for EVERY patient (we call it the "shotgun approach"), but it's simply not economically feasible for the bulk of our patient population as we don't cater to only the wealthy. Up to a certain point, we were NOT requiring SHBG as a mandatory test, but were simply adding it as an "additional" follow-up lab (and hence additional follow-up cost) for cases where it was deemed necessary. Those of us that know Vince's history, including yourself, know that he has been perfectly dialed in essentially from day one and, consequently, never required the additional expense of the additional labs. My approach changed about 6 months ago as we were able to obtain a more favorable price point for the SHBG test (in addition to booting progesterone from the required panel due to the LabCorp reference range snafu) and, consequently, began adding it as a mandatory test for all initial and follow-up labs without creating too much additional financial burden for patients.

On a side note, VC, you know I love your contributions both here and more recently on PeakTestosterone as well as our long history of doctor-patient relationship (forgive my assumption, but if you are not "HRTGuru" over on PeakT then I believe you have a long-lost twin as some of the main talking points and punchlines are almost identical...and yes I do pay that much attention to the writings of my fellow community members, lol), but I've sensed a decidedly more antagonistic tone over the past several months (not towards me, but towards Defy in general). To my eyes it seems this started with some of your potential gripes with Hallandale pharmacy and then transcended more recently into views on our newer providers, Melissa our PA and Dr Calkins (anastrozole prescribing, etc). I hope all is going well with your treatment and there isn't a bigger source of discontent at the root of this? If so, please discuss with me.

 

[Vince]

As Dr Saya noted, I was dialed in right for the start. When I ordered my last labs, I requested that shbg be added on. The reason, we post about shbg so much on this form.

 

[akirez]

Thanks for sharing. No way I want to do weekly if that's what E3D looks like.

 

[johndoesmith]

Thanks for sharing. No way I want to do weekly if that's what E3D looks like.

There are clinical studies of weekly injections with labs from every day. Also they study more than one person so your experience may vary.

 

[CoastWatcher]

There are clinical studies of weekly injections with labs from every day. Also they study more than one person so your experience may vary.

"Your experience may vary." That ought to be appended to every single post related to TRT-oriented advice!

 

[Tom Larabee]

"Your experience may vary." That ought to be appended to every single post related to TRT-oriented advice!

Yes everyone seems to forget we are all unique body chemistries, so your mileage may vary is something that should be in the back of everyone's thoughts.

 

[Vince]

I do know at least one person that's very happy with once every 2 weeks injections.

 

[akirez]

I do know at least one person that's very happy with once every 2 weeks injections.

Interesting. This whole TRT thing is clearly more complex than it seems on the surface. Thanks for the reply. (To you and the others who mentioned it being highly individual.)

 

[Vince Carter]

It's a delicate dance with trying to balance costs for cash paying patients when it comes to required labs (I know you are VERY fortunate to have your insurance cover every penny of your labs, but the vast majority are not so lucky).

I'd personally love to have EVERY lab for EVERY patient (we call it the "shotgun approach"), but it's simply not economically feasible for the bulk of our patient population as we don't cater to only the wealthy. Up to a certain point, we were NOT requiring SHBG as a mandatory test, but were simply adding it as an "additional" follow-up lab (and hence additional follow-up cost) for cases where it was deemed necessary. Those of us that know Vince's history, including yourself, know that he has been perfectly dialed in essentially from day one and, consequently, never required the additional expense of the additional labs. My approach changed about 6 months ago as we were able to obtain a more favorable price point for the SHBG test (in addition to booting progesterone from the required panel due to the LabCorp reference range snafu) and, consequently, began adding it as a mandatory test for all initial and follow-up labs without creating too much additional financial burden for patients.

On a side note, VC, you know I love your contributions both here and more recently on PeakTestosterone as well as our long history of doctor-patient relationship (forgive my assumption, but if you are not "HRTGuru" over on PeakT then I believe you have a long-lost twin as some of the main talking points and punchlines are almost identical...and yes I do pay that much attention to the writings of my fellow community members, lol), but I've sensed a decidedly more antagonistic tone over the past several months (not towards me, but towards Defy in general). To my eyes it seems this started with some of your potential gripes with Hallandale pharmacy and then transcended more recently into views on our newer providers, Melissa our PA and Dr Calkins (anastrozole prescribing, etc). I hope all is going well with your treatment and there isn't a bigger source of discontent at the root of this? If so, please discuss with me.

This is a perfect reminder of costs I needed a reminder of when I was paying OOP for labs, PRIMARY, reason I became your patient was the ability to work my insurance for the labs and how you gave me the pathway to do it.
I am bothered though that on EM we have to spend time undoing Anastrozole (over) use. I use it, I know its an important drug. However having anyone from any clinic/provider present this as part of his start point, Anastrozole use is worrisome. Again, because we spend time undoing their crashed E and trying to right the ship, as it were.
I'm totally a disciple of your care and teachings, I had to back off referrals so as I didn't appear to be in business with Defy, but the changes I noticed in AI prescription did to me seem to coincide with new Medical Staff. And even perhaps its because guys demand and expect it in the treatment they receive.
I do not intend to malign Defy and certainly not, you.

 

[Dr Justin Saya MD]

This is a perfect reminder of costs I needed a reminder of when I was paying OOP for labs, PRIMARY, reason I became your patient was the ability to work my insurance for the labs and how you gave me the pathway to do it.
I am bothered though that on EM we have to spend time undoing Anastrozole (over) use. I use it, I know its an important drug. However having anyone from any clinic/provider present this as part of his start point, Anastrozole use is worrisome. Again, because we spend time undoing their crashed E and trying to right the ship, as it were.
I'm totally a disciple of your care and teachings, I had to back off referrals so as I didn't appear to be in business with Defy, but the changes I noticed in AI prescription did to me seem to coincide with new Medical Staff. And even perhaps its because guys demand and expect it in the treatment they receive.
I do not intend to malign Defy and certainly not, you.

Understood and appreciated VC. My new providers have undergone rigorous training under my direction and are now waist deep in learning the real world intricacies of comprehensive hormone treatment.

I just wanted to make sure all is well for you. Don't hesitate to reach out.

 

[Country23030]

Amazing how fast it tails off.

Thanks for doing this testing.

I feel bad for folks that are prescribed huge dose once every 2 weeks or more. Recipe for failure.

Been there, done that...

 

[Saul]

First, thanks for posting. Very interesting.
.
Second, sorry if already posted but were these your first injections or had you been on this E3D protocol for awhile? Surprised at the drop off since you would have a shot 6 days ago at about 1/2 life and then your 3 day ago shot which still had several days to go until it hit half life. Did not think it would drop off / rise this much. Same with E2 - changes a lot.

 

[johndoesmith]

First, thanks for posting. Very interesting.
.
Second, sorry if already posted but were these your first injections or had you been on this E3D protocol for awhile? Surprised at the drop off since you would have a shot 6 days ago at about 1/2 life and then your 3 day ago shot which still had several days to go until it hit half life. Did not think it would drop off / rise this much. Same with E2 - changes a lot.

At that time I had maintained that protocol for 6 months.

 

[at15]

this is classic upregulated clearance efficiency due to long term testosterone usage.