Latest bloodwork on new regimen with Defy

So I got my blood test results back today. This is the 3 month tests since starting with Defy. Here are the important numbers prior to my initial Defy consult (tests done in Sept 2015):

Total T: 745 ng/dL (range 348-1197)
Free T: 20.9 pg/mL (range 8.7-25.1)
Estradiol sensitive 29.8 pg/mL (range 8.0-35.0)
DHEA 165.6 ug/dL (range 102.6-416.3)

And here are those same numbers as of January 2015:

Total T: 649 ng/dL (range 348-1197)
Free T: 18.9 pg/mL (range 8.7-25.1)
Estradiol sensitive 45.2 pg/mL (range 8.0-35.0)
DHEA 194.3 ug/dL (range 102.6-416.3)

This is exactly what I thought based on how I've been feeling the past few months...I figured either my T went down, my E went up, or both...and I was dead on.

The only changes made between the tests were as follows:

Same dose of T, on the same injection cycle (every 3.5 days), but switched from IM to SubQ
Added HCG at 100 units every day in the AM
Added DHEA/Pregnenolone cream (50/100 MG/ML) applied daily in the AM

So is the difference in my numbers (and more importantly, in the way I feel) really all down to the injection method change?? I hear many men do better, with better numbers, on the same dose with SubQ vs. IM...but apparently I'm in the exception group on this.

I have a consult with Defy next week...it couldn't come sooner!!

One additional note: the first results were done on a true trough day (Friday, before my injection). This last set was done the day before my next injection, so Thursday in the AM. So these latest numbers would likely be slightly lower had I waited a day to test, but my schedule dictated...

Oopps...one more thing. I had my SHBG tested this time. The last time I had it tested was in March of 2015 (1 month after being on TRT) and the results were:

20.3 nmol/L (range 16.5-55.9)

Results this time around (January 2015) were:

27.5 nmol/L (range 16.5-55.9)

Helboi-

Are you with me or Dr Crisler? Either way, looks like some adjustments will be in store for your consult next week.

Dr Justin Saya said:

Helboi-

Are you with me or Dr Crisler? Either way, looks like some adjustments will be in store for your consult next week.

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I've spoken with you both (Crisler for my initial, you on my shorter followup to talk about my hematocrit issue..). But my appointment next week is with you...looking forward to it!

Look forward to it, I have some ideas for you that we'll discuss.

Just got off my consult with Dr. Saya. We're changing things up from the protocol above. We'll be dropping the DHEA/Pregnenolone cream altogether in favor of 25mg oral DHEA per night. Also dropping the HCG entirely for now. And we'll be switching to 50mg injections every other day on my testosterone. He suspects that the pregnenolone (edit: AND the HCG) is causing my estrogen to spike and many of the negative symptoms I've experienced. I'll be starting the new protocol this week and we'll test again in 6-8 weeks and see where things stand.

Just want to say that I love Defy and I'm so glad I found them. Dr. Saya and Dr. Crisler and their team are top-notch in every way. I trust them with my protocol and know that eventually we'll dial me in perfectly. My wife will be starting HRT with them soon as well and we can't wait for that.

That is fantastic! I hope you can let us know how your wife does over time as well.

I would love to get my wife on HRT but she remains uninterested.

This looks like me. HCG probably caused your estrogen issues, the pregnenolone / DHEA may have contributed as well. The raised estrogen level increased SHBG. It seems in some men on exogenous T, the main thing HCG does is activate testicular aromatase. I guess the question becomes to continue to utilize HCG, and DHEA, etc and try to control E by adding an aromatase inhibitor; OR reduce or eliminate HCG, etc. and avoid aromatase inhibitors.

Looking forward to hearing more of your updates!

ERO said:

That is fantastic! I hope you can let us know how your wife does over time as well.

I would love to get my wife on HRT but she remains uninterested.

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I will definitely do that. She's been wanting to for some time now, just to optimize her levels. But now it's more urgent as we (and her doctor) believe she's going through early menopause. I won't say her age here, but let's just say she's FAR to young to be going through that just yet (but there is a history of it in her family). We'll see soon...labs come back this week we hope.

JPB said:

This looks like me. HCG probably caused your estrogen issues, the pregnenolone / DHEA may have contributed as well. The raised estrogen level increased SHBG. It seems in some men on exogenous T, the main thing HCG does is activate testicular aromatase. I guess the question becomes to continue to utilize HCG, and DHEA, etc and try to control E by adding an aromatase inhibitor; OR reduce or eliminate HCG, etc. and avoid aromatase inhibitors.

Looking forward to hearing more of your updates!

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Wow, yeah, that does sound similar to my case. I failed to give HCG its due in helping cause my estrogen spike...he said it was likely both that and the pregnenolone.

As you mentioned, the option was to either simplify the regimen and dial in the T, or add an AI, which both he and I are reluctant to do. I'll post updates next testing round (and inbetween if my symptoms show good improvement).

Helboi said:

Wow, yeah, that does sound similar to my case. I failed to give HCG its due in helping cause my estrogen spike...he said it was likely both that and the pregnenolone.

As you mentioned, the option was to either simplify the regimen and dial in the T, or add an AI, which both he and I are reluctant to do. I'll post updates next testing round (and inbetween if my symptoms show good improvement).

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Very pleased to hear you're working to avoid an AI. There's a time and place for anastrozole, but if it can be done without it, so much the better. Good luck.

Appreciate the feedback guys!

I failed to mention that we are also going back to IM injections. I have a personal preference for them after having tried subQ from November until now. He said some men just get better, more consistent T distribution on IM and I'm likely one of them. I may try shallow IM, using 25g 5/8" needles, but I don't really want to inject anywhere other than my glutes, so I might just stick with the 25g 1" tips I was using previously.

JPB said:

This looks like me. HCG probably caused your estrogen issues, the pregnenolone / DHEA may have contributed as well. The raised estrogen level increased SHBG. It seems in some men on exogenous T, the main thing HCG does is activate testicular aromatase. I guess the question becomes to continue to utilize HCG, and DHEA, etc and try to control E by adding an aromatase inhibitor; OR reduce or eliminate HCG, etc. and avoid aromatase inhibitors.

Looking forward to hearing more of your updates!

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I completely agree with you on that though I seem to do better with an overall higher estrogen number myself. I don't use an AI and try to follow the T:E ratio of 14-20 whereas I seem to do best in the 14/15 side of that ratio.

Just got my blood drawn for the followup to my protocol change (mentioned in my posts above). I can't wait to get the results back and see how things are going numbers wise. As for my symptoms over the past 7 weeks, I'm definitely sensing a more stable mood, less ED problems, slightly better libido, but that's about it so far. Sleep, energy, motivation, body composition, etc have all remained about the same as far as I can tell. I'll post again when I get the results back in a week or so.

Results are finally in! I felt like a kid in 1985 getting a Nintendo for Christmas when Defy told me they were finally here (it's been 13 days since the draw).

Before I post results, I'll just mention the symptom improvements I've seen since the protocol change we made 8 weeks ago (see post from Feb 2 above). So I've noticed a big change in mood. I have a long history with depression since my late teens, and I think this is the best, most stable mood I've been in for the past 15 years. I've gained about 5 pounds, which I do believe is mostly muscle. I've noticed a hardening and thickening of my muscles in some areas, even though I'm not currently working out and haven't changed my diet (which is still not ideal). My motivation seems to be returning, and my energy levels are decent, but both of those areas I think could still stand to improve. My sleep is still off and on, but not much changed in the past 8 weeks.

And here are my results (I've re-posted the results from prior to the protocol change for comparison):

January 2015 results (160mg/week split every 3.5 days plus daily 100 units of HCG, DHEA/Pregnenalone cream daily):

Total T: 649 ng/dL (range 348-1197)
Free T: 18.9 pg/mL (range 8.7-25.1)
Estradiol sensitive 45.2 pg/mL (range 8.0-35.0)
DHEA 194.3 ug/dL (range 102.6-416.3)
SHBG 27.5 nmol/L (range 16.5-55.9)

And here are results from March of 2015 (50mg T every other day IM, 25mg DHEA/day, no HCG or pregnenalone):

Total T: 1137 ng/dL (range 348-1197)
Free T: 25.6 pg/mL (range 8.7-25.1)
Estradiol sensitive 49.6 pg/mL (range 8.0-35.0)
DHEA 280.7 ug/dL (range 102.6-416.3)
SHBG 31.3 nmol/L (range 16.5-55.9)

Needless to say, I was shocked at my T nearly doubling (and free T jumping 6-7 points)! I figured it'd be up to 800 or so. I was also surprised to see that my E2 went up, but the overall ratio of E to T is much improved, so I guess that's why I'm feeling subjectively like my E2 went down. DHEA could still use a boost I think. But otherwise my numbers are golden and I feel pretty damn great, though could still use improvements in motivation, energy levels, body composition...but I'd imagine those elements will improve as I maintain these levels over the next 6-12 months.

Can't wait to consult with Dr. Saya again and see what he thinks.

What do you guys think?

Looks good. So, nothing you're feeling that might be attributed to elevated E2?

I would surmise that you, like me, don't absorb that DHEA/Preg cream. Dr S and I decided to switch to oral micronized.

CoastWatcher said:

Looks good. So, nothing you're feeling that might be attributed to elevated E2?

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I was having hot flashes and some water retention and moodiness BEFORE the change when it was 46, but now with the protocol change all of that is gone and it still went up to 49. So the T/E ratio must be the explanation there.

Vince Carter said:

I would surmise that you, like me, don't absorb that DHEA/Preg cream. Dr S and I decided to switch to oral micronized.

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Yeah, he took me off the cream when it didn't seem to be upping my DHEA numbers and my E went up (he said it could partly have been the pregnenalone). I now take micronized 25mg per day orally and that seems to have been a much better thing for me, since my DHEA number rose quite a bit (the cream I was on before was 50mg DHEA/day).