Had consult with Defy, meds arrived, afraid to take the plunge.

[sanelb]

About me: 28 year old male, soon to be 29. 6'1" 182lbs, low body fat, moderate exercise (4 times a week), low carb diet, eat healthy fats and proteins for the most of the part.

My problem: I don't have morning erections anymore, I probably haven't had one in 4 years, if I do, it's maybe once a month. I'm not as energetic as I used to be, I also tire much quicker at the gym. I've also lost motivation and confidence, that "manly" drive seems lessened. I probably have more anxiety than most people, stuff doesn't roll off of as much as it used to. At times I feel like I'm much older for my age. I also had pubertal gynocomastia which I finally had surgically removed 2 years ago.

So, I decided to have a consult with DefyMedical, I spoke to a Dr. Calkins and he approved me for TRT, medication ordered. I currently had the medicine/syringes sitting in my room, unopened, for 4 days now.

I had my labs drawn on 2/21/2019 at 2:22pm. I didn't do them in the morning because I was too tired. So keep in the mind these are T results that are during the day. Testosterone was 578 (264-916), which is still quite low for my age. Free T was 17.6 (9.3-26.5).

Now, here's what's giving me second thoughts, my RBC was 5.57 (4.14-5.80), Hemoglobin 17.1 (13.0-17.7), and hematocrit 50.4 (37.5-51.0). This is something he pointed out, but wouldn't be a problem with donating blood every 3 months. He also asked me if I had sleep apnea, smoke, live in high altitude, or was dehydrated, I said no. I even have old lab results of a CBC that had extremely similar values, so it wasn't a lab error.

I'm just honestly worried starting TRT due to the blood values, and how TRT can rise the levels, which I'm already on the high end. And donating every 3 months seems absurd, I feel lie that would destroy my iron.

I've also added full thyroid panel results from a different doctor, which shows my thyroid is normal. And it shows my testosterone at 459! This one was drawn in the morning. Obviously my testosterone isn't right, and I'm feeling crappy because of it. I remember posting a thread here about being suckered into a T-mill, they gave me 200mg of test, which I only did for 2 weeks, because they had no idea what they were doing, but I certainly felt much better. After hearing about Defy, and them treating over 10,000 patients I figure I actually try them, I feel like they can help.

Here is the protocol I was given.

"Plan:
Begin T Cyp 200 mg/ml – 0.35 ml inject IM/SQ twice weekly (25G, 5/8” needle/ (1cc syringe Luer only)
Begin HCG 500 iu inject SQ twice weekly to reverse/prevent testicular atrophy
Begin Anastrozole 0.125mg twice weekly– h/o elevated E2, titrate on follow-up
Begin Vitamin D3 5000 iu daily
Begin Fish oil 3-4 g daily for HDL support

F/U in 3 months with full labs


Dr Calkins"


Any advice?

Also, how did my shbg go from 23 to 36.1?

 

[HealthMan]

Your testosterone is not optimal but is far from being low. Your symptoms may have another cause so it might be worth investigating a bit more.
Chances are you will likely have to donate blood in order to keep HCT below 51-52 given your baseline is almost 51.
If it was me at your age and with these testosterone levels I wouldn’t start TRT. Further investigation and life style changes would be a better first approach in my opinion

 

[JV63]

My exact thoughts Healthman.

If you do decide to go ahead, use a smaller needle and don't use the AI until labs or symptoms support it.

 

[sanelb]

My exact thoughts Healthman.

If you do decide to go ahead, use a smaller needle and don't use the AI until labs or symptoms support it.

What if I risk extremely high E2 by not taking an AI? Wouldn't that cause me to get gynocomastia? Something I had surgically removed due to having it not go away during puberty.

 

[CoastWatcher]

What if I risk extremely high E2 by not taking an AI? Wouldn't that cause me to get gynocomastia? Something I had surgically removed due to having it not go away during puberty.

If you had surgical intervention to deal with gynecomastia, weren't the glands excised at the time of surgery?

Even if not, you're going to be monitoring your estradiol on an ongoing basis. It's something that can be addressed if it becomes an issue.

 

[S1W]

Your testosterone is not optimal but is far from being low. Your symptoms may have another cause so it might be worth investigating a bit more.
Chances are you will likely have to donate blood in order to keep HCT below 51-52 given your baseline is almost 51.
If it was me at your age and with these testosterone levels I wouldn’t start TRT. Further investigation and life style changes would be a better first approach in my opinion

This. Exactly this.

 

[Systemlord]

Clearly not being on TRT isn't working for you, only one direction to go. You're just going to have to keep an eye on hematocrit and donate however often as needed.

 

[sanelb]

If you had surgical intervention to deal with gynecomastia, weren't the glands excised at the time of surgery?

Even if not, you're going to be monitoring your estradiol on an ongoing basis. It's something that can be addressed if it becomes an issue.

They never fully remove the glands in gyno surgery, otherwise it creates something called a crater deformity. They take away enough to remove the puffy nipple appearance. Every man has a bit of glandular breast tissue, unfortunately for me mine never went down during puberty, so I had to have some of it removed. There are exceptions though, some surgeons do remove the whole gland for bodybuilders, but that risks involves a possibility of depression of the areola.

 

[Charliebizz]

I personally wouldn’t start trt with your numbers. I had way lower numbers then you and trt didn’t help with much if anything for me. Especially libido and erection. So much more to that aspect then testosterone. I would check a.m fasting cortisol levels

 

[JayLay777]

You could always give TRT a try and see how feel on it for a couple months and see if you feel any better. If you try it and don’t really feel any benefits chances are very high that you’re numbers will just return to baseline or what they were before you started. Actually I’m 100 % sure they would return to baseline, especially if you only tried it for a couple months or even 6 months.

 

[Tad1979]

I wouldn’t start TRT with those lab values. Yes, you’ll feel better, but you’ll be consigning yourself to lifelong medication when labs would seem like indicate something else is the cause of how you’re feeling.

Just curious - I didn’t see a Vitamin D value on your labs - was that tested? If your vitamin D is low, raising it can raise T levels by 20%, and symptoms of D deficiency mimic those of low T

 

[Joey786]

If you would’ve tested in the morning your total could be 700ng/dL or higher.

 

[Vvs1]

JW if you had any of these tests done: iron, ferritin, 24hr cortisol, reverse t3? I think it's worth digging into as to why you're so tired. It's also good to get a baseline on everything before starting TRT.

However, I would recommend trying something like Tribulus in the meantime. Try to find one that's high quality.

 

[broker]

Your numbers arent bad at all. Most guys are araid of T because they are afraid to lose their hair.

 

[MikeXL]

Just jump in. Yes, I know that seems like I am not giving any advice. However, if you are afraid, you are afraid, and no one logical argument will convince you. Do it

 

[lowtforever]

Not bad levels honestly. Up to you. I'm sure he thought you needed trt for a reason, though. I'm sub 300 in the morning and starting clomid through defy.

 

[fifty]

Your numbers arent bad at all. Most guys are araid of T because they are afraid to lose their hair.

I was worried about that too. I think the ai hurts my hair more than anything. With no ai and raised estrogen my hair actually seems better...at least less shedding.