Another new guy

Smitty57

New Member
Hey all! Let me start by saying I'm in the very early stages of looking into TRT, and am currently a bit short of information I'm able to provide.

By that, I am meaning: I've recently switched PCP, and just had bloodwork done (for reasons other than strictly TRT). I was called late last week and informed things were "normal" other than low test, but naturally "within range", and something regarding arthritis. I will be getting copies of reports, and can/will update with more specific info/results when I have them in hand.

That said, the main reason for my early-on post is, I live in northern Mississippi, and it seems local resources are extremely limited here. Don't get me wrong, I believe I've made a wise decision with current PCP choice (granted only 1 visit so far), but they seem thorough enough.

Having read through some info on the internet, I'm not expecting much in the way of assistance with TRT from them. That is pointing me to Defy, which led me here.

I believe I'd seen some of their staff are members here, so I'm hoping to get a couple general questions answered, either by them, or anyone else who knows.

I'll get right to them:

1- Is treatment from Defy available in Mississippi?

2- There is no decent internet connection available to me for teleconferencing. I use a Verizon hotspot and a data limit. It sucks, but it is what is is. Is this a deal-breaker?

3- There are also no DiscountedLabs here, so I'm unsure what my options are there, or if my recent tests from my Dr would suffice, in the event I went forward with Defy?

A bit of additional info, 64yo, work-out 3 days a week (past 3 years) other than a 3-4 month break when I jacked-up my shoulders, and over the past year have been "losing ground", sleep sucks, mood/attitude sucks.

Any and all advice is appreciated.

Thanks!
 

Cataceous

Super Moderator
1. Yes, their services are available in the U.S.

2. They don't do video conferencing. You just need a phone.

3. Do you have any LabCorp or Quest locations nearby? As a Defy patient you'll get some of the best pricing for self-pay testing. Otherwise Defy will probably accept results from elsewhere if they include the required tests.

Give some serious thought to trying a testosterone nasal gel, such as Natesto or Empower's version, before going with full blown TRT. The nasal gel allows your own testosterone production to continue, potentially avoiding some of the problems that can occur with TRT.
 

Systemlord

Member
I was called late last week and informed things were "normal" other than low test, but naturally "within range", and something regarding arthritis.
Trust me when I say you don't want your provider to prescribe you TRT. You can get so much better care privately.

I believe I've made a wise decision with current PCP choice (granted only 1 visit so far), but they seem thorough enough.
By thorough enough you mean your doctor ordered Total T, Free T (Equilibrium Dialysis or Ultrafiltration method), SHBG, CBC, lipids, prolactin, LH and FSH?
 
Last edited:

Smitty57

New Member
1. Yes, their services are available in the U.S.

2. They don't do video conferencing. You just need a phone.

3. Do you have any LabCorp or Quest locations nearby? As a Defy patient you'll get some of the best pricing for self-pay testing. Otherwise Defy will probably accept results from elsewhere if they include the required tests.

Give some serious thought to trying a testosterone nasal gel, such as Natesto or Empower's version, before going with full blown TRT. The nasal gel allows your own testosterone production to continue, potentially avoiding some of the problems that can occur with TRT.
I was aware they operated in the US, just wasn't sure if it was State specific. Some others in the same business don't operate in all States.

Not sure where I got the teleconferencing then? Evidently reading too much different info and not keeping it separated. it's certainly a confusing amount of info to try to digest. It's all over my head, and have serious doubts about being able to ever get a grasp on much of it.

I believe there's a Quest about 50 miles away. Never heard of the nasal spray, and just looked it up. Please don't think I'm being dismissive of your advice, as I certainly appreciate it, it doesn't sound as if it would be something I'd care for. 12 pumps a day (2 per nostril x 3/day), and the common problems it seems to cause make it less appealing. I have no issues with needles, and from what little on the subject my pea-brain has absorbed, it seems injections keep things on the most even-keel of all the methods.

But, I could be totally incorrect in that assumption too.

Thanks again for the advice.
 

Smitty57

New Member
Trust me when I say you don't want your provider to prescribe you TRT. You can get so much better care privately.


By thorough enough you mean your doctor ordered Total T, Free T (Equilibrium Dialysis or Ultrafiltration method), SHBG, CBC, lipids, prolactin, LH and FSH?

Yes, that's what I'm learning. There's actually a Urologist in the same Clinic, which was sort of my reasoning for going there initially.

I mostly just wanted to see what I could learn, and was overdue for a general once-over from a Dr anyway, as I hadn't been in a couple years.

I should have been more clear with that "thorough enough" statement, as that wasn't directed towards the testosterone testing per say. I went for a "wellness" check. I'm not even sure what all they'd tested me for (but they took 4 vials of blood), I remember thyroid was one. I will need to have reports in hand before I can honestly say which tests were performed.

I have an appointment for Friday for a pre-out-patient surgical procedure, as well as being given an appointment date for a Rheumatologist, and will get copies of reports then.

Worse case scenario, I'll make an appointment at Quest, if that's the direction I'm given here once I am able to provide more info.

Again, appreciate the advice.
 

Smitty57

New Member
OK, here's an update.

Appointment today to review labs, test was at 270, low range for insurance to cover?????

264, LOL....go figure

Have other results, not directly related, but all in all she said I was in pretty good shape (aside from test naturally).

Long story short, I had her write me a 'script and told her I'd just pay for it. 100mg/week, told her I would do 50mg 2x/week, subQ.

She had no issues with it.

Can't pick-up until 1st of the week. Dr had given me some syringes/needles, but they're 3mL, so I went ahead and ordered some 1cc with 21ga loading and 25x5/8" to inject.

Will go back for blood 4 weeks after I actually start. Dr is extremely accommodating and seems willing to work with me, so I'm going to let it roll for a while and see how it goes. $45 for 10 weeks is better for me ATM than shelling-out 15x that amount to go elsewhere. I always have that option, should it come to it.
 

madman

Super Moderator
OK, here's an update.

Appointment today to review labs, test was at 270, low range for insurance to cover?????

264, LOL....go figure

Have other results, not directly related, but all in all she said I was in pretty good shape (aside from test naturally).

Long story short, I had her write me a 'script and told her I'd just pay for it. 100mg/week, told her I would do 50mg 2x/week, subQ.

She had no issues with it.

Can't pick-up until 1st of the week. Dr had given me some syringes/needles, but they're 3mL, so I went ahead and ordered some 1cc with 21ga loading and 25x5/8" to inject.

Will go back for blood 4 weeks after I actually start.
Dr is extremely accommodating and seems willing to work with me, so I'm going to let it roll for a while and see how it goes. $45 for 10 weeks is better for me ATM than shelling-out 15x that amount to go elsewhere. I always have that option, should it come to it.

Welcome!

Much to come as you start your journey.

Forget the 21G to load and 25G to inject.

Would be much more sensible let alone efficient to use 1ml or .5ml 27-31G (6MM/8MM/12.7MM needle length) LDS fixed insulin syringes.

The main benefits of using LDS (low dead space) fixed insulin syringes are a minimal waste of medication (esterified T), virtually painless, minimize scar tissue/trauma, easier to read for accurate dosing especially when injecting lower volumes of oil more frequently.

Keep in mind that since you are injecting 100mg/week split (50mg every 3.5 days) that you need to test at the true trough which would be 84 hrs post-injection.

You should have your TT, FT, estradiol, SHBG, DHT, prolactin, and DHEA let alone other critical blood markers such as RBCs/hemoglobin/hematocrit.

It is critical that you use the most accurate assays for TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Knowing where your SHBG sits is critical as it will have a significant impact on FT let alone can dictate what injection frequency may suit one best.


post #2

 

Smitty57

New Member
Thanks for the info and welcome mm!

It will take me a bit to adjust. I ordered syringes in a hurry, many items OOS, so I took what I could get to get me by for a while. Doc gave me a few, but not enough for the 10 week supply. Not totally unfamiliar with injecting as I'd given BPC-157 a try for a several months. Seemed to help the knee, not so much shoulders and elbows.


Regarding other labs, I did have a few other things checked (along with total test0 Cholesterol (HDL/LDL and ratio), Triglycerides, CBDC with platelet and differential, CMP, Thyroid, PSA, CRP, Antistreptolysin, CCP antibodies, all in range. Uric Acid low.

ANA flagged as 180>150and Vit D flagged 107 ng/ml (which I supplement fairly heavy, so no surprised), but was informed I was near toxic level (over 100 ng/ml). Doc asked me to drop supplementing D, so I'm greatly reducing the supplemental side of that specific Vit. GFR also slightly elevated (creatinine 1.01 in a 0.70-1.30 range? not fully seeing an issue, but?) Kidney function and electrolytes in range. BUN was 23 in a range of 8-23, Glucose high at 100 of 65-99.

Doc is scheduling appt with Rheumatologist. 10 year ASCVD is 7.4%.

I'm trying to find out if Quest offers a test package which covers those you mentioned. but they're pretty vague on the website, so I may just have to call them. Then again, I need to find-out exactly what the Doc has in mind for testing at 4 weeks in.
 

Smitty57

New Member
I guess nothing's simple anymore. Never heard from Pharmacy, was told Mon/Tues for 'scrip to be filled.....so I just went to find out what the holdup was.

They had no clue who I was, nor anything regarding my prescription. After about 15 minutes of playing 20 questions, they finally found the hard copy of my 'scrip.....unfilled.

I will withhold adding what my opinion was to them as I snatched my prescription out of her worthless hand, and left.

Drove a couple blocks to Kroger, had it filled in 20 minutes, and for half the price I was told at the other place.

I did see it's only 100mg/ml. i thought 200 was the "norm"? Is my doc just being overly cautious, waiting for 4 week labs? Being at 270, I'd have thought I'd have been given more of a boost.
 

madman

Super Moderator
I guess nothing's simple anymore. Never heard from Pharmacy, was told Mon/Tues for 'scrip to be filled.....so I just went to find out what the holdup was.

They had no clue who I was, nor anything regarding my prescription. After about 15 minutes of playing 20 questions, they finally found the hard copy of my 'scrip.....unfilled.

I will withhold adding what my opinion was to them as I snatched my prescription out of her worthless hand, and left.

Drove a couple blocks to Kroger, had it filled in 20 minutes, and for half the price I was told at the other place.

I did see it's only 100mg/ml. i thought 200 was the "norm"? Is my doc just being overly cautious, waiting for 4 week labs? Being at 270, I'd have thought I'd have been given more of a boost..

When it comes to trt the most commonly used esters are (cypionate/enanthate).

The majority are using 200 mg/mL strength.

Advantages would be more cost-effective let alone less volume of oil when injecting which is beneficial when injecting strictly sub-q.

I would wait 6 weeks before getting blood work done.

The most sensible piece of advice would be to start low and go slow.

You were already prescribed 100 mg/week split into twice-weekly injections (50 mg every 3.5 days) which is a sensible dose when starting trt.

You may very well end up achieving a high-end trough FT on such protocol.

Forget worrying about where your pre-trt TT sits.

I would be more concerned with where your SHBG sits as it will have a significant impact on FT level achieved on such protocol (dose T/injection frequency).

Most men are injecting 100-200 mg/week (high-end dose) and trust me when I tell you that many men can easily achieve a healthy let alone high-end or even absurdly high trough FT on 100-150 mg/week.

Unfortunately, many of the run-of-the-mill T clinics are jacking men up on T (200mg/week) from the get-go let alone throwing in an AI to boot trying to control the sky-high estradiol!

Such protocol will have FT through the roof and in many cases can cause numerous issues as most will end up struggling one way or another.

Patience is key.

Much easier increasing your dose slightly (if need be) than getting jacked up from the get-go and having to come back down.
 

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