Defy Medical Help

[52hoosier]

I've been a Defy patient for a few years. They are very good and can be expensive, especially for me the every 6 month blood work. Nurse Jill does my consultations.

I must say that their customer service is becoming hit and miss. I got a snarky email today because I hadn't had my labs done and they were overdue. The problem is that they never notified me that they were due until today. As much as I pay them, it seems like they could check their own emails to see if you've been notified or not before sending a less than friendly email.

UPDATE: I did receive an apology for the email after I responded to it. They are blaming their system and supposedly not having the right phone# which is odd as I've always had the same phone# with Defy and have received text lab notifications in the past.

 

[fifty]

Trt places will prescribe you trt if your levels are 1000. Don’t worry about that part. $ is $.

 

[Dr Justin Saya MD]

Trt places will prescribe you trt if your levels are 1000. Don’t worry about that part. $ is $.

While that may be true of some in this field/industry, come on fellas...you know that’s not how we operate.

To the OP - you would benefit from a comprehensive lab evaluation and consultation (full thyroid, SHBG, LH, prolactin in addition to the basics). Not much can be determined without same.

 

[Vtail]

While that may be true of some in this field/industry, come on fellas...you know that’s not how we operate.

To the OP - you would benefit from a comprehensive lab evaluation and consultation (full thyroid, SHBG, LH, prolactin in addition to the basics). Not much can be determined without same.

I've been struggling to understand the treatment protocols of TRT clinics, and I'm talking about the responsible, knowledgeable doctors like yourself. If someone comes to you with TT at 1000, you will deny TRT treatment (as I assume you should). However if someone comes to you with TT at 200, you will treat (all things being equal). Then as treatment progresses the aim is to get the TT levels to the top of the reference range at trough shooting for FT at about 2% of TT. At this point the patient is likely supraphysiological for much of the time, especially if it's a 1x or 2x per week schedule. From my limited understanding, the peak could be ~1500 (+/-). Is there no concern about someone being so far above the reference range? Or is it at this point symptom driven with little regard to the peak blood levels?

 

[Jason Sypolt]

I've been struggling to understand the treatment protocols of TRT clinics, and I'm talking about the responsible, knowledgeable doctors like yourself. If someone comes to you with TT at 1000, you will deny TRT treatment (as I assume you should). However if someone comes to you with TT at 200, you will treat (all things being equal). Then as treatment progresses the aim is to get the TT levels to the top of the reference range at trough shooting for FT at about 2% of TT. At this point the patient is likely supraphysiological for much of the time, especially if it's a 1x or 2x per week schedule. From my limited understanding, the peak could be ~1500 (+/-). Is there no concern about someone being so far above the reference range? Or is it at this point symptom driven with little regard to the peak blood levels?

Great question, but there is really no one-size-fits-all answer to it. We could be talking natural vs hypogonadal, vs someone on an existing TRT protocol, and even comparing 2 patients often is not a great comparison at all because many people need very different amounts of T and other medications for treatment of symptoms despite what their lab results show in numbers.

Whichever clinic someone looks at for treatment, you want to make sure that you are treated individually. That is, your lab results, your symptoms, your concerns and questions. Because if all of those things are not taken into account as a whole health snapshot as your case vs everyone else then you likely are not going to get the most out of your effort and time and money to improve your health.

That is one of the great things about Defy and why I became a patient years ago. It isn't about only numbers or symptoms or testosterone. It's about looking at what does it take to get you feeling better and change your life.

 

[Cataceous]

...
That is one of the great things about Defy and why I became a patient years ago. It isn't about only numbers or symptoms or testosterone. It's about looking at what does it take to get you feeling better and change your life.

Ok, but it would still be interesting to see more discussion of @Vtail's question: "Is there no concern about someone being so far above the reference range?"

I've been on daily propionate for a year and when I come to my consultations with trough testosterone around 400-500 ng/dL I can feel the tacit disapproval, "Well I guess if you feel ok that low..." I had to argue that my peak was much higher, and only recently confirmed that in fact it's been over 1,000 ng/dL.

The point is that something similar happens with longer esters and less frequent injections, so guys are routinely ending up at supraphysiolgical levels earlier in their injection cycles. The obvious answer is to inject more frequently at lower average doses, but then you may run into compliance issues. An overall dose reduction is problematic, as I suspect that going full days at lower levels—i.e. later in the injection cycle—is when the problems start. This is in contrast to natural healthy men who can have normal and "low" levels each day, depending on the time.

 

[slicktop]

Ok, but it would still be interesting to see more discussion of @Vtail's question: "Is there no concern about someone being so far above the reference range?"

I've been on daily propionate for a year and when I come to my consultations with trough testosterone around 400-500 ng/dL I can feel the tacit disapproval, "Well I guess if you feel ok that low..." I had to argue that my peak was much higher, and only recently confirmed that in fact it's been over 1,000 ng/dL.

The point is that something similar happens with longer esters and less frequent injections, so guys are routinely ending up at supraphysiolgical levels earlier in their injection cycles. The obvious answer is to inject more frequently at lower average doses, but then you may run into compliance issues. An overall dose reduction is problematic, as I suspect that going full days at lower levels—i.e. later in the injection cycle—is when the problems start. This is in contrast to natural healthy men who can have normal and "low" levels each day, depending on the time.

Daily enanthate user here. Are you saying your trough range, on daily injections, is 400-500? And you're hitting a peak of over 1,000? That seems like a massive swing for a long ester in a 24 hour period.

 

[Cataceous]

Daily enanthate user here. Are you saying your trough range, on daily injections, is 400-500? And you're hitting a peak of over 1,000? That seems like a massive swing for a long ester in a 24 hour period.

"I've been on daily propionate for a year..." Before that, on EOD enanthate, any fluctuations in my total testosterone were basically undetectable. On propionate, daily hormonal swings are routinely almost +/-60% around the predicted averages.

 

[Jason Sypolt]

Ok, but it would still be interesting to see more discussion of @Vtail's question: "Is there no concern about someone being so far above the reference range?"

I am only able to give my personal opinion on that for what that is worth. I do have a question though - I will PM you.

 

[52hoosier]

UPDATE: I did receive an apology for the email after I responded to it. They are blaming their system and supposedly not having the right phone# which is odd as I've always had the same phone# with Defy and have received text lab notifications in the past.

Customer Service has also reached out to me. I don't blame the young lady who sent the email. She was only doing her job sending out a form email that, in my opinion, is poorly written and accusatory.

 

[52hoosier]

I've been a Defy patient for a few years. They are very good and can be expensive, especially for me the every 6 month blood work. Nurse Jill does my consultations.

I must say that their customer service is becoming hit and miss. I got a snarky email today because I hadn't had my labs done and they were overdue. The problem is that they never notified me that they were due until today. As much as I pay them, it seems like they could check their own emails to see if you've been notified or not before sending a less than friendly email.

Defy has reached out to me about this. Just got off the phone with Jason and he apologized and said he agreed that tone was unfriendly and that he and others are reviewing and rewriting this particular email and some others. I'm glad because that email did not at all reflect Dr. Saya and his good attitude and care. Thank you, Defy.

 

[Jon H]

I've been struggling to understand the treatment protocols of TRT clinics, and I'm talking about the responsible, knowledgeable doctors like yourself. If someone comes to you with TT at 1000, you will deny TRT treatment (as I assume you should). However if someone comes to you with TT at 200, you will treat (all things being equal). Then as treatment progresses the aim is to get the TT levels to the top of the reference range at trough shooting for FT at about 2% of TT. At this point the patient is likely supraphysiological for much of the time, especially if it's a 1x or 2x per week schedule. From my limited understanding, the peak could be ~1500 (+/-). Is there no concern about someone being so far above the reference range? Or is it at this point symptom driven with little regard to the peak blood levels?

Don't buy into the hype that anything over 1,000TT is supra-physiological. That's simply not the case. Just five years ago, having a peak of ~1500TT would have been considered barely above normal range. LabCorp changed the range 2-3 years ago to 264-916TT.
https://www.labcorp.com/assets/11476
They even admit that they used "a population of lean healthy males" in their earlier study, so they felt they should use men that were more fat for the next study, since fat can lower testosterone levels. In the newer study they said they used healthy non-obese males with a BMI of <30. That means that a sedentary couch potato, 6'0'' tall, weighing 220lbs, (with 50 lbs of abdominal fat and no muscle) would qualify as being non-obese and healthy. It's a slick sales job that makes sick people think they fall into the categories of normal and healthy.
Calculate Your BMI - Standard BMI Calculator

For years before that the range was 348-1197, meaning someone with a TT of 1100 would've been considered perfectly physiological. 20 years before that the range would've been even higher. 10 years from now, the range will probably be changed to 200-650, and doctors will be aghast if someone has a peak level of 800TT. Testosterone, sperm-count, and general virility of males in modern culture has dropped at an alarming rate for decades, and the general medical community's way of addressing it is just to change the definition of "normal". The middle of the current "normal" range is actually not that great, and is nothing I'd want to aim for. I never want to feel "not bad". I want to feel good.

 

[Cataceous]

Don't buy into the hype that anything over 1,000TT is supra-physiological. That's simply not the case. ...

It is supraphysiological if you have normal SHBG. For example, TT of 1,000 ng/dL and SHBG of 30 nMol/L yields a Tru-T free testosterone of 36 ng/dL, above the healthy normal range of 16-31. This latter range is based on healthy men, not the overall population.

 

[dushkuloriccx]

I have similar health problems, and the attending physician said that I needed a clinic for a regular check-up. And a doctor who will guide me throughout my life. I have been looking for a good option for a very long time, since I am a state employee and money is a problem. I reviewed many options, and phoned a lot of doctors. As a result, my stepfather, he is a doctor with great experience. Arranged me in this clinic Cloud Based Allied Health Practice Management Platform, Allied Health Software | iinsight. It was the perfect option for me, the services are not expensive, and the clinic is 30 minutes from my house.