starting TRT with Defy

[peet64]

After being on clomid mono therapy ( 25 mg daily) for almost 2 years I am switching to TRT. Back in February this year I had sought advice on this forum, as my clomid protocol was not working for me anymore. You guys suggested to try Defy, so in March I became a new patient with Defy. My labs were :


Total Testosterone 830 ng/dL (264 - 916 )

Free Testosterone 11.5 pg/mL (7.2 - 24.0 )

Estradiol 79.4 pg/mL (8.0 - 35.0 )

SHBG 68.9 nmol/L (19.3 -76.4)

DHEA-sulfate 107.3 ug/dL (48.9 - 344.2)

At my first consultation in March, I was told I could start TRT or continue with the clomid protocol along with .125 Anastrozol, 10mg Boron and 200mg DIM for 3 mths. I decided to continue with the clomid, but felt no better.

In June my labs were:

Total Testosterone 781 ng/dL

Free Testosterone 8.2 ng/dL

T4,Free 0 .89 ng/dL (0.82 -1.77 )

Estradiol 77.3 pg/mL

SHBG 82.2 nmol/L

DHEA sulfate 290.9 ug/dL

Reverse T3 12.8 ng/dL (9.2 - 24.1)

Triiodthyronine
(T3) Free 3.1 pg/mL (2.0 - 4.4 )


So my meds arrived today and will be starting tomorrow with a 2 time a week regimen, Sundays and Wednesdays. The plan for me is to inject .35 mg testosterone cypionate (2 x per wk ) and 350 IU hcg (2 x per wk ) Also .125 Anastrozol 2 x per wk, 200mg DIM and 10 mg Boron.

I am thinking of starting with a lower dose of testosterone ( .25mg 2 x wk ) and hcg (250IU 2 x wk). Depending on how I feel, increase the dosage. I heard if one takes smaller frequent dosages of testosterone and hcg this can help to reduce high estradiol thus eliminating the use of AI.
Should I do the lower testosterone and hcg dose or should I start with what I have been prescribed?

 

[fifty]

I think it's a good idea to try what you say at .25ml (50mg) twice a week.

Your clomid numbers looked pretty good other than SHBG creeping up. It's really too bad enclomiphene is not more readily available.

 

[Gman86]

I also tried Clomid mono, and had same results. SHBG sky rocketed, and felt the worst I’ve ever felt in my life.

I was going to recommend you start with a lower dose. So you read my mind on that one. If I could go back, I would do the start low and go slow method. I would start with either 80 or 100mg per week, and titrate up slowly until I found a dose that worked for me without an ai. I would also drop the HCG. That’s me personally though, you can keep the HCG if you want. HCG seems to just complicate things too much. I would personally just start low, and keep it simple at the beginning. Then add in HCG afterwards if fertility is important, and/ or if you just want to try it out to see if you get any subjective benefits from it. But if I could go back, I would of kept it simple and started without it.

I was personally on HCG for years and years, and have been off of it for the past 5-6 months. Haven’t noticed any differences, good or bad, once I stopped it. Am going to need to add it back in eventually, for fertility purposes. And I also want to give it another go at some point and see if I notice any positives from starting it again, after being off of it for so long.

 

[Systemlord]

I suspect 50mg twice weekly will not be enough, you need excess androgens to help suppress SHBG which is high. You'll probably need 1000> ng/dL.

 

[Gman86]

I suspect 50mg twice weekly will not be enough, you need excess androgens to help suppress SHBG which is high. You'll probably need 1000> ng/dL.

His SHBG is only high due to the Clomid. Even if he didn’t use anything, but discontinued the Clomid, his SHBG would come back to baseline. My SHBG was 91 on Clomid, and then my next protocol was HCG mono. On the HCG my androgens were lower than my when I was on nothing at all pre-HRT, and my SHBG was 41. Which is on the low side for me. So to get his SHBG down to baseline, or slightly lower, he doesn’t need to push his total T that high to start. Definitely smarter to start low and go slow. No offense to you systemlord, obviously. Don’t mean to disagree with you. It would just be foolish to start his testosterone dose unnecessarily high based off of his SHBG level while on Clomid. His SHBG will be just fine once the Clomid clears from his system. Below is my labs while on HCG mono, right after stopping Clomid mono.


HCG - 2000IU split into EOD dosing

Total - 559 (250-1100)
Free T- 64.5 (46.0-224.0)
SHBG 41 (10-50)
E2 NOT Sensitive - 30

 

[Systemlord]

His SHBG is only high due to the Clomid.

I thought the first set of labs were off clomid for some reason. That would mean his SHBG is artificially high and will probably be about mid-range normally.

I need some coffee.

 

[Gman86]

I thought the first set of labs were off clomid for some reason .

Nope, both were while on Clomid. He started with defy while already on Clomid. Then they asked if he wanted to continue or stop Clomid, and he continued, and then had labs done again while with defy, while still using Clomid. The very high SHBG with the very high E2 levels are dead giveaways for being on Clomid mono

 

[Vince]

I would follow Defy Medical protocol until you have labs and adjust from there. Did Defy talk about your thyroid levels?

 

[peet64]

I would follow Defy Medical protocol until you have labs and adjust from there. Did Defy talk about your thyroid levels?

Defy did address my thyroid levels. I was told that my thyroid levels looked ok but in 3 months they will check it again.

 

[wondering]

Follow the protocol the doctors at Defy prescribed and adjust from there. Doctors need patients to be honest with them and follow protocols as defined. What do you plan on telling them once labs come in and you need adjusting? It is also grounds for being dismissed from a practice. Everything I have read here is they are reasonable and will take your input into consideration. For heavens sake, give them a chance.

 

[jmzwy]

this...

I would follow Defy Medical protocol until you have labs and adjust from there. Did Defy talk about your thyroid levels?