I've been on TRT With Defy Over a Year - Still Can't Figure Out Appropriate Dosage

tarnation · May 6, 2018

Hey everyone,

I've been a patient with Dr. Saya, at Defy Medical, for more than a year now, and we are still unable to figure out the appropriate protocol for me. I am currently taking 140mg testosterone along with 700 units of HCG a week split into two doses. I am also taking 180mg of Natural Desiccated Thyroid every morning. I recently got my lab results back and I am a little concerned about my high e2 / testosterone and low thyroid. I haven't had any noticeable symptoms but I think I should get my e2/thyroid back in range.

I am thinking about decreasing my testosterone or HCG dose. Does anyone have any suggestions on how much I should lower it by? Also, my thyroid levels are obviously need work - any recommendations on what I should be looking for in terms of a possible fix? Lastly, does anyone have any additional insight on my labs down below?

Thanks in advance!

Testosterone 1,451 ng/dL 193 - 824 ng/dL
Testosterone Free % 3.6 % 1.4 - 3.2 %
Testosterone Free 527.2 pg/mL 41.7 - 180.2 pg/mL
Estradiol 60.1 pg/mL 10.0 - 42.0 pg/mL
Protein, Total 7.3 g/dL 6.3 - 8.0 g/dL
Albumin 4.8 g/dL 3.9 - 4.9 g/dL
Calcium 9.9 mg/dL 8.5 - 10.2 mg/dL
Bilirubin, Total 1.1 mg/dL 0.2 - 1.3 mg/dL
Alkaline Phosphatase 62 U/L 36 - 108 U/L
AST 24 U/L 14 - 40 U/L
Glucose 66 mg/dL 74 - 99 mg/dL
Hematocrit 48.0 % 39.0 - 51.0 %
PSA 0.40 ng/mL 0.00 - 2.59 ng/mL
PSA, Percent Free 78 %
Free T3 2.3 pg/mL 2.3 - 4.1 pg/mL
Free T4 0.7 ng/dL 0.9 - 1.7 ng/dL
TSH 0.385 uU/mL 0.400 - 5.500 uU/mL

Blackhawk · May 6, 2018

Based on your (lack of) symptoms, sounds like you are indeed on the right track. The numbers are only part of the reasoning/basis for your dosages, how you feel is equally or even more important.

So, if you are concerned, yes, look into reducing T dose, re-evaluate after 6-8 weeks, and yes, ask Saya about the thyroid. Especially, reverse T3, it is possible your diodinases are out of whack and you are converting to RT3.

tarnation · May 6, 2018

Thanks - I was always under the assumption that lab results > symptoms. Is that not the case? Also, what are your thoughts on possibly introducing an AI instead of decreasing the test? I think I already know the answer, but I'd love to get your thoughts!

Vince · May 6, 2018

I'm really surprised at your high testosterone numbers, when you have your next consultation I definitely would discuss any concerns you have with Dr. Saya. I just started with synthetic T3 because my free T3 has been low and I'm finally going to have my reverse T3 checked.

can cytomel by itself be used to treat hypothyroidism

https://www.excelmale.com/forum/sho...mel-by-itself-be-used-to-treat-hypothyroidism

madman · May 6, 2018

tarnation said:
Thanks - I was always under the assumption that lab results > symptoms. Is that not the case? Also, what are your thoughts on possibly introducing an AI instead of decreasing the test? I think I already know the answer, but I'd love to get your thoughts!

Of course improvement/relief of low t symptoms is what really matters and numbers on labs should be used as guidance in determining whether one may benefit from decreasing/increasing testosterone/hcg/aromatase inhibitor dose.

You definitely can try lowering dose as your total t/free t levels are high if it was taken at trough as you may very well lower e2 by getting your trough into the 900s and and bringing down your free t a little.

120 mg/week (60mg every 3.5 days) would be worth trying and then gauge how you feel along the way and have lab work done 6 weeks later.

I would discuss with Dr. Saya before changing your protocol.

Sure even though you are not experiencing any high e2 symptoms and you feel well overall you may very well still benefit at a lower t dose.

I would definitely avoid adding an a.i. if not needed.

Sure labs are just numbers to some but they let you know how a specific dose effects your hormones among many other health markers.

There are the low and high end of ranges and regarding total t/free t many will argue about what the ranges should be but highly doubtful anyone need to have their total t TROUGH at 1000+ along with free t on the upper end.

Regarding free t many will state 2-3% is the norm when in fact searching the literature free testosterone is 2% on average and 98% of testosterone is bound (shbg bound fraction/albumin bound fraction).

Many seem to feel they need to have really high total t/free t levels when in fact a lot of men do well having testosterone levels fall in the mid-normal physiological range where as others need to have levels in the high end of the physiological range to experience relief/improvements of their low t symptoms and I doubt anyone needs to be running supra-physiological testosterone levels to benefit from trt.

To each his own but I personally feel it is best to use the least amount of testosterone ones physiology needs to experience benefits from trt.

HealthMan · May 6, 2018

Your testosterone levels are way too high. I would drop your dosage to at least 100mg/week and retest in 2 months

CoastWatcher · May 6, 2018

When did you draw these labs, relative to your injection schedule?

tarnation · May 6, 2018

I got these labs done 3-5 hours before I usually take my biweekly shots.

tarnation · May 6, 2018

Okay, do you think dropping to 120 is better than 100? I'm worried my testosterone levels might drop too low by going down to 100.

tarnation · May 6, 2018

Vince said:
I'm really surprised at your high testosterone numbers, when you have your next consultation I definitely would discuss any concerns you have with Dr. Saya. I just started with synthetic T3 because my free T3 has been low and I'm finally going to have my reverse T3 checked.

can cytomel by itself be used to treat hypothyroidism

https://www.excelmale.com/forum/sho...mel-by-itself-be-used-to-treat-hypothyroidism

Thanks I'll definitely bring it up with Dr. Saya during my next consultation. I did, however, want to get as many opinions as possible. Its just really frustrating waiting months for my next consultation, and I want to handle any problems that might arise before they actually arise.

Thanks for the link! I never looked into cytomel - very interesting read!

tarnation · May 6, 2018

madman said:
Of course improvement/relief of low t symptoms is what really matters and numbers on labs should be used as guidance in determining whether one may benefit from decreasing/increasing testosterone/hcg/aromatase inhibitor dose.

You definitely can try lowering dose as your total t/free t levels are high if it was taken at trough as you may very well lower e2 by getting your trough into the 900s and and bringing down your free t a little.

120 mg/week (60mg every 3.5 days) would be worth trying and then gauge how you feel along the way and have lab work done 6 weeks later.

I would discuss with Dr. Saya before changing your protocol.

Sure even though you are not experiencing any high e2 symptoms and you feel well overall you may very well still benefit at a lower t dose.

I would definitely avoid adding an a.i. if not needed.

Sure labs are just numbers to some but they let you know how a specific dose effects your hormones among many other health markers.

There are the low and high end of ranges and regarding total t/free t many will argue about what the ranges should be but highly doubtful anyone need to have their total t TROUGH at 1000+ along with free t on the upper end.

Regarding free t many will state 2-3% is the norm when in fact searching the literature free testosterone is 2% on average and 98% of testosterone is bound (shbg bound fraction/albumin bound fraction).

Many seem to feel they need to have really high total t/free t levels when in fact a lot of men do well having testosterone levels fall in the mid-normal physiological range where as others need to have levels in the high end of the physiological range to experience relief/improvements of their low t symptoms and I doubt anyone needs to be running supra-physiological testosterone levels to benefit from trt.

To each his own but I personally feel it is best to use the least amount of testosterone ones physiology needs to experience benefits from trt.

I don't feel bad on my current protocol - but the lab results have me a little worried (especially the e2 and the thyroid). I also want to stop any problems before they might arise. Do you think I should speak with Dr. Saya before making any changes to my protocol? It's frustrating waiting months to make address problems that might lead to long term health consequences. I was thinking about droping my dosage to 120 a week and then get labs done before my next consult.

Systemlord · May 6, 2018

tarnation said:
Okay, do you think dropping to 120 is better than 100? I'm worried my testosterone levels might drop too low by going down to 100.

Most guys hit high normal testosterone levels (650-850) on 100mg weekly split twice weekly, there's little to no concern of dropping levels too low at this dosage.

madman · May 6, 2018

tarnation said:
I don't feel bad on my current protocol - but the lab results have me a little worried (especially the e2 and the thyroid). I also want to stop any problems before they might arise. Do you think I should speak with Dr. Saya before making any changes to my protocol? It's frustrating waiting months to make address problems that might lead to long term health consequences. I was thinking about droping my dosage to 120 a week and then get labs done before my next consult.

I would speak with Dr. Saya first and let him know your concerns as seeing you feel ok overall a few months is not going to result in any health consequences and even then with the test levels you are posting right now for a TROUGH 1400+ yes it is really high and even than that dose not mean one will run into long term health issues.

When the time comes if you end up lowering your dose try 120 mg/week (60 mg every 3.5 days) as it will make a difference in lowering your total t/free t and e2 as 20 mg less will have a big impact and no need to jump down to 100 mg/week right away.

tarnation · May 6, 2018

madman said:
I would speak with Dr. Saya first and let him know your concerns as seeing you feel ok overall a few months is not going to result in any health consequences and even then with the test levels you are posting right now for a trough 1400+ yes they are really high and even than that dose not mean one will run into long term health issues.

When the time comes if you end up lowering your dose 120 mg/week (60 mg every 3.5 days) it will make a difference in lowering your total t/free t and e2 as 20 mg less will have a big impact and no need to jump down to 100 mg/week right away.

Thanks! I'll try to get on the phone with someone from Defy tomorrow!

Blackhawk · May 6, 2018

Re thyroid, what time of day was your blood draw and what time did you take the NDT?

You could have a lower number if NDT was early and draw was later afternoon

tarnation · May 6, 2018

Blackhawk said:
Re thyroid, what time of day was your blood draw and what time did you take the NDT?

You could have a lower number if NDT was early and draw was later afternoon

NDT was taken at around 6:30 AM and the tests were done at around 5:30PM

HealthMan · May 6, 2018

tarnation said:
Okay, do you think dropping to 120 is better than 100? I'm worried my testosterone levels might drop too low by going down to 100.

Why would you want to keep your testosterone levels that high? I don’t see any health benefits other that building muscle and potentially some health issues. Your FT is very high. I doubt a 20mg drop in your weekly dosage will bring your FT to more reasonable levels

Dr Justin Saya MD · May 6, 2018

Tarnation - don’t have your full chart in front of me, but a reduction would be worthwhile, while monitoring for the occurrence (since you don’t currently have any) of symptoms.

Reduce 20% from 0.35ml (70mg) BIW to 0.28ml (56mg) BIW and recheck T/E after at least 6 weeks (and before consult to be most efficient).

madman · May 6, 2018

HealthMan said:
Why would you want to keep your testosterone levels that high? I don't see any health benefits other that building muscle and potentially some health issues. Your FT is very high. I doubt a 20mg drop in your weekly dosage will bring your FT to more reasonable levels

Some may feel more comfortable not making such a large jump from 140 mg/week - 100 mg/week.....................sure only dropping to 120 mg/week may not result in lowering levels enough but from the mental aspect some are nervous when having to decrease testosterone dose especially when they are so use to a said protocol.

tarnation · May 6, 2018

Dr Justin Saya said:
Tarnation - don't have your full chart in front of me, but a reduction would be worthwhile, while monitoring for the occurrence (since you don't currently have any) of symptoms.

Reduce 20% from 0.35ml (70mg) BIW to 0.28ml (56mg) BIW and recheck T/E after at least 6 weeks (and before consult to be most efficient).

Thank you so much for replying, Dr I'll decrease the testosterone to 56mg twice a week. Would you like me to change my thyroid protocol before our next consult as well?

I've been on TRT With Defy Over a Year - Still Can't Figure Out Appropriate Dosage

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