1. #1

    Need answers while I have the energy to do something about it...

    I posted this in ďask the docĒ but Iím posting it here too because I desperately need answers from anyone who has them. I need to figure out a plan while I actually have the energy to do something about it...

    Iím going to try to be a minimalist so this post doesnít run away from me but as an FYI Iím happy to provide more info and blood work if needed.

    I have recently lost 100 pounds. I did so by ketogenic eating, working out like a mad man and sometimes intermittent fasting. No supplements. I currently weigh 280 and ALL my weight loss/hard gaining has stopped. After practically forcing my doctor to run the test my total test came back at 270. (Imagine what it was when I was 100 pounds heavier and eating a low fat diet) He refuses to do anything because 270 is ďwithin normal reference rangeĒ even though I explained to him that the society of endocrinologists says thatís normal for an 80 year old.

    Iím in my early 30ís and planning to have kids soon so impotence is not desirable to me. I donít need to be a massive man just a healthy man with dry hard muscle would be great. Iíve done tons of research and my goal is to reach a side effect free total test level of 1,000 or more with a good healthy lipid panel.

    The drugs im strongly considering are Aromasin, Enclomiphene and SR9009 for its lipid benefits more so than performance although Iíll take any advantage I can get. If that didnít set me up nicely I would consider adding HCG or HMG.

    Is this a good or acceptable strategy? I know Iím no doctor but I have to do something and Iím battling with zero energy and a grey outlook on life. I need to make a decision and I need to make it now. Please help because no doctor in my small town will.

    Lastly, despite low T my libido has always been sky high. Does that signify anything relevant that I should be considering?

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  3. #2
    Moderator Vince's Avatar
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    Losing weight can cause your thyroid to slow your metabolism by increasing your reverse T3. I would get a complete thyroid panel with TSH, FT4, FT3, reverse T3 and antibodies. I would also get a complete testosterone panel with testosterone serum, Free T, DHEA - Sulfate, Estradiol, Sensitive, SHBG and DHT.

    Total T of 270 is extremely low for any man, we have two clinics that advertise here that would treat you. Defy medical and Prime body.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  4. #3
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    But how would they treat me? Exogenous test doesnít seem desirable to me as Iím supposed to have a kid next year. Thereís only 1500 people in this town, I canít rely on this doctor I have to figure this out myself.

    I heard of a place called discount labs that Iím thinking of ordering through.

  5. #4
    Well of course with any grey market or black market meds, aside from potential legal issues, you have the problem of not being sure you're really getting what you ordered.

    I just posted these in another thread but we have the Lipschultz study and also user experiences from here showing that you can go on testosterone with HCG (and FSH if budget allows) and still retain fertility, most likely, but of course no guarantees in life. Better chance if your pre-TRT sperm count isn't too low. You can order semen analysis through Discounted Labs.

    Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. http://www.ncbi.nlm.nih.gov/pubmed/23260550

    https://www.excelmale.com/showthread...to-TRT-and-hCG

    https://www.excelmale.com/showthread...d-While-on-TRT

  6. #5
    Quote Originally Posted by Fatboy View Post
    But how would they treat me? Exogenous test doesn’t seem desirable to me as I’m supposed to have a kid next year. There’s only 1500 people in this town, I can’t rely on this doctor I have to figure this out myself.

    I heard of a place called discount labs that I’m thinking of ordering through.
    Why don't you contact both Prime Body and Defy and discuss the issue with them? Gather as much information as to cost and process, and determine if you can proceed with treatment under their direction. Clearly, fertility is important to you, understandably so, yet you're considering a self-managed protocol utilizing underground pharmaceuticals. Make a few phone calls before jumping into that lake.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  7. #6
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    Quote Originally Posted by CoastWatcher View Post
    Why don't you contact both Prime Body and Defy and discuss the issue with them? Gather as much information as to cost and process, and determine if you can proceed with treatment under their direction. Clearly, fertility is important to you, understandably so, yet you're considering a self-managed protocol utilizing underground pharmaceuticals. Make a few phone calls before jumping into that lake.

    Those doctors arenít in my state, although I would rather have pharma grade stuff with doctors supervision Iím afraid Iím going to have to do this myself. My doc wonít do anything or refer me anywhere. My fiancť is a nurse and is extremely supportive. So if I canít get treatment I at least have her as a resource.

    So I am definitely still seeking a doc but Iím still curious if this protocol would work well for 2 reasons. First I donít want exo T if I can avoid it but I also donít want to go to a doc requesting something that is simply ineffective. Second if I canít affordably and realistically get treatment I will do it on me own. I think itís imoortant for me to keep in mind that being low T also loses significant risks. I canít be complacent about it anymore. One way or the other I need a result and I want to make sure I have ALL my bases covered.

  8. #7
    Quote Originally Posted by Fatboy View Post
    Those doctors aren’t in my state, although I would rather have pharma grade stuff with doctors supervision I’m afraid I’m going to have to do this myself. My doc won’t do anything or refer me anywhere. My fiancť is a nurse and is extremely supportive. So if I can’t get treatment I at least have her as a resource.

    So I am definitely still seeking a doc but I’m still curious if this protocol would work well for 2 reasons. First I don’t want exo T if I can avoid it but I also don’t want to go to a doc requesting something that is simply ineffective. Second if I can’t affordably and realistically get treatment I will do it on me own. I think it’s imoortant for me to keep in mind that being low T also loses significant risks. I can’t be complacent about it anymore. One way or the other I need a result and I want to make sure I have ALL my bases covered.
    You don't have to be in state to use them. They will do everything over the phone. A guy in my office is on TRT and as long as he takes his HCG he remains fertile. They just had their 3rd child...

  9. #8
    Quote Originally Posted by Fatboy View Post
    Those doctors aren’t in my state, although I would rather have pharma grade stuff with doctors supervision I’m afraid I’m going to have to do this myself. My doc won’t do anything or refer me anywhere. My fiancť is a nurse and is extremely supportive. So if I can’t get treatment I at least have her as a resource.

    So I am definitely still seeking a doc but I’m still curious if this protocol would work well for 2 reasons. First I don’t want exo T if I can avoid it but I also don’t want to go to a doc requesting something that is simply ineffective. Second if I can’t affordably and realistically get treatment I will do it on me own. I think it’s imoortant for me to keep in mind that being low T also loses significant risks. I can’t be complacent about it anymore. One way or the other I need a result and I want to make sure I have ALL my bases covered.
    You don't need to live in Florida to be a Defy patient. Their tele-health model offers coverage across the country. Many members here rely on them for treatment. Give them a call.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  10. #9
    Quote Originally Posted by Fatboy View Post
    Those doctors arenít in my state, although I would rather have pharma grade stuff with doctors supervision Iím afraid Iím going to have to do this myself. My doc wonít do anything or refer me anywhere. My fiancť is a nurse and is extremely supportive. So if I canít get treatment I at least have her as a resource.

    So I am definitely still seeking a doc but Iím still curious if this protocol would work well for 2 reasons. First I donít want exo T if I can avoid it but I also donít want to go to a doc requesting something that is simply ineffective. Second if I canít affordably and realistically get treatment I will do it on me own. I think itís imoortant for me to keep in mind that being low T also loses significant risks. I canít be complacent about it anymore. One way or the other I need a result and I want to make sure I have ALL my bases covered.
    Defy Medical and Prime Body are helping a lot of people on TRT via a legitimate tele-med service. The meds they prescribe and offer are not black market. They do not have to be in your state of residence. You can not go wrong with reaching out to them. They both are members of the forum, participate on it often, and have banners/ads on the forum as they are sponsors.

  11. #10
    Moderator Vince's Avatar
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    I'm a patient of Defy Medical and live in Wisconsin. I use Defy Medical because I couldn't find anyone knowledgeable enough to treat me. There a chance that they could treat you Clomid and you could remain fertile.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  12. #11
    I'm in Canada and I worked with Defymedical.com in Tampa by phone. If you can get a copy of your physical from your MD (no reason anyone cannot get that) then all you do is get labs and they'll take you on as a client for not much $$ and set your protocol to work. The short answer is what you suggest is far from a normal protocol.

  13. #12
    I'm in Socal and had a Defy consult yesterday and am going to proceed with the treatment that was suggested by Dr. Saya. I'm sure in 10 years this telemedicine will become the norm everywhere, medicines will be delivered by drones. You don't even need to get up off the couch.

  14. #13
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    This is awesome. Thank you all for pointing me the right direction. Iíll be looking into them both and proceeding with one of them more than likely.

    Are levels over 1,000 common or acceptable? And just how much will this help me in terms of weight loss, energy and grey outlook on life?

    Itís weird that Iíve always had very high libido and very muscular arms and legs to me for having such low test. I mean I have not an ounce of fat on my arms or legs but my midsection is enormous.

  15. #14
    Quote Originally Posted by Fatboy View Post
    This is awesome. Thank you all for pointing me the right direction. I’ll be looking into them both and proceeding with one of them more than likely.

    Are levels over 1,000 common or acceptable? And just how much will this help me in terms of weight loss, energy and grey outlook on life?

    It’s weird that I’ve always had very high libido and very muscular arms and legs to me for having such low test. I mean I have not an ounce of fat on my arms or legs but my midsection is enormous.
    Try not to fall into the tempting trap of chasing a number. It's fair to say that a total testosterone value of 1,000 is certainly not unusual, but to focus on total testosteone, and not weigh the importance of free testosteone (for example), can blind a fellow to where attention needs to be paid.

    You'll in good hands with either Prime Body or Defy. When you contact them you should ask as many hard questions as you can think of (cost, mode of treatment, and so on). They won't dodge.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  16. #15
    Moderator Vince's Avatar
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    Quote Originally Posted by Fatboy View Post
    This is awesome. Thank you all for pointing me the right direction. I’ll be looking into them both and proceeding with one of them more than likely.

    Are levels over 1,000 common or acceptable? And just how much will this help me in terms of weight loss, energy and grey outlook on life?

    It’s weird that I’ve always had very high libido and very muscular arms and legs to me for having such low test. I mean I have not an ounce of fat on my arms or legs but my midsection is enormous.
    Here's my latest labs.

    testosterone serum 1117 ng/dL range 264 - 916
    Free T 30.3 pg/mL range 6.6 - 18.1
    DHEA - Sulfate 347.3 range 48.9 - 344.2
    Estradiol, Sensitive 29.5 range 8.0 - 35.0
    SHBG 48.8 range 19.3 - 76.4
    HCT 47.9 range 37.5 - 51.0
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  17. #16
    Dosing will depend on your SHBG level and how sensitive you are to androgens, I'm very sensitive to androgens and can't handle the 600 range without breaking out in acne all over my body. So you see chasing a high number (1000) only causes me misery.

  18. #17
    Quote Originally Posted by Fatboy View Post
    ...............Are levels over 1,000 common or acceptable? And just how much will this help me in terms of weight loss, energy and grey outlook on life?...................
    Levels at or over 1,000 are common and acceptable as long as the other important areas are within proper boundaries. If levels are at 1,000 or greater and other areas are completely out of whack due to the high testosterone levels then it isn't going to be acceptable. If everything lines up and you are dialed in with levels at 1,000 you will feel typically feel good, have energy, and it should help you manage your weight. High levels of testosterone won't just make everything in your life perfect. You still need to manage your life, your diet, work out and stay in shape, etc.......but having good levels of testosterone will help you get to where you would like to be. It takes a while to get dialed in and it is a marathon not a sprint. My levels are similar to Vince's.

    Element Range Unit Result
    Testosterone 264 - 916 ng/dl 1055
    Free Test 7.2 - 24.0 pg/ml 30.1
    % Free to Total 2.0 - 3.0 % 2.85%
    Estradiol, Sensitive 8.0 - 35.0 pg/ml 35.3
    SHBG 19.3 - 76.4 nmol/l 30.0
    DHEA-S 49 - 344 ug/dl 261
    Hematocrit 37.5 - 51.0 % 48.0

    I do not use an AI and I don;t believe that Vince does either.

  19. #18
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    Hey guys,

    I realized chasing a number is silly and there are a myriad of things the docs will consider. Iíve led a very stressed out life since childhood so I theorize that me cortisol, prolactin and surely estrogen levels are out of whack. I also take the point about free T and SHBG. But I still canít stop this question from running through my mind: My T has been so low for so long, what would it be like to have high T? Thatís where the number chasing comes into play I think.

    I wish I knew how to post pictures. The contrast in me is unbelievable. I have well defined legs and arms but a giant gut. I look pretty ridiculous I think. I eat once a day, keto, do HARD cardio on the freestrider 5 days a week and lift 5 days a week. Still canít lose anymore fat or gain any strength. Itís been so frustrating. I canít wait to see how a healthy level of test changes all that. Maybe I wonít be a hard gainer/loser anymore.

    Iím going to call both places here in about 20 minutes and Iíll let you guys know how that goes. To be honest I donít really even know what questions to ask them and at this point I plan on going with whoever is willing to TRY to raise levels without TRT before we just jump on the full TRT train.

  20. #19
    Interesting that Vince's SHBG is higher than MarkM's, and yet Vince's free test is also higher. Just proves that how sticky each person's SHBG is, and the level at which it binds to testosterone/ estrogen, is another factor to consider with SHBG, not just the number itself.

  21. #20
    Quote Originally Posted by Gman86 View Post
    Interesting that Vince's SHBG is higher than MarkM's, and yet Vince's free test is also higher. Just proves that how sticky each person's SHBG is, and the level at which it binds to testosterone/ estrogen, is another factor to consider with SHBG, not just the number itself.
    So many variables and we are all different. Vince has higher Total T and has a ratio of Free T:Total T of 2.71% and my ratio is slightly higher at 2.85%.

  22. #21
    Quote Originally Posted by Fatboy View Post
    Hey guys,

    I realized chasing a number is silly and there are a myriad of things the docs will consider. I’ve led a very stressed out life since childhood so I theorize that me cortisol, prolactin and surely estrogen levels are out of whack. I also take the point about free T and SHBG. But I still can’t stop this question from running through my mind: My T has been so low for so long, what would it be like to have high T? That’s where the number chasing comes into play I think.

    I wish I knew how to post pictures. The contrast in me is unbelievable. I have well defined legs and arms but a giant gut. I look pretty ridiculous I think. I eat once a day, keto, do HARD cardio on the freestrider 5 days a week and lift 5 days a week. Still can’t lose anymore fat or gain any strength. It’s been so frustrating. I can’t wait to see how a healthy level of test changes all that. Maybe I won’t be a hard gainer/loser anymore.

    I’m going to call both places here in about 20 minutes and I’ll let you guys know how that goes. To be honest I don’t really even know what questions to ask them and at this point I plan on going with whoever is willing to TRY to raise levels without TRT before we just jump on the full TRT train.
    Just watched a Youtube video about a doctor talking about Keto. He says in his experience anyone on Keto will most likely lose muscle, or rarely maintain what muscle they have, unless they are on androgen therapy. Just something to consider for you. Keto is good for losing weight, and endurance activities, but not good for things like building muscle. Just something to consider. I'll link the video https://www.youtube.com/watch?v=RM0uMA0KXRA

    Also, sounds like HRT is in your future. Have you had your free testosterone level checked? In regards to fertility, HCG mono would probably be a good first choice if you're secondary. Clomid could also be an option. I just personally had a bad experience with it, but then again I was on a high dose of 50mg/ day. Even TRT with at least 1,000iu's of HCG/ week with it can keep you fertile to a certain extent.

    And ya, if you do need a clinic to help you, Defy Medical is the place I would personally go. Wish I would of found them years ago.

  23. #22
    Quote Originally Posted by MarkM View Post
    So many variables and we are all different. Vince has higher Total T and has a ratio of Free T:Total T of 2.71% and my ratio is slightly higher at 2.85%.
    Ya good point. My SHBG must be extremely sticky. Me and Vince have around the same SHBG, yet at his total T level he has a free T almost double the top end of the normal range, while when my total T was around his my free T was mid range. We are all very different, that's for sure.

  24. #23
    Moderator Vince's Avatar
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    Quote Originally Posted by Gman86 View Post
    Ya good point. My SHBG must be extremely sticky. Me and Vince have around the same SHBG, yet at his total T level he has a free T almost double the top end of the normal range, while when my total T was around his my free T was mid range. We are all very different, that's for sure.
    The range that LabCorp uses account also for age, I'm 63.
    I am not a medical practitioner. Any suggestions I provide are not medical recommendations and are just my opinions. Please consult with your physician on any matters concerning your health.

  25. #24
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    Ok spoke to Defy, Prime and Dr Rands office. Before I continue with that I want to asks a question. Why do we know free T has to do with SHBG stickiness/levels and not some other limiting factor at play?

    Prime: I left a voicemail unfortunately. I looked up some reviews though and it didnít look totally promising.

    Defy: Seemed great. He sent me a bunch of emails to get us going and told me I could get a physical done at Walgreens? Iíve never heard of this. But he also mentioned urgent care which seems legit to me. He also said that treatment will be about 1,500 per year which Iím satisfied with. 250 for initial consult and 284 for bloods from their lab. Do you guys find that annual estimate to be accurate?

    PSR: Iíve seen Dr McClain on YouTube and believe him to be an authority on this issue, which I like. Am I wrong in that? She wasnít sure of annual costs but the initial consultation with Rando is 800 and the 90 day follow ups are 200 if under 30 minutes. 400 for anything over 30 minutes. Iím not sure about the cost of the meds. The cost of the labs they want to draw is 350. They draw from the same lab as Defy so maybe the extra cost is in extra tests being run?

    Both said they would be willing to try and treat with HGC and an AI of some type if I donít want to jump straight to the needle but both were vague about that because I wasnít speaking to the doctors themselves yet. PSR did say Dr McClain strongly dislikes clomid and more than likely wonít prescribe it. She said he is partial to Anastrosol. (Spelling?)

    Iím already grateful for you guys pointing me in the right direction but if anyone is willing to answer the above questions and give me their thoughts in general about these options & new info provided please feel encouraged.

  26. #25
    Dr. Rand McClain is at DefyMedical and so is Dr. Saya and Dr. Caulkins all are very good hormone specialists. I'm surprised and confused there is a difference in costs with McClain since he works at Defy. Is there another Dr. McClain perhaps?
    At $1500. a year I assume that includes all meds as well. Yeah it's a great price considering they are one of the best out there. There are TRT mills that charge $600 + a month. Clomid can have lots of sides and is used mostly to determine if you are primary or secondary and also good for restarts. What no one mentions is that clomid works best on younger men.

  27. #26
    Quote Originally Posted by ratbag View Post
    Dr. Rand McClain is at DefyMedical and so is Dr. Saya and Dr. Caulkins all are very good hormone specialists. I'm surprised and confused there is a difference in costs with McClain since he works at Defy. Is there another Dr. McClain perhaps?
    At $1500. a year I assume that includes all meds as well. Yeah it's a great price considering they are one of the best out there. There are TRT mills that charge $600 + a month. Clomid can have lots of sides and is used mostly to determine if you are primary or secondary and also good for restarts. What no one mentions is that clomid works best on younger men.
    It's my understanding that Dr. McClain maintains a separate practice at this point, based in California, and that his relationship with Defy is a very casual one and reflects the historical connection that was once in place. As in all things, I am open to correction.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  28. #27
    Quote Originally Posted by Fatboy View Post
    Ok spoke to Defy, Prime and Dr Rands office. Before I continue with that I want to asks a question. Why do we know free T has to do with SHBG stickiness/levels and not some other limiting factor at play?

    Prime: I left a voicemail unfortunately. I looked up some reviews though and it didn’t look totally promising.

    Defy: Seemed great. He sent me a bunch of emails to get us going and told me I could get a physical done at Walgreens? I’ve never heard of this. But he also mentioned urgent care which seems legit to me. He also said that treatment will be about 1,500 per year which I’m satisfied with. 250 for initial consult and 284 for bloods from their lab. Do you guys find that annual estimate to be accurate?

    PSR: I’ve seen Dr McClain on YouTube and believe him to be an authority on this issue, which I like. Am I wrong in that? She wasn’t sure of annual costs but the initial consultation with Rando is 800 and the 90 day follow ups are 200 if under 30 minutes. 400 for anything over 30 minutes. I’m not sure about the cost of the meds. The cost of the labs they want to draw is 350. They draw from the same lab as Defy so maybe the extra cost is in extra tests being run?

    Both said they would be willing to try and treat with HGC and an AI of some type if I don’t want to jump straight to the needle but both were vague about that because I wasn’t speaking to the doctors themselves yet. PSR did say Dr McClain strongly dislikes clomid and more than likely won’t prescribe it. She said he is partial to Anastrosol. (Spelling?)

    I’m already grateful for you guys pointing me in the right direction but if anyone is willing to answer the above questions and give me their thoughts in general about these options & new info provided please feel encouraged.
    Dr. McClain and Dr. Saya, the medical director at Defy, are close friends and respect each other very much (both have so stated here on the Forum). Dr. McClain runs his own Q&A here at Excelmale - go the Forum's front page and scroll down to find it. Then search Dr. Saya's name and read his contributions. All of us at Excelmale, whether patients of either of them, are fortunate to have their experience to draw on.
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  29. #28
    Oh I see... I didn't realise this. Because I had seen this and assumed Rand was at Defy's

    https://www.defymedical.com/about-us/our-team

  30. #29
    Quote Originally Posted by ratbag View Post
    Oh I see... I didn't realise this. Because I had seen this and assumed Rand was at Defy's

    https://www.defymedical.com/about-us/our-team
    I know he was "present at the creation" of Defy, but don't believe he is seeing patients through the Defy intake process. As I remind us elf all the time, I may be wrong...
    I am not a physician. Comments offered here are for discussion purposes only. Please consult your doctor before initiating, changing, or stopping any therapy.

  31. #30
    Quote Originally Posted by Vince View Post
    The range that LabCorp uses account also for age, I'm 63.
    Oh very interesting Vince, I had no clue that some labs take the patients age into consideration in their ranges. Thanks for that info.

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