Completed first steps for Defy Medical

[CoastWatcher]

When is your next consultation w/Dr. Saya?

 

[Pranayama]

Coast: My next consult will be August 16. Defy has these labs.

Paul: My last donation was May 17. I will wait until the consult and see what is recommended before I would donate. Probably, they have seen these kinds of results before.

I am not sure really if I am primary or secondary hypogonadism and it did not specify which one. It only said hypogonadism, when I was diagnosed a few years ago at another place. My Testosterone level was 225.

 

[Dr Justin Saya MD]

Pranayama - certainly several things to discuss in our consult my friend 😉 We knew your case was going to be a unique one based on how it began.

Wouldn't donate blood any further for now with the low iron/ferritin. Hydrate well as it appears you may be a little dry based on hemoglobin:hematocrit ratio. Typically hematocrit should be 3x hemoglobin. Your hemoglobin is 16.5, so should correlate with a hematocrit of ~49.5...however your hematocrit is quite a bit higher at 52.6 - suggesting some mild dehydration is playing a role (hemoconcentration we call it).

Feeling better subjectively is encouraging, especially considering we still need to make further adjustments based on your numbers. Talk soon!

 

[Pranayama]

Thank you Dr. Saya. Looking back, I am sure now that before those labs I had not hydrated enough. I will stay mindful about it and drink more water even when I don't feel the need. I look forward to the consult and getting the therapy more dialed in !

 

[Pranayama]

I had my consult last week and received new protocols and the medication arrived today. The goal is to get the Test level in a optimal range and the estrogen under control and in a good range.

Some protocols have stayed the same but here they are: Test Cyp: Mon, We'd, Fri. 40mg per inj. for a total of 120mg per week. Hcg: remains the same with M,W,F. 250iu each day. Anastrozole/DIM 0.35/200 mg 1 cap M,W,F.

Labs will be followed up in a few months to see where I am at. I feel good all things considered.

 

[PAUL-E]

Sounds like a good protocol, I'm Glad your feeling better!
keep us up to date and post updated blood work.

 

[Pranayama]

Thanks Paul. Yes, I will definitely post the next blood work with updates.

 

[Loki]

I am a patient of Dr Saya as well with lower HDL... Curious if I should start taking Niacin too.... I have never (even prior to TRT) had an HDL lab in range... I saw deal from Nelson recommending it too...

 

[Dr Justin Saya MD]

I am a patient of Dr Saya as well with lower HDL... Curious if I should start taking Niacin too.... I have never (even prior to TRT) had an HDL lab in range... I saw deal from Nelson recommending it too...

There is still debate, even amongst the lipid experts and cardiologists, about the efficacy of niacin. Personally I have seen some favorable results, assuming that the patient doesn't experience (or can tolerate) the most common side effect - flushing.

 

[Dr Justin Saya MD]

Pranayama - you're on the right path, not quite at the final destination just yet.

 

[Loki]

There is still debate, even amongst the lipid experts and cardiologists, about the efficacy of niacin. Personally I have seen some favorable results, assuming that the patient doesn't experience (or can tolerate) the most common side effect - flushing.

What about the claims on the Niacin that says "no flushing"?

 

[Dr Justin Saya MD]

What about the claims on the Niacin that says "no flushing"?

It has been claimed (and I would tend to agree based on my observations of patients taking same) that the non-flushing doesn't work (or at least not as well). Non-flushing typically have very low (or no) levels of nicotinic acid (responsible for flushing, but also responsible for the beneficial effects).

Slow release niacin (available from compounding pharmacies and I believe OTC as well) tends to be more tolerable when it comes to flushing.

Some folks actually enjoy the flushing, believe it or not. Further, many patients develop a tolerance to the flushing over time (where the flushing drastically reduces or goes away completely). Lastly, for any folks that (already) take a baby aspirin daily, taking the aspirin about 30min prior to the niacin typically prevents any flushing (although I don't encourage taking aspirin daily for only this purpose).

 

[Loki]

It has been claimed (and I would tend to agree based on my observations of patients taking same) that the non-flushing doesn't work (or at least not as well). Non-flushing typically have very low (or no) levels of nicotinic acid (responsible for flushing, but also responsible for the beneficial effects).

Slow release niacin (available from compounding pharmacies and I believe OTC as well) tends to be more tolerable when it comes to flushing.

Some folks actually enjoy the flushing, believe it or not. Further, many patients develop a tolerance to the flushing over time (where the flushing drastically reduces or goes away completely). Lastly, for any folks that (already) take a baby aspirin daily, taking the aspirin about 30min prior to the niacin typically prevents any flushing (although I don't encourage taking aspirin daily for only this purpose).

Sounds good, I think I will try the slow release and see if I can improve my numbers... You had me scheduled last week but you were sick so the nurses filled in for you (they did a great job). They bumped by ADEX from .1 twice per week to .5 twice per week. What is the soonest I can follow up to ensure my E won't crash?

 

[Loki]

View attachment 2306View attachment 2305View attachment 2307

Are you having any symptoms with Estradiol this high? I am just curious if the high Free T somehow offsets...

 

[Dr Justin Saya MD]

Sounds good, I think I will try the slow release and see if I can improve my numbers... You had me scheduled last week but you were sick so the nurses filled in for you (they did a great job). They bumped by ADEX from .1 twice per week to .5 twice per week. What is the soonest I can follow up to ensure my E won't crash?

Yes, kids gave me laryngitis and voice was COMPLETELY gone last Wednesday. I agree, they did a good job and we'll make appropriate adjustments as needed.

For follow-up estradiol labs - minimum of 4 weeks barring any unforeseen side effects.

 

[Loki]

Yes, kids gave me laryngitis and voice was COMPLETELY gone last Wednesday. I agree, they did a good job and we'll make appropriate adjustments as needed.

For follow-up estradiol labs - minimum of 4 weeks barring any unforeseen side effects.

Only side effect so far is I stopped crying when watching Pixar movies... Hey, UP is pretty sad right out of the gate!!!

 

[ERO]

Are you having any symptoms with Estradiol this high? I am just curious if the high Free T somehow offsets...

The T:E: ratio here is 13 and the ideal range is between 14 and 20. Now I know that is a "rule of thumb" not an iron-clad rule, but it may account for a lack of overt high E2 symptoms.

 

[Pranayama]

Loki: After I saw those lab results with the high estrogen, I thought perhaps I have been a bit more emotional than usual, but I never dwelled on it. It was never that bad. I did have some acne manifesting here and there, but manageable. I'll be glad to get the estrogen down that's for sure.

As Dr. Saya mentioned, I am heading in the right direction, but not there yet....

 

[Speed]

It has been claimed (and I would tend to agree based on my observations of patients taking same) that the non-flushing doesn't work (or at least not as well). Non-flushing typically have very low (or no) levels of nicotinic acid (responsible for flushing, but also responsible for the beneficial effects).

Slow release niacin (available from compounding pharmacies and I believe OTC as well) tends to be more tolerable when it comes to flushing.

Some folks actually enjoy the flushing, believe it or not. Further, many patients develop a tolerance to the flushing over time (where the flushing drastically reduces or goes away completely). Lastly, for any folks that (already) take a baby aspirin daily, taking the aspirin about 30min prior to the niacin typically prevents any flushing (although I don't encourage taking aspirin daily for only this purpose).

@Dr Justin Saya, MD


In case you didn't know, REAL niacin (as nicotinic acid) in extended release form, doesn't have flush effect. It's really important that it's wax-matrix niacin ( either canuba wax or rice bran wax) Because this form INCREASE HDL.
With this Niacin my HDL went from 30 to 57 with 500mg in the morning, and 500mg before bed.
http://www.iherb.com/Doctor-s-Best-Niacin-Time-Released-With-Niaxtend-500-mg-120-Tablets/27751

Great info about NIACIN forms on this link >>> http://www.agelessforever.net/anti-...s-what-you-need-to-know-about-niacin-products !!!

 

[Pranayama]

Another note: Waiting today to get new recommendations for anastrozole dose. Probably a very low dose if any. I was hydrated for these labs so was surprised about hematocrit which read 56. When I went to donate blood the test said my hematocrit was 54. This is in line with my hemoglobin reading multiplied x3.

I donated again yesterday. I feel good. No more donations for awhile. I will also check my iron level in 2 or 3 months this time before I would donate again. Hematocrit yesterday was: 51

Update: New labs done. Some elevated hemoglobin, RBC and Hematocrit. Had not donated since May a2016. Good news is iron is fine. I donated last week and will donate once more tomorrow. I should be fine after that for awhile. I should have donated sooner but wanted to see my iron level, first.

I am now on HCG MWF, 400iu each day to improve fertility. Anastrozole dose of MWF was too strong. It crashed my estrogen. I cut it back to once a week for the last two months. May not need it at all, or a very low dose. I feel good overall. Note: Had to repeat some tests from draw due to error from Labcorp. Repeat: test, estradiol