Defy patient need advice before next appt PLEASE.

[timzjp]

I'm currently a Defy patient with updated blood work and need some advise.
I called today to set up my follow up, but Dr Saya is 5 weeks out for phone consult YIKES!
My concern is that I'm currently doing testosterone 3x per week at .20ml, HCG 3x per week at .25ml and .25mg AI also 3 times per week.

Without going into a long post my E2 sensitive was 39 and now it's 17 and my test levels dropped from 775 to 720. I'm not so much worried about numbers but I'm concerned that E2 is getting to low. I'm not sure if its the slight drop in test or E2 being less than half that are causing these systems that have been coming up= more fatigue, aching joints and lower libido. Just not feeling as well as when I started this protocol.

My main concern is going another 5 weeks until I address this issue before I make any changes.
My thoughts are to increase test to .23 and drop 1 AI pill per week until I get to speak with him.

Any thoughts with going with Melissa or another PA?

Thanks in advance

 

[Vince Carter]

You don't have to see Dr Saya unless you want to, you can get in with the Nurses or the PA...I really like Nurse Jill. And it's cheaper.

So you've gone from 39-17, AFTER adding the .25mg 3XW or what's the story there? Maybe you need twice per week...most would agree that 17 is on the low side.

Whne you're doing your injections and your testing, it can't be overstated that consistency is key to having comparability in your numbers. Inject at the same time every time, same with bloods, same time every time. I would say that 775/720 are rather insignificant difference. It could be a matter of you tested as little as two hours, later, than the time you pulled the 775. It's that important to test at the same times.

 

[timzjp]

Yes Vince, went from 39 before adding AI. Ive been on AI for 8 weeks and it's down to 17. I was thinking the same thing as to taking the AI 2 times per week instead of 3. My blood draw was only an hour difference max. I also agree that the testosterone number are insignificant.
Thanks for your thoughts on Nurse Jill.

 

[Dr Justin Saya MD]

Hi timzjp!

There is light at the end of the tunnel with wait times as we have Jill (nurse), Melissa (PA), and I am in the final stages of training our newest team member, Dr Calkins.

I don't typically like to change protocols over the forum, but cutting back on the anastrozole at this point would be logical. Twice weekly for now and perhaps 3 times weekly at 0.15mg upon follow-up/refill. With testosterone being a controlled substance, I will refrain from suggesting a change (increase) in dosage on that until within the context of a consult as there are many variables to consider.

 

[timzjp]

Hi timzjp!

There is light at the end of the tunnel with wait times as we have Jill (nurse), Melissa (PA), and I am in the final stages of training our newest team member, Dr Calkins.

I don't typically like to change protocols over the forum, but cutting back on the anastrozole at this point would be logical. Twice weekly for now and perhaps 3 times weekly at 0.15mg upon follow-up/refill. With testosterone being a controlled substance, I will refrain from suggesting a change (increase) in dosage on that until within the context of a consult as there are many variables to consider.

Thank you sir for the reply.
I will contact the office tomorrow to check the others schedule.

 

[Vince]

Thank you sir for the reply.
I will contact the office tomorrow to check the others schedule.

I use Jill RN and I'm very happy with her.

 

[excelnelg]

If 17 is on the low side, what's the optimum range? Or does it only depend on how one feels?

 

[CoastWatcher]

If 17 is on the low side, what's the optimum range? Or does it only depend on how one feels?

Managing estradiol involves assessing symptoms and lab results, the subjective with the objective (as is being done in this case).

 

[timzjp]

If 17 is on the low side, what's the optimum range? Or does it only depend on how one feels?

I seemed to feel better a couple weeks after using .25 3x per week, then I felt like I was getting more fatigued and a lot less libido.
I will try dropping 1 pill a week until consult.

 

[Dr Justin Saya MD]

I seemed to feel better a couple weeks after using .25 3x per week, then I felt like I was getting more fatigued and a lot less libido.
I will try dropping 1 pill a week until consult.

The estradiol pendulum may have swung a bit too far in the other direction, the adjustment should help.