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[Fizzypopcorn]

long story short....went through some personal stuff some time ago and really started feeling like garbage. Went to see a urologist who tested my T and said I was low and recommended TRT. He wasn’t super knowledgeable as I was the one that mentioned hcg and anastrazole to him as he was recommending only cyp. I decided I would just backburner it all. Fast forward about 1.5 years.....About 4 months ago started working out with a trainer pretty hard and eating better. Trainer was astonished I wasn’t moving the scale at all and recommended I get some labs done. Attached are the results. I mistakenly talked to a place (T-mill) here in FL that wanted an astronomical amount per month for treatment. I’m cool with paying more than what I would through insurance but, not 10x more. They recommended:


HRT Package - Testosterone 200mg/ml , Anastrozole 1mg every other day, HCG daily (20 units daily)


I am having a consult with a different testosterone clinic on Monday.


I’ve read up on Defy here and their pricing is far better than I was quoted in my first consult. Again, I’m not trying to be cheap, but, price matters as this is longterm. if I was I would just go through my urologist and have a $45/mo copay for my scripts. I am definitely wanting quality care as we all are.



Thoughts on my labs?

definitely looking forward to being more active on the forums!

 

[CoastWatcher]

long story short....went through some personal stuff some time ago and really started feeling like garbage. Went to see a urologist who tested my T and said I was low and recommended TRT. He wasn't super knowledgeable as I was the one that mentioned hcg and anastrazole to him as he was recommending only cyp. I decided I would just backburner it all. Fast forward about 1.5 years.....About 4 months ago started working out with a trainer pretty hard and eating better. Trainer was astonished I wasn't moving the scale at all and recommended I get some labs done. Attached are the results. I mistakenly talked to a place (T-mill) here in FL that wanted an astronomical amount per month for treatment. I'm cool with paying more than what I would through insurance but, not 10x more. They recommended:a


HRT Package - Testosterone 200mg/ml , Anastrozole 1mg every other day, HCG daily (20 units daily)


I am having a consult with a different testosterone clinic on Monday.


I've read up on Defy here and their pricing is far better than I was quoted in my first consult. Again, I'm not trying to be cheap, but, price matters as this is longterm. if I was I would just go through my urologist and have a $45/mo copay for my scripts. I am definitely wanting quality care as we all are.



Thoughts on my labs?

definitely looking forward to being more active on the forums!

Your estradiol was measured with the incorrect lab test. Men should only have estradiol evaluated with the sensitive, LC, MS/MS lab test. Your test, one that is used for women, is unreliable and of no value. The fact that it was ordered indicates a fundamental failure on the part of the medical practice to understand how the TRT game is played. It's an important signal. The protocol the suggested is cookie-cutter in approach. Anastrozole at the beginning of treatment? A whopping dose of testosterone? Where does your SHBG sit?That is critical to know if you want a protocol to work. An odd bunch of thyroid tests, some relevant, some not. CBC and CMP?

How old are you? Any history of steroid use? Was LH and FSH measured, to determine primary or secondary status? How do you sleep at night?

How much is your health worth? Only you can answer that question. Are there good doctors in the insurance networks? Yes, there are. Not many.

 

[MarkM]

Welcome to the forum!

You mentioned that your doctor wasn't very knowledgeable and that shows to be honest with you. If his recommended protocol is 200 mg of Test Cypionate per week, 1 mg of Anastrozole every other day, and 20 units of HCG daily then he is setting you up for failure right from the beginning.

200 mg weekly of Test Cypionate is way to strong for the vast majority of people. It has the potential to create all sorts of unnecessary problems and side effects for you. You should begin with 100 mg per week and go from there. I did not see that he tested for SHBG (Sex Hormone Binding Globulin) which is critical to know as it will determine what type of injection schedule you should have. If your SHBG is very low, you will do better with small injections daily or every other day (EOD). If it is high, you would do better with one larger injection per week. If in the middle you would do best with injections every 3. days. So, in order to establish your best protocol you need to know the SHBG.

The Estradiol test he ran is the wrong test. He ran the test (Roche ECLIA) for women. The proper test for men is the Estradiol Sensitive test, LC/MS/MS assay. The test he ran normally estimates your estradiol too high. In our case, the test came back at just over 24 which means that your Estradiol Sensitive test will come back quite a bit lower. If you take 1 mg of anastrozole EOD you are going to crash your Estradiol. That is a huge does of anastrozole and you do not want to crash your estradiol. I would recommend that you fill the prescription to have on hand but that you not take it until you have symptoms of extremely high estradiol.

Without question your Total and Free Testosterone are low and you could benefit from TRT......unless you take 1 mg of anastrozole EOD with it which will remove any benefit you feel.

The recommended does of HCG of 20 iu per day is really low and quite honestly a does that is so low it won't do diddly squat. Now doses are anywhere from 150 to 500 iu from two to three times a week. I would recommend that you start off with Test Cypionate alone. However, if you are trying to remain fertile than HCG can be a good thing and if that is the case you will want a much higher dose than 20 is EOD.

You should also look more at your thyroid. Your doctor did not run enough test but it looks like you might have some thyroid issues. Your TSH, Thyroid Stimulating Hormone, at 3.74 is in range but still too high and could indicate Hypothyroidism. You really need to have a full thyroid panel ran to include the following: TSH, Free T3, Free T4, Reverse T3, and both thyroid antibodies (ATA and TPO). If you do you a thyroid that is under performing you will want to address that because it can give you many of the same symptoms of low testosterone.

B12 is a little low so you should probably take a Vitamin B12 supplement.

Did you have a CBC panel ad CMP panel ran too? Those are pretty standard. If you did, you should post those as well.

Again, welcome to ExcelMale!

 

[Fizzypopcorn]

Your estradiol was measured with the incorrect lab test. Men should only have estradiol evaluated with the sensitive, LC, MS/MS lab test. Your test, one that is used for women, is unreliable and of no value. The fact that it was ordered indicates a fundamental failure on the part of the medical practice to understand how the TRT game is played. It's an important signal. The protocol the suggested is cookie-cutter in approach. Anastrozole at the beginning of treatment? A whopping dose of testosterone? Where does your SHBG sit?That is critical to know if you want a protocol to work. An odd bunch of thyroid tests, some relevant, some not. CBC and CMP?

How old are you? Any history of steroid use? Was LH and FSH measured, to determine primary or secondary status? How do you sleep at night?

How much is your health worth? Only you can answer that question. Are there good doctors in the insurance networks? Yes, there are. Not many.

36. No history of use (though was diagnosed with low t years ago). I don’t see LH or FSH on my report. I’m not the best sleeper. Never have been really (which I’m sure plays into some of my issues). Maybe 6-7 hours on a good night. Workout with a trainer 3-4 nights a week with lots of strength training.

 

[Fizzypopcorn]

Thanks for the prompt and thorough reply! What’s crazy is that this dr is at one of the local T clinics that has super hot flashy models and muscly men parading around as spokespeople. It was my urologist I didn’t feel comfortable with hence why I went elsewhere (and from the sounds of it, didn’t do much better). This isn’t a place I can get the scripts for and do my own thing really. It’s a monthly fee of about $350 to be a part of their protocol. As far as the other tests, I attached my complete set of labs that was ordered. I know that during the consult he said that the T would have been 1/2 dose every 3 days. I was thinking that was a lot of anastrazole from everywhere I read.

Im kind of bummed that some of the tests were not ordered correctly. So far I’ve put out $150 for labwork and $200 for a consult and I seem to have gotten no where.

I appreciate your input!


Also, you will see the high cholesterol. I’ve had it for many years and it is monitored by my primary. Some is genetics.

 

[Fizzypopcorn]

These were the tests ordered on my lab req to LabCorp



TEST ORDERED (TOTAL 10)
IGF-1 with Z-Score
Comp. Metabolic Panel (14)
CBC With Differential/Platelet
Lipid Panel With LDL/HDL Ratio Testosterone,Free and Total Thyroid Panel With TSH
PSA Total (Reflex To Free) Estradiol
Progesterone Vitamin B12

 

[CoastWatcher]

These were the tests ordered on my lab req to LabCorp



TEST ORDERED (TOTAL 10)
IGF-1 with Z-Score
Comp. Metabolic Panel (14)
CBC With Differential/Platelet
Lipid Panel With LDL/HDL Ratio Testosterone,Free and Total Thyroid Panel With TSH
PSA Total (Reflex To Free) Estradiol
Progesterone Vitamin B12

You are missing critical tests.


SHBG
DHT
DHEA
Estradiol/Sensitive (LC, MS,MS)
LH
FSH
Prolactin
fT3
rT3
Both thyroid antibody panels

 

[Fizzypopcorn]

You are missing critical tests.


SHBG
DHT
DHEA
Estradiol/Sensitive (LC, MS,MS)
LH
FSH
Prolactin
fT3
rT3
Both thyroid antibody panels

Well darn. An expensive lesson for sure.

I just got got off the phone with Defy. An intake person will be calling me Monday. I saw that they will write a script so insurance can cover it once the $250 consult fee is paid. This is an option.

i also have a consult with a place called Tampa testosterone. We shall see.

So many options out there and apparently so many bad ones.

 

[Systemlord]

A lot of us here at Excelmale are Defy patients including myself, Dr. Saya is a top notch hormone specialists. You will not be disappointed if you choose to go with them.

 

[Jesse-Defy]

Well darn. An expensive lesson for sure.

I just got got off the phone with Defy. An intake person will be calling me Monday. I saw that they will write a script so insurance can cover it once the $250 consult fee is paid. This is an option.

i also have a consult with a place called Tampa testosterone. We shall see.

So many options out there and apparently so many bad ones.

Unfortunately we do not work Saturdays, so it's only patient care staff.

Depending on how they forwarded it to us, I may be the one to reach out to you on Monday.

Of course, there are a few requirements when it comes to having insurance cover labs, which either myself or one of my colleagues will be happy to go over with you.

When it comes to your health, it is best to go with a provider/clinic that you're comfortable with.

I do believe I am familiar with the clinic you've mentioned, IIRC I've driven past it on Kennedy.

You're more than welcome to email me directly at [email protected] if you'd like.

 

[CoastWatcher]

Well darn. An expensive lesson for sure.

I just got got off the phone with Defy. An intake person will be calling me Monday. I saw that they will write a script so insurance can cover it once the $250 consult fee is paid. This is an option.

i also have a consult with a place called Tampa testosterone. We shall see.

So many options out there and apparently so many bad ones.

Day after day men join EM with stories like yours. They consult a doctor in good faith, drop a substantial amount of money, and get nowhere; it happened to me years ago. It's an expensive lesson too many of us have had to learn.

 

[Fizzypopcorn]

You are missing critical tests.


SHBG
DHT
DHEA
Estradiol/Sensitive (LC, MS,MS)
LH
FSH
Prolactin
fT3
rT3
Both thyroid antibody panels

Welcome to the forum!

You mentioned that your doctor wasn't very knowledgeable and that shows to be honest with you. If his recommended protocol is 200 mg of Test Cypionate per week, 1 mg of Anastrozole every other day, and 20 units of HCG daily then he is setting you up for failure right from the beginning.

200 mg weekly of Test Cypionate is way to strong for the vast majority of people. It has the potential to create all sorts of unnecessary problems and side effects for you. You should begin with 100 mg per week and go from there. I did not see that he tested for SHBG (Sex Hormone Binding Globulin) which is critical to know as it will determine what type of injection schedule you should have. If your SHBG is very low, you will do better with small injections daily or every other day (EOD). If it is high, you would do better with one larger injection per week. If in the middle you would do best with injections every 3. days. So, in order to establish your best protocol you need to know the SHBG.

The Estradiol test he ran is the wrong test. He ran the test (Roche ECLIA) for women. The proper test for men is the Estradiol Sensitive test, LC/MS/MS assay. The test he ran normally estimates your estradiol too high. In our case, the test came back at just over 24 which means that your Estradiol Sensitive test will come back quite a bit lower. If you take 1 mg of anastrozole EOD you are going to crash your Estradiol. That is a huge does of anastrozole and you do not want to crash your estradiol. I would recommend that you fill the prescription to have on hand but that you not take it until you have symptoms of extremely high estradiol.

Without question your Total and Free Testosterone are low and you could benefit from TRT......unless you take 1 mg of anastrozole EOD with it which will remove any benefit you feel.

The recommended does of HCG of 20 iu per day is really low and quite honestly a does that is so low it won't do diddly squat. Now doses are anywhere from 150 to 500 iu from two to three times a week. I would recommend that you start off with Test Cypionate alone. However, if you are trying to remain fertile than HCG can be a good thing and if that is the case you will want a much higher dose than 20 is EOD.

You should also look more at your thyroid. Your doctor did not run enough test but it looks like you might have some thyroid issues. Your TSH, Thyroid Stimulating Hormone, at 3.74 is in range but still too high and could indicate Hypothyroidism. You really need to have a full thyroid panel ran to include the following: TSH, Free T3, Free T4, Reverse T3, and both thyroid antibodies (ATA and TPO). If you do you a thyroid that is under performing you will want to address that because it can give you many of the same symptoms of low testosterone.

B12 is a little low so you should probably take a Vitamin B12 supplement.

Did you have a CBC panel ad CMP panel ran too? Those are pretty standard. If you did, you should post those as well.

Again, welcome to ExcelMale!

Your estradiol was measured with the incorrect lab test. Men should only have estradiol evaluated with the sensitive, LC, MS/MS lab test. Your test, one that is used for women, is unreliable and of no value. The fact that it was ordered indicates a fundamental failure on the part of the medical practice to understand how the TRT game is played. It's an important signal. The protocol the suggested is cookie-cutter in approach. Anastrozole at the beginning of treatment? A whopping dose of testosterone? Where does your SHBG sit?That is critical to know if you want a protocol to work. An odd bunch of thyroid tests, some relevant, some not. CBC and CMP?

How old are you? Any history of steroid use? Was LH and FSH measured, to determine primary or secondary status? How do you sleep at night?

How much is your health worth? Only you can answer that question. Are there good doctors in the insurance networks? Yes, there are. Not many.

Unfortunately we do not work Saturdays, so it's only patient care staff.

Depending on how they forwarded it to us, I may be the one to reach out to you on Monday.

Of course, there are a few requirements when it comes to having insurance cover labs, which either myself or one of my colleagues will be happy to go over with you.

When it comes to your health, it is best to go with a provider/clinic that you're comfortable with.

I do believe I am familiar with the clinic you've mentioned, IIRC I've driven past it on Kennedy.

You're more than welcome to email me directly at [email protected] if you'd like.

hey Jesse! I’m glad (for you) that you get Saturdays off! I did name drop you and was told that they will give you my info on Monday along with my email and phone number. You are absolutely correct on the place on Kennedy. It’s obvious after I put some money out that it’s all about profit and very little about health. Better I learned that now rather than after starting.

 

[Jesse-Defy]

hey Jesse! I’m glad (for you) that you get Saturdays off! I did name drop you and was told that they will give you my info on Monday along with my email and phone number. You are absolutely correct on the place on Kennedy. It’s obvious after I put some money out that it’s all about profit and very little about health. Better I learned that now rather than after starting.

I do sometimes think it'd be helpful to work Saturdays(especially today as I lost power for a few hours) as many patients have a hard time talking during business hours and it'd be beneficial to be able to reach out to them on Saturdays.

Most likely my colleague emailed me your contact info and I will be sure to call you 9am local time(based on your area code, although I'm suspecting you're local) to answer your questions.

I never speak poorly of competitors though, but it is interesting when I'm driving home and pass by.

 

[Fizzypopcorn]

I do sometimes think it'd be helpful to work Saturdays(especially today as I lost power for a few hours) as many patients have a hard time talking during business hours and it'd be beneficial to be able to reach out to them on Saturdays.

Most likely my colleague emailed me your contact info and I will be sure to call you 9am local time(based on your area code, although I'm suspecting you're local) to answer your questions.

I never speak poorly of competitors though, but it is interesting when I'm driving home and pass by.

i shot you an email as well. 9 would be great (I’m in 727) as I have a 10am meeting. Thanks again!

 

[Jesse-Defy]

i shot you an email as well. 9 would be great (I’m in 727) as I have a 10am meeting. Thanks again!

Perfect! Since you're in the state of Florida there are some benefits you have that out of state patients do not have which I'll be sure to explain.

 

[Fizzypopcorn]

Spoke with Jesse as he promised on Monday. We ordered some new tests which were done the same day. Really looking forward to the results and being able to get in with the dr.

 

[Fizzypopcorn]

I received updated labs today for the missing pieces. I’m scheduled to meet the the PA at Defy on August 8.

I’m seeing my high reverse T3. I have gone through some increased stress (thanks to a divorce) and have always had some super slow metabolism. Have always had a tough time losing weight even with diet and exercise. Could explain some of it.

Thoughts?