Switch to a new clinic?

[LiveX2]

Hi, brand new member here. Lots of good information and discussions on this forum. I'm with Peter MD and so far so good. Already had labs, so I got into (virtually) see a physician right away and started my treatment. I would have liked to have started at a higher ml/inj, but I'm open to see how current protocol goes at 0.4ml 2x/wk (160mg) + HCG 25u ...started 4 wks ago.

Labs were: Test - 265ng/dL; FT - 37.3 pg/mL

Clinic has some great add-ons like nandrolone and oxandrolone if medically necessary. I looked into Defy Medical and see they offer those as well, plus stanozolol. Medical necessity required it seems, but also for recomp and adding a more anabolic compound to therapy. Additionally, looks like you can compound cypionate and enanthate together, even add nandrolone, and choose the oil base (sesame/grape/etc). Defy just seems to have wider options on their TRT/anabolic therapies available. For now, I'm getting what need, just curious if I wanted to start on a nandrolone for joint pain after a recent RCuff surgery and add in oxandrolone to further recomp, how receptive is Peter MD (for those who have experience) , same with Defy, and has anyone switch clinics bc one wouldnt allow to add anabolic therapies?

 

[Systemlord]

I would have liked to have started at a higher ml/inj, but I'm open to see how current protocol goes at 0.4ml 2x/wk (160mg) + HCG 25u ...started 4 wks ago.

160 mg is above average for a TRT dosage. Most are 100-150 mg per week. This seems to hold true across many different doctors.

It’s best to stick with one ester.

 

[LiveX2]

I hear you. Not the lowest levels, but def crushed and I suppose it’s that after realizing the likely main source to my symptoms, I'd prefer to start higher and dial it back. I know it’s supposed to be mildest protocol and work up, but now knowing what I know…
Wasn’t seriously considering 2 esters just noticed they had a wide selection.

 

[Blackhawk]

I hear you. Not the lowest levels, but def crushed and I suppose it’s that after realizing the likely main source to my symptoms, I'd prefer to start higher and dial it back. I know it’s supposed to be mildest protocol and work up, but now knowing what I know…
Wasn’t seriously considering 2 esters just noticed they had a wide selection.

Might work fine for you, but this can be a painful approach. I personally would start low and progress higher if needed. Increasing tends to feel good (Up to a point), but withdrawal from dose reduction can be a real B&tch. I started on 150mg/wk in 2016, and reduced about ten times to 49/week, now doing 7mg daily. This is unusually low, and this last reduction seems to have put me feeling a bit low after about a 2 month period. I will ride it our for one more month as it takes me 2-3 months to fully adjust to reductions, but my blood levels are still robust. There are a few us here who do well at these truly physiological replacement doses. My Free T was 2.1 before therapy and on this tiny dose is 19.7ng/dL, range 5.00-21.00.

Remember that free T measured by Ultrafiltration or equilibrium dialysis and using vermuelen calculator are better references for your physiological testosterone. Total T is misleading, and Free T direct tests are highly inaccurate. See @madman 's posts on this.

In terms of combining esters, cypionate and enanthate are similar enough that you probably will get no extra benefit. A few of us are doing well/better on either a cypionate/proprionate or enanthate/propionate blend at tiny doses daily. The proprionate is shorter acting and for me the effect from tiny daily injections creating a bit of daily variation is a noticeable improvement over just cypionate alone.

In hindsight if I was starting all over again, I would start on 60mg/week divided into either daily or every other day dosing. This is pretty darm low, but the amount puts my free T over the top of "normal range", and is far beyond hypogonadal levels.

Of course this is not enough for many men, Some indeed need as much as 160mg/week. Starting that high is on the verge of putting you at risk for multiple complications. There are probably over 100 accounts of these problems on this forum, and new ones pop up seems more often than weekly sometimes.

Good luck!

Addendum:

Compounding other steroids with T is not a good idea. It means if you want to change something, your compounded vial is no longer useful. Better to just combine multiples in the syringe.

I do mix my own enanthate/proprionate blend from vials of each ordered through Defy, but started this in very small batches to be sure the ratio works well. Now mix 5ml at a time, then add HCG in the syringe. I also used nandrolone for a short while but it shot up my hematocrit. I am glad It wasn't compounded into my T. I would have had to throw it out and buy new T.

I've been with Defy since 2016 and am very happy with Dr Saya, but not the company itself. They are good at what they do, I just find the gatekeeping function of support staff to be unpleasant and unnecessary. They will prevent you from scheduling until you jump the hoops that they want you jump, and this is fraught with trouble if you are getting labs done through other channels ordered by other doctors. Part of their business model is to provide a comprehensive service, everything , labs, prescriptions etc, and if your needs are different, it gets to be a PITA. I am used to it and know what to expect, but the process is not smooth, there are always issues for them even when I have submitted everything requested. The reports etc are not in the same format they are used to through their own channels, and the support staff does not understand the doctor/patient relationship I have established with Dr Saya.

 

[LiveX2]

Thanks for the reply @Blackhawk ... good advice. I'll keep running how I was prescribed, it's all good so far. I know this is TRT and I'm not looking to blast, but to be honest, the anabolic effect so far is a real plus in treating my symptoms - is there anyone who doesn't like the increased muscle from TRT? I know more is not always better, but would be nice to enhance TRT and its anabolic properties with oxandrolone, nandrolone or stanozolol.

Might work fine for you, but this can be a painful approach. I personally would start low and progress higher if needed. Increasing tends to feel good (Up to a point), but withdrawal from dose reduction can be a real B&tch. I started on 150mg/wk in 2016, and reduced about ten times to 49/week, now doing 7mg daily. This is unusually low, and this last reduction seems to have put me feeling a bit low after about a 2 month period. I will ride it our for one more month as it takes me 2-3 months to fully adjust to reductions, but my blood levels are still robust. There are a few us here who do well at these truly physiological replacement doses. My Free T was 2.1 before therapy and on this tiny dose is 19.7ng/dL, range 5.00-21.00.

Remember that free T measured by Ultrafiltration or equilibrium dialysis and using vermuelen calculator are better references for your physiological testosterone. Total T is misleading, and Free T direct tests are highly inaccurate. See @madman 's posts on this.

In terms of combining esters, cypionate and enanthate are similar enough that you probably will get no extra benefit. A few of us are doing well/better on either a cypionate/proprionate or enanthate/propionate blend at tiny doses daily. The proprionate is shorter acting and for me the effect from tiny daily injections creating a bit of daily variation is a noticeable improvement over just cypionate alone.

In hindsight if I was starting all over again, I would start on 60mg/week divided into either daily or every other day dosing. This is pretty darm low, but the amount puts my free T over the top of "normal range", and is far beyond hypogonadal levels.

Of course this is not enough for many men, Some indeed need as much as 160mg/week. Starting that high is on the verge of putting you at risk for multiple complications. There are probably over 100 accounts of these problems on this forum, and new ones pop up seems more often than weekly sometimes.

Good luck!

Addendum:

Compounding other steroids with T is not a good idea. It means if you want to change something, your compounded vial is no longer useful. Better to just combine multiples in the syringe.

I do mix my own enanthate/proprionate blend from vials of each ordered through Defy, but started this in very small batches to be sure the ratio works well. Now mix 5ml at a time, then add HCG in the syringe. I also used nandrolone for a short while but it shot up my hematocrit. I am glad It wasn't compounded into my T. I would have had to throw it out and buy new T.

I've been with Defy since 2016 and am very happy with Dr Saya, but not the company itself. They are good at what they do, I just find the gatekeeping function of support staff to be unpleasant and unnecessary. They will prevent you from scheduling until you jump the hoops that they want you jump, and this is fraught with trouble if you are getting labs done through other channels ordered by other doctors. Part of their business model is to provide a comprehensive service, everything , labs, prescriptions etc, and if your needs are different, it gets to be a PITA. I am used to it and know what to expect, but the process is not smooth, there are always issues for them even when I have submitted everything requested. The reports etc are not in the same format they are used to through their own channels, and the support staff does not understand the doctor/patient relationship I have established with Dr Saya.

Makes sense...I suppose when you are dialed in, premixed would be convenient. Personally, I would like the individual vial for each compound.

Your comments about Defy make me happy I chose Peter MD. Start to finish, it's been very smooth.

 

[Blackhawk]

Your comments about Defy make me happy I chose Peter MD. Start to finish, it's been very smooth.

Dr Saya is a gem, and also helped me work through thyroid dosage problems compounded by liver problems induced by complications from leukemia. It is worth the other administrative trouble for me to keep him as my hormone doc.

 

[Vince]

Hi, brand new member here. Lots of good information and discussions on this forum. I'm with Peter MD and so far so good. Already had labs, so I got into (virtually) see a physician right away and started my treatment. I would have liked to have started at a higher ml/inj, but I'm open to see how current protocol goes at 0.4ml 2x/wk (160mg) + HCG 25u ...started 4 wks ago.

Labs were: Test - 265ng/dL; FT - 37.3 pg/mL

Clinic has some great add-ons like nandrolone and oxandrolone if medically necessary. I looked into Defy Medical and see they offer those as well, plus stanozolol. Medical necessity required it seems, but also for recomp and adding a more anabolic compound to therapy. Additionally, looks like you can compound cypionate and enanthate together, even add nandrolone, and choose the oil base (sesame/grape/etc). Defy just seems to have wider options on their TRT/anabolic therapies available. For now, I'm getting what need, just curious if I wanted to start on a nandrolone for joint pain after a recent RCuff surgery and add in oxandrolone to further recomp, how receptive is Peter MD (for those who have experience) , same with Defy, and has anyone switch clinics bc one wouldnt allow to add anabolic therapies?

I like your testosterone dose but what's 25 u of HCG?

 

[LiveX2]

I like your testosterone dose but what's 25 u of HCG?

25iu or .25ml

 

[Vince]

25iu or .25ml

Don't you think that's too low to have any effect on you? I use 500 IU twice a week and it keeps my testicles nice and full.

 

[LiveX2]

I've never had experience with HCG. But seeing a lot of others' doses are much higher than what Ive seen prescribed. I will bring it up at my 12 wk consult. and see how the boys are doing.

 

[Blackhawk]

I've never had experience with HCG. But seeing a lot of others' doses are much higher than what Ive seen prescribed. I will bring it up at my 12 wk consult. and see how the boys are doing.

Quite sure 25 iu won't do a thing, but .25ml if mixed at 1ml=1000iu is 250iu. I doubt your solution is 1ml=100iu, that is unheard of.

Vince's dosage is common, but 500iu single dose size is too much from me and provokes estrogenic symptoms. He is on 1000iu/week.

Yes, just how I am like with T, I don't need as much as many others. I take 200iu every other day so 700mg/week. This does is effective for my testicles, and reduces estrogenic sides.

There has been much argument over this, and even knowledgeable people who will deny that 200iu would have any useful effect, but ultimately the way to know is to try and find what works for you.

 

[LiveX2]

I should have wrote 250iu. If dose is 25u, that's .25ml. Right?

 

[Blackhawk]

I should have wrote 250iu. If dose is 25u, that's .25ml. Right?

HCG is measured in IU or international units. Doses are in IU. This is an amount of HCG, and does not mean the amount of fluid.

The units on your syringe are not the same. Those units are of fluid volume.

HCG comes a dry powder that for our purposes*, bacteriostatic water is mixed into.

*(for other fertility purposes sometimes a vial is single use and does not require the bacteriostatic component, so normal saline is used) .

The number of IUs in a given fluid volume can vary. It is commonly mixed at 1000iu per 1ml, At that concentration if you re injecting .25ml, yes the dose is 250iu. This is probably what you are getting.

To know the actual dose, you need to know the concentration in the fluid.

 

[LiveX2]

The number of IUs in a given fluid volume can vary. It is commonly mixed at 1000iu per 1ml, At that concentration if you re injecting .25ml, yes the dose is 250iu. This is probably what you are getting.

To know the actual dose, you need to know the concentration in the fluid.

Ok, yeah, concentration is 1000iu per ml., I just forgot the zero on end of the 250iu. Was worried for a moment, thought I had been underdosing.