TRT has not been good to me.

[Tonyp56]

6-17-17 thru ~5-2018 Universal Men's Clinic
First injection following Defy 7-2018...
I'm 42 years old now and my original main reason for getting checked out was because of fatigue after the gym or any physically demanding task. For instance, helped sister in law move, felt fine (was In good shape) caring boxes, but for 3 days after felt absolutely dead, no energy, couldn't get erections and so on. Stuff like this kept happening, so decided to go get checked. Thought, "mens" clinic would know rather or not it was testosterone or not so went. Currently weigh 242 pounds (I'm 6-0) down from ~256 in July, so I've been trying to lose weight, not super strict, just trying to eat "clean" most of the time avoiding as much junk as I can. At a slight deficit.

Anyways current protocol is .2 ml (40mg) of testosterone cypionate (changed from .18 at my consult on 11-19) EOD, .1 mg of anastrozole EOD, and 500 iu of hcg twice weekly. Along with this I take magnesium, fish oil, a multi, and vitamin D. I'm not a picky eater so eat wide range of foods, from fish to beef, most all vegetables, etc so should be getting nutrients. Dont drink at all and dont do drugs except advil for mainly headaches or doms sometimes. I use to dip (18 years), smoked for a year when quitting and then went to vaping so I'm a vapor for last 6 years or so.

I try to go gym 3 days a week. I'm trying to gain strength more than build muscle (my focus is more on powerlifting and less on body building, because I enjoy that more, doing 100 sets of curls is very low on my interest). This was actually the first struggle. I went 3 years plus with out missing more than a couple training sessions, after starting trt I have went months without training, several times (I'd take off for 2-3 months, return for 1-3 months, then miss another 2-4 months so on). Seems to be an absolute lack of drive, I just cant get motivated. Currently I've been training about 2 months. Do I see some changes? Strength wise maybe a little but that is quickly squashed when dont have energy or just lack of drive to go.

Erections have gotten better with defy, pretty much for that year I was at universal mens clinic I couldn't even get an erection, let alone maintain it. However, that said continues to be a struggle and an unpredictable situation. (Have no way knowing if it will work and cant even predict if it will or wont) when it does work, it is not even fully erect.

Mood issues. I've delt with depression in my life, but after trt is is relentless! I keep going from feeling fine to being deeply depressed back to fine. This is new and started from first injection on 6-17-17 has just gotten worse. Last Tuesday's consult was the latest, it was such a disappointment, it ruined my whole week.

My consult on 11-19 was a disappointment. First in year and a half at defy I've never consulted with dr. I have consulted with nurse practitioner, and I like her. But thought, since I continue to have trouble if I talk to Dr directly maybe he can help. Of course, set it up with Dr Saya himself. $165 got called 20 mins late and my consult lasted 17 mins! What was his "help" 1) change my testosterone injection to .2ml from .18ml, which was changed at last consult (so not the fix for issues) said free t would like it around 30 and mine is 23 something but dont know this will do anything, 2) add a trial of thyroid to see if I'm someone that would benefit from thyroid meds even though normal blood levels to increase energy, 3) add low dose cialis/tadalfil daily for erections.

I've ordered thyroid meds, will see, but doubt they will do anything. $100 for 40 days worth (tadalfil) is beyond what I can afford (basically I'd have to pay out $100 ~every 3 weeks, no way ontop of everything else). Never mind that I cant afford it, dont even know if it would work and that's a big price for that.

It was like he wouldn't even listen to me or consider that my issues continue to plague me. Had talked about possibly TRI-MIX last consult with nurse practitioner and was wanting to ask about that and he instantly shut it down, which is fine dont want injection, but didnt even give me a chance to ask how likely would I ever be of getting erection on my own after TRI-MIX. And besides something in protocol is causing issues in my opinion, Hcg?

Anyways anyone know alternatives or ideas? Went to Roman, doubt will find cheaper solution but want to, NEED to try something. Would like to find new clinic too. Having to get a yearly physical and explain Defy is getting harder. Along with I'm sorry, in my opinion, lack of interest in patients.

Labs. I know everyone here likes seeing them. My triglycerides were 231, disappointment here too, considering I've been losing weight and trying to eat better, Dr's fix, avoid carbs and increase fish oil from 2,000 to 4,000 mg. (Cholesterol is total 164, hdl is 41, vldl 46, ldl 77) Glucose was high (102) wants more testing at next labs (this too was disappointing) estradiol sensitive 21pg/ml 8-35, total t 879 ng/dl 264-916, free t 23.2 pg/ml 6.8-21.5, dht 45. Shbg 19.5 nmol/l

 

[Vince]

Your present Labs don't look too bad. What were you last at before starting trt?

 

[Tonyp56]

Your present Labs don't look too bad. What were you last at before starting trt?

6-17-17 at universal mens clinic before being put on trt
Tt 357 (Ref Range:348-1197 ng/d)
LH 2.8 (Ref Range:1.7-8.6 mIU/mL)
Estradiol 14.1
(Ref Range:7.6-42.6 pg/mL
Roche ECLIA methodology)
shbg 44.7 (Ref Range:16.5-55.9 nmol/L)

1-4-2017 (testing via discounted labs) wanted to look seen the results thought I was normal later (6-17) went to universal mens clinic because issues continued)
tt 448.6 (ref 348.0-1197.0 ng/dl)
ft 9.5 (Ref Range:8.7-25.1 pg/mL)
estradiol sensitive 14.9 (Ref Range:8.0-35.0 pg/mL)

also checked thyroid, again wanted to know just in case.
T4,Free(Direct)
1.14 NORMAL (Ref Range:0.82-1.77 ng/dL)

TSH
1.800 NORMAL (Ref Range:0.450-4.500 uIU/mL)

Triiodothyronine,Free,Serum
3.8 NORMAL (Ref Range:2.0-4.4 pg/mL)

 

[Tonyp56]

Also should add had to donate blood two weeks ago. My last labs show slight elevated red blood cells and hemotricit. Go tuesday for follow up cbc

 

[Charliebizz]

What’s up tony you pre trt labs similar to mine. My t is actually lower but thyroid looks same. I was a patient of dr crislers and I too couldn’t get dialed in on trt. I also experience the mental sides from it. I’m really wondering if it could be thyroid related I have a lot of hypo symptoms but my numbers are fine. My body temp is always low 97. Sometimes even in 96 range. Trt has also made my low normal cortisol numbers lower in the past and only way I don’t feel like death on trt is with low dose ssri.

I did have less aches and pains on trt but all the sides are so terrible I’m in the same boat as you. I hope you have luck with thyroid and if you do that will give me some hope. Good luck my brother

 

[wondering]

Your thyroid looks a little low. That said TRT has done zero for me. Thyroid same. Pt141 nothing. Viagra nothing. Daily cialis almost nothing. 3 days of supplemental scrotal tcream...better mood, but nothing if not worse sexually. Been like this for 23 years. This isn't living. Started dating a smoking hot woman. Last week in bed for first time and no response. Not sure how patient she will be.

 

[Gman86]

Your thyroid looks a little low. That said TRT has done zero for me. Thyroid same. Pt141 nothing. Viagra nothing. Daily cialis almost nothing. 3 days of supplemental scrotal tcream...better mood, but nothing if not worse sexually. Been like this for 23 years. This isn't living. Started dating a smoking hot woman. Last week in bed for first time and no response. Not sure how patient she will be.

Interesting with the cream and decreased libido/ erections, but improved mood. I’m experiencing the same. My mood seems a little better than on injections, but sexual function is a little down. What was your TRT protocol(s) on injections?

 

[Tonyp56]

What’s up tony you pre trt labs similar to mine. My t is actually lower but thyroid looks same. I was a patient of dr crislers and I too couldn’t get dialed in on trt. I also experience the mental sides from it. I’m really wondering if it could be thyroid related I have a lot of hypo symptoms but my numbers are fine. My body temp is always low 97. Sometimes even in 96 range. Trt has also made my low normal cortisol numbers lower in the past and only way I don’t feel like death on trt is with low dose ssri.

I did have less aches and pains on trt but all the sides are so terrible I’m in the same boat as you. I hope you have luck with thyroid and if you do that will give me some hope. Good luck my brother

Thanks. My temp runs 98.6 normally. I would hate to get SSRI's because that would add to side-effects etc...

I dont know what I'll end up doing but will see what roman says cost wise and if decent ill try viagra and see if it helps at all. Before I spend $100 on 40 doses and find out it dont work or worse yet makes me feel worse. But even if it did work I cant afford that. Though not sure about getting from overseas either. So really not sure.

 

[Systemlord]

I wonder have you ever tried TRT in isolation without HCG? Reason I ask is HCG can cause erectile problems for some men. I can't touch AI's as it instantly kills libido and erections even at 0.050 doses.

Things balance out better on daily dosing, I have low SHBG like you.

 

[Tonyp56]

Your thyroid looks a little low. That said TRT has done zero for me. Thyroid same. Pt141 nothing. Viagra nothing. Daily cialis almost nothing. 3 days of supplemental scrotal tcream...better mood, but nothing if not worse sexually. Been like this for 23 years. This isn't living. Started dating a smoking hot woman. Last week in bed for first time and no response. Not sure how patient she will be.

Tsh was only thyroid checked last time (11-5-2019 is date of my last labs) and it was 1.91

My wife is beautiful and I've had to use other tools to keep her happy. Which is fine for her but sucks for me because I dont get to experience fun too as much. Have to say though, better now than universal mens clinic, I bet you could have cut it off and I wouldn't had been able to feel that. (No sensitivity, at all) crashed e2. At time they told me it was sensitive test, but now that I signed up on labcorp's site I see that it wasnt sensitive test that they were running. Anyways it came back <5 a few times there

 

[Tonyp56]

I wonder have you ever tried TRT in isolation without HCG? Reason I ask is HCG can cause erectile problems for some men. I can't touch AI's as it instantly kills libido and erections even at 0.050 doses.

Things balance out better on daily dosing, I have low SHBG like you.

What I've honestly felt all along but again Dr. Saya would have to listen and let me try. I've ran out of hcg a few times and decided to take my time on reordering. To be honest I'd feel better, but after couple weeks id start having issues so end up back using it. But haven't given it a long, 40 days plus run. To let things even out and didnt adjust t dose, which I would think I would need to. But dont know.

Also daily injections would be fine here if it made a difference. But have no idea where to start on dosing. To me (I'm not a doctor or do I know this for a fact) but I think higher (900 and up, possibly 800 and up) test levels make me feel worse and cause more issues. But again have no idea where to start or what goal should be. Also think anastrozole is part of problem for me too, and nurse practitioner wanted to reduce from .125 to .1 for that very reason. But estradiol reaches 60 plus without. Though I understand hcg is part of this issue.

 

[Charliebizz]

Thanks. My temp runs 98.6 normally. I would hate to get SSRI's because that would add to side-effects etc...

I dont know what I'll end up doing but will see what roman says cost wise and if decent ill try viagra and see if it helps at all. Before I spend $100 on 40 doses and find out it dont work or worse yet makes me feel worse. But even if it did work I cant afford that. Though not sure about getting from overseas either. So really not sure.

good temps and decent numbers I would doubt it’s your thyroid

 

[Tonyp56]

I would like to say something. I am in no way doubting Defy or Dr Saya. I was disappointed and feel that I've shown a great deal of patience. Of course, he also said the doors are always open if I need help. And that is great, the issue with that is I have to 1) get labs, and then 2) purchase consult. So when I've spent the money I'd like to be listened to and took seriously. Not basically told, try this see you in six months. Six more months of things not working and feeling less than optimal at best.

I also understand they help, well more people than those that are having issues and part of this is being busy and having more patients waiting for consult. Calling 20 mins late was him going over my chart (first time he had actually dealt with me and all).

But isnt part of making trt better for everyone really looking at those that dont respond very well? Why? Is an important question that I would think any provider would want to answer.

 

[Dr Justin Saya MD]

Hi Tony, I remember our consult and this is one of those times where 1 + 1 doesn’t always = 2...as happens occasionally with the many moving parts of hormone treatment. Since you haven’t tried PDE-5 inhibitor (viagra/cialis) yet, for your benefit, as we discussed, I wanted you to try that as a less risky alternative before escalating to a more aggressive (and more risky) treatment such as trimix. If tadalafil does the job, then it is less risky (priapism) than trimix long term. Doing a trial of discontinuing HCG is always an option. Most guys respond well, some or few don’t - for those guys it can be addition by subtraction. As I mentioned to you my door is always open and I’m sorry you/we haven’t found success yet.

 

[Tonyp56]

Hi Tony, I remember our consult and this is one of those times where 1 + 1 doesn’t always = 2...as happens occasionally with the many moving parts of hormone treatment. Since you haven’t tried PDE-5 inhibitor (viagra/cialis) yet, for your benefit, as we discussed, I wanted you to try that as a less risky alternative before escalating to a more aggressive (and more risky) treatment such as trimix. If tadalafil does the job, then it is less risky (priapism) than trimix long term. Doing a trial of discontinuing HCG is always an option. Most guys respond well, some or few don’t - for those guys it can be addition by subtraction. As I mentioned to you my door is always open and I’m sorry you/we haven’t found success yet.

Dr Justin Saya,

Thank you for responding. And forgive me for, how I've posted here. This whole process has been disappointing for me. And honestly it's getting to me.

I honestly dont want TRI-MIX, my question was really if it came down to that, does that mean, ability without it would become impossible?

Daily cialis would require how many days before I would notice anything if it is going to work? I ask this because of cost, I've seen it for way more $ else where, but it's still expensive, if I got 40 doses is that enough or would it require more of an investment. If viagra is only used when needed, within couple uses i would know its working or not correct? (I know I'm using brand names here, the much much more expensive option, simply using them because simpler)I know you said more side effects with viagra, hence cialis recommendation. Ask all of this to spend (waste) the least amount of $ I have to on things that wont work. Hope it's not cialis, because of long term cost. (They all are expensive). Also want to be sure to try either long enough to rule them out. (If I take for a month and it dont work and quite and then find out 2 months minimal then I've wasted a month and have to start over too.)

I'll continue everything else as is for now (can see in 6 months about hcg and anastrozole) . As soon as I get thyroid in (has been ordered) I will take as directed (understand empty stomach so that body absorbs it) and see what that does for energy (possibly mood?) And watch for jitters etc. Pde5 as soon as possible and will see if it helps.

Thanks

Tony

 

[trt reznor]

Dr Justin Saya,

Thank you for responding. And forgive me for, how I've posted here. This whole process has been disappointing for me. And honestly it's getting to me.

I honestly dont want TRI-MIX, my question was really if it came down to that, does that mean, ability without it would become impossible?

Daily cialis would require how many days before I would notice anything if it is going to work? I ask this because of cost, I've seen it for way more $ else where, but it's still expensive, if I got 40 doses is that enough or would it require more of an investment. If viagra is only used when needed, within couple uses i would know its working or not correct? (I know I'm using brand names here, the much much more expensive option, simply using them because simpler)I know you said more side effects with viagra, hence cialis recommendation. Ask all of this to spend (waste) the least amount of $ I have to on things that wont work. Hope it's not cialis, because of long term cost. (They all are expensive). Also want to be sure to try either long enough to rule them out. (If I take for a month and it dont work and quite and then find out 2 months minimal then I've wasted a month and have to start over too.)

I'll continue everything else as is for now (can see in 6 months about hcg and anastrozole) . As soon as I get thyroid in (has been ordered) I will take as directed (understand empty stomach so that body absorbs it) and see what that does for energy (possibly mood?) And watch for jitters etc. Pde5 as soon as possible and will see if it helps.

Thanks

Tony

Cialis works for me in a matter of hours. I can’t take much, or I’ll get some serious flushing/redness/headaches.

It’s kind of crazy that your E2 will get up to 60 without AI; but as you said you didn’t get the sensitive test so who knows what it really was. As some have suggested, I would consider starting from the ground up, both without HCG and the AI. It’s hard to tell what’s causing what. Personally, I always suspect the AI, but I’m no doctor. I just know that Id MUCH rather have higher E2 than low, it forced to take one. I know some here can get by with two 250iu doses of hCG and it’s enough to keep the boys hanging low. If I were in your position, I would stop AI first. See if you start moving in the right direction within a couple weeks. Stay with that as long as you keep feeling better. If your E2 starts climbing up, try reducing hCG to 500 a week split into two 250iu doses. You can also use zinc plus a low dose of copper to control mild E2 issues (research this). Cialis can work for erections but the libido may still suffer until you get yourself a little more balanced. It’s still much better than being soft in bed though, lol!

I think you still have options to explore. Take this advice with a grain of salt, and talk it over with your Dr. of course. Good luck to you.

 

[fifty]

If you feel worse after doing trt for over a year why don’t you just stop? Your issues are not totally out of the ordinary...including the dedication to trt despite feeling bad on it.

 

[Tonyp56]

Cialis works for me in a matter of hours. I can’t take much, or I’ll get some serious flushing/redness/headaches.

It’s kind of crazy that your E2 will get up to 60 without AI; but as you said you didn’t get the sensitive test so who knows what it really was. As some have suggested, I would consider starting from the ground up, both without HCG and the AI. It’s hard to tell what’s causing what. Personally, I always suspect the AI, but I’m no doctor. I just know that Id MUCH rather have higher E2 than low, it forced to take one. I know some here can get by with two 250iu doses of hCG and it’s enough to keep the boys hanging low. If I were in your position, I would stop AI first. See if you start moving in the right direction within a couple weeks. Stay with that as long as you keep feeling better. If your E2 starts climbing up, try reducing hCG to 500 a week split into two 250iu doses. You can also use zinc plus a low dose of copper to control mild E2 issues (research this). Cialis can work for erections but the libido may still suffer until you get yourself a little more balanced. It’s still much better than being soft in bed though, lol!

I think you still have options to explore. Take this advice with a grain of salt, and talk it over with your Dr. of course. Good luck to you.

Right away I've got to clarify. Universal mens clinic shoved anastrozole down my throat, they compounded it in injection and later cream (1 mg per shot, cream was more confusing but crashed my e2 still) they were the ones that were not using correct test. Ontop of compounded they even wanted me to take 1mg pill once a week ontop of compounded anastrozole! I did at times trying to follow their directions but got so bad August-September I thought I was dying and i was pissed when they said oh your estrogen shows <5

Switched to defy started off twice a week no anastrozole at first. (Testosterone and hcg) my e2 went up tried to avoid anastrozole and e2 continued going up. It got over 60 for more than a month and I felt horrible.

Between universal and defy ~2 months I was off of everything and shortly in beginning things improved. However, things have never been as good as they were pre-trt. (Low/crashed e2 --- high e2, high dose of anastrozole (1-3 mg per week)--low dose (.4mg per week) delt with same lack of ability.

And finally it isnt a lack of wanting. I can be super excited and wanting my wife really bad, brain is all there and then when it is time it's like it is in another room and does not respond. Or basically wife and I say "he took a nap" in the middle (responds and then just poof nothing)! Rarely does it respond and stay throughout though. Pre-trt I could at least time it (ok I had hard training at gym today it will be 2 days before we can)

Thanks for response. That's a few hours with low dose daily? So if I ordered 1 tab that can be divided into 4 (odt) take 1 quarter and within few hours it will work if it's going to?

 

[Tonyp56]

If you feel worse after doing trt for over a year why don’t you just stop? Your issues are not totally out of the ordinary...including the dedication to trt despite feeling bad on it.

There isnt any going back in time before trt. You cant just stop trt after this long (even a year ago) at over 40. Part of the reason this is all a big disappointment

 

[fifty]

I did. I’m 40. I have a little less energy but at least I can sleep and don’t have high anxiety anymore