Had another post going while I was making the decision of whether to to go from Clomid/Anastrozole regimen I’ve been on for 8 years (35mg Clomid 3xweek and 0.1mg Anastrozole 1xweek). My SHBG climbed over the years of treatment and below are my recent labs with Defy. It should be noted that I accidentally missed my AI dose the week before these labs, so my E2 value is 2 weeks since my previous 0.1mg dose (coincidentally, I had strong morning wood all week following for the first time in a long time).
I’ve had my initial consult with Defy (Dr. Calkins) and he recommended and prescribed the following protocol:
80mg test twice per week
500iu HCG twice per week
0.1mg Anastrozole twice per week
25mg DHEA nightly
I plan on starting as soon as everything arrives, but he did leave me with a few choices and I kind of have decision fatigue at this point.
Start at 80mg twice per week and lower later I’d we need to OR start at 70mg or 75mg twice per week and go up if we need to
IM or Sub Q for my TC injections
Since I’m a TRT virgin, and a lot of you are clearly experienced, would love to see what you think of my protocol as well as the options he’s left me with. One of my concerns is driving E2 too low, but he felt that this is going to get my E2 high enough that I’ll need the 2nd weekly 0.1mg dose.
Thanks and ton in advance and just trying not to run into this blinded by the pure excitement of what TRT may do for me over time. I plan on updating this thread with my journey until I get dialed in.
Yes. Sat at 21-22 for the past 3 years. Prior to that (and AI) I was going up into 38-42 ranges. But prior to starting Clomid, I was below range. Clomid seemed to have driven it up over time. And I know, Clomid and TRT aren’t a 1:1. I know 0.2 is a small dose and I really want to follow his recommendation but something about doubling makes me uneasy.
You got morning boners after dropping it for 14 days. Drop the AI. It does no good if your aren’t symptomatic of high E2. And its obviously negatively affecting you.
Looks like an example of a low T clinic that uses a cookie cutter approach and over prescribes. However, perhaps there is sound rationale behind it which is unknown to us?
I think you’d be fine with weekly injections if you would like to start with them. No problem with twice weekly though. 160mg per week is fine.
Why hCG? Are you currently trying to conceive or concerned with testicular atrophy?
Not sure you need anastrozole either. You were at 22 after missing it. Bet you were pretty low with it. Unless there is an underlying history indicating otherwise, seems reasonable to take a wait and see approach here.
Coincidentally? Probably not a coincidence.
Not sure you need DHEA.
I would want to know why hCG, why anastrozole, and why DHEA if I am you.
This was Defy, which after research, seemed reputable. Regarding HCG, they were adamant to the point of it seeming like a non-starter. No, don’t want more kids. 3 are plenty.
Regarding the AI, he heard my concerns but felt that I’ll be fine as I’ll be producing more T and hence more E than ever before.
If you are an AI over-responder, it won’t matter how much T your through at your system. Dial in to your TRT protocol without an AI by dosing smartly, if it proves unsuccessful, then introduce an AI.
It’s rare anyone would need an AI on daily dosing, we produced 7-10mg daily anyhow so it will be optimal.
Does the fact that I’m not daily (twice per week) make a difference? I feel like I may have just dumped a bunch of money into the wrong doctor and feeling a bit lost.
Your SHBG is high so twice weekly is optimal, Defy Medical was a good choice. You can always increase injection frequencies and lower the dose per shot to lower estrogen if AI’s don’t work well for you.
I need a ridiculously small dose AI, we are talking a pinch of the stuff gets the job done.
Thank you for the vote of confidence with Defy. What do you think of the protocol otherwise? 160mg make sense given my high SHBG (which I think was Clomid induced)?
You have to keep in mind that most people that these doctors see are middle age guys like us who are at the end of their rope. Just by sheer nature of us being guys, we don’t seek help until there are no options left. That being the case, the majority of those who come to Defy are more than likely in pitiful shape, completely down and out, and extremely overweight due to prolonged hormone deficiency. When you realize this, along with the fact that most overweight guys will likely aromatase even moderate TRT dosages excessively until they get the excess body fat under control, then it’s easy to see why their “default” protocol utilizes AIs.
There is also something to be said for being your own advocate. In my limited experience with Defy, once the doc realized that I had done a little homework on my own, and that I wasn’t completely clueless, he had no issues whatsoever with me having my say in the protocol, and did not push HCG or AIs any further.
Interesting point. I think that is very telling. Right is right and wrong is wrong. If it is right for one who is uneducated (completely clueless) then it is right for someone who has done a little homework.
