Hi everyone,
I have an initial consult with Defy Medical coming up and I thought I’d ask for input on questions to make sure to ask or topics to discuss.
I’ve been on trt for about 15 months, currently 100mg/week T-Cyp divided into 2 injections and nothing else.
Still don’t feel well, mental and physical fatigue, ed, low libido, brain fog, persistent joint pain.
Total T 565 ng/dl. 264-916 ng/dl
Free T 13.1. 7.2-24.0
If those are your labs on your current protocol they’ll definitely bump you up. I’d just tell them your symptoms and they’ll interpret your labs and prescribe accordingly. The consult isn’t hard.
Not sure they’ll go that route with an HCT of 53%.
I would make sure that the HCT issue is highlighted, and also ask them about DHEA supplementation.
Also, you are estrogen dominant (very high E2 for that level of T) so you’re going to want to make a hard case on your side that you would like to talk about addressing aromatase issues (excess fat) and increasing T levels. Try to avoid AI’s if possible, as the Defy Staff will try to go that route (they try to start with AI’s typically, and it’s rarely the best option).
I am typically anti-AI, but in your case it may be a little risky pushing T levels with that HCT so you may have to try micro dosing for a short time. If this is the case (and even if it isn’t really) you should put ALL PRIMARY FOCUS on whatever is causing your excess aromatase, whether that be scrutinizing you’re diet or hitting the gym hard to lose more fat, or preferably BOTH.
The sooner you get that conversion problem calmed down, the sooner you are going to feel better.
I had the same thoughts as Brady. Your E2 is extremely high for your Free T, but I still do not recommend using an AI. What is the state of your fitness/body fat/nutrition?
You’ve both correctly surmised that I’m overweight by a large amount, I’m down about 30lbs, 150ish to go. I’m working with a stength coach and a nutritionist and am moving in the right direction, but it’ll be a long haul. Which is fine, I didn’t get here over night. A low back injury and other joint pain can be very limiting for me some days, at the worst literally lurching from hand hold to hand hold to get to the bathroom and otherwise basicly immobile without opiates (bad days, good days I don’t take that, but still can’t walk more than 5 min due to pain). I have just been approved for an RFA procedure that should help with that.
I’m personally not adverse to the idea of the ai as a stop gap while the weight comes off. I do not want to crash it though, my joints hurt enough as it is.
You have a rough road brother and you have my deepest sympathies. I can’t imagine how hard this must be for you. Know that we are all here for you to help you out in any way we can…Moral support…answering anything we can…whatever…
Best of luck man. You’re going to get there if you don’t give up…That much I know!
Ditto what Brady said. But given your joint pain, I would not recommend an AI for you! Stay away, brother.
It’s great that you are taking ownership of your health and fitness. Losing that weight will improve every aspect of your life.
Defy will treat you well provided you go in with an educated perspective. I recommend reading through some of the forums here and listening to the TOT Revolution interviews, particularly the episodes with Keith Nichols and Neal Rouzier.
Write all your questions down on a piece of paper so that when it comes time you cover everything and get your money’s worth. There’s nothing worse than a missed opportunity.
I’d go ahead and try 15mg T Cyp a day for 8 weeks. Likely this will be your best protocol as it’ll limit how much estrogen you aromatize the most. After 8 weeks I’d check bloodwork and assess how you feel. Likely you’ll feel a lot better, and at this point you might decide trying 17-20mg dailies protocol. Then, when you lose your excess weight (under 15% bodyfat) you can try 120mg split twice a week for 8 weeks and see how this one works for you as you will aromatize less estrogen compared to now. But good chance dailies will just be your most optimal choice.
You likely need higher TT and FT to feel optimal, but your estrogen is way out of wack, even by conservative T to E ratios. Increasing injection frequency is the best way to limit estrogen without using an AI. Just try dailies for a long enough time (8 weeks) and only after should you consider an AI. Defy may also try to include DHEA in your protocol, but I’d hold off on it until you get your estrogen in a proper range.
In addition,
Are you on thyroid meds? Thyroid looks really good for your weight.
Anyway.
To help you lose weight optimize thyroid and testosterone the best you can without using an ai. And start focused on losing weight.
Also check cortisol. Esp AM cortisol and night cortisol. If cortisol is off, much harder to lose weight.
Also if you are insulin resistance very hard to lose weight.
Check fasting insulin and also a random insulin blood test.
A1c and glucose.
If signs of insulin resistance and/or elevated glucose, metformin will help you!