Yeah you’re at the peak, but on EOD there probably isn’t a ton of variation, unless SHBG is very low
What do you think of the numbers - too high? Need to lower my dose?
I’ll be meeting with my doc this week but he’s usually onboard with what I suggest.
I figure run TT as high as you can while keeping lipids, BP, CBC, heart health, etc in good range. I doubt 2kng is a “healthy” level, although I’m sure it feels awesome, I wouldn’t run that high for long
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Anyone here worked with Marek? How’s it been?
Everything is easy/convenient with Defy, but I haven’t received much expert guidance. Seems like I’ve put everything together myself.
Thinking from a long-term health perspective, Marek would likely be superior (I trust Derek), though I’m sure it’d be a pain to transition.
Do you mind if i ask what your schedule with Defy is? My current TRT provider wants to see me potentially every 2.5-3 months, which isnt a big deal money wise, but i hate having to do labs that often. Pretty sure he is going to have me start seeing him every 10 weeks, which i have to do labs and its a 175 dollar payment for the appt.
Defy requires 1-2X per year check-ins, I believe, but I do them (and bloods) every 3 months. Wanna be as on top of things as possible.
Maybe I just need to see Dr. Saya instead of a PA…
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Seems you are not a fan of him
What makes you think he doesn’t? I know he’s not an MD but sure seems to know his stuff
I’m seeing Saya starting now 
Gotcha, sorry I’ve missed those posts. Seems to me he’s ahead of a lot of folks on stuff like ARBs.
Great appointment with Dr. Saya. We discussed my catch-22: VERY high T numbers, and generally feeling good, but still no libido!
Reminder of where we are:
- Protocol: 252 mg T-cyp, EOD @ 72 mg
- TT 2996 (Ref 264-916)
- FT 109 (Ref 5.0-21.0)
- SHBG 85.4 (Ref 16.5-55.9)
We discussed the potential of two auxiliary compounds I’ve tried before (Danazol and Oxandrolone). I did not feel good on Oxandrolone, though my bloodwork was great. Dr. Saya suspects I had too much free estradiol in my system on that protocol (I know that’s a controversial take). Unfortunately, I did not have Free E2 measured.
I felt my best to date in June 2019, with T @ 260/week and Danazol @ 25 mg EOD. I then escalated the Danazol dose to 25 mg ED and felt worse. So we’re going back to Danazol @ 25 mg EOD. I am not opposed to trying Oxandrolone again – at a lower dose – but I believe Danazol is the smarter bet at this point.
- I have repeatedly cycled off auxilaries, and tried to avoid them, because they do not strike me as a viable long-term solution. However, Dr. Saya assuaged my concerns. He thinks, as long as they are applied appropriately, auxilaries CAN be incorporated into a healthy long-term regimen.
We will reduce my injection frequency. When I felt my best, I was injecting 2X/week. Lately I’ve been doing EOD. For most men, stable T levels are superior. However, Dr. Saya noted that “those who seem to buck this trend” are high-SHBG guys like myself, who seem to respond well to bigger, less frequent doses. So we’re going back to 2X/week.
We will introduce Tadalafil (@ 3-5 mg/day), an ED/blood pressure drug. We had a good chat about Angiotensin II receptor blockers, but that would be extreme given my current BP. An ARB is a potential add-on down the road if my BP worsens, but Tadalafil is sufficient for now – and, as an added benefit, an increased erection frequency could create a positive feedback loop that perks up my libido.
Other potential changes down the road:
- We discussed lowering my T dose. I’m 100% open to this but we don’t want to change too much at once.
- Neurotransmitters play a key role in libido. Thus, we might try manipulating dopamine, potentially adding Tyrosine (the conservative route) or Wellbutrin (aggressive). Interestingly, when I saw a PCP prior to going down the hormonal route, his initial prescription was Wellbutrin. I did not take it, however, after doing more research.
- I may add the following supplements down the road to help with libido: Ashwaganda, Rhodiola rosea, B-12 (taken previously), Zinc (taken previously).
- One more dramatic option to bear in mind: Pregnenolone. Experimenting with the “mother of all hormones” might come into play if nothing else works, but that seems far down the road.
- L-carnitine helps with androgen receptor density. I may consider it, but Dr. Saya does not see any reason to suspect receptor density is my issue.
- I am not currently taking HCG but also not trying to conceive. The wife and I will be in 1-2 years. Dr. Saya recommended re-starting HCG 6 months before we’re ready to try – but no need to use it now.
This makes me curious… from past SSRI use my libido is always garbage. I assumed it messed with dopamine levels, even after 3 years of zero use it hasn’t moved any. I wonder if he’d be able to help?
I called them twice and ended up picking someone else. Service was slow, and prices were insane. They are really riding the hype and prices for “extras” were 3-4x higher than I found at other clinics. And they use the same compounders, so not like you’re getting different products. IDK seems like they’re after the money. I’m sure their docs are fine tho.
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What have you used in terms of SSRIs?
I asked if Wellbutrin is an SSRI (it’s not). I am not a proponent of SSRIs after reading Johann Hari’s “Lost Connections.” I’m not saying they’re always bad, but I think they’re rarely the solution…and can cause a lot of negative side effects.
Has your libido gotten WORSE when on SSRIs?
I recommend chatting with Dr. Saya. Dude knows his stuff.
Thanks, man. My sense, from reading similar anecdotes, is that Marek’s service IS good, but their prices do not warrant it for most people.
If you do your homework, it seems you can find service just as good at a fraction of the price.
I’m sticking with Defy for now. I think working with Dr. Saya directly, instead of a PA, will be quite helpful. He’s the first provider I’ve met with – and I’ve met with many – who I knew FOR SURE knew more about the topic than me. I have some funny stories about the incompetence of some of those medical providers.
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I was 100% normal in all regards and after taking Lexi pro for 6 months 3 years ago I’m completely fucked up
That’s terrible. Could be other factors at play, too, obviously, but definitely adds to the “don’t take an SSRI” noise. So many mixed opinions on the subject.
There’s millions of people effected by them. I noticed something was off instantly, but it started as just being able to last longer which I thought was cool… missed the first red flag 
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We’re really bad at being objective when it comes to evaluating ourselves. Makes this whole hormone thing tricky!
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