During the previous years large surge in testosterone prescriptions and TRT clinics there are unfortunately many men who have been misdiagnosed with low testosterone, yet placed on TRT when it may not have been needed in the first place. If you are one of these men and you are considering the discontinuation of testosterone treatments there is a protocol that can help restore your own hormone axis. You do not want to stop testosteone "cold turkey", this will lead to unecessary symptoms that could last for many months. This is an example of just one protocol, since there really is no "one way" to do it. This has proven a very effective foundational protocol for Defy, but of course every patient is different and therefore treatments are individualized as needed. A good TRT doctor will customize the approach based upon the patients response. TRT: Endogenous Restoration protocol for Men Discontinuing TRT Male patients who have been taking any form of exogenous Testosterone long term, longer than 12 weeks, will have secondary hypogonadism induced by the negative feedback response to the exogenous testosterone use. The purpose of this protocol is to stimulate the testes using HCG so that they are able to produce testosterone once again,while also preparing them to respond to endogenous LH/FSH(gonadotropins). Tamoxifen is taken beyond the HCG as it is shown, as aSERM, to stimulate the pituitaries release of LH/FSH whole suppressing the negativeeffects of excess estradiol. Clomid is also commonly used as a SERM. Estradiol can elevate in men who discontinueTRT so it is important to run the SERM for some time after discontinuing TRT to mitigate E2 rebound. Meds needed: HCG 11,000iu+mixing kit Clomiphene 50mg #30-#60 tablets Tamoxifen 20mg #30-#90 tablets Syringes and supplies for HCG Basic Protocol Begin protocol 5 days after the last T injection (Cyp/Enanth). If the patient is taking a T cream than begin the protocol one day followingthe last application of T cream. First 30 days: HCG 350iu daily sq Tamoxifen 20mg- 1 tablet POQD DHEA 50mg- 1 capsule QHS (Optional) Request Sildenafil (Viagra) or Tadalafil (Cialis) for any ED. Many patients experience ED during initial recovery. 30 day blood work follow up: Draw the following labs: Testosterone F&T; Sensitive Estradiol; CBC; CMP ** Physician can order additional labs at his/her discretion. After 30 days of HCG+Tamox After the initial 30 days of HCG+Tamox; If the total Testosterone is elevated at the follow up blood test, then it can be assumed that patient is responding well to HCG. Discontinue HCG and titrate tamoxifen dosage to 10mg after last dose of HCG. Continue the Tamoxifen 10mg for 30 more days. Add Clomid 50mg QHS for 30 days. Set lab reminder for follow uplabs 2 weeks after last dosage of Tamoxifen/Clomid. Levels should remain elevated from there. If not, at the physicians discretion the above protocol can be repeated until labs reflect a desired response. Symptomology (the study of your symptoms) must also play a role in determining desired response. Labs Needed: Testosterone Free and Total; Sensitive Estradiol; LH; CBC; CMP-14; DHEA; PSA If the Patient Does not Respond after 30-90 days of HCG+Tamox If the patient does not respond to the HCG+Tamoxifen after90 days (3 cycles), then it can be assumed there is possible primary hypogonadism. This would not have been caused by the TRT, more than likely it has developed naturally with age or has been present for a long time. In this case itis best to suggest continuing TRT so that T levels remain optimal and the patient’s life quality and health also remain optimal. Educate the patient on the importance of maintaining good levels of T, even if that means being treated with TRT. My good friend Nelson Vergel has provided great information regarding HPTA recovery after using androgens. This article also includes a study with HIV patients who cycled testosterone medications followed by a protocol designed to restore normal hormone function. You can read it here: http://www.excelmale.com/content.php?56-How-to-Stop-Testosterone-Safely-and-Possibly-Reset-Your-Hormonal-Axis
Published in Defy Medical Blog
Why do I need blood work? One of the purposes behind drawing blood for analysis is to provide our physician a means to compare how you are responding to therapy with your hormone blood levels and other important indicators of your health. This information allows Dr. Saya to make appropriate adjustments to your regimen that not only improve how you are feeling but minimize any side effects and risks with treatment. The laboratory analysis of your blood will also provide a comparison with initial blood work and provide data that will aid in the development of your treatment plan.

Who is required to have blood work? Any patient who is on hormone replacement therapy (HRT) or testosterone restoration therapy (TRT).

How often is blood work required? Each patient at Defy Medical starts with a comprehensive blood analysis prior to beginning therapy. The first follow up is required 90 days after starting therapy. Once this review is complete, follow-up labs will be required twice per year, unless additional labs are requested by Dr Saya or the patient. In some cases, certain conditions or diseases may require additional monitoring where more blood work is required.

What blood tests am I receiving? This depends on factors such as the patient’s sex, type of therapy, and medications being prescribed. Typically our standard follow-up lab panel includes analysis of kidney, liver, and other organ function through a comprehensive metabolic panel (CMP-14). We also look at red and white blood cells; immune function; Lipids; diabetes risk; and nutritional deficiencies. Lastly, we look at key hormones such as testosterone, thyroid and pituitary function (growth hormone), Adrenal gland function, estrogens, and other sex hormones. We also have additional testing available by request, such as vitamin D3 and our cardiovascular risk panel. Follow up labs are customized to each patient depending on what program we are monitoring.

Where are the labs drawn? All blood is drawn at Defy Medical in Tampa, FL, or at a one of the Labcorp locations across the US. To find a Labcorp location near your home or office, please visit http://www.defymedical.com/services/laboratory-blood-testing

Will insurance cover my blood work? Although Defy Medical does not accept insurance, in some cases insurance does cover labs. Please let us know if you would like us to check your coverage. We also provide Claim Assistance by completing the necessary paperwork needed to submit for reimbursement from your insurance company. Claim Assistance does not guarantee reimbursement; this will be determined by your insurance company.

How do I schedule my blood work follow up? Patient Portal: You may order and schedule your lab work by logging into your patient portal and following the instructions for ordering lab work. If you have not been registered for the new online patient portal, please let any of our staff know and we will assist you in the process. Email: Send your lab request to: [email protected] Phone: Call our main number at 813-445-7342 and any of our staff can assist you with your lab order. Fax: Send your lab order request to 813-445-7340 Labs will tell us what is happening in your blood, we need you to tell us what is happening to you. How do you feel today? Are you experiencing any symptoms which you would like Dr Saya to address? As usual, you are welcome to call us at our office to schedule a consultation anytime. Our goal is to provide all patients with optimal service and medical care. If you need assistance or would like to speak with Dr Saya regarding your treatment, please let us know.
Published in Defy Medical Blog