T Nation

My Defy Medical Consultation Experience and Plan of Action


I finally had my Defy Medical consultant yesterday and it went better than I had expected, Dr. Saya is in a league of his own for sure. Dr. Saya hit on important points that were never covered before with my previous endocrinologists.

We discussed my previous protocol (50mg twice weekly) that was responsible for my initial labs below, that the 677 range was likely supraphysiological for me since it causes acne all over my body, even in places I never knew one could get acne.

We agreed the high E2 is causing problems with mood, therefore periodic irritability/stress together with my 7 months long chronic cough is likely responsible for my elevated Reverse T3, so balancing estrogen and reducing insulin resistance is critical to bringing down Reverse T3 naturally because the main thyroid hormones are good.

A1C has lots of room for improvement and IGF-1 is a little lower than Dr. Saya would like, so we discussed ​peptides, 300mcg SQ injection of ipamorelin to increase growth hormone naturally.

I’ve been on a new protocol for the past 4 weeks, 16mg EOD (64 weekly) and noticed muscles were getting noticeably firmer after only the second week. Muscles are continuing to get firmer every week, muscles are stiff and sore 24/7 and that feel good burn you get after a workout is constant all without the workout.

I went ahead and ran blood test at the 4 week mark (today) so Dr. Saya can dose the AI properly rather than going by outdated numbers from my old protocol. I don’t plan on being on the AI for long, after I lose significant weight I’m going to stop it and see how I do. Most guys after losing significant weight can reduce or drop the AI completely since aromatase enzymes lives in fat tissue.

My erections are starting up again as I draw nearer to the 6 week mark on my new protocol, testicles are tingling with sensitivity on and off throughout the day. I’m going to start berberine 500mg twice daily in place of Metformin since I have a negative reaction to it, coughing and hoarseness.

Going to take fish oil daily as well. I’m going to try everything suggested without HCG for right now. We are going to reassess thyroid in three months and recheck thyroid with another full thyroid panel. We are also going to do a 4 point cortisol saliva test.

Dr. Saya said one hormone out of balance is all it takes to cause a domino effect, high E2->emotional imbalance-> stress -> high heart rate-> high blood pressure. All of these broken systems can wreak havoc on many different hormones.

I’m going to start eating 80% whole foods, Steak, fish, eggs, veggies and some fruits. I will refuse to eat past 6pm, maybe raspberries/strawberries for snacking.

I’m very pleased with my consultation and look forward to my next check-in in 3 months to see what progress I have made.

I’ll update labs earlier next week and by weeks end I should know AI dosing.

Previous protocol = 50mg twice weekly.

Total T = 677 ng/dL 264-916 ng/dL

Free T = 29.2 pg/mL 6.8-21.5 pg/mL

SHBG = 16.2 nmol/L 16.5-55.9 nmol/L

Sensitive E2 = 70.6 8.0-35.0 pg/mLTSH .902 0.450-4.500 uIU/mL

Free T4 1.37 0.82-1.77 ng/dL

Free T3 3.6 2.0-4.4 pg/mL

Reverse T3 22.4 9.2-24.1 ng/dL

Thyroglobulin Antibody 1.1 0.0-0.9 IU/mL

Thyroid Peroxidase (TPO) Ab 10 0-34 IU/mL

Hemoglobin 16.7 13.0-17.7 g/dL

Hematocrit 48.8 37.5-51.0

RBC 5.58 4.14-5.80

DHEA-Sulfate = 224.1 - 71.6-375.4 ug/dL

Cortisol = 14.2 6.2 - 19.4 ug/dL

IGF = 153 67-205 ng/mL

Prostate Specific Ag, Serum 1.0 0.0-4.0 ng/mL

Magnesium, RBC 5.7 4.2-6.8


Great info for all.

Interesting how he intends to bring down your reverse t3.

Keep us posted. And GL


I also have high reverse t3 (25 so higher than yours, but also have good FT3 and FT4), and a consultation with Dr. Saya on the 30th this month. IGF-1 was also at the bottom end for me (103), so I am interested to see how the peptides work for you.

I agree that you probably were in a supraphysiological state (you free T was really high).

Will follow along on this one.


I think he said Dr intends to bring down rt3 by controlling e2 and insulin not igf


Nice thanks for sharing. Similar to finding the right professional to manage your trt depending on where you live there are profrssionals that can manage your diet and tailor your caloric needs to your activity level and to your trt protocol.

My trt doc and sports nutritionist actually consult one another often. Instead of winging the diet seek consultation. As your weight/workouts /protocols /goals change so do your nutritional needs. I see the nutritionist every 3 months ish for tweaks.


Sounds like both are going to be controlled. I was not trying to suggest rt3 being controlled by igf1, just that we both are high for rt3, and low for igf1.


may i ask why this ^ its good whole food but not eating past 6 will worry me and i need my oats and atleast gluten free bread. like i said in my post my igf1 is low too. can you actually mix trt with igf medication?


You can mix peptides with TRT, it will enhance anabolic action within your body. Its no different if you had your natural testosterone production, ipamorelin will increase your natural growth hormone levels and only has minor side effects if you are taking too much.

I’m choosing a high fat, high protein low carb diet. Will see how it works out for me.


the diet was chosen by you or did saya told you to eat that way?


Doctor Saya suggested a keto diet. I’m sure by looking at my blood biomarkers he could see that I was deficient in certain things and made a recommendation based off that.


Super good info here systemlord… I myself have been on a keto type diet for the last 3 weeks and it helps me a ton I hope you reap the same benefits. I find it enjoyable as well and satisfying which gives me high hopes for longevity. I filled out all my paperwork for defy on Thursday with Jesse and sent in my lab history. I have a few more tests to do tomorrow and go get the physical. Very excited to hear your experience thank you. I hope this can bring me answers and assistance as well​:ok_hand:t3: I hope you start to feel better :slight_smile:


You have great FT numbers despite a mediocre TT number. That likely explains your acne. Have you had your DHT tested while having the acne problem?


No DHT testing, but my family notice hair was thinning and disappearing in places and hair was doing some funky curling towards the end of the strands on the back of my neck. Acne was everywhere, never had that kind of acne in my life.

I wonder if DHT levels would be similar if I scored in the 600 ranges again this time on smaller doses (16-20mg) EOD, my thinking is those larger twice weekly 50mg peaks could be responsible for excess DHT do to the larger peaks.

I will test DHT once I find the ranges that suits me best, then find out where DHT lies.


Let me know what you find, because I battle DHT acne as well. In my case it didn’t start until 6 months after starting TRT. And I had been doing once a week IM injections. I switched to twice a week SQ, but had no improvement there. But perhaps twice a week is still too much of a spike?



what e2 number range are you shooting for?


Do to low SHBG I will be shooting for between 20-30 pg/ml do to low SHBG. I have a feeling this dosage (16mg EOD) is too low, the closer I get to 6 weeks to less good I feel. The erections I had a week ago aren’t there anymore and I starting to feel a little bit like I did pre-TRT.

When I was doing 20mg EOD my erections were much further along by week 5, definitely have fizzled out.

My labs are due any day now.


Interesting. Keep us posted.

I believe erections are driven by testosterone level and libido by estrogen level, as you CAN have one without the other. Right now my test is 860 on my protocol and I have great morning and night erections, but not so much around sex, as libido is nil, so I’m thinking it’s e2 is in the wrong spot. The other tests (DHT, shbg, etc) are all pretty normal.


My TT and FT numbers are in for my 16mg EOD protocol and it’s exactly what I was expecting since I’ve been feeling like crap the last week. Dr. Saya will recommend and adjustment within 24 hours on the test dosage and AI dosage. If anyone is considering peptides like the slowest release ipamorelin peptides it only costs $165 every 7 weeks, a little more than test cypionate.

Total T = 376 ng/dL 264 - 916 ng/dL
Free T = 15.1 ng/dL 6.8 - 21.5
Sensitive E2 = 29.6 pg/mL 8.0 - 35.0
SHBG = 16 nmol/L 16.5 - 55.9 nmol/L

These results suggest I need Free T to be closer to the top of the ranges. To think that my muscles are responding to such a low Total T is amazing, but if I want to get it up, I got to get Free T higher. I was experiencing high estrogen symptoms at this number and since my dosage is going to increase so to with my estrogen, an AI is needed.

Remember SHBG is low at 16 nmol/L and low SHBG men are sensitive to estrogen, once I lose 50-60 pounds and improve insulin levels I expect SHBG to increase a little. Belly fat and insulin resistance can lower SHBG.


I agree. Increase test—>increases e2---->likely increase shbg.

Yes AI I’d think.

EDIT!!! Do I have the above correct?!


How goes the Defy protocol?