T Nation

TRT: Clinic or Telemed?

I’ve been on try for about 8 years now. It was great at first and has totally changed my life. Lately tho it seems like my clinic is dropping the ball a lot and I’m not sure if I should stay. The staff has changed numerous times and it currently seems like none of them really care. They’ve got me on a take home set up now and I get a month at a time. There’s a few other variables in there but that’s pretty much the gist of it. I’m not super happy and I’m thinking of trying out a telemedical trt situation like Defymedical.com but I don’t know a whole lot about it.

I asked for labs because I wanted to post them here and see what you guys think. I got a pretty vague 2 page printout on my last two blood draws. not sure if its enough to go on tho.

Me: 43 year old male in decent shape. About 5’6 and 170 lbs. When I started treatment I was at about 330 ng. I think. Stopped going to the gym about 2 years ago and recently started again. I eat well and stay active with my job. Also, I have to get “therapeutic phlebotomy” once in a while because of high hematocrit. Never had that before starting treatment tho.

thanks for any suggestions in advance.

Defy medical gives you T-cyp to last about 3 months, other medications are different. I’m signed on with Defy and Dr. Saya and Dr. Caulkins are the top two doctors at Defy, even the PA mike can run circles around most endo’s.

The clinic which you are with now isn’t testing diddly squat, no Free T or any of the other important biomarkers. This isn’t hormone optimization, this has T-mill written all over it.

It doesn’t appear this T-mill is using the correct E2 labs, the sensitive estradiol or LC/MS/MS method is the correct test.

I knew it! Those labs look really skimpy in comparison to what most guys here know about their blood work. My clinic doesn’t even go over the results with me. I have to ask and when I do, I get, “it all looks good”. pfft. “T-mill” is exactly how it feels too. I think I’m going to contact Defy tomorrow. I don’t have insurance so I pay out of pocket but if this breakdown at peaktestosterone.com is correct then that means I’m paying more and getting less at my clinic ($75-$100 more). Irritating.

Because they don’t care about the patient, they are selling a package to everyone.

Also dr Keith Nichols works telemedicine he is a great doctor student of Neil Rouzier. His prices are similar to Defy

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.
On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.


If you are open to it, I’d appreciate to know more about what changes you experienced. I’m roughly same age with slightly lower total T as when you started and have been debating whether or not to do TRT. Also debating using a local clinic or telemed. I have no idea how to self inject/etc so I am thinking doing local clinic w/ insurance at least for the first year or two to ‘learn the ropes’.

It’s pretty simple. The pointy end goes into your body :slight_smile:

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The prices are slightly different than when that was written, just so your not surprised if you call.

I think I’ve always been lowT. I didn’t catch it until my late 30’s tho. I’ve always been skinny (130 lbs since I was about 15), moody and prone to snapping, depressed, hairless lol!, no muscle and an insomniac for years. The only symptom I never had was ED. I probably would’ve checked things out sooner if id have had that one. I’ve worked out many times but I could never gain or maintain muscle. In my thirties I got serious about it and started bulk/cut phases and going to the gym 4-5 days a week. If I gained any muscle (most of it was fat, especially love handles) it was gone after I cut. I looked into testosterone and found that I hit almost every symptom. My life improved after my first shot almost immediately. Honestly, even if my muscle gain situation (I weigh 165-180 depending on what my routine/diet looks like) hadn’t improved or any other problem, it would still be worth it just for the fact that my depression went away. My wife is as thankful as I am for trt. She had to deal with me and all of my problems for years and now things are 1000 times better. she never complained but its rough dealing with a moody depressed person.

As far as injecting goes. It’s not a big deal. I was the same way, I didn’t want to do it and it kinda freaked me out. The clinic I go to does it but they started a take home program and I do that now. My wife gives me the shots. I was going to a dr for a while and I did shots at home but administered them in my thigh. Don’t do that. It sucks and I hated it. The ass is much better.

If you’re that low, I suggest getting tested. You won’t regret it. Just make sure you’re at a good place (I’m not apparently). Don’t bother with Dr’s either. They’re awful, you need someone who knows T. I called Defy this morning and I’m getting a physical set up. They seem WAAAAAYYY more knowledgable and helpful than my clinic. If I were you I’d start there. Seems like a good setup.

oh and as far as insurance, there’s a lot of hurdles when dealing with a clinic. The first one being that I think you have to be under 350 ng. and they arbitrarily decide what they will and won’t pay for. They’ll work with you’re Dr easy enough but Dr’s generally don’t know what’s going on and don’t test for the right things and almost always try and keep you ridiculously low on T, make you do dumb stuff like inject every two weeks and stuff like that.

good luck and sorry about the wall of text.

I think this is the same for me. Very minimal body and facial hair, insomnia, I did not have ED, but would only have morning or nocturnal erections maybe once a month. I was able to put on muscle and be fairly strong (think I did 475, 325, and 485 for the squat bench and deadlift), but I was getting really fat, and had major difficulty losing any of it.

Only been on the TRT about 4 months now. Haven’t lost much weight, but my body looks better. In 4 months I have squatted 490, benched 330, and deadlifted 550 (big PR there).

Some don’t like it, but some don’t feel a difference with subQ. I use a 27 gauge slin pin, and hardly feel it.

This is me also, minus the insomnia. I too was able to put on muscle and get stronger. Not quite as strong as you but I felt good about it. I battled injuries quite a bit getting there though and believe it was low t and e that contributed to them.

My bluecross pays for all my labs with Defy. That cuts the cosy quite a bit.


Well, my numbers are not so good for 5’10" @ 230 lbs.

Well shit now I don’t feel so good about my numbers at 6’2" 250 lbs lol

Well, I also train for PLing. Squat is also in wraps.

Yeah I’m not a PL by any means. I’m your everyday gym rat that likes getting stronger and building some muscle after being 160-170lbs in high school and being known as the tall lanky kid.

Good to know, I have them too

Might depend what plan you have though. I have healthmate coast to coast and blood work is never questioned as long as its an apprived code. I can get all the blood work i want

Hi, I am searching for the best doctors that can treat you online and help fix hormones
Any suggestions?