Patients in the randomized controlled trials lost between 9% – 12%
My patients along with the dietary advice lose close to 15% – 20%. For someone who weighs close to 200 lbs, I expect them to lose 30 lbs

The randomized controlled trials were done with both medications take together. In my practice we have seen a better response when the medication is taken together.
As we know Phentermine can lead to jitteriness, high energy state and topamax balances this side effect out. Hence the combination works really well.

The total cost is usually less than $30 if you pay cash and use goodrx coupons.

If you have BMI > 30, or BMI > 27 with hypertension, diabetes or obstructive sleep apnea, and do not have any contraindications

BMI Calculator Link https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

It is classified as a sympathomimetic amine and functions as an appetite suppressant.
Here’s how phentermine works:
1. Appetite Suppression: Phentermine stimulates the release of certain chemicals in the brain, such as norepinephrine, which activates the “fight or flight” response. This activation leads to a decrease in appetite and an increased feeling of fullness. By reducing hunger and cravings, phentermine helps individuals consume fewer calories and supports weight loss efforts.
2. Increased Energy Expenditure: Phentermine also stimulates the release of adrenaline, which can increase energy expenditure and metabolic rate. This effect may contribute to weight loss by burning more calories.
3. Central Nervous System Stimulation: Phentermine acts on the central nervous system, specifically the hypothalamus, to reduce hunger signals and increase satiety. It affects certain neurotransmitters, such as dopamine and serotonin, which are involved in regulating appetite and mood.

It’s important to note that phentermine is typically prescribed for short-term use, usually a few weeks to a few months, due to concerns about potential side effects and the risk of developing tolerance to its effects

It is FDA approved medication but can have side effects.
Common side effects of Phentermine can include:
1. Increased Heart Rate: Phentermine is a stimulant, and one of its effects is an increase in heart rate. Some people may experience a faster or irregular heartbeat while taking phentermine.
2. Elevated Blood Pressure: Phentermine can raise blood pressure levels, and individuals with pre-existing hypertension should be cautious when using this medication. Regular monitoring of blood pressure is recommended during treatment.
3. Insomnia: Phentermine is known to have stimulating effects on the central nervous system, which can lead to difficulty falling asleep or staying asleep. Taking phentermine too late in the day may exacerbate insomnia.
4. Dry Mouth: Phentermine can cause a reduction in saliva production, leading to a dry or uncomfortable sensation in the mouth. Staying hydrated and chewing sugar-free gum may help alleviate this side effect.
5. Gastrointestinal Issues: Some individuals may experience digestive disturbances such as constipation, diarrhoea, or stomach discomfort while taking phentermine.
6. Restlessness or Nervousness: Phentermine’s stimulating effects can sometimes lead to feelings of restlessness, nervousness, or anxiety in some individuals.
7. Dizziness or Headache: These symptoms may occur as a result of changes in blood pressure or the stimulant effects of phentermine.
It’s important to remember that not everyone will experience these side effects, and the severity and frequency can vary among individuals. If experience any bothersome or persistent side effects, it’s recommended to stop the medication and contact us immediately.

It is FDA approved medication but can have side effects.
1. Cognitive and Psychiatric Effects: Topamax can cause cognitive difficulties, including difficulty with concentration, memory problems, and confusion. It may also lead to mood changes, such as depression, anxiety, or irritability. Some individuals may experience changes in thinking or behavior.
2. Dizziness and Coordination Issues: Topamax can cause dizziness, unsteadiness, or problems with coordination, which may increase the risk of falls or accidents.
3. Tingling or Numbness: Some people may experience a sensation of tingling or numbness, often in the extremities, such as the hands or feet.
4. Fatigue or Sleepiness: Topamax can cause drowsiness or fatigue in some individuals, which may affect daily activities or alertness.
5. Vision Problems: Topamax can affect vision and may cause blurred vision, double vision, or other changes in visual perception.
6. Loss of Appetite or Weight Loss: Topamax is known to cause a decrease in appetite, which can lead to weight loss in some individuals.
7. Digestive Issues: Topamax can cause gastrointestinal side effects such as nausea, diarrhea, or stomach pain.
8. Kidney Stones: There have been reports of an increased risk of kidney stones in individuals taking Topamax. Maintaining adequate hydration and following a recommended fluid intake may help reduce this risk.

After initial treatment with Phentermine/Topamax for few months the patient is switched over to Semaglutide.
This approach helps patients to maximise weight loss by working different mechanism of actions of medications.

The total cost is $ 99 a month, includes provider visit, medication and shipping costs.
You will be paying for the lab work every 6 months. The cost of lab work at Quest is $200 cash price.

Testosterone vial with the supplies is send directly to your address.

You are sent a 10 mg Testosterone vial, 200 mg testosterone cypionate/ml. Hence a total of 2000 mg.
This vial should last you for a total of 10 weeks if you inject 1 ml every week.

Use proper sterile technique. Clean the site with alcohol swab before injecting.
Testosterone injections are typically administered into the muscle tissue (intramuscular injection).
For self injection you can target the middle and outer portion of the thigh muscle
If someone can administer, you could chose the gluteal muscles (buttocks), specifically the upper outer quadrant of the buttocks, known as the dorsogluteal site.

Most patient needs between 1 ml (200 mg) ever week to 2 weeks depending on testosterone levels.

Testosterone replacement therapy (TRT) can have potential side effects, although not everyone will experience them. It’s important to note that side effects can vary depending on the individual, dosage, method of administration, and other factors. Here are some possible side effects of testosterone therapy:
1. Acne: Testosterone can stimulate oil production in the skin, leading to the development or exacerbation of acne in some individuals.
2. Fluid Retention: Testosterone can cause fluid retention, which may result in swelling or bloating, particularly in the hands, feet, or ankles.
3. Increased Red Blood Cell Count: Testosterone therapy can lead to an increase in red blood cell production, which may contribute to a thickening of the blood. This can increase the risk of blood clots or other cardiovascular problems.
4. Decreased Testicular Size: Exogenous testosterone can suppress the body’s natural testosterone production, leading to testicular shrinkage. However, this is usually reversible upon discontinuation of testosterone therapy.
5. Gynecomastia: In some cases, testosterone can be converted into estrogen in the body, potentially causing breast tissue enlargement or tenderness (gynecomastia). Monitoring hormone levels and adjusting the dosage can help mitigate this side effect.
“6. Mood Changes: Testosterone can influence mood and behavior. Some individuals may experience mood swings, increased irritability, or changes in aggression levels.
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7. Sleep Apnea: Testosterone therapy can worsen or exacerbate sleep apnea, a condition characterized by breathing interruptions during sleep.
8. Prostate Effects: Testosterone therapy may cause an increase in prostate-specific antigen (PSA) levels, which is a marker associated with prostate health. Regular monitoring is crucial to evaluate any potential impact on prostate health.

It’s important to remember that not everyone will experience these side effects, and the severity and frequency can vary among individuals. If experience any bothersome or persistent side effects, it’s recommended to stop the medication and contact us immediately.