Finding a TRT Physician

[kuilontli]

Low testoterone... don't have the actual info. Drs office called just to tell me that but woul not tell me how low. Got to go back and see the doctor next week

But, doctor told me he won't prescribe testosterone because he not up to date with all it involves. Cant seem to find an actual doctor in the Jacksonville, FL area
They are all 800 numbers for doctors out on the west coast. On average they want around 300 per month with only 2 vials included... is that normal?
(They provide pct, needles, etc)

Added: The two vials are supposed to last 6 months, total cost 1200

[Tzm24]

Any advice for a canadian not getting the right attention

[bass]

walk to NY and find a doctor there unfortunately Canada is way behind when it comes to TRT, we had few members here from Canada and they struggles finding a TRT doc. your best bet is call on someone like LowT.com (banner on upper right) and see if they have an office close to you. not sure which side you're at, but another option is Dr. Crisler which is in Michigan.

[Carloscomacho]

Hey my friend, I am a newbie and posted a question in the TRT section concerning my lab work. Your avatar is showing you as a senior member, is there anyway you could look at it, and give me your honest opinion?

Thanks.

[kelkel]

Will do.

[sfw]

I found a doctor, Dr. Thomas O'Connor in CT who is an expert in trt and sexual optimization. Has made a huge difference in my life. His price is great and also deals with insurance.

[jomamma007]

always wondered why LH and FSH are suggested for follow-up labs.
Is this just to make sure say the gels are absorbing and the man is really shut down?

[bass]

always wondered why LH and FSH are suggested for follow-up labs.
Is this just to make sure say the gels are absorbing and the man is really shut down?

yes, but this is not suggested by doctors, just another indicator that your TRT is doing what it supposed to. after that don't waste money checking it.

[Vettester]

always wondered why LH and FSH are suggested for follow-up labs.
Is this just to make sure say the gels are absorbing and the man is really shut down?

Not just that, but if those values were elevated during administration of TRT, it could indicate a potential pituitary disorder. Granted, MRI's should always be factored prior to being diagnosed, especially if there is any speculation that there could be an underlying condition, but we all know it doesn't always play out that way. If a patient is comfortable with their diagnosis, I wouldn't go out of my way to get LH/FSH, but then again I won't close the door on them either if the doctor has it on the requisition. It's always good to be reassured that the process is working

[luciuswillson]

Ok. I am a 36 yo male that has been on testosterone cypionate 1.5 biweekly for the past year. I had been on androgel prior but it had been about a year in between because of insurance issues. My first run about 4 years ago with the gel I got my numbers up to a high 800 range but they keep falling every year. Last year when I got new insurance that covered TRT I got tested again and I was about 150 when I started the cypionate and started with 1ml. After a month I had just got my number ups to a low 300 and my Doc increased me to a 1.5. I got tested last week and my numbers he said were the best they were going to get at around 400. I feel like he is missing something. I have asked him about estrogen and GH and he said that I should not worry about those. I still feel like shit. I have been doing a IF diet the last 3-4 months have lost about 20 lbs. Currently I am 6'0 269 around 19%BF according to skin fold.

My question is I would like to find a doctor who specializes in male hormones and is in a reasonable driving distance for me (2-3 hours max) and wold take my insurance. I have looked at the low testosterone page but the closest doctor is about 6 hours away. Does anyone know of a good hormone doctor in the Lexington KY area? I live in south east KY on the TN/VA Border and Lexington and Knoxville TN are about 2 hours away.

Thanks

Sorry I have never use AAS and I don't know why my T levels dropped either my ass got to fat or the Andro poppers I took when they were out fd me up.

[EquilibriumZ]

Do you need to fast before the full bloodwork? if yes how many hours?

[WilmingtonPL]

Okay, I found an A4M certified NP in my area who specializes in "natural bio identical hormone replacement therapy for women and men". Do you think this would be bye right place to start if I want to get TRT? Or do you see any red flags in that wording? I've already been to one dr who said he doesn't prescribe test to anyone.

[kelkel]

No red flags at all. A4M is a great certification. Just call first and ask office staff that if TRT is prescribed to you will HCG be as well? And an aromatase inhibitor if needed?

[WilmingtonPL]

I was reading about my insurance and it says that injectable are to be used/covered only after a topical, such as androgel has been tried and failed. I saw on a different forum someone suggested throwing away the topical to get the to the injectable. I feel like the doc is probably not stupid and would know if I wasn't taking the prescription to manipulate to situation. Any suggestions? Are topicals worth the while? Or, am I just wasting my time trying to get TRT legally vs just going black market?

[WilmingtonPL]

BTW, thanks so much for taking the time to answer my questions. I'm sure I probably sound dumb.

[kelkel]

I was reading about my insurance and it says that injectable are to be used/covered only after a topical, such as androgel has been tried and failed. I saw on a different forum someone suggested throwing away the topical to get the to the injectable. I feel like the doc is probably not stupid and would know if I wasn't taking the prescription to manipulate to situation. Any suggestions? Are topicals worth the while? Or, am I just wasting my time trying to get TRT legally vs just going black market?

Rather odd for an insurance to stipulate that as gels are much more expensive. There's nothing wrong with gels such as Androgel 1.62% etc. I used it initially but eventually had absorption issues. Many do very well on gels, you just have to try and then evaluate it. See if it works for your lifestyle or not. It's far better than low T, right!

And yes, an astute doctor would know if you're manipulating things. No, you're not wasting time doing it the right way. Self-administering a protocol is an extreme last resort, imho. Partner up with your doctor and self-educate at the same time. You're not a number on a chart and make sure you're not treated that way. If in time you don't like the gels I'm sure if you're up front with your doc you can probably find a way to move over to injections.

Good luck Wilmington.

[xthedukex]

good reading !!

[WilmingtonPL]

I went to a GP (not the A4M doc) and re-tested. My T came back at 117. I did try to tank it a little but all I did was cut out fat and carbs for that dinner and breakfast and cut my sleep to 5 hours so I doubt I did much. More interestingly he found hypothyroidism and wants to start me on thyroid replacement. He's ready to start me on topical T-replacement after my MRI results come back. He wants to rule out cancer first. He did say that if we went to injections that they would be every 8-10 days and I could expect to crash before each injection. Why would he purposely send me on a roller coaster rather than inject every 5 days? I figure he'll eventually let me self administer but it seems like it's gonna be a long drawn out process getting there. Oh, and he asked me about power lifting so I guess he's had me pegged as a drug seeker at first but I think after comming back so low he shouldn't have any reason to not trust me. I'm wondering if I should just be honest and tell him now that I want my T to be around 800, not the bottom of normal, or should I just be a good little patient and play along for a while first. I know no one can give me a definitive answer on these questions but you guys have a lot more experience than me so any input is appreciated. Thanks!

[kelkel]

That's a low number. Had you cycled or used any pro-hormones recently?
Hypothyroid can cause hypogonadism. Visit stopthethyroidmadness.com and self-educate. Great site. Simply correcting thyroid issues can sometimes be enough to get you where you need to be.
What are your LH and FSH results on your BW? These are important and indicate pituitary function.
Excellent that you're getting an MRI.
Gels can work great for some people so don't arbitrarily rule them out.
Injections every 8-10 days is ridiculous as you well know.
Remember free T is far more important then total T. But don't get too hooked on numbers. Just use them as a guide and go off of how you feel.
I'd be up front in conversation with your doc. If you're uncomfortable with something, say so. Try and work through it. As long as what your saying is based in fact you should be able to find common ground.

[WilmingtonPL]

No, Ive never used anything like that. I want to, and after 2 years of not getting any help from my former doc I was going to start which is why I came to this forum. Reading what you had to say prompted me to give it one more try from a new doc, which is the the experience Ive been talking about on here.
Looking at my old labs I don't see those LH and FSH numbers on here, I havent received my new labs yet, they just told me what the numbers were over the phone.
They called me today and told me the MRI showed non-cancerous abnormalities in my pituitary glands, so they want me to see an endo.
AND they want me to do a sleep study so after all that maybe they'll start me on T.
I'm not ruling out topical, I hope it does work, it would be great to feel good again. Honestly, I had grown fond of the idea of just doing steroids , obviously I know thats not a long term solution, but I bet I'd help me get that PL total up! I wanna total 2000 at 275, but I guess getting healthy has to take priority.
Once again thanks for taking the time to help me out, its really cool of you.

[kelkel]

Ok. You really need a copy of your BW and of the MRI assessment. Your next appt with whoever should be revealing. "Non-cancerous abnormalities" on your pituitary? You need to ask them if they mean an adenoma. They can be either micro or macro-adenomas depending on size. If so, the report will give you the size of your pituitary as well as the adenoma. These are not "that" uncommon so don't panic if it is one. I happen to be the proud owner of one which is what put me on TRT years ago.

Most are micro adenomas and require no surgery, only treatment based on what effect it is exerting on your system. If this is the case and the adenoma is effecting your T levels then your LH and FSH levels will be low or tanked as well. It indicates secondary hypogonadism.

Make sure you are comfortable with your doctor here. I understand a sleep study but it may not be relevant if there's a pituitary issue. Regarding topicals, they work well for some people and others they don't. I used them and did well but eventually had absorption issues.

Don't leap into anything. Seriously begin self-educating on these topics. And yes, get healthy first, then worry about the other stuff.

Let me know what you find out and good luck to you.

kel

[WilmingtonPL]

Here are the lab results they sent me, I think it's just their summery, because my older labs had a lot more information on them. I don't see anything about LH and FSH levels.
Also, I was wondering about contamination with AG, I don't want my GF growing a mustache, she's already almost as strong as me!
I saw there is also a patch. They are both "preferred" by my insurance. Do you have an opinion on the patch vs AG 1.62? Thats the decision I need to have made before I see my doctor again.

Thanks!
WilmingtonPL

[WilmingtonPL]

I cant delete.

[kelkel]

Well, your T levels do suck. Now you need to know why. LH/FSH is a good start. I assume you have a doc appt scheduled?

[WilmingtonPL]

Yes, I'm seeing an Endo next week. I'm going to ask him about LH, TSH, HCG , and Aromatase Inhibitors (all the stuff you've mentioned.

I apologize if this next part is redundant. I'm still getting used to how this forum works, I tried to edit my last post to add this after I posted the first time but I dont think it worked.

Also, I was wondering about contamination with AG, I don't want my GF growing a mustache, she's already almost as strong as me!
I saw there is also a patch called "AndroDerm". They are both "preferred" by my insurance. Do you have an opinion on the patch VS AndroGel 1.62? Thats the decision I need to have made before I see my doctor again.
Thanks!

[WilmingtonPL]

I saw the endo yesterday and he was actually willing to put mo on self administered Cyp on the spot, because I have 2 years worth of labs showing my T to be very low. Then he realized my insurance requires topical to be tried first so he prescribed AG 1.62. His attitude was we'll let this fail and then move on. He did say that the does would be 1ml (200mg) every 14 days which is even less that the GP was talking. I forgot to ask him what kind of numbers he was shooting for. Obviously I'm thinking like, 800. He did say we'd administer, and then test at the 2 week mark to see if we need to adjust. I wonder if he will let me decide what I think "normal" is of if he'll want to hover me at the very bottom of normal and let me roller coaster down from there. I know that's not a question anyone can answer. I asked about HCG and estrogen blockers, he wasnt interested. I asked about gyno and he said it usually goes away with a couple weeks of TRT. Any thoughts?

[kelkel]

It's a shame you just can't go with the shots. Agel works fine for many people so be positive. I've used it myself.

200mg every 14 days indicates your doc does not know hormones. At all. He's dosing you based on terminal life and not half life. Half life of test is 5-7 days metabolism dependent. Therefore injections need to be weekly at a minimum, but even better if the weekly dose is split in half. Such as 50mg every 3.5 days instead of 100mg once per week. You would feel like crap on week 2 on his protocol.

200mg is also high end TRT. Most never need that amount. The more you take the more you have to manage, think estrogen, RBC's, etc. Less is more in TRT and you should always start at a lower dose and titrate up if needed based on blood work. 100mg (split) is a great starting dose when the time comes. Educate your doc. It's your health.

[WilmingtonPL]

Thanks,
I was thinking that when the time comes I could split the dose myself and not tell him [just do 0.5cc (100mg) every 7 days], that still wouldn't be optimal but it'd would be better than than 14 days.
Obviously educating him would be the better route, but' I'd definitely have to come correct. Can you point me toward some literature that he'll respect?

[kelkel]

Any of Crislers Papers.
Testosterone for Life by Morgantaler
Testosterone, A Mans Guide by Nelson Vergel.

[WilmingtonPL]

I just read Crisler's "TRT, a recipe for success". It was a very good read! It made me a lot more optimistic about actually getting the desired effect from the AndroGel . Like you said, rubbing gel on myself everyday is probably a lot better than living with low T. That being said I still feel like AndroGel is not something I want to do for the rest of my life, especially when the alternative is a weekly injection. Also I found "Testosterone For Life" for free on Kick Ass Torrents, so I'll be giving that a read soon too. Thanks for the advice, I'm sure I'll be back soon with more questions, but you have done a great job of arming me with the resources to educate myself and find the answers on my on.

[kelkel]

Outstanding Wilmington! That's exactly what this forum is for. It's your health so be proactive. One thing I did when I was new to this arena is that when I have a doc appt I'd take a notepad in with specific questions to ask so I didn't forget anything. I would always try and know the answer ahead of time so that if the doc's answer was different I could further the conversation.

Also maintain copies of all your blood work. It's yours so sign the release at the lab and they will fax or mail you a copy. Labcorp is on line now at labcorpbeacon.com. I would always pull my BW early enough so I could evaluate it myself and be totally prepared for the appointment. Nothing worse than leaving your doc's office and realizing you should have asked a particular question.


Stick around the forums and visit some of the others as well. The lounge can be quite entertaining and many of the others can be very helpful. Let me know how things go. PM if you like.

[newbjuice]

Id go this route but its expensive.

[WilmingtonPL]

I'm on Day 4 of androgel 1.62. So far I havent seen any noticeable change except some aching and softening in the testicles, and an extra good mood for a couple hours last night which may or may not have had anything to do with it. I found (the chart below) on a different forum, do you think these are reasonable expectations? BTW, I can't PM you till I get 50 posts on here.

· Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond.
· Changes in erections/ejaculations may require up to 6 months.
· Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer.
· Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks.
· First effects on erythropoiesis (increased red blood cells) after 3 months, peaking at 9-12 months.
· Prostate specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy.
· Effects on lipids appear after 4 weeks, maximal after 6-12 months. I
. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3-12 months.
· Changes in fat mass, lean body mass and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years. Effects on inflammation occur within 3 to 12 weeks.

[kelkel]

Yes, they are on point. Appears to be Nelson's writings, yes?

[WilmingtonPL]

Yes, it is Nelson! I joined his forum as well as the TRT section on *********. Actually, ********* has a very clear breakdown on forum/thread etiquette. Apparently what I've done here is "hijacked" your thread, so I do apologize for that. I guess if it had bothered you, you would have said so.

I had no idea it was going to take so long and also how much information I was going to need to be able to digest to be able to steer my treatment. I just want to get it right from the beginning but thats not really possible when most doctors don't know that much about TRT and are not going to go the extra mile to learn all this stuff and run all these tests that are way above the normal testing. But, I guess I have the rest of my life to figure it out! I just wish there was a "TRT expert Doc" database or something like that so I didn't have to go to each guy to figure out there philosophy is.

As always, thanks for taking the time Kel, you'e been a huge help.

[kelkel]

No hijacking as it all relates. Nelson's a friend and a good guy. You are on the right path as self-education is key. I'll throw a wrench at you, look into Aveed injections for TRT. It's testosterone undecanoate which has a very long lasting ester. Meaning you'd take a large initial injection, a booster about six weeks later then I believe it's one shot every 10 weeks after that. It has about a 90 day half-life.

It's been used for years overseas ( trade name Nebido) with much success and several guys here are on it and love it. Our FDA is always a bit slow and just approved it earlier this month. Do some research on it and talk to your doc about it. May be an option for you. Odds are your doc is not aware of it just yet.

[Gus Mackay]

You have no idea how long I have looked for advice like this... thank you! Will check out the website.
Had a T test down which came back at 305. My Dr. said it was within normal range...
305 for a 28 year old lifter at 15%bf is normal? According to her, yes.

Talked to another Doc who said I might want to pursue treatment, because of my age. But that was a doc I knew working at a clinical trial facility, and not someone who could help me.

Talked to a sports Doc, he basically thought I was nuts. Talked to my endo, she thought I was crazy too.

One out of four doctors basically knew squat about test.

[kelkel]

You have no idea how long I have looked for advice like this... thank you! Will check out the website.
Had a T test down which came back at 305. My Dr. said it was within normal range...
305 for a 28 year old lifter at 15%bf is normal? According to her, yes.

Talked to another Doc who said I might want to pursue treatment, because of my age. But that was a doc I knew working at a clinical trial facility, and not someone who could help me.

Talked to a sports Doc, he basically thought I was nuts. Talked to my endo, she thought I was crazy too.

One out of four doctors basically knew squat about test.

They receive very minimal training in med school. That said, if they don't pursue it themselves you're out of luck. You definitely need to find a doc that knows hormones and locate the problem which can hopefully be fixed. Don't start on TRT without knowing the reason you're low. And being "low" is not a diagnosis at your age. Full BW is always where you start and you have examples at the top of this thread.

And remember, type of doc doesn't really matter. They just have to know hormones!

[Elijah V]

Is LowTestosterone.com only available to those living in the U.S.?

Do you become a TRT patient just to get your hCG prescription to add to your AAS cycle or is it purely for those who have low T? I read it's a life-long commitment. Someone told me they're a patient of LowTest just so he can get his 500iu hCG p/w during his AAS cycle and that confused me :/

[kelkel]

Yes, only in the U.S.

No, you become a TRT patient as you suffer from low T and need the help. It is normally a life long commitment.
HCG is available via other sources if you look.