Pretty Clueless, little help??

[Fuq40]

I'm brand new to the board, first post.

Been reading up on HRT and TRT for a couple of weeks and have a couple questions I'm hoping you guys can help with.

I'll give you some quick background:
39yo
202lb (down from 224 getting my ass back in shape)
6'0
athlete background but more surgeries now than you can count on both hands (but I'm bound and determined to get back in shape and I won't be stopped)

My main beginning question is in regards to Endocrinologist's and Urologist's. I have good insurance and it's a PPO so I can self refer to either type of specialist. I went on-line a week ago and there are quite a few of both in my area (Sacramento - Northern Cal) but from what I've learned from reading posts on this board a lot of these guys/gals aren't going to be the type of doc I'm looking for with good TRT/HRT background.

I've done basic google searches for my area and their is 1 anti-aging place but my insurance won't cover them and they look ridiculously expensive.

So what I need is some advice in how I should go about searching out a Doc that is going to be good for determining whether I need therapy and one that knows his way around HRT/TRT.

What do you think guys, any suggestions?

[zaggahamma]

they can both prescribe test where a endo usually has more training for hormones (endocrine system-"endo") but a good school of thought is sometimes putting a call into some of them and making sure they prescribe injectible test to those with low T can help you weed out some androgel pushers....rare to find either that is schooled in trt/hrt as its still new to men...if youre around 40 you shouldnt have too much trouble...its best to be knowledgeable yourself as your the only one that truly is looking out for number one

let us know if you have any questions off that

best of luck

[forrest_and_trees]

Have you had any blood work done yet? If not, *that* is your first step.

To add to jpkman's comment, as he inferred, endo's tend to be a little more up to speed however, it's really a matter of the individual doctor and their *personal* position on it.

In my case, I use a GP who happens to be open, cooperative and willing to take my suggestions to heart. I've actually educated him on some points which is truthfully a good thing. We have a working relationship and in the end, results are what matters most.

Don't be surprised if you get a lot of push back, it tends to be the norm. Finding the right individual is the biggest hurdle so you may have to work your way through the list until you do. For this reason, it's important to be as educated as possible about Low T, TRT/HRT because a lot of doctors will try to stonewall you and you need to know what to listen to and what to ignore. It sounds challenging however, unlike a lot of conditions, Low T and TRT/HRT has received some bad press over the years and therefore many docs have the wrong position on it or are flat out, uneducated on the subject.

Worry not though. You've come to the right place. Now you just need to do *a lot* of reading, and continue asking questions to educate yourself.

For the record, docs tend to be slow to write scripts for self injectable test. They usually start you out with Androgel and or administering the shots in their office. Once they know your serious and not just looking to get "juiced", they will eventually write you a script to self inject, because the truth is, if you have low T, TRT is for life and injections are the only reasonable way to live with it.

Hope you find what you're looking for. Best of luck

F/T

[tonyinnh]

i was diagnosed with low t years ago,,, and till recently i was determined to get myself better..

I went to my normal doctor,, gave them my signs.. asked them to run a blood test.. they agreed,, came back with low t... I already knew that from 5 or so years ago.. My problem was I refused to use topical crap.. I have 2 girls and my wife who wasn't allow to touch me or my dirty clothes,, I would take a shower and my wife would freak for me to wash my towel.. etc. etc.. it wasnt living .. it was trying not to touch my kids... I explained it to my doctor and told her I wanted injections... She never delt with them and referred me to a endro...

He is a chinese man who believes in the old ways,,,, you know eating flowers will make all better.. I didnt back down in our first meeting till i walked out of there with my prescription.. the way I figured,, If he didnt give it to me,, then there was others to go see,,, so here I am know.. only 4 shots so far.. and I feel like a teenager to mid 20's again.... My whole life if better, Im more productive at work..... etc,,,, and in the bedroom,, woooohoooo

so if you have an issue it wont be hard to get injections.... you just got to give them real reasons.... like i did.. he was still a total dick to me and tried to talk me out of it.... I cant wait for my follow up to tell him how insane he was to try to talk me out of this... I feel like i wasted the last 10 years of my life... being depressed,, no energy,,, could gain muscle for a million dollars.. etc etc...

if you have a problem,, get it fixed....

[Fuq40]

First off, thanks to all 3 of you for chiming in, great stuff, I’m already learning a ton and it’s helping me formulate ideas and igniting new ones.

Didn’t quite understand it would be potentially this difficult to find a TRT/HRT specialist when I have access to Endo’s and Uro’s, thanks now I know what I’m up against.

Forrest – To address your question, no I have not had blood work done yet, still in the initial gathering information stage. Partially wanted to hear some feedback, like yours in regard to your primary care, before going for the blood test.

My primary care Doc is a good guy, young about my age or younger but extremely conservative. I’ve had to push on him pretty hard over certain issues in the past. So my guess is I can get him to do the blood work no worries there. Although I do have a question in regards to the specific blood work, as I understand it getting them to test Free T is as or more important than just testing overall T.

Is testing Free T something they can just check off and the local lab (Like a Quest Diagnostics can run it) or is it more of a specialty procedure?

Part of all of my questions was to determine do I try and have this blood work done by my Primary or just go straight to and Endo or Uro who might be more willing to listen about the Free T issue.

What do you guys think? Would appreciate some insight on this.

Tony – appreciate you sharing your experience with Androgel , have a young daughter myself so it gives me a good angle to push back if I need to in the future, really appreciate that.

Also love the idea I read on another post about contacting a compounding pharmacy and working back from them to find docs who are prescribing the correct stuff. Would that work with Testosterone or is that for more specialty product? Should I just ask the pharmacist about who is prescribing T? Thought that was mentioned in the other post but T alone doesn’t need to be compounded (I don’t believe) so are there other meds I should be asking about to get back to the right docs?

Sorry for all the questions guys!! But you got the wheels turning want to make sure I educate myself and try not to take too many mis-steps.

Again appreciate the feedback, off to the gym on my lunch, damn it’s good to be back!!!!!

[zaggahamma]

First off, thanks to all 3 of you for chiming in, great stuff, I’m already learning a ton and it’s helping me formulate ideas and igniting new ones.

Didn’t quite understand it would be potentially this difficult to find a TRT/HRT specialist when I have access to Endo’s and Uro’s, thanks now I know what I’m up against.

Forrest – To address your question, no I have not had blood work done yet, still in the initial gathering information stage. Partially wanted to hear some feedback, like yours in regard to your primary care, before going for the blood test.

My primary care Doc is a good guy, young about my age or younger but extremely conservative. I’ve had to push on him pretty hard over certain issues in the past. So my guess is I can get him to do the blood work no worries there. Although I do have a question in regards to the specific blood work, as I understand it getting them to test Free T is as or more important than just testing overall T.

Is testing Free T something they can just check off and the local lab (Like a Quest Diagnostics can run it) or is it more of a specialty procedure?

Part of all of my questions was to determine do I try and have this blood work done by my Primary or just go straight to and Endo or Uro who might be more willing to listen about the Free T issue.

What do you guys think? Would appreciate some insight on this.

Tony – appreciate you sharing your experience with Androgel , have a young daughter myself so it gives me a good angle to push back if I need to in the future, really appreciate that.

Also love the idea I read on another post about contacting a compounding pharmacy and working back from them to find docs who are prescribing the correct stuff. Would that work with Testosterone or is that for more specialty product? Should I just ask the pharmacist about who is prescribing T? Thought that was mentioned in the other post but T alone doesn’t need to be compounded (I don’t believe) so are there other meds I should be asking about to get back to the right docs?

Sorry for all the questions guys!! But you got the wheels turning want to make sure I educate myself and try not to take too many mis-steps.

Again appreciate the feedback, off to the gym on my lunch, damn it’s good to be back!!!!!

your primary shouldnt give u a hard time checking off the boxes....would be great to get your baseline estradiol(estrogen/e2) checked at that time as well....go this route first...

the compounding thing is a way but think youre going to like meds from regular pharmacies and a lot of insurance wont cover compounding meds

[APIs]

If you have good insurance then stay away from the clinics IMO. Just take the time to find the "right" Doctor, as your insurance will likely cover all the meds & blood work doing it this way. You can also sign up with some TRT Specialists out there who work on a yearly retainer. If they are in your network, you can make them your primary doctor and all the meds & blood work will still be paid through insurance. I'd refer you to one who works remotely, but you cant receive PMs yet. Just food for thought...

[Fuq40]

JP - In regard to primary and checking boxes, what about Free T? I want this tested also correct? Is this a pretty standard test these days? Yes, definitiely going to get estrogen checked also. If I tell him I want a complete profile because I turn 40 this year will I need to specify things like, T, Free -T, Estrogen, etc? I'll ask him either way but would like to hear some thoughts.

As far as the compounding thing, maybe I wasn't clear. In another thread someone talked about using a compounding pharmacy pharmacist to get the names of some local docs (I would specify I would like Endo's or Uro's) who prescribed those types of meds. I planned on potentially using this as a way to try and find some Endo's or Uro's who are open to TRT/HRT therapy in my area. Since, like I mentioned before, I have a PPO and can self refer, I was hoping if I got a few names one would be in network. That's the goal to keep it all in network and find a local doc to monitor me, that's the goal, we'll see if that's the reality.

API - Yep, that's the plan. If you wouldn't mind e-mailing me the name of the provider I'd definitiely appreciate it, I could check to see if he's in network. Think I remember reading I need 75 posts to get messages, that'll take a while. Anyway if you don't mind the e-mail is:

[email protected]


Appreciate it guys. I'll keep posting as I have questions and as I work through the process, hopefully it will be a help to others also.

[zaggahamma]

yeh u can ask those pharmacies but i would assume(not always good to do) that they would moreless get u in touch with doctors that work with them therefore requiring you to use their compunded meds.....i may be wrong...

yes free test is a very common lab but like you said....make sure he either checks it or you look at what color pen he's using when he checks the boxes OR...these days YOU DONT need a doctor to get bloodwork done...not sure if insurance requires the script though to pay.....lot of variables...sometimes a lotta red tape..

back to endo's/uro's...there are VERY few that are OPEN to trt/hrt....they are MOSTLY conservative...you may get lucky

[Fuq40]

Gotcha - good point about the compounding issue and the pen color As far as my primary and blood test, I'm just gonig to tell him what I want, don't think he'll have an issue in regard to the blood test.

Thanks for the feedback JP

[forrest_and_trees]

Fuq40- A good place to start is take the "ADAM Questionnaire" and print the results to take to your doc when asking for the the blood test. Just do a Google search for it.

As far as which tests, a "complete male anti aging blood panel" should cover everything.

If you have any issues finding a doc who will work with you, you can request the test yourself on line. They're the same tests and labs used by most insurances companies. I personally use Privatemdlabs.com

At the very least, the test you want is "Total T". Free T is good to know as a follow on because you can have normal T levels and still show symptoms of Low T if you're not getting enough Free T. High E2 can also be the culprit for normal Total and free levels while still have the symptoms of Low T. it's also good to have to have a base line of your E2 for comparison because TRT will raise your E2 levels and you'll want to know by how much.

Like many things related to TRT/HRT, some docs don't always understand the necessity for men to check E2 levels, so don't be surprised if they're little hesitant. Just stick to your guns.

[steroid.com 1]

Another important thing to consider is hCG . There are docs who will prescribe T but won't prescribe hCG...for whatever reason. The result is testicular atrophy. Make sure your doc is willing to prescribe this if you want to keep you balls healthy and not get the ugly sides if not. It's just another thing for you to understand and know as you manage your protocol.

[GotNoBlueMilk]

My doc didn't start me on hCG with my Test. Later when I asked him to add it in because my boys were getting sore he had no problem with it. Just wish he would have done it on day one. When I asked for it he even mentioned that he usually held off until the first followup visit just to see if it was needed.

[APIs]

JP - In regard to primary and checking boxes, what about Free T? I want this tested also correct? Is this a pretty standard test these days? Yes, definitiely going to get estrogen checked also. If I tell him I want a complete profile because I turn 40 this year will I need to specify things like, T, Free -T, Estrogen, etc? I'll ask him either way but would like to hear some thoughts.

As far as the compounding thing, maybe I wasn't clear. In another thread someone talked about using a compounding pharmacy pharmacist to get the names of some local docs (I would specify I would like Endo's or Uro's) who prescribed those types of meds. I planned on potentially using this as a way to try and find some Endo's or Uro's who are open to TRT/HRT therapy in my area. Since, like I mentioned before, I have a PPO and can self refer, I was hoping if I got a few names one would be in network. That's the goal to keep it all in network and find a local doc to monitor me, that's the goal, we'll see if that's the reality.

API - Yep, that's the plan. If you wouldn't mind e-mailing me the name of the provider I'd definitiely appreciate it, I could check to see if he's in network. Think I remember reading I need 75 posts to get messages, that'll take a while. Anyway if you don't mind the e-mail is:

[email protected]

I emailed you as requested. Please confirm receipt...

[Fuq40]

Forrest - Beautiful man. The questionairre, exact blood test, being able to skip my doc for blood test if need be, etc. This is the type of stuff I was looking for. I had previously found a test on Men's Health but not nearly as good. Thanks very good stuff.

API - Yes, I got the info, thank you. Going to put it in my back pocket as a last resort if I can't find anyone local and covered by my insurance, figure that is my #1 priority but great to know I have a fall back plan if it comes to that, thank you.

One additional question, I know the NORMAL ranges for T and Free T but chime in on what you guys think (not docs, you guys) is the cut-off where you would personally either start or not start therapy.

Really appreciate all the info guys. Next step get to the doc and see if he'll do the type of test I want.

[zaggahamma]

Forrest - Beautiful man. The questionairre, exact blood test, being able to skip my doc for blood test if need be, etc. This is the type of stuff I was looking for. I had previously found a test on Men's Health but not nearly as good. Thanks very good stuff.

API - Yes, I got the info, thank you. Going to put it in my back pocket as a last resort if I can't find anyone local and covered by my insurance, figure that is my #1 priority but great to know I have a fall back plan if it comes to that, thank you.

One additional question, I know the NORMAL ranges for T and Free T but chime in on what you guys think (not docs, you guys) is the cut-off where you would personally either start or not start therapy.

Really appreciate all the info guys. Next step get to the doc and see if he'll do the type of test I want.

i think i speak for many but symptoms are more of a factor than the levels/numbers.....test levels decline at your/our age....some guys may have been used to running at a higher level to begin with so if one guy had close to 1,000 total test then towards his 40's he dips to 500 that may be similar to the next guy where he had 650 and now pushin 40 he's got 250 total T but they both are showing symptoms...

my .02

[forrest_and_trees]

Forrest - Beautiful man. The questionairre, exact blood test, being able to skip my doc for blood test if need be, etc. This is the type of stuff I was looking for. I had previously found a test on Men's Health but not nearly as good. Thanks very good stuff.

Anytime! Glad I could help! I know what it's like, it wasn't too long ago I was exactly where you are and I owe *a lot* to the people on this board, so I'm just payin it back. ...when the time comes, pass it on.

i think i speak for many but symptoms are more of a factor than the levels/numbers.....test levels decline at your/our age....some guys may have been used to running at a higher level to begin with so if one guy had close to 1,000 total test then towards his 40's he dips to 500 that may be similar to the next guy where he had 650 and now pushin 40 he's got 250 total T but they both are showing symptoms...

my .02

Agreed. it's really a matter of symptoms and what you're used to. Unfortunately, that usually doesn't fly with the docs, if you're above 300 Total T, good luck getting them to prescribe Test, it ain't going to happen. At that point the only legal channel would be an AA clinic or if you're lucky enough, get a referral to a doc who is *way* liberal. But that's a LONG shot.

Best of luck with your endeavors! Keep us posted an let us know how it goes.

[Meester]

I don't see my doc being liberal enough to even send me to a screening and I don't have the money to shop around for a liberal doc. I'm just looking for a little increase in my energy levels, reduced recovery time and the other benefits one would get from an increase in the hormones levels that have dropped off around 40. Would androsterone help or should i be looking at something closer to test. From what I read here anyone over forty could handle 100mg of test a week.

Is there any supplement on AR-R that someone could\would recommend to boost test levels a bit with little side effects? And I'll keep reading the sticky's.

[zaggahamma]

I don't see my doc being liberal enough to even send me to a screening and I don't have the money to shop around for a liberal doc. I'm just looking for a little increase in my energy levels, reduced recovery time and the other benefits one would get from an increase in the hormones levels that have dropped off around 40. Would androsterone help or should i be looking at something closer to test. From what I read here anyone over forty could handle 100mg of test a week.

Is there any supplement on AR-R that someone could\would recommend to boost test levels a bit with little side effects? And I'll keep reading the sticky's.

you really dont need your doctor anymore to do labwork unless you need your insurance to pay but it would be ridiculous if you couldnt have him do the job he's being paid for and or you couldnt fire him and find a doc without their head in their as$...theres even commercials all over prime time tv "low T...low T....check for low T....golf with your buddies again...dance the night away...i can hear the lil jingle still in my head(douche playin the guy btw...maybe i'll go audition..bam bam pow pow)...give the guy a fvckin smack in the face for Christs sake...NOTHINGS gonna give u a boost bro..if u have symptoms of low T at 40 chances are...u know...if it walks like a duck.......
good luck

[forrest_and_trees]

If you're here in the states, you can still pick up a bottle of DHEA at any pharm or health food outlet without a script and it's only $10-$20 a bottle. You might want to give that a try but the truth is, what ever you do, without a blood test, you don't really know for sure if it's working. It's worth it to pop for one of the $39 Total Testosterone blood tests you can get on line without a doctors request. Then you know your baseline and test again in about 8 weeks to see if your levels have increased. Who knows, you may find your levels are low enough to take to the doc and get a legit script.

[GotNoBlueMilk]

When I had my bloodwork done I found out my vitamin D was very low. It is supposed to be 30-110. Mine was 25. I immediately started taking 10,000 IU of D every day. Within 2 days my energy levels were much much better and my mood was much much better. I would have never known this without a blood test. Two months later my level was still only 37 (the 50 neighborhood is optimal level). Vitamin D is necessary for T synthesis in your body. There are a lot of things that go into having good T. You will never know exactly what the issue is unless you either experiment a heck of a lot and get some bloodwork. Either way it unfortunately cost money. But you can do it with research and labs, minus the doctor. Things like forrest suggests, DHEA with baseline bloodork is a start.