Recently discovered Low T:In-network BCBS treatment or straight to bodylogicmd?

[asiandudexxx]

Didn't want to make a new thread so just updated the title

Background: 24 years old, 5'6 122 lbs 8-10% bf (started at 120 18% bf). Been lifting 2 years 3-4 times a week using SS in the beginning and now on a 5/3/1. Brazilian Jiu Jitsu for 4 years. I track my macros, eat veggies, healthy fats, lean meats, fish oil, Multi, vitamin D3, etc. I don't drink or smoke and get ~8 hours of sleep. Whenever I bulk ~80% of my gains are fat so for the past two years even with on point nutrition/lifting heavy, I barely put on any muscle.

I have had terrible symptoms that matched low T that have been getting worse in the past 12-18 months, but Kaiser doctors wouldn't touch me. Got Blue Cross and they thankfully tested me on my first visit even though the doc thought it was all in my head. Asked for full thyroid/hormone panel but he only agreed to total T and general measures.

Got the results back and my total T was 183 ng/dL (reference range 200-1000)

The doctor said this was "slightly low," which automatically made me suspicious since I know better. He ordered another round of tests for Free T, LH, and I talked him into adding FSH. Will hopefully get the results back soon. When I talked to him regarding possible treatments, he was slightly knowledgeable about TRT but seemed very standoffish and said IF the tests come back off, he'll send me to an endo who will run even more tests before they even think about treatment. It sounds like if I do get treated, it'll be way off in the future and probably will be a silly protocol like cream or EOW low dose injections.

So my question is, should I keep playing the game and get treatment through them,or go to my local Bodylogicmd (Encino)? The Bodylogic doctor has a seminar video on Youtube and he really seems to know his stuff, so I'm confident that I'll get an optimal treatment protocol through him. I just want to feel better and live a normal life again.

Thanks guys for helping a newbie out!

Update: Round of test results taken one week later were
LH<2 (ref range 5-25 mIU/mL)
FSH 3.4 (ref range 4.0-15.0mIU/mL)
Testosterone ,Percent Free 0.6 % (Reference Range: Adult Males: 1.5 - 3.2)
Sex Hormone Binding Globulin 72.8 nmol/L (Reference Range:20 - 49y: 16.5 - 55.9, >49y: 19.3 - 76.4)
Testosterone,Free 5.0 pg/mL (Reference Range: Adult Males: 52 - 280)
Testosterone,Total 63ng/dL (2nd test) & 83 ng/dL (3rd test) (Reference Range: Adult Males>18 348-1197)

Going to see an experienced endo at UCLA medical to rule out any serious health conditions before considering TRT clinics (BodyLogicMD or Ageless Men's Health)

Edit # 2: If anyone has experience with Dr. Karlis Ullis or any good doctor in and around Los Angeles, please chime in! I have heard recommendations for Dr. Ullis but not much first hand information.

[kelkel]

Welcome to the forum Asian xxxx. Before you start treatment you need to find out the cause of your TRT and see if you can fix it. Your 24 so it's not normal to have such a low T level. Better BW is your starting point but obviously your current doc is clueless and probably a waste of your time, IMO.

You need to find out if your primary or secondary hypogonadal and the causative factor. Many things can cause low T and are correctable. Thyroid issues, cortisol, testical or head trauma, pathologies, etc. You need a good doc first and foremost. If determined to not be correctable, then TRT for sure. Theres got to be a reason your low like this. Find it. Don't just settle for treatment as a bandaid. It would suck to find out 10 years from now that you really didn't need it and the issue was fixable!

Get good blood work and post it up with ranges if you can.

kel

[bigboy67]

Welcome to the forum Asian xxxx. Before you start treatment you need to find out the cause of your TRT and see if you can fix it. Your 24 so it's not normal to have such a low T level. Better BW is your starting point but obviously your current doc is clueless and probably a waste of your time, IMO.

You need to find out if your primary or secondary hypogonadal and the causative factor. Many things can cause low T and are correctable. Thyroid issues, cortisol, testical or head trauma, pathologies, etc. You need a good doc first and foremost. If determined to not be correctable, then TRT for sure. Theres got to be a reason your low like this. Find it. Don't just settle for treatment as a bandaid. It would suck to find out 10 years from now that you really didn't need it and the issue was fixable!

Get good blood work and post it up with ranges if you can.

kel

+1 as always to what Kel said. I would also be cautious being treated by a doc that thinks a 183 is "slightly low".... it is EXTREMELY low. But ya, like Kel said, you just want to make sure you get the cause rooted out before starting TRT.

[asiandudexxx]

Welcome to the forum Asian xxxx. Before you start treatment you need to find out the cause of your TRT and see if you can fix it. Your 24 so it's not normal to have such a low T level. Better BW is your starting point but obviously your current doc is clueless and probably a waste of your time, IMO.

You need to find out if your primary or secondary hypogonadal and the causative factor. Many things can cause low T and are correctable. Thyroid issues, cortisol, testical or head trauma, pathologies, etc. You need a good doc first and foremost. If determined to not be correctable, then TRT for sure. Theres got to be a reason your low like this. Find it. Don't just settle for treatment as a bandaid. It would suck to find out 10 years from now that you really didn't need it and the issue was fixable!

Get good blood work and post it up with ranges if you can.

kel

Thanks! Will update when I get the rest of the results back. He doesn't seem to think it's thyroid since my TSH came back normal (1.3; reference range 0.34-5.6). No head or testicular trauma I can think of. You're right, I should exhaust all my other options first. I just have that youthful impatience and am desperate to enjoy life again.

What other BW should I really push for? I forgot to ask for prolactin, and he shot down E2, T3, T4, SHBG, and TBG. Worst case, I might just get BW done through bodylogicmd and get reimbursed by BCBS.

[kelkel]

If he's judging your thyroid only by TSH then he's a retard. TSH is a weak indicator of thyroid function at best. Be good to have TSH, T3, T4, FT3, FT4, T3 Uptake, RT3. Do what you have to do to get the full blood work. An example is in the Finding A TRT Doc sticky thread at the top of this forum. I'd also add in DHEA-S and Pregnenolone.

I know you may feel like crap but don't rush into this. Be patient and do it right. You have a long life ahead of you and I'd hate to have to start TRT at your age unless absolutely necessary.

kel

[asiandudexxx]

Still waiting on Free T, LH, and FSH but this time my total T came out to 63 ng/dL. Kinda scary.

[asiandudexxx]

If he's judging your thyroid only by TSH then he's a retard. TSH is a weak indicator of thyroid function at best. Be good to have TSH, T3, T4, FT3, FT4, T3 Uptake, RT3. Do what you have to do to get the full blood work. An example is in the Finding A TRT Doc sticky thread at the top of this forum. I'd also add in DHEA-S and Pregnenolone.

I know you may feel like crap but don't rush into this. Be patient and do it right. You have a long life ahead of you and I'd hate to have to start TRT at your age unless absolutely necessary.

kel

Thanks man will definitely be sure to push for those next time. Your finding a TRT doc thread is gold, I read it a bunch of times a few days ago and it led me to good info and that Bodylogic doc .

[HRTstudent]

Id just like to say there isn't anything necessarily silly about creams. And for what it's worth, you might desperately want treatment to start ASAP, but your course will run much better if you get the appropriate labs up front.

I'm not saying run labs for a year, but do understand, a good physician wants to find out what's wrong with you rather than just throw you on injects and call it a day, especially for an early 20's patient.

[kelkel]

Asian you need a proper diagnosis. Really need to see LH/FSH and if they are in the pits then you need an MRI to check for pituitary issues. Normal LH/FSH and low T is indicative of primary hypogonadism (testical issues) and low LH/FSH and low T = secondary hypo (pituitary issue.)

Make sure your doc figures it out.

[asiandudexxx]

Asian you need a proper diagnosis. Really need to see LH/FSH and if they are in the pits then you need an MRI to check for pituitary issues. Normal LH/FSH and low T is indicative of primary hypogonadism (testical issues) and low LH/FSH and low T = secondary hypo (pituitary issue.)

Make sure your doc figures it out.

Got the LH/FSH results and it looks to be secondary
LH<2 (ref range 5-25 mIU/mL)
FSH 3.4 (ref range 4.0-15.0mIU/mL)

For LH, the lab can't pick up results less than 2.

Still waiting on Free T (probably will get it by tomorrow).

I was given a referral to an endo and my PCP said the endo would be the one from here on out to take any extra bloodwork. Here's to hoping I can get an appointment in the near future. Definitely gonna push for all the BW you mentioned.

[asiandudexxx]

Checking in with the rest of my results.
LH<2 (ref range 5-25 mIU/mL)
FSH 3.4 (ref range 4.0-15.0mIU/mL)

03484 - TESTO. FREE (TOTAL+SHBG):
Testosterone ,Percent Free 0.6 % (Reference Range: Adult Males: 1.5 - 3.2)
Sex Hormone Binding Globulin 72.8 nmol/L (Reference Range:20 - 49y: 16.5 - 55.9, >49y: 19.3 - 76.4)
Testosterone,Free 5.0 pg/mL (Reference Range: Adult Males: 52 - 280)
Testosterone,Total 83 ng/dL (Reference Range: Adult Males>18 years 348-1197)

I have an appointment set up with an endocrinologist a week after Thursday. He seems to have a good amount of experience with hypogonadism so hopefully I can get some answers and get on the road to recovery. Thanks to those who posted with advice!

[kelkel]

Wow Asian. Those numbers are not good and I've been there. Make sure you prepare for your visit by reading everything you can including all the stickies here. Write down all your questions and take them with you so you don't forget any. Know the answers ahead of time if you can and be prepared to question the answer if it's not what you expect.

Be sure you ask the endo about an MRI scan for pituitary issues. You need to rule this avenue in or out. Good luck with everything and update this thread after your appointment.

[asiandudexxx]

Wow Asian. Those numbers are not good and I've been there. Make sure you prepare for your visit by reading everything you can including all the stickies here. Write down all your questions and take them with you so you don't forget any. Know the answers ahead of time if you can and be prepared to question the answer if it's not what you expect.

Be sure you ask the endo about an MRI scan for pituitary issues. You need to rule this avenue in or out. Good luck with everything and update this thread after your appointment.

Most definitely, I have been researching non-stop since I got my first test results back. This board has a wealth of knowledge that I've been digging through and I'm also looking up supporting medical publications just in case the doctor needs some justification to questions or requests.

My endo is an experienced physician at UCLA medical. I'll wait for him to rule out any serious health conditions before considering TRT clinics. From some publications I've read by him, it seems he does administer sensical TRT to his patients when necessary, so if TRT does seem the way to go, hopefully I'll have good luck with him right off the bat.

[GotNoBlueMilk]

BCBS will not cover you unless you are below range. You meet that criteria so try an in-network Dr. and try to get it covered. The blood work and Dr. visits add up if you are paying out of pocket. If the insurance route fails, you can always go the other route and pay out of pocket. But once you start TRT and not have it under insurance, you will have to go off TRT and get baseline bloodwork done before you can get on insurance. Not a pleasant thing.

[asiandudexxx]

BCBS will not cover you unless you are below range. You meet that criteria so try an in-network Dr. and try to get it covered. The blood work and Dr. visits add up if you are paying out of pocket. If the insurance route fails, you can always go the other route and pay out of pocket. But once you start TRT and not have it under insurance, you will have to go off TRT and get baseline bloodwork done before you can get on insurance. Not a pleasant thing.

I believe both TRT clinics are partially covered by my BCBS insurance. Ageless Men's Health is about ~$20 a week after my $200 deductible. BLMD is supposedly covered at about 60% after my deductible, but even then it's still a good chunk of change. I also emailed my Kaiser doctor (I'm currently double insured) to see what services I can get through them to save me money (bloodwork, MRI, etc) but I'm not holding my breath.

Hopefully when I see the endo, he will run one more exhaustive battery of tests to rule everything out. This whole "check one thing before we check the next" is really grinding my gears.

Best case is the endo knows his stuff and, if I truly need TRT, he will write the prescription so I can self-administer. If not, hopefully I can get the BW I need paid for by BCBS or Kaiser and send it to BLMD to save myself some money. Worst case, I go to AMH every week. Only thing is I want to get on hcg for fertility and I don't believe AMH offers that. They also said they offer an estrogen blocker as needed but only after 5 weeks of test cyp. Is that okay or is it recommended that I get on an AI right off the bat?

[asiandudexxx]

More tests from Kaiser (8 am draw):
Fasting glucose 84 mg/dL (ref range 70-99)
Creatinine 1.0 mg/dL (ref range <1.4)
Glomerular Filtration >89-NB (no ref range)
Chloride 105 mEq/L (ref range 101-111)
CO2 27 mEq/L (ref range 21-31)
Potassium 4.2 mEq/L (ref range 3.5-5.0)
Sodium 143 mEq/L (ref range 135-145)
Cholesterol 206 mg/dL (ref range <200)
Cholesterol/HDL 4.1 (ref range <5.0)
HDL 50 mg/dL (ref range >/=40)
LDL calculated 146 mg/dL (ref range <100)
Triglyceride 57 mg/dL (ref range <150)
HCT auto 43.9% (ref range 42-52)
HGB 14.6 g/DL (ref range 14.0-18.0)
MCH 30.7 pg/cell (ref range 27-35)
MCV 33.3 g/dL (ref range 80-94)
Platelets, Automated count 227 x1000/cumm (ref range 130-400)
RBC, Auto 4.88 mil/cumm (ref range 4.7-6.1)
RDW, Blood 13.6% (ref range 11.5-14.5)
WBC's Auto 4.1 thou/cumm (ref range 4.0-11.0)
MPV 9.5 FL (ref range 7.4-10.4
Iron 168 mcg/dL (ref range 59-158)
Total Iron Binding Capacity 313 mcg/dL (ref range 250-425)
Iron Saturation 54% (ref range 20-50)
TSH 1.16 uIU/mL (ref range 0.35-4.00)
Albumin 5.1 gm/dL (ref range 3.3-4.8)
AST 31 units/L (ref range <35)
ALT 32 units/L (ref range <64)
Total Testosterone 270.4 ng/dL (ref range 249-836 ng/dL)
LH 1.3 (no ref range for their lab)
FSH 3.3 (no ref range for their lab)
Vitamin D, 25-Hydroxy 57 ng/mL (ref range 30-100)(all d3)
SHBG 59.20 nmol/L (ref range 14.5-48.4)

I computed Free test and Bioavailable test with the FAI:
Free test 3.35 ng/dL (mayo clinic ref range 9-30 ng/dL)
Bioavailable test 92.8 ng/dl (mayo clinic ref range 83-257 ng/dL)

Even though this was at 8 am when my test is the highest it will be of the day, Kaiser may just look at the total test and say "NORMAL RANGE, YOU'RE FINE!". We'll see though.

Looking for other doctors with my BCBS coverage. Came upon Dr. Karlis Ullis. Has anyone had any personal experience with him? I know he wrote some books and articles on the subject but in this situation anecdotal experience may be helpful. If anyone has any recommendations for doctors in and around Los Angeles or the San Fernando Valley, I'm all ears.