Seeing Endo next week. Here is my blood work and history.

[Black]

Sorry for the bump. Does anybody see anything in my above BW that jumps out at you?

My endo's solution to get my albumin level back to within normal limits was to stop taking all vitamins and retest in a month, but she wasn't overly concerned about it...or anything else.

She says that my total test of 311 ng/dl was completely normal, even with the symptoms I've been experiencing. I won't be making a follow up appointment with her.

I'd make a point to tell her "thank you" for telling me I'm normal and not treating my symptoms. Suddenly, everything is better. Dumb broad.

FIRED!!!!

[kelkel]

LH & FSH are low as expected. Thus low T.
So, she tests albumin but not SHBG. Is she just guessing her way through this? Albumin is a minor player compared to shbg when it comes to transporting / binding hormones.

Your doc is treating you like a number on a chart......don't accept that.

[Chauffeur]

Indeed, she basically admitted to guessing her way through this. Her words were "there is definitely something wrong with you, but it's not your testosterone , we'll figure it out."

She was completely unwilling to even entertain the idea that this was hormone related. Her biggest concern before the BW was that I had either HIV or hepatitis...seriously...that's what she said to me.

[kelkel]

You need to move on. Guessing will not help you.

[Chauffeur]

I have an appointment with a well respected urologist next week. From what I can gather from online reviews and reports that he's published, he knows what he's doing.

If the appointment doesn't go well I'm going to swing by a compounding pharmacy and see if they can help point me in the right direction.

[Chauffeur]

Had my appointment with the urologist today, didn't go as well as I'd hoped. He seemed like a nice guy, but he made it pretty clear that TRT was not something that he would consider in my case.

He said that while my numbers were not optimal, they were still within normal limits, and that if low test was causing my issues I would be seeing higher LH and FSH numbers. He suggested that I see another endocrinologist or even a sex therapist...which actually made me a bit angry.

I could bore you with all of the other details of my visit but it's all stuff that you've heard a million times from new posters like me. Bottom line, he wasn't looking at me, only the numbers.

On my way home I stopped by a compounding pharmacy to speak with the staff about locating a doctor. They were unbelievably nice and took the time to listen to my sob story. They provided me with a printout of doctors who use hormone therapy, and even gave me some recommendations.

Many of them work in obstetrics, so I'm assuming that i shouldn't bother with those doctors. The rest of them all seem to be physicians working at various anti-aging clinics and bioidentical hormone therapy centers. All are board certified, but there aren't any endocrinologists or urologists on the list.

Obviously I'd like to be seen by a doctor within my insurance plan. These clinics appear to be expensive. Honestly, I'm at the point where I'd consider paying any amount of money to fix my problems but that probably isn't the smartest idea. Most of these clinics will submit to my insurance for me, but I imagine that they wouldn't pay for my treatment based on the fact that technically, my numbers are within normal limits.

Should I avoid these types of clinics? Are they a scam of some sort? Are bioidentical hormones legit? Obviously I should discuss this with my insurance provider, but is this something that insurance sometimes covers? I realize that there are many variable, but what's the ballpark cost of these medications if I were to pay out of pocket? Any advice for what my next move should be? I'm not sure if it's beneficial for me to keep seeing other doctors and simply hoping that one will take pity.

Thanks.

[luciuswillson]

I would have to say if you have to go to an anti aging center you would be better off driving to the closest LowT.com center. Most of the anti aging centers I have looked at don't take insurance and it was going to cost me a lot of money to go there. When I called the compounding pharm's I specifically asked what doctors in the area perscibed TRT for men and got a good list. Hope you can find what you are looking for.

[Metalject]

Had my appointment with the urologist today, didn't go as well as I'd hoped. He seemed like a nice guy, but he made it pretty clear that TRT was not something that he would consider in my case.

He said that while my numbers were not optimal, they were still within normal limits, and that if low test was causing my issues I would be seeing higher LH and FSH numbers. He suggested that I see another endocrinologist or even a sex therapist...which actually made me a bit angry.

I could bore you with all of the other details of my visit but it's all stuff that you've heard a million times from new posters like me. Bottom line, he wasn't looking at me, only the numbers.

On my way home I stopped by a compounding pharmacy to speak with the staff about locating a doctor. They were unbelievably nice and took the time to listen to my sob story. They provided me with a printout of doctors who use hormone therapy, and even gave me some recommendations.

Many of them work in obstetrics, so I'm assuming that i shouldn't bother with those doctors. The rest of them all seem to be physicians working at various anti-aging clinics and bioidentical hormone therapy centers. All are board certified, but there aren't any endocrinologists or urologists on the list.

Obviously I'd like to be seen by a doctor within my insurance plan. These clinics appear to be expensive. Honestly, I'm at the point where I'd consider paying any amount of money to fix my problems but that probably isn't the smartest idea. Most of these clinics will submit to my insurance for me, but I imagine that they wouldn't pay for my treatment based on the fact that technically, my numbers are within normal limits.

Should I avoid these types of clinics? Are they a scam of some sort? Are bioidentical hormones legit? Obviously I should discuss this with my insurance provider, but is this something that insurance sometimes covers? I realize that there are many variable, but what's the ballpark cost of these medications if I were to pay out of pocket? Any advice for what my next move should be? I'm not sure if it's beneficial for me to keep seeing other doctors and simply hoping that one will take pity.

Thanks.

No matter how many times it's said it's very hard to get this through people's heads; endocrinologist and urologist are normally the worst doctors you can see for TRT. Beyond that, important points:

1. TRT is not difficult medicine. Any doctor that has taken the time to learn about testosterone can provide you with what you need, and that includes an OBGYN. The problem with most endo's and urologist, ego and training that is 40yrs out of date and the ego will not allow them to update the training. They are supposed to be experts in the field of hormones, ego will not let them say otherwise.

2. The best doctors I've ever known (personally) who treat low testosterone - one specializes in bariatrics and got into TRT and HCG and related things later on. Another is an eye surgeon. A few others are regular family doctors, general practice. All have a better understand of TRT than any endocrinologist or urologist I've ever met.

3. Bio hormones, that's nothing more than a clever marketing term. I can tell you, however, many of the people that work at the clinics do not realize it's nothing more than a marketing term. They too believe there is something special about their testosterone. Whether the testosterone is made by a big pharma company, a compounding pharmacy or some company that puts the term "Bio" on it, once in the body it's all the same testosterone.

[Chauffeur]

I would have to say if you have to go to an anti aging center you would be better off driving to the closest LowT.com center. Most of the anti aging centers I have looked at don't take insurance and it was going to cost me a lot of money to go there. When I called the compounding pharm's I specifically asked what doctors in the area perscibed TRT for men and got a good list. Hope you can find what you are looking for.

Thanks, I'll definitely look into them. There sure are a ton of clinics advertising online! I had no idea how big this industry was until recently. I just always assumed that anything advertised in a banner across the top of a website was too good to be true, or some type of scam.

As much as I'm looking to be treated, I'd also like to be in the care of a doctor who isn't just blindly prescribing medications to me with no regard for my actual health. Is a place like LowT.com legitimate in that sense? Or is it just a "you give us money, we give you testosterone " type of deal?

No matter how many times it's said it's very hard to get this through people's heads; endocrinologist and urologist are normally the worst doctors you can see for TRT. Beyond that, important points:

1. TRT is not difficult medicine. Any doctor that has taken the time to learn about testosterone can provide you with what you need, and that includes an OBGYN. The problem with most endo's and urologist, ego and training that is 40yrs out of date and the ego will not allow them to update the training. They are supposed to be experts in the field of hormones, ego will not let them say otherwise.

2. The best doctors I've ever known (personally) who treat low testosterone - one specializes in bariatrics and got into TRT and HCG and related things later on. Another is an eye surgeon. A few others are regular family doctors, general practice. All have a better understand of TRT than any endocrinologist or urologist I've ever met.

3. Bio hormones, that's nothing more than a clever marketing term. I can tell you, however, many of the people that work at the clinics do not realize it's nothing more than a marketing term. They too believe there is something special about their testosterone. Whether the testosterone is made by a big pharma company, a compounding pharmacy or some company that puts the term "Bio" on it, once in the body it's all the same testosterone.

I have definitely figured that out the hard way. I've seen a GP, endo, and now a urologist, none of which were willing to look beyond my age and "normal" bloodwork. At the risk of sounding over dramatic, my symptoms are destroying my life. None of the doctors that I saw were able to understand how much this is affecting me. I'm sure they're not all bad, but the 3 that I've seen were certainly clueless.

So an OBGYN is something that I should consider? They won't look at me sideways when I walk in? I assumed that they only see women. If not an OBGYN, what type of doctor should I be seeking out? If endocrinologists and urologists aren't the ideal choice, who are the experts with this stuff? My GP was little help, should I just seek out a different GP?

An eye doctor that treats low T, that's awesome! I wonder if my orthopedist is a TRT guru. I doubt that I'd be that lucky.

I did some basic research of BHRT today and most people share your sentiment. Fancy name and that's about it. Not a magical treatment, and also not much different than what other doctors are prescribing. Thanks for clearing that up.

[Metalject]

What part of the country do you live in?

[Chauffeur]

I'm on the east coast. I can PM you my exact location if that helps.

[Chauffeur]

Just wanted to provide an update to those of you who have helped me throughout my process. I've decided to put a hold on jumping into TRT through LowT.com or other avenues for the time being. Definitely not ruling them out, just slowing down a bit before I make any decisions.

I met with the owner of a compounding pharmacy the other day. Great guy who really knows his stuff. We talked at length about TRT, hormones, thyroid, adrenal issues, etc. We spent close to 2 hours talking about my issues, possible causes, treatments, and he educated me on the inner workings of the endocrine system. Everything he said was in line with the information that you guys have provided me.

He was the first person, besides you guys, who took my symptoms seriously. As soon as I handed him my bloodwork he immediately said, "holy shit, your testosterone is really low". It felt good to finally have a medical professional acknowledge my crappy BW.

He was up front with everything and said that if TRT is something I would like to pursue, he'd help me, but stressed the importance of getting to the root of the problem before I make any big decisions. He meticulously went over my BW with me so I had a better understanding of what things meant, and where my numbers should actually be.

He's putting his money on the fact that I'm suffering from severe adrenal fatigue, and asked me to take a saliva test to measure my cortisol and DHEA levels, something that none of my 3 previous blood tests measured. It's a 4 part test to see where my levels are throughout the day. He's pretty confident that my numbers will be off, and we can go from there.

In the meantime, he wants me to start with some vitamins and supplements (plus some dietary changes) to see if we can get my system functioning normally again. Yes, he sold me the supplements. I'm not going to lie, I'm as skeptical as you guys probably are about this. It's definitely a more holistic approach to my treatment, something I never thought that I'd be into, but he says that he's seen this type of treatment help guys like me before so they can avoid TRT.

I just met the guy, and I'm putting a huge amount of trust in him, but he genuinely seems that he has my best interest in mind here. He's been doing this for nearly 2 decades and has a very successful business. I can't imagine that would be possible if he was selling snake oil.

He was realistic about all of this and made no claims to be some type of shaman healer. He said that it's possible that it may not work and then we can decide if we want to get more aggressive with treatment if that's the case. We discussed a possible HCG restart if this fails, and TRT if that's the route that I choose.

He told me that this is my health and it's my decision to treat this how I'd like to, but that he tries to fix the underlying problem before moving forward with TRT. That seems to be in line with the general consensus here as well.

I'd be lying if I said that I wasn't skeptical, but at this point I'm willing to try just about anything. Maybe that's not a good thing, we'll see.

[kelkel]

Good luck with this Chauffeur! If this fails, why not try to see Crisler in Michigan or Shippen in PA? Two of the best in the business.

[Chauffeur]

Good luck with this Chauffeur! If this fails, why not try to see Crisler in Michigan or Shippen in PA? Two of the best in the business.

Thanks! I haven't ruled out traveling to get treatment, but it sounds like I'm in good hands with this fella.

We loosely discussed potential protocols if I/we decide to pursue TRT, and I was very happy with his treatment modalities. It seems like I may not need to travel in order to receive care from somebody who knows what they're doing...which is a huge relief. Before I could even ask, he brought up the topic of HCG and AI.

While he helps treat people with various illness', hormone therapy is his wheelhouse, so I trust that he will treat me responsibly if it comes to that.

I know it's not really something that's discussed around here, but do you know of people who've been successful fixing their low testosterone through a more holistic avenue? It's hard for me to wrap my head around, but that's likely because I know very little about it.

I mean, it's all about finding the cause right? Let's assume that my cortisol and DHEA levels turn out to be funky. Is that something that can realistically be fixed without hormones?

Am I a hippy now?

[kelkel]

It is about finding the cause and correcting it if possible. Yes, cortisol, dhea, thyroid and many factors that contribute to low T can be fixed. And hopefully yours is simply that! To many docs simply treat the low T without analyzing the other numbers closely as they are in range, but in range doesn't mean optimum.

[Chauffeur]

It is about finding the cause and correcting it if possible. Yes, cortisol, dhea, thyroid and many factors that contribute to low T can be fixed. And hopefully yours is simply that! To many docs simply treat the low T without analyzing the other numbers closely as they are in range, but in range doesn't mean optimum.

One of the highlights of my appointment with him was when he told me that he would be much more comfortable with my total T being an absolute minimum of 600. Almost made me tear up to finally speak with a medical professional who recognized that my numbers are far from optimal.

For now we will be taking a more conservative route, but I feel good knowing that if this doesn't work out for some reason he will do what it takes to get my numbers up.

I'm torn, part of me wanted him to say that he'd recommend TRT right away. The other part of me realizes that this is probably the correct way to approach my treatment. Not just slap some T on a problem without fixing it.

I'll do whatever it takes to get better, I can't live like this for much longer though, I suppose there is no such thing as a quick fix.

[kelkel]

Glad you found this guy. But don't focus on total T. Focus on free T. Be sure you do that. Free T is what works for you.

[Chauffeur]

Still awaiting the results of of my cortisol and DHEA saliva tests, should know by next week. Hopefully that will give us a clue to the causes of my issue.

What's the standard treatment for low cortisol? Or high cortisol? I will certainly discuss that with him as well. My doctor is expecting my levels to be low.

We will also soon be having a consult about starting me on hCG , and see if we can avoid TRT altogether. I imagine we will be doing detailed blood work as well.

Any advice? Questions I should ask?

[Chauffeur]

Time for an update.

The results of my saliva test are in and here are the results:

DHEA - 240 (137-336)

Morning cortisol - 6.78 (25-30)
Afternoon cortisol - 4.8 (15-16)
Evening cortisol - .75 (4-5)
Nighttime cortisol - .92 (2-3)


As you can see, my cortisol levels suck. The doc was fine with my DHEA being where it is, but wants to address the cortisol issue as this may be the root of my problems.

He wants me to start by taking a licorice root supplement to raise cortisol. Low dose to start and work our way up. Only apparent side effect seems to be that many patients experience an increase in blood pressure. I'll keep an eye on it.

If the licorice root doesn't do the trick, the next step would be prescription hydrocortisone.

Do any of you have any input on this course of treatment? Any experience with low cortisol levels?

Thank you!

[BallSak]

Time for an update.

The results of my saliva test are in and here are the results:

DHEA - 240 (137-336)

Morning cortisol - 6.78 (25-30)
Afternoon cortisol - 4.8 (15-16)
Evening cortisol - .75 (4-5)
Nighttime cortisol - .92 (2-3)


As you can see, my cortisol levels suck. The doc was fine with my DHEA being where it is, but wants to address the cortisol issue as this may be the root of my problems.

He wants me to start by taking a licorice root supplement to raise cortisol. Low dose to start and work our way up. Only apparent side effect seems to be that many patients experience an increase in blood pressure. I'll keep an eye on it.

If the licorice root doesn't do the trick, the next step would be prescription hydrocortisone.

Do any of you have any input on this course of treatment? Any experience with low cortisol levels?

Thank you!

I am dealing with the same thing. This is the first I've heard or licorice root, I will have to look into it. I was told to take adaptogens such as ginseng, rhodiola and ashwaghanda, as they promote adrenal health.

Adaptogens: Nature's Miracle Anti-stress and Fatigue Fighters

[thisAngelBites]

Licorice root serves to stimulate the adrenals to produce more hormone. I've not tried it myself, but I know other people who have gotten decent results. Those people have been those with mildly low cortisol, and yours seems lower than what I would expect to be helped by licorice, but you never know, and there is no harm in trying.

Low cortisol can be a result of the adrenals not producing enough but it can also be caused by problems in the pituitary or hypothalamus, which are responsible for signaling the adrenals. But if this was the case, I would generally expect your DHEA to be low as well.

Has your doc said anything about checking your aldosterone levels or an ACTH stimulation test to see if your adrenals are capable of making sufficient cortisol, but aren't due to signaling, or if the adrenals themselves are not doing well?

[Chauffeur]

Thanks for the info. He didn't mention aldosterone nor the ACTH stim test. In hindsight that's certainly something I should have asked about, I read that the ACTH is the go-to test for adrenal insufficiency before my appointment but it slipped my mind...my memory has been terrible lately.

If this were a pituitary issue, would that have been apparent based on LH and FSH numbers from prior blood work? Or is the ACTH test the only way to rule that out?

He did mention that a small percentage of AI cases are the result of tumors impinging on the adrenal glands, but he didn't think that was the case with me. I'm not sure why he feels that way though.

[thisAngelBites]

Typically, if you have a pituitary problem/tumour, your DHEA would be low as well, but theoretically, your aldosterone would be okay, because it is stimulated by the kidneys rather than pituitary.

Adrenal adenomas (that your doc didn't think would be the case with you) are more likely to secrete cortisol, so they create the opposite problem of too much cortisol (they also can secrete aldosterone or some of the sex hormones) rather than not enough. I am not familiar with cases in which an adrenal adenoma causes decreased cortisol production (although pituitary adenomas can), but perhaps that it is a possibility I am unaware of. In any case it would be much more likely to cause the opposite of what is happening with you.

The point of the ACTH test is to find out whether the problem with the low cortisol levels is due to the adrenals not working themselves, or whether it is a signaling problem.

[Chauffeur]

Awesome info, thanks. So a positive ACTH test would be indicative of Addison's disease correct? I don't think he was ready to go down that road yet but I trust that this doctor will order an ACTH if he feels it's necessary...or I ask to have one.

At this point it just seems that I may have stressed my adrenals so much with a demanding work schedule (I work 24-36 hour shifts, often times with only a few hours of sleep), and use of caffeine to get through those shifts. Throw in a physically demanding job, gym routine, and other life stress'...I guess it was just too much.

Right now he thinks that the low cortisol is causing my low testosterone , is it possible that it's the other way around?

[Chauffeur]

Now I've got a doctor who wants to rule out Lyme disease.

Never thought I'd have to write something like that when I made this thread.

[Chauffeur]

My GP called to tell me that my Lyme, ACTH, and CBC all came back normal. He says that my adrenal glands are functioning perfectly.

Should I ask for a more detailed thyroid test even though my TSH has been within range? I'm grasping at straws looking for an answer here and I'm not really sure what to do at this point.

At what point do I just accept the fact that the only thing wrong with me is less than optimal testosterone levels ?

Any suggestions as to what I should do from here?

[smokeyman]

My GP called to tell me that my Lyme, ACTH, and CBC all came back normal. He says that my adrenal glands are functioning perfectly.

Should I ask for a more detailed thyroid test even though my TSH has been within range? I'm grasping at straws looking for an answer here and I'm not really sure what to do at this point.

At what point do I just accept the fact that the only thing wrong with me is less than optimal testosterone levels ?

Any suggestions as to what I should do from here?

Hi Chauffeur.

I'm in a sort of similar situation as you. I'm only 24 and I believe my sexual dysfunction may be caused by low t. Here's my results:

Total Testosterone: 429 ng/dL (348-1197)
Free Testosterone: 9.1 pg/mL (9.3-26.5)
Prolactin: 6.0 ng/ml (2.1-17.7)
Lutenizing Hormone: 2.4 mIU/ml (1.5-9.3)
FSH: 2.6 mIU/ml (1.4-18.1)
Estradiol: 20 pg/ml (0-39.8)
DHEA: 292.8 ug/dL (164.3-530.5)
SHBG: 27.0 nmol/L (16.5-55.9)

As you can see, I have low free t and just barely okay total t. I have low libido, low motivation, fatigue, and brain fog. Also sexual dysfunction. It's like I've lost feeling down there. Like low penis, scrotum sensitivity. I can still get erections, but they are difficult to keep. Not often do I have morning erections either.

Is your sexual dysfunction similar?

[Chauffeur]

Not really. Mine is mostly a complete lack of libido, no issues with losing sensitivity.

[Chauffeur]

Update:

Doctor called me with the results of the latest round of lab work, everything looked completely fine to him. He's sending me copies in the mail so I don't have all of the numbers handy, but he said that my thyroid panel came back normal.

I also asked for another testosterone test, for which he only ordered total T (I know, I know). It came back at 430 ng/dl, so it's improved from my previous tests a little bit.

He said that he's exhausted all options in terms of blood work, and he doesn't see any point in any further testing.

At this point I'm pretty stumped and unsure of where to go from here. I've had a handful of blood tests done, most of which put me in the low-normal range for testosterone (usually in the low 300's).

I understand that TRT is a huge commitment and something not to be taken lightly, but I really don't think I can live like this for much longer. It almost seems worth it to me to put all of my eggs in the TRT basket and hope that it solves my problems. I realize that it's not a miracle cure but it seems that many people in my same position have benefitted from it.

If you were in my shoes, what would you do?



Edit:

Free T3 - 2.8 (2.3-4.2 pg/dl)
Free T4 - 1.1 (.8-1.8 ng/dl)

ESR, Westergren - 2 (0-15 mm/hr)

Total testosterone - 436 (241-827 ng/dl)

Cortrosyn Stim Test
PTH, intact - 18 pg/ml (15-59)
Cortisol - 10
60 min cortisol - 25.4
30 min cortisol - 19.9

[Fishin dude]

Hi. New to this forum. I joined to learn more about my condition which sounds much like yours Chauffeur. Low drive. Some e.d. moments, but the biggest problem for me has been foggy headedness, inability to concentrate or focus espically at work. Had labs done tt of 150. Uroligist started me on axiron 2 pumps. Raised ne up to 268 after 2 months. Told me to increase dose to 4 pumps. Seemed to start feeling a little better at 4 but not a ton better. I went off of it for 6 weeks started up again 3 weeks ago 2 pumps. Still brain foggy and tired at work. This low t thing has me frustrated.

[CaliburKid]

Don't forget you can always see another doc. Or suck it up and travel to one of the top ones in the country. First visit in person and after that virtual. May be something to consider.

I apologize for bringing up an older topic, but I'm curious as to who would be considered one of the top doctor's in the country?

[OingoBoingo]

Dr. Crisler, Dr. Gordon, Dr. Mariano.

IIRC, on this sub-forum there's a thread about the top ten TRT docs.

Found it: http://forums.steroid.com/hormone-re...t-therapy.html