Finding a TRT Physician

[kelkel]

We see this issue rear its ugly head here all the time. The struggle to find an effective TRT doctor who is willing to partner with you in achieving a successful protocol. Someone who will listen to your specific, individual needs as we are all different. If you are being treated poorly or not up to your expectations with your current physician and are seeking change, the following thoughts/recommendations are from both personal experience and the collective experience of the members of this forum during my tenure here.

In 2012 the owner of this site took it upon himself to develop a working model for TRT Clinics nationwide. This effort was in response to the success of this forum and the overwhelming realization of the need for effective and efficient care for TRT patients around the country. In short, there are just far too many patients being treated poorly by physicians who are not up to current standards in Hormone Replacement Therapy.

After much time and effort in 2013 LowTestosterone.com has become a reality and clinics are starting to open in various locations across the country. These will in fact be your one-stop shot for all your hormone replacement therapy needs. Run by doctors who understand hormones who will treat you with progressive, modern methodologies as expected by the members of this forum and in-line with leading doctors in this industry.

Spend some time reading this forum and you will quickly understand how little knowledge the normal doctor has when it comes to low testosterone and its proper diagnosis and treatment. That being said, please take the time to click on the LowTestosterone.com link above. It very well may change your life for the better!

Do your homework and educate yourself in all aspects of hormone replacement therapy using all available sources including this forum and the sticky threads above it. Remember, an educated patient is the successful patient.

INITIAL LABWORK:

After a complete Medical History, which laboratory assays should be run as part of your initial hypogonadism workup? Following is a list, but certainly other specialists in this area may run expanded or attenuated panels, per individual clinical experience and expertise. Of note, additional tests which should be included to complete a comprehensive Anti-Aging Medicine workup, inflammatory markers, insulin , comprehensive thyroid study and as always, the panel needs to be tailored to the individual patient. Here are examples only recommended by Dr. John Crisler in his paper “Current Best thoughts on How to Administer TRT for Men.”

• Total Testosterone
• Bioavailable testosterone (aka Free and Loosely Bound)
• Free Testosterone
• SHBG
• DHT (gel users especially pay attention to this)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• Prolactin
• Cortisol
• Thyroid Panel (complete)
• CBC
• Comprehensive Metabolic Panel
• Lipid Panel
• PSA (age dependent)
• IGF-1, IGFBP-3 (if HGH therapy is being considered)
• Vitamin D


FOLLOW-UP LABS:

• Total Testosterone
• Bioavailable Testosterone
• Free Testosterone
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (for those over 40 with family history of prostate CA. >45 all others)
• IGF-1, IGFBP-3 (if GH therapy has been initiated already)


Get the actual test results from the lab or doctors office. You paid for them therefore they are yours. Begin to maintain a chronological file for all your lab work. An excel spread-sheet is even nicer. It will pay off later when analyzing progress. If you’re not being treated at LowTestosterone.com do not accept that “your results are normal.” Many doctors don’t know what normal is and “normal” is really a relative term. Get your own results and do your own research. Always insist on seeing your actual results. Get a copy for your own records as stated above.

Many members here have ended up having to go from doctor to doctor until they can find one who will work with them. Many doctors surprisingly know very little about TRT. You know your body better than they do. Insist on a proper diagnosis first and foremost before therapy begins. Find the causative factor! If and when therapy does begin, be sure to get ALL of your symptoms treated. Take some time and watch this video by Dr. Abraham Morgantaler, arguably the most knowledgeable Urologist on the planet when it comes to Testosterone. It will help you to eliminate some concerns that are rampant in the media and forums:





DO NOT believe the ranges the lab report shows. DO NOT believe that you are fine just because you are “in range.” Ranges are relative and a good range for one person may not be correct for another. I repeat, do your own research.

Remember, you are in charge of your health and your doctor is there to help you. Not the other way around. This, in and of itself is one of the reasons LowTestosterone.com was developed!

Hope the above helps! In good health!

Kel


Contributions by GDevine & Bass

[bass]

sticky this thread! Kel congratulation for turning red!

[Logonzo]

^^^+1

[Sicko]

good info kelkel...

[steroid.com 1]

If this is stickied it would be a great resource for men researching TRT.

We see the same problem here over and over again where a man finds a Physician who does not understand correct protocols but will go a head any way with a half ass plan that ultimately hurts a man even more.

This post is critical to helping men avoid this situation in my opinion.

Excellent post Kel!

gd

[bass]

another thing would be good to include in Kel's original post is the recommend hormone test panels... this question is always asked and we always have to list them again and again!

[kelkel]

^^^good idea. and done.

[bass]

now this is an awesome thread. lets all PM or go one on one with the staff asking to make it sticky.

[tall76]

This advice is perfect- exactly what I needed to see after the appts I've had with my pcp and an endo he recommended. They dismiss my symptoms and turn it back on me making me feel like a "drug seeker " when all I want is to be back the way I used to feel. The dr also at one point said a normal active 31 yr old would be at 500-600 test. Then later on said my 288 wasn't that far off normal??? That's like half of what he told me it should be at??

[Vettester]

Nicely written, Kelk! The part about not accepting "normal" and "being within range" is spot on! Take for example, I've seen E2 lab reference ranges that show 3 -to- 45. This is a night and day variance, and anybody in their right mind would not accept an E2 score of 3 or 45 as being anywhere near close to normal. In fact, keeping one's E2 score at 3 for any real length of time could be detrimental to one's health!

#8 is truly the summary of everything being talked about. A doctor/patient relationship really needs to be a partnership of sort, where the door can swing both ways. The HRT industry is growing rapidly, and the pool of talent for doctors is also getting better. The doctors who don't adapt, and who won't check their egos at the door will be the doctors who start getting left behind.

[Viking13]

Very helpful!! Thank you so much for posting this!! I just turned 35 and have been researching TRT because I am feeling very rundown, lack of libido, more emotional etc. I actually called some compound pharmacies today and only one returned my call and he wouldn't even give me a doctors name. He told me to go get some lab work done and then he would give me a name. I was like WTF. Figured instead of lurking I would post so I could get my 50 in and hopefully have someone here in the Tennessee area to help me.

[kelkel]

Glad it helped. You need to get the BW done and post it up on a new thread introducing yourself to everyone. You will receive amazing help from the members here. We've all been in your shoes one way or another. Good luck and welcome!

ps: face to face at the pharmacies if you can. It's much harder to not help someone when they are staring you in the face.

[Viking13]

Kel, I spoke with an excellent compound pharmacist today. He regurgitated everything in regards to testing and general thought process listed here. He is a former aas user and competitive bodybuilder so I was impressed with his knowledge. Stated that he wanted to recommend a DR. and work as a team together, which I liked. I set up a consult with him, but the only problem is that he wanted to do a saliva test which I think is not very reliable from what I've read. Any thoughts on how I approach from here?

[kelkel]

I'm not that much up on saliva tests as it's not the preferred method in TRT at this point and I don't know of anyone here with a specific interest in it for determining serum, free & Bio-T. I have not heard of any doctors routinely ordering it for their patients such as ourselves. If you google it it seems to be the "way to go" allegedly. I have never had one done although one of the benefits it that it covers a broad spectrum throughout the day as compared to the snapshot a blood draw captures. Whether that is effective to the degree BW is, I really have no clue. Someone else will probably chime in here with that answer as I've never looked into it.

To play devils advocate, why won't he give you the Doc's name and then just come back to him for your scripts? It seems like he's over-stepping his bounds as if it's some type of clinic. Is this something he's charging you for? If so, what does the whole process involve? What are the next steps. It sounds as if he's working in concert with a particular doctor.

Last question. Does your insurance cover this?

[Viking13]

I don't mind the devil's advocate at all bro, this is new to me and I appreciate the guidance.

This particular pharmacist did give me a few names. He likes to work alongside the docs to help get the patient what he needs from what it sounded like. I would be charged for a consult with him, as far as insurance goes I will no more about that tomorrow. My insurance should cover it though. The next step is to do a consult with him, do a saliva test, go to the doctor that he recommends (which happens to be my old GP), determine which path to go in terms of injections vs gel, dosage etc.. He was all about HCG , Arimedex as well.

[kelkel]

Then you are on the right path my friend. Your comments just left me questioning motives but now that you've explained more in depth it sounds like a great course of action. Hopefully, all covered by insurance. I'm lucky there myself as my insurance covers virtually everything.

When it comes to injections vs gel's, it's a personal choice. I started on androgel and did great for a while then had some issues and recently switched to injections, read this thread if you like, http://forums.steroid.com/showthread...DHT-Agel-Issue. The majority of guys here will vote for injections for a variety of reasons. If you go that route, talk to your doc about injection frequency (at home) as cyp's half life is about 72hrs. The norm seems to be every 5-7 days although some will split the weekly dose and inject every 3.5 days for even more consistency (I am). Once again, a personal choice impacted by your lifestyle.

Make sure you get good baseline tests done as listed above. Make sure to including E2 and DHT also. And as I stated before, start a thread with what you brought up here. Introduce yourself. You will get good responses from good people here. I think it's interesting what your pharmacist is willing to do, so will the other members here. Sticky threads such as this tend to get overlooked by the day to day readers so post up please and you will get many more responses. Then update as you go along with your BW, saliva results, etc. Below is the insert for Androgel 1.62% to read up on just in case:

http://www.rxabbott.com/pdf/androgel1_62_PI.pdf

Keep us posted! Start one please.

[flatscat]

Nice one Kelkel - congrat's we needed this.

[kelkel]

Thanks Flats! Happy New Year!

[Cruzmeyers]

This is great information. Your thread interested me so I joined the forum. I use to live in San Diego and I would just go to Mexico to get my gear, that was 4 years ago. I have been suffering from low libido, depression, excessive weight gain, and sleeping disorders, and no matter how hard I try I just cant make it out the door to the gym. I have been wanting to start another cycle in hopes that a little testosterone will give me a boost but I am not sure were to find gear in my area, I am very shy about approaching people. I have been researching TRT as a option as it is legal and safer but a lot of my research results in clinics that seem like scams or will only provide patients with limited amounts of hormones that seem ineffective. I will most def follow your advice in selecting a TRT clinic. If you could pm me anything you know of in SLC or lead me in the right direction that would be great, if there are issues with doing that i understand. After reading this thread I still have a few more questions for you. I find that all of the clinics I have researched did not accept insurance, you said your insurance pays for this, is there something I should look for in a med ins policy that will cover this? If so what is needed as I am currently shopping around for policies. Also, what are typical prices for a initial exam, blood work, prescriptions, follow ups, etc... I find they range from 500 to 1000 dollars for the initial exam and then run a few hundred dollars a month for prescriptions and follow ups. Does that seem right? Thanks in advance for your help.

[kelkel]

Welcome Cruz. You cannot get PM's until you have 50 posts. First and foremost you need to have complete BW done, as listed above. Without that you are just really guessing with your health and how any protocol will help you. Cycles and TRT and two different things. TRT is for life based on a medical need. Don't do it unless you have to. It's a wonderful advantage that our generation has that our fathers did not, but it's still a lifetime committment requiring a lot of discipline that takes time to get dialed in.

When it comes to insurance, I've had the same coverage all my life so I can't speak regarding other policies except to say that coverage is going to be based on need and whether you fall into the prescribed parameters for clinically low T. I consider myself very lucky insurance wise as they pay for absolutely everything, including syringes. If your insurance gives you a hard time your doctor can always write a "Letter of Medical Necessity" to your provider which will often help.

First choice in my opinion would be to find a doctor to work with, not a clinic. Someone you can work together with and find out exactly what the underlying problem is and fix it. As stated, without complete BW guys here can't really guide you. We would all just be guessing. Your issue very well may be T related but there's always the possibility it's not.

Start a thread, post up complete bloodwork and introduce yourself. Great people here who will sincerely try to help you.

Welcome and good luck!

[Cruzmeyers]

Thanks for the response, I understand that TRT is a medical condition, I should of been more clear in regards to my posting of previous steroid experience. It was to clarify that I have had experience with supplementing hormones and to also validate that I might have a possible medical condition of lowT because of my previous use. Am I correct in my understanding that my previous use of steroids could have resulted in a decrease in my body's ability to make testosterone at the normal levels? Like you said its all a guessing game though until I get actual lab results of my BW.

My next question derives mainly from my fear in approaching a Dr. and asking for this BW to be done. Is this a normal request or is there a high probability the Dr. will reject my request? What would be the best way to approach the Dr. in asking him to perform this lab work. Do I just tell him I think I suffer from lowT? Sorry if these questions are repetitive and have been answered before, I could use all the advice I can get to ensure this is a successful process and I don't waste my money paying for this. Thanks

[kelkel]

Yes, past AAS usage can cause that result. Asking your doctor for help is what it's all about. No matter what got you there. I would suggest being totally up front with him. This is someone you have to develope a relationship with and it has to be based on trust. If he feels your being deceptive it really won't help your goals. Educate yourself, read all the stickies, visit Crislers web site and take charge of your health. The doc works for you and should not turn you down for bloodwork or due to past AAS usage.

[Cruzmeyers]

Thanks Bro. I needed the encouragement. Just scheduled an apt on Friday. Once I get the results I will post them.

[Viking13]

Alright KelKel, I have my appointment with a GP tomorrow after meeting with the pharmacist on Tuesday. I've got a copy of dr.crisler's blood work to take along. Insurance does cover the test. Any last advice before going in? Thanks bro!

[kelkel]

Yes. Re-read some of the relevent stickies to prepare. If you have the time write down your questions that you may have for your doctor. Go in there and take notes if needed. Nothing worse than walking out of a visit and then remembering an important question. Many people seem to freeze up in front of their doctors and become afraid to ask them direct questions in fear they will offend them. Don't do this. You are paying him. Make him aware nicely that if TRT is going to be in your future for the rest of your life then you are on a mission to educate yourself, and you've already started.

The doc should not turn you down for any requested bloodwork. Remember to get DHT as it may come into play later on. It's the most powerful androgen in our body. T turns into DHT everywhere in the body except skeletal muscle. So, you need those good baselines. Remember E2 has to be the sensitive assay. If you use a Labcorp I can give you the proper code for it: E-Sensitive 140244, CPT code 82670. This will help the office staff as many are just not used to it and can/will code in the wrong test (did to me) by mistake and you'll come back with an E test meant for a female.

When at the lab sign off on the HIPAA form and have all results mailed or faxed to you so you can review results ahead of doc visits and prepare your questions via research, this forum, etc. I'd suggest getting a virtual fax via efax or faxaway (free versions) and it will then be faxed right to your email. You just have to tell them the number and to do it every time.

Post your results on a NEW thread please Viking! You will get a ton of great responses! Good luck!

[Viking13]

Damnit! I had to reschedule for next week cos the doc has the flu. I was ready to go today after getting up so early lol. It's okay, it will just give me more time to study the stickies and formulate questions. I can't thank you enough for the guidance kel. I will start a thread as soon as I have bloodwork in hand.

[juiceproduce]

Hi all,

I was wondering if anyone could recommend a TRT dr. in NYC or the vicinity?
thanks
j

[kelkel]

JP post up on a new thread. You will get a better response. Introduce yourself. On trt now, symptoms, etc. If you've been lurking and reading for a while then you know there are good people here who are willing to help.

[Logonzo]

Jp Where do u live?

[Ace111]

Regarding No.2 and Dr Crisler's protocols, can someone link me to said protocols? I checked his website but not sure where or what I'm looking for.

Thanks

[kelkel]

Hi Ace! Regarding #2 we are referring to his guidelines and methodology. In otherwords, his papers listed on his site that go through his logic and reasoning for TRT, HCG , AI's. He will not list a protocol as there is no "one size fits all" in trt. It needs to be tailored to the individual. There are relative norms and ranges but everyone is different and it all depends on bloodwork. Some guys here get by on 80mg per week and others are at 200mg. We all are different and it takes time to get dialed in.

[Ace111]

I see.
I might have to start doing 3 and 5 because the endo I'm seeing doesn't believe in optimal levels, as long as you're in range, even low normal then you're fine according to him.

[kelkel]

He'll change his opinion when his time for TRT rears its head. Good luck Ace and keep us informed. Start a thread!

[bass]

Kel, can you add this link TimeRoman posted to your first post?

http://forums.steroid.com/showthread...or-by-zip-code

[bwats13]

This is great information. Your thread interested me so I joined the forum. I use to live in San Diego and I would just go to Mexico to get my gear, that was 4 years ago. I have been suffering from low libido, depression, excessive weight gain, and sleeping disorders, and no matter how hard I try I just cant make it out the door to the gym. I have been wanting to start another cycle in hopes that a little testosterone will give me a boost but I am not sure were to find gear in my area, I am very shy about approaching people. I have been researching TRT as a option as it is legal and safer but a lot of my research results in clinics that seem like scams or will only provide patients with limited amounts of hormones that seem ineffective. I will most def follow your advice in selecting a TRT clinic. If you could pm me anything you know of in SLC or lead me in the right direction that would be great, if there are issues with doing that i understand. After reading this thread I still have a few more questions for you. I find that all of the clinics I have researched did not accept insurance, you said your insurance pays for this, is there something I should look for in a med ins policy that will cover this? If so what is needed as I am currently shopping around for policies. Also, what are typical prices for a initial exam, blood work, prescriptions, follow ups, etc... I find they range from 500 to 1000 dollars for the initial exam and then run a few hundred dollars a month for prescriptions and follow ups. Does that seem right? Thanks in advance for your help.

cruzmeyers... i know exactly how ya feel. i'm in ut as well and ran in to a lot of the same issues. there are a few dr.'s though here that are more than willing to write a scrip, even without having the BW done. research DO's in the area. type their name into health grades.com and check to see if they have a sanctions history for some type of misconduct. if they have a record of misconduct, then plug their name into a google search and look for the minutes from the utah osteopathic physician and surgeon's licensing board meeting at dopl.utah.gov to find what type of violations they have had, and select one that has been had issues with their scheduled prescribing methods. you can also go straight to the minutes if you would rather just read through them all and just hunt for one. most of these docs are repeat offenders since it is generally a slight slap on the wrist for their "unsatisfactory prescribing methods." good luck with the search bro, let me know if i can help in any other way

[kelkel]

Great post bwats! Welcome to the forum.

[j2048b]

im new here and have been on trt since august of 2011, and from my experience if u cannot find a good aag online, then just use google earth and type in compounding pharmacies and it will bring up a crap load in the area u choose, and do as stated in the OP, call the pharmacies and ask for referalls and then call the docs to gauge their knowledge of the practice, make sure ur insurance is taken and go from there, good luck!

im about to switch to a local doc myself, as i hat pinning myself, it just plain sucks to me,

[kelkel]

But do you want to depend on that doc every week for the rest of your life? What gauge needle are you using and where are you pinning? j2 read some of the threads here on pinning with insulin syringes. It may be easier for you. And welcome to the forum. Stick around!

[R3NZ]

I wonder why all Eurologists dont have all this knowledge about TRT , isnt part of their specialty?
While ago I was trying to get info from this doctor at Kaiser and he had no clue..

[kelkel]

It's just not part of their training. It's basically a speciality but is slowly becoming more common as the $$$ potential has been noted. Always look for the A4M Certification if possible.