TRT: navigate alone? or course correct? or give up?

[TESTes123]

New member to the forum, and thank you in advance for letting me join the family.
Appreciate all of the stickies and threads that have helped educate me to this point.
Supplying all the information requested in one of the stickies, thus sorry for the information overload, but want to be thorough.

Bio:
- Male, 33, caucasian, south-east US, 5'10", fluctuate between 155 and 165lbs, skinny-fat build (toothpick arms/legs, tendency to carry a gut)
- Have been going to my primary care physician (PCP) for over 10 years now

Constraints:
- HMO health care insurance through work, requires my PCP to do it all or refer to a specialist, anything I do on my own isn't covered
- Limited funds to do much, if anything, on my own outside of my insurance

Background:
- Between the ages of 28 and 31, routinely told my PCP during my annual physicals that I was battling constant "grey skies" feelings, subtle mood swings, constant fatigue, zero libido with difficulty to get an erection but when I got one was very rigid, and seemingly no ability to gain muscle mass despite exercise. PCP always brushed this off as stress, continued my prescriptions for Xanax. I tried to focus my efforts on reducing stress, but never could find a stress free life to help these other problem areas.
- At my 32 year old annual physical, described the same problems and growing frustrations, and told my PCP I was going to hire a personal trainer to see if maybe my exercise was all wrong, and getting help physically could be the magic element to help the other problem areas.
- Nearly a year into training and still had no progress on the problem areas, so I hired a nutritionist to see if maybe my diet was to blame. She immediately said it sounds like I had low testosterone and should talk to my PCP about options. I had never thought about being nearly 33 years old and having low T.
- At my 33 year old annual physical, told my PCP I was advised to get my T checked. He brushed it off and said at my age and health there was such a slim chance it could be low T. I insisted he run blood work, because after 5 years of this I was fed up.

Dr Visits, Blood Work, and Progress Timeline:

- Feb 2014 = BW Results (Ranges)
• Total Testosterone
286 (241-827)
• Bioavailable testosterone (aka Free and Loosely Bound)
No Test
• Free Testosterone
No Test
• SHBG
No Test
• DHT (gel users especially pay attention to this)
No Test
• Estradiol (specify “sensitive” assay for males)
No Test
• LH
No Test
• FSH
No Test
• Prolactin
No Test
• Cortisol
No Test
• Thyroid Panel (complete)
No Test
• CBC
WBC 5.3 (3.8-10.8), RBC 5.18 (4.20-5.80), Hemoglobin 15.5 (13.2-17.1), Hematocrit 46.1 (38.5-50.0), MCV 89.0 (80.0-100.0), MCH 30.0 (27.0-33.0), MCHC 33.7 (32.0-36.0), RDW 14.2 (11.0-15.0), Platelets 240 (140-400), Neutrophils Absolute 3042 (1500-7800), Lymphocytes Absolute 1813 (850-3900), Monocytes Absolute 350 (200-950), Eosinophils Absolute 58 (15-500), Basophils Absolute 37 (0-200), Neutrophils Relative 57.4, Lymphocytes Relative 34.2, Monocytes Relative 6.6, Eosinophils Relative 1.1, Basophils Relative 0.7
• Comprehensive Metabolic Panel
Glucose 90 (65-99), BUN 12 (7-25), Creatinine 0.75 (0.60-1.35), GFR MDRD Non Af Amr 121 (>=60), GFR MDRD Af Amer 140 (>=60), BUN/Creatinine Ratio N/A, Sodium 140 (135-146), Potassium 4.1 (3.5-5.3), Chloride 101 (98-110), CO2 20 (19-30), Calcium 10.2 (8.6-10.3), Total Protein 8.4 (6.1-8.1), Albumin 5.6 (3.6-5.1), Globulin Total 2.8 (1.9-3.7), Albumin/Globulin Ratio 2.0 (1.0-2.5), Total Bilirubin 0.4 (0.2-1.2), Alkaline Phosphatase 52 (40-115), AST 18 (10-40), ALT 23 (9-46)
• Lipid Panel
Cholesterol Total 202 (125-200), Hdl 57 (>=40), Triglycerides 98 (<150), LDL Calculated 125 (<130), Chol/HDL Ratio 3.5 (<=5.0), Non HDL Chol. (LDL+VLDL) 145
• PSA (age dependent)
No Test
• IGF-1, IGFBP-3 (if HGH therapy is being considered)
No Test
• Vitamin D
No Test

- PCP said all results were normal, nothing to worry about. I put my foot down again and said no, I am not a doctor but even I can tell from the results that Total Testosterone was low, even if considered in range. He agreed to order another lab test in two months.

- Apr 2014 = BW Results (Ranges)
• Total Testosterone
252 (241-827)
• Bioavailable testosterone (aka Free and Loosely Bound)
No Test
• Free Testosterone
38.6 (46.0-224.0)
• SHBG
No Test
• DHT (gel users especially pay attention to this)
No Test
• Estradiol (specify “sensitive” assay for males)
No Test
• LH
3.0 (1.5-9.3)
• FSH
2.5 (1.6-8.0)
• Prolactin
14.1 (2.0-18.0)
• Cortisol
No Test
• Thyroid Panel (complete)
No Test
• CBC
No Test
• Comprehensive Metabolic Panel
No Test
• Lipid Panel
No Test
• PSA (age dependent)
No Test
• IGF-1, IGFBP-3 (if HGH therapy is being considered)
No Test
• Vitamin D
No Test

- PCP said my T levels were on the lower side (other levels were fine), which made me eligible for TRT; come back in 2 months for re-check.

- May 2014 through June 2014, 1ml of 100mg Test Cyp every 10 days

- Jul 2014 = BW Results (Ranges)
• Total Testosterone
175 (241-827)
• Bioavailable testosterone (aka Free and Loosely Bound)
No Test
• Free Testosterone
No Test
• SHBG
No Test
• DHT (gel users especially pay attention to this)
No Test
• Estradiol (specify “sensitive” assay for males)
No Test
• LH
No Test
• FSH
No Test
• Prolactin
No Test
• Cortisol
No Test
• Thyroid Panel (complete)
No Test
• CBC
No Test
• Comprehensive Metabolic Panel
Glucose 135 (65-99), BUN 16 (7-25), Creatinine 0.83 (0.60-1.35), GFR MDRD Non Af Amr 116 (>=60), GFR MDRD Af Amer 134 (>=60), BUN/Creatinine Ratio N/A, Sodium 141 (135-146), Potassium 4.4 (3.5-5.3), Chloride 107 (98-110), CO2 22 (19-30), Calcium 9.5 (8.6-10.3), Total Protein 7.3 (6.1-8.1), Albumin 4.5 (3.6-5.1), Globulin Total 2.8 (1.9-3.7), Albumin/Globulin Ratio 1.6 (1.0-2.5), Total Bilirubin 0.4 (0.2-1.2), Alkaline Phosphatase 61 (40-115), AST 48 (10-40), ALT 32 (9-46)
• Lipid Panel
No Test
• PSA (age dependent)
No Test
• IGF-1, IGFBP-3 (if HGH therapy is being considered)
No Test
• Vitamin D
No Test

- PCP said my T levels were still on the lower side (other levels were fine), so we needed to adjust the dosage; come back in 2 months for re-check. I let him know I was experiencing some pain/discomfort from what appeared to be my testicles shrinking and being pulled up into my body instead of hanging. My sack resembled more of a small tight mound of flesh not very far from my groin instead of an average size/hang as it had been since puberty. PCP said TRT only added to my natural T, and would not be shrinking my testicles.

- July 2014 through Aug 2014, 1ml of 100mg Test Cyp every 7 days

- Sep 2014 = BW Results (Ranges)
• Total Testosterone
751 (241-827)
• Bioavailable testosterone (aka Free and Loosely Bound)
No Test
• Free Testosterone
No Test
• SHBG
No Test
• DHT (gel users especially pay attention to this)
No Test
• Estradiol (specify “sensitive” assay for males)
No Test
• LH
No Test
• FSH
No Test
• Prolactin
No Test
• Cortisol
No Test
• Thyroid Panel (complete)
No Test
• CBC
No Test
• Comprehensive Metabolic Panel
Glucose 89 (65-99), BUN 12 (7-25), Creatinine 0.71 (0.60-1.35), GFR MDRD Non Af Amr N/A, GFR MDRD Af Amer N/A, BUN/Creatinine Ratio 17 (7-25), Sodium 140 (135-146), Potassium 4.5 (3.5-5.3), Chloride 106 (98-110), CO2 27 (19-30), Calcium 9.5 (8.6-10.3), Total Protein 7.0 (6.1-8.1), Albumin 4.5 (3.6-5.1), Globulin Total N/A, Albumin/Globulin Ratio N/A, Total Bilirubin 0.5 (0.2-1.2), Alkaline Phosphatase 53 (40-115), AST 58 (10-40), ALT 26 (9-46), Anion Gap 12 (7-14)
• Lipid Panel
No Test
• PSA (age dependent)
No Test
• IGF-1, IGFBP-3 (if HGH therapy is being considered)
No Test
• Vitamin D
No Test

- PCP said everything looked good now, stay on current dosage; come back in 5 months for re-check during annual physical. I asked my PCP again about the constant discomfort in my testicles, and mentioned I read online that TRT did in fact stop my own natural T production which is why I was seeing atrophy. PCP seemed embarrassed, and told me he would refer me to a urologist to continue this discussion.

- Sept 2014 through present, 1ml of 100mg Test Cyp every 7 days

- Oct 2014, urologist (without even looking at my testicles) said everything I described was natural with TRT and my only option was to stop TRT. I asked about medication to help bring back their size and more importantly their function. Urologist said if I was referring to hCG, he doesn't prescribe it, it isn't covered by my insurance, and all it did was bring back the size which was a cosmetic benefit only. Told me to pick between the benefits TRT provided with the drawbacks, or the life I had before TRT.

Current State:
- "Grey skies" feelings are no more! I am happy and remember again what a good mood feels like!
- Subtle mood swings have lessened, crop up less frequently
- Fatigue went from 100% down to 25%, which has been great. Forgot what it was like to get through a day without needing a nap!
- Libido went from 0% to 40%, which is an improvement, but my ability to get an erection still exists, and when I do get an erection it is anything but hard (more like semi hard that will go soft at any moment)
- Seeing what I would consider are normal muscle gains now, not looking to get ripped, but finally for the first time in my life seeing some definition and tone from my 2-3 day a week workout routine with my trainer

Questions:
1) From day one, my doctor has either been ignorant to TRT or has zero interest in helping me. I pushed for the initial test, the re-test, and have yet to see my PCP showing any interest in this therapy. I don't want to do this alone, but I also don't want to go through the major hassle of finding a brand new PCP next time open enrollment comes around at work (that's the only time I can switch PCPs). Switching means 10+ years of history together gone, and I may switch to someone else who is just as ignorant. What do you recommend?
2) My testicle size reduction and function shutdown (hypogonadism) is something I have tolerated, but it isn't something I am willing to just let go. Do I pursue hCG on my own and hide this from my PCP? I am not a fan of self-medicating. Or do I let this go?
3) Over the past two months I have started to develop man-tits (gynecomastia) in addition to the existing erectile dysfunction. With how my PCP has reacted thus, I doubt he would be entertain the idea of pursuing a medication to reduce E2 and/or prolactin. Do I pursue Anastrozole and/or Cabergoline on my own and hide this from my PCP? I'm not a fan of self-medicating. Or do I let this go?
4) Am I missing something else? Another option? Another route to course correct to?

Thank you all in advance for your help, education, and guidance. I really feel my TRT is pointing things in the right direction, but we just aren't fully on the tracks like it needs to be.

[Lifted1]

doctor is uneducated on TRT, but atleast he got you to a once a week protocol. if you do your own injections, split the dose in half (50mg) and do it every 3.5 days. you can find Hcg on the internet fairly cheap and add it to your protocol starting with 250iu every 3.5 days (you can inject T and Hcg together in same shot).

it sounds like you could benefit from running a higher test level, but your doc is oblivious.

[Machdiesel]

Only problem with self administering HCG is you need to have your doc test E2 and make sure everything is in range. If I were you id be pretty happy finding a doc that prescribes and is letting you self inject. Figuring out The rest is easy, just takes time

[Low Testosterone]

Like the others have said, you really need to find a new doctor. Your physicians comment about the testosterone you're taking simply adds to your existing testosterone is enough to show he has absolutely no idea what he's talking about. I understand your situation regarding being able to afford alternatives outside of your PCP, but you may need to consider one questions - what's worse, budgeting a little money and trying to find a way to afford it or continue down the current path and have your insurance pay for something that will not work? In my opinion, that's where you're at.

[kelkel]

Happy you're feeling better but what's sad is that your doctor never searched for the actual cause of your low T.
Many insurance companies cover HCG. It's actually on most package inserts that it's used for Hypogonadic Hypogonadism. Sometimes all it takes is a letter of medical necessity from a doc...
You need better follow up BW. Particularly concerning your E2 and possible gyno sides.
Agree, find another doctor. Don't do it blindly. Interview staff over the phone first as related in the stickies.
I caught the Bevis and Butthead reference!

Op, that's a very thorough first post.

[HGH4Lymes]

you guys really know ur stuff. its great to read threads like this and to have found this site. wish i had found it 10 yrs ago!

[2Sox]

You can get hCG overseas for about $23 per 5000iu vial. I've been getting mine like that for a couple of years. After you build up your post numbers, we can PM you with a web address.

[GSXRvi6]

IMO HCG with TRT is a must. I ran out of HCG for a few weeks (long story) and I could tell, it felt like I was slipping back a bit to the old days, got a fresh script fill and within a few days I was feeling good again, it makes a big difference for me.

[TESTes123]

Lifted1: I am thankful that even in his uneducated state my PCP prescribed me Cyp. I will look into adding hCG, including where, how much, how often, etc. Thanks for the tip for splitting my dose into twice a week instead of once a week. Appreciate your advice.

[TESTes123]

Machdiesel: I agree that if I start self-administering hCG I want to first make sure it is safe and legit, then as a close second make sure it isn't throwing other numbers/counts off inside of me. Do you suggest perhaps asking my PCP to include additional pieces of my BW? Just E2, or anything else?

[TESTes123]

Low Testosterone: I am most frustrated by my uneducated PCP, so thank you for your advice to start searching for a new one. Perhaps during the time I am searching for the best one to move to (and get my health provider to approve the move) I can get as much as I can out of my current PCP for the time being.

[TESTes123]

kelkel: Thanks for the advice to keep searching for a new dr. Any tips on what to ask or how to ask it so it doesn’t sound like I am shopping for something I am not? I’ve read posts here where doctors seem to clam up the second you start speaking in an educated manner to them. I tried to be as thorough as possible to give you guys as much info as possible so you can help guide me; I do appreciate you taking the time.

[TESTes123]

HGH4Lymes: I wished I had found it a year ago before I started down this path, but I am grateful for the help you guys are able to give me now

[TESTes123]

25ox: I haven’t done my research yet to know if that is expensive or not, but I will look into it. Do you know if it is against the rules here to message me outside of PM for advice? I have an anonyfish dot com account (free, secure/encrypted, 100% anonymous) that you could message me through. My name there is TESTes123. Will take me a while to build up 50 posts it seems

[TESTes123]

GSXRvi6: your PCP prescribes hCG? or a specialist? How long have you been taking it regularly? What improvements have you seen it provide you?

[JTR12]

I might be overly pessimistic, but I would disabuse yourself of the notion that you'll find a PCP with the knowledge and willingness to get too heavily invested in TRT (HCG, AIs, etc.). They exist, of course, but you may get very frustrated in the process of trying to locate one. General providers, endos, urologists, are all so far behind the times it's pathetic. It might be better to consider one of the concierge services online, which can service you remotely and act as an adjunct to your PCP's test prescription: you'll be guaranteed pharma-grade stuff and get monitored by a real doctor. Always preferable to winging it.