Getting TRT With Insurance After using Non-Insurance Clinic

[vrocketv]

Hi all,

I recently realized that I have low testosterone after going to my doctor with symptoms and convincing him to do a blood test. Since I am "only 26 years old" my doctor read my low results and STILL said I was in the normal range. Results were:


Testosterone, Serum 343 ng/dL
Free Testosterone(Direct) 7.5 pg/mL


As you can see these are OBVIOUSLY low... so I went to another doctor (and Endo this time). About a month after my oroingal blood test, the new doctor performed his own blood test which included the following:

TESTOSTERONE 469 ng/dl
FREE TESTOSTERONE 0.03 ng/ml

Range :
20 - 49 YEARS.........0.09 - 0.43 ng/ml
> or = 50 YEARS.......0.08 - 0.35 ng/ml


SHBG 20.3 (low)
CORTISOL 21.5
FREE T4 1.2 0.8 - 1.9 ng/dl
FSH 3.0
LH 4.24
PROLACTIN 20.3
IGF-1(SOMATOMEDIN C) 152.0
FREE T3 3.89 1.8 - 4.2 pg/ml
DHEA-S 56.0 (LOW)


My Free T went down (when adjusting the units to match), and my new doctor STILL will not prescribe TRT.


My question is this: If I go to one of the many TRT clinics that don't take insurance but are ~$200/month, for a few months (such as : www . LowTestosterone . com)

Can I THEN go to a doctor that accepts insurance and tell him I am already ON TRT and just need to change doctors, and therefore now USE my insurance to get TRT?

Sorry if that sounds confusing. Please let me know if I should clarify.

[kelkel]

And your doctor shouldn't prescribe TRT just yet until you find a reason you're low. Blood work is almost always the key.
That said:

What are the ranges on your prolactin and cortisol?
Any prior AAS or other drug use?
Any head or testical trauma in the past?

Many things can cause hypogonadism from hypothyroid (even sub-clinical) to elevated prolactin, cortisol, drug use or trauma. Before you jump on any form of TRT you need to find out the root cause and try to fix it.

Welcome to the forum vrock.

[vrocketv]

And your doctor shouldn't prescribe TRT just yet until you find a reason you're low. Blood work is almost always the key.
That said:

What are the ranges on your prolactin and cortisol?
Any prior AAS or other drug use?
Any head or testical trauma in the past?

Many things can cause hypogonadism from hypothyroid (even sub-clinical) to elevated prolactin, cortisol, drug use or trauma. Before you jump on any form of TRT you need to find out the root cause and try to fix it.

Welcome to the forum vrock.

Hey thanks for the feedback man! I've read A LOT of your stuff on here. My levels are:


CORTISOL 21.5

PROLACTIN 20.3

Zero drug use in the past. No head or chest or testicular trauma.

All other levels are good per my original post with the exception of DHEA-S..which is super low.

I have a near prefect diet. Every gram is measured, lots of healthy fats. CBC came back excellent, REALLY good cholesterol etc.

I don't know what could be the cause but my free T level is SO low somethings gotta be done. Especially since I came in with symptoms before I even knew anything about low testosterone.

[OingoBoingo]

How's your Vitamin D level?

[vrocketv]

How's your Vitamin D level?

That I dont know, and I know it is related to low T, but I do get plenty of sunlight here in FL and take a multi vitamin.

[kelkel]

Hey thanks for the feedback man! I've read A LOT of your stuff on here. My levels are:


CORTISOL 21.5

PROLACTIN 20.3

Zero drug use in the past. No head or chest or testicular trauma.

All other levels are good per my original post with the exception of DHEA-S..which is super low.

I have a near prefect diet. Every gram is measured, lots of healthy fats. CBC came back excellent, REALLY good cholesterol etc.

I don't know what could be the cause but my free T level is SO low somethings gotta be done. Especially since I came in with symptoms before I even knew anything about low testosterone.

Looking for ranges vrocket.

[OingoBoingo]

That I dont know, and I know it is related to low T, but I do get plenty of sunlight here in FL and take a multi vitamin.

Usually there is precious little Vitamin D in multi-vitamins.

Because the UV rays needed to make Vitamin D can't make it through the ozone layers at oblique angles, Vitamin D can only be made a few hours each day.

Gotta remember our ancestors were nudists, and if you are not outside with your shirt off for a half hour between the hours of 10 and 2, chances are your levels are low.

IIRC, only 36% of Floridians have sufficient levels of Vitamin D, compared to the national average of 30%.

[vrocketv]

Looking for ranges vrocket.

Sorry, I misread your question.

Ranges are:

CORTISOL 21.5 (3.1 - 22.4)
PROLACTIN 20.3. (MALES 2.1 - 17.7)

I talked to my doctor about the prolactin being a bit high but he said it's not too high so I shouldn't worry. He said "high would be like 50-200+.

He wants to do an MRI of my pituitary gland to keep searching for and underlying reason. What do you think?

[vrocketv]

Usually there is precious little Vitamin D in multi-vitamins.

Because the UV rays needed to make Vitamin D can't make it through the ozone layers at oblique angles, Vitamin D can only be made a few hours each day.

Gotta remember our ancestors were nudists, and if you are not outside with your shirt off for a half hour between the hours of 10 and 2, chances are your levels are low.

IIRC, only 36% of Floridians have sufficient levels of Vitamin D, compared to the national average of 30%.

Whoa! That's some great insight. Do you think I should try a vitamin D supplement and see how I feel? (Without getting another blood test to check vitamin D levels)

[kelkel]

Sorry, I misread your question.

Ranges are:

CORTISOL 21.5 (3.1 - 22.4)
PROLACTIN 20.3. (MALES 2.1 - 17.7)

I talked to my doctor about the prolactin being a bit high but he said it's not too high so I shouldn't worry. He said "high would be like 50-200+.

He wants to do an MRI of my pituitary gland to keep searching for and underlying reason. What do you think?

First, know that both elevated cortisol and prolactin can substantially suppress your testosterone production. Doing the MRI to look for adenomas is the absolute correct thing to do. An adenoma is what shut down my test production to a 59 T level and dropping years ago. It sounds like you have a decent doc. Stick with it and find the cause! You're to young for TRT unless absolutely necessary.

[vrocketv]

First, know that both elevated cortisol and prolactin can substantially suppress your testosterone production. Doing the MRI to look for adenomas is the absolute correct thing to do. An adenoma is what shut down my test production to a 59 T level and dropping years ago. It sounds like you have a decent doc. Stick with it and find the cause! You're to young for TRT unless absolutely necessary.

Gotcha. I can't tell you how valuable your advice is. I will move forward with the MRI. Do you happen to know what can be done to decrease cortisol and prolactin? From my limited knowledge I know that decreasing cortisol is associated with increased sleep and stable blood sugar. But I already have good glucose levels and sleep 8-10 hrs a night.

Maybe ZMA?

[kelkel]

Well, cortisol is a stress hormone and when it's elevated it will effect your hormone cascade. Relieve your stress. Vitamin C will help but don't go overboard. 1-2 grams per day is fine. When it comes to prolactin, D2 agonists are needed such as Cabergoline or Pramipexole. They are dopamine agonists that will reduce prolactin quickly and effectively.

[OingoBoingo]

Whoa! That's some great insight. Do you think I should try a vitamin D supplement and see how I feel? (Without getting another blood test to check vitamin D levels)

An interesting rule of thumb is that one cannot make Vitamin D if their shadow is longer than their height. Good thing to remember.

Dr. Bruce Hollis (who did an interesting study saying that it took a minimum of 6,500IU of D3 given to nursing mothers daily (IIRC, living in Atlanta where they make Vitamin D year-round) for their milk to contain enough Vitamin D to raise their babies' Vitamin D to sufficient levels), said there is no sense to taking less than 10,000IU of D3 daily.

If you were a nudist living in an area where you could make Vitamin D year-round, you would make about 10,000IU per day.

If a nudist making 10,000IU daily, supplemented with 10,000IU daily, they would still be way below the daily 46,000IU amount proven to cause hypercalcemia.

The half-life of D3 is about 2 months (Vitamin D made by your body has a slightly longer half-life), which means it would take about 6 months for blood levels to stabilize.

It is my opinion that one's Vitamin D level is something we should all track for life. So I wouldn't say don't get your Vitamin D levels checked. Although it's important to understand that as it takes 6 months to blood levels to stabilize, checking Vitamin D twice a year is probably good enough.

I live just 13 or so degrees above the equator, took 10,000IU daily for about 6 months, and noticed no adverse reactions. Blood Calcium is normal. Didn't measure urine Calcium because I don't care about that; if my Vitamin D was above 125 nmol/L I would expect urine Calcium to be higher because that's how we get rid of excess Calcium.

Recently, I read that high-levels of Vitamin D can increase E2 (can't remember if it was Aromatase or a different pathway/enzyme), and decreased my D3 to 5,000IU daily. I'm regretting that now (as I didn't know it took 6 months for blood levels to stabilize), but will ride it out for 6 months to see what happens.

I don't know if you'll feel better, but there is increasing evidence that Vitamin D is one of the most important things you can supplement.

So things to take away:

• Check your Vitamin D levels for life!
• Don't be afraid of D3 10,000IU daily.

Hope that helps.

[lovbyts]

An interesting rule of thumb is that one cannot make Vitamin D if their shadow is longer than their height. Good thing to remember.

Dr. Bruce Hollis (who did an interesting study saying that it took a minimum of 6,500IU of D3 given to nursing mothers daily (IIRC, living in Atlanta where they make Vitamin D year-round) for their milk to contain enough Vitamin D to raise their babies' Vitamin D to sufficient levels), said there is no sense to taking less than 10,000IU of D3 daily.

If you were a nudist living in an area where you could make Vitamin D year-round, you would make about 10,000IU per day.

If a nudist making 10,000IU daily, supplemented with 10,000IU daily, they would still be way below the daily 46,000IU amount proven to cause hypercalcemia.

The half-life of D3 is about 2 months (Vitamin D made by your body has a slightly longer half-life), which means it would take about 6 months for blood levels to stabilize.

It is my opinion that one's Vitamin D level is something we should all track for life. So I wouldn't say don't get your Vitamin D levels checked. Although it's important to understand that as it takes 6 months to blood levels to stabilize, checking Vitamin D twice a year is probably good enough.

I live just 13 or so degrees above the equator, took 10,000IU daily for about 6 months, and noticed no adverse reactions. Blood Calcium is normal. Didn't measure urine Calcium because I don't care about that; if my Vitamin D was above 125 nmol/L I would expect urine Calcium to be higher because that's how we get rid of excess Calcium.

Recently, I read that high-levels of Vitamin D can increase E2 (can't remember if it was Aromatase or a different pathway/enzyme), and decreased my D3 to 5,000IU daily. I'm regretting that now (as I didn't know it took 6 months for blood levels to stabilize), but will ride it out for 6 months to see what happens.

I don't know if you'll feel better, but there is increasing evidence that Vitamin D is one of the most important things you can supplement.

So things to take away:

• Check your Vitamin D levels for life!
• Don't be afraid of D3 10,000IU daily.

Hope that helps.

Thanks, I just found a good argument for moving to a nudist colony and it not be for voyeurism reasons.

[OingoBoingo]

Thanks, I just found a good argument for moving to a nudist colony and it not be for voyeurism reasons.

Yeah, well, moving to a nudist colony and taking 5mg of Cialis daily might get me a part-time job as a human sundial!

Coincidentally, this afternoon a friend and I were walking along the beach in Pattaya getting a little Vitamin D, we were talking about Vitamin D, and I mentioned the Florida statistic; 36% are sufficient in Vitamin D compared to the national average of 30%.

He asked me if I knew the levels of every state.

"Nope, only Florida."

"Why Florida," he asked.

"I find Florida interesting; it's the only place in the world where, statistically, people are born Hispanic, and die Jewish."

[kelkel]

An interesting rule of thumb is that one cannot make Vitamin D if their shadow is longer than their height. Good thing to remember.

Great, now I'll be staring at my shadow all the time.

[vrocketv]

OK, got the BMP to do the MRI. Did the MRI. Have an appointment with the endo on Friday, but here are the notes from the brain scan:

Thoughts?


Impression
HYPOPLASTIC APPEARANCE TO THE PITUITARY GLAND. NO EVIDENCE OF INJURY TO
THE PITUITARY STALK OR PITUITARY DWARFISM. NO DISCRETE PITUITARY MASS.

FINDINGS WHICH MAY REFLECT MILD GENERALIZED CEREBRAL ATROPHY, CLINICAL
CORRELATION ADVISED. NO ENHANCING BRAIN MASS. NO ACUTE INFARCT.


SELLA: Somewhat hypoplastic appearance to the pituitary gland, which
measures approximately 4 mm in craniocaudad dimensions. The pituitary
stalk is midline and enhances normally. Posterior "bright spot" is
normally located. At the junction of the anterior and posterior lobes of
the pituitary gland a punctate focus of hypoenhancement is demonstrated
favored to relate to the pars intermedia. Otherwise, the pituitary gland
enhances homogeneously. The cavernous sinuses enhance symmetrically.

MRI BRAIN: The sulcal pattern and ventricular system are mildly
prominent. No restricted diffusion. No extraaxial collections. No
abnormal enhancement.

Mucosal thickening in the right ethmoid air cells. Mastoid air cells are
aerated.

[vrocketv]

No opinions/suggestions? That's a first lol.