Finding a TRT Physician

[kelkel]

It's a shame you just can't go with the shots. Agel works fine for many people so be positive. I've used it myself.

200mg every 14 days indicates your doc does not know hormones. At all. He's dosing you based on terminal life and not half life. Half life of test is 5-7 days metabolism dependent. Therefore injections need to be weekly at a minimum, but even better if the weekly dose is split in half. Such as 50mg every 3.5 days instead of 100mg once per week. You would feel like crap on week 2 on his protocol.

200mg is also high end TRT. Most never need that amount. The more you take the more you have to manage, think estrogen, RBC's, etc. Less is more in TRT and you should always start at a lower dose and titrate up if needed based on blood work. 100mg (split) is a great starting dose when the time comes. Educate your doc. It's your health.

[WilmingtonPL]

Thanks,
I was thinking that when the time comes I could split the dose myself and not tell him [just do 0.5cc (100mg) every 7 days], that still wouldn't be optimal but it'd would be better than than 14 days.
Obviously educating him would be the better route, but' I'd definitely have to come correct. Can you point me toward some literature that he'll respect?

[kelkel]

Any of Crislers Papers.
Testosterone for Life by Morgantaler
Testosterone, A Mans Guide by Nelson Vergel.

[WilmingtonPL]

I just read Crisler's "TRT, a recipe for success". It was a very good read! It made me a lot more optimistic about actually getting the desired effect from the AndroGel. Like you said, rubbing gel on myself everyday is probably a lot better than living with low T. That being said I still feel like AndroGel is not something I want to do for the rest of my life, especially when the alternative is a weekly injection. Also I found "Testosterone For Life" for free on Kick Ass Torrents, so I'll be giving that a read soon too. Thanks for the advice, I'm sure I'll be back soon with more questions, but you have done a great job of arming me with the resources to educate myself and find the answers on my on.

[kelkel]

Outstanding Wilmington! That's exactly what this forum is for. It's your health so be proactive. One thing I did when I was new to this arena is that when I have a doc appt I'd take a notepad in with specific questions to ask so I didn't forget anything. I would always try and know the answer ahead of time so that if the doc's answer was different I could further the conversation.

Also maintain copies of all your blood work. It's yours so sign the release at the lab and they will fax or mail you a copy. Labcorp is on line now at labcorpbeacon.com. I would always pull my BW early enough so I could evaluate it myself and be totally prepared for the appointment. Nothing worse than leaving your doc's office and realizing you should have asked a particular question.


Stick around the forums and visit some of the others as well. The lounge can be quite entertaining and many of the others can be very helpful. Let me know how things go. PM if you like.

[newbjuice]

Id go this route but its expensive.

[WilmingtonPL]

I'm on Day 4 of androgel 1.62. So far I havent seen any noticeable change except some aching and softening in the testicles, and an extra good mood for a couple hours last night which may or may not have had anything to do with it. I found (the chart below) on a different forum, do you think these are reasonable expectations? BTW, I can't PM you till I get 50 posts on here.

· Effects on sexual interest appear after 3 weeks plateauing at 6 weeks, no further increments beyond.
· Changes in erections/ejaculations may require up to 6 months.
· Effects on quality of life manifest within 3-4 weeks, but maximum benefits take longer.
· Effects on depressive mood appear after 3-6 weeks with a maximum after 18-30 weeks.
· First effects on erythropoiesis (increased red blood cells) after 3 months, peaking at 9-12 months.
· Prostate specific antigen and volume rise, marginally, plateauing at 12 months; further increase related to aging rather than therapy.
· Effects on lipids appear after 4 weeks, maximal after 6-12 months. I
. Insulin sensitivity may improve within few days, but effects on glycemic control become evident only after 3-12 months.
· Changes in fat mass, lean body mass and muscle strength occur within 12-16 weeks, stabilize at 6-12 months, but marginally continue to improve over years. Effects on inflammation occur within 3 to 12 weeks.

[kelkel]

Yes, they are on point. Appears to be Nelson's writings, yes?

[WilmingtonPL]

Yes, it is Nelson! I joined his forum as well as the TRT section on *********. Actually, ********* has a very clear breakdown on forum/thread etiquette. Apparently what I've done here is "hijacked" your thread, so I do apologize for that. I guess if it had bothered you, you would have said so.

I had no idea it was going to take so long and also how much information I was going to need to be able to digest to be able to steer my treatment. I just want to get it right from the beginning but thats not really possible when most doctors don't know that much about TRT and are not going to go the extra mile to learn all this stuff and run all these tests that are way above the normal testing. But, I guess I have the rest of my life to figure it out! I just wish there was a "TRT expert Doc" database or something like that so I didn't have to go to each guy to figure out there philosophy is.

As always, thanks for taking the time Kel, you'e been a huge help.

[kelkel]

No hijacking as it all relates. Nelson's a friend and a good guy. You are on the right path as self-education is key. I'll throw a wrench at you, look into Aveed injections for TRT. It's testosterone undecanoate which has a very long lasting ester. Meaning you'd take a large initial injection, a booster about six weeks later then I believe it's one shot every 10 weeks after that. It has about a 90 day half-life.

It's been used for years overseas ( trade name Nebido) with much success and several guys here are on it and love it. Our FDA is always a bit slow and just approved it earlier this month. Do some research on it and talk to your doc about it. May be an option for you. Odds are your doc is not aware of it just yet.

[BuzzardMarinePumper]

No hijacking as it all relates. Nelson's a friend and a good guy. You are on the right path as self-education is key. I'll throw a wrench at you, look into Aveed injections for TRT. It's testosterone undecanoate which has a very long lasting ester. Meaning you'd take a large initial injection, a booster about six weeks later then I believe it's one shot every 10 weeks after that. It has about a 90 day half-life.

It's been used for years overseas ( trade name Nebido) with much success and several guys here are on it and love it. Our FDA is always a bit slow and just approved it earlier this month. Do some research on it and talk to your doc about it. May be an option for you. Odds are your doc is not aware of it just yet.

Kel what is BW follow up after this injection as in how soon and as this injection relates to E-2

[Gus Mackay]

You have no idea how long I have looked for advice like this... thank you! Will check out the website.
Had a T test down which came back at 305. My Dr. said it was within normal range...
305 for a 28 year old lifter at 15%bf is normal? According to her, yes.

Talked to another Doc who said I might want to pursue treatment, because of my age. But that was a doc I knew working at a clinical trial facility, and not someone who could help me.

Talked to a sports Doc, he basically thought I was nuts. Talked to my endo, she thought I was crazy too.

One out of four doctors basically knew squat about test.

[kelkel]

You have no idea how long I have looked for advice like this... thank you! Will check out the website.
Had a T test down which came back at 305. My Dr. said it was within normal range...
305 for a 28 year old lifter at 15%bf is normal? According to her, yes.

Talked to another Doc who said I might want to pursue treatment, because of my age. But that was a doc I knew working at a clinical trial facility, and not someone who could help me.

Talked to a sports Doc, he basically thought I was nuts. Talked to my endo, she thought I was crazy too.

One out of four doctors basically knew squat about test.

They receive very minimal training in med school. That said, if they don't pursue it themselves you're out of luck. You definitely need to find a doc that knows hormones and locate the problem which can hopefully be fixed. Don't start on TRT without knowing the reason you're low. And being "low" is not a diagnosis at your age. Full BW is always where you start and you have examples at the top of this thread.

And remember, type of doc doesn't really matter. They just have to know hormones!

[Elijah V]

Is LowTestosterone.com only available to those living in the U.S.?

Do you become a TRT patient just to get your hCG prescription to add to your AAS cycle or is it purely for those who have low T? I read it's a life-long commitment. Someone told me they're a patient of LowTest just so he can get his 500iu hCG p/w during his AAS cycle and that confused me :/

[kelkel]

Yes, only in the U.S.

No, you become a TRT patient as you suffer from low T and need the help. It is normally a life long commitment.
HCG is available via other sources if you look.

[kelkel]

Not sure when the follow up would be. That will be up to the attending physician and insurance protocols developed for this particular product. One thing I did learn is that the U.S. (FDA) downsized the dose by 1/4 as compared to across the pond. That said, I think there will be a ton of unhappy users of this product as they may not attain a level that they want / need, imho. But that remains to be seen.

[Ryanmcd]

Not sure when the follow up would be. That will be up to the attending physician and insurance protocols developed for this particular product. One thing I did learn is that the U.S. (FDA) downsized the dose by 1/4 as compared to across the pond. That said, I think there will be a ton of unhappy users of this product as they may not attain a level that they want / need, imho. But that remains to be seen.

Looking over all the people that took the trial most got around 5-600 test levels, that's not bad to be honest if you are at 200. Most here want 800+ I guess it all comes down to risk and how good your doc is, at 5-600 you have less E2 / side issues as well so I can see why they are happy at that level, I feel good at that level but great at 7-800

[kelkel]

And that's the thing. We all will not feel good at the same number and I don't know what type latitude they will have to make adjustments. But remember, the insurance industry pretty much controls this. And remember, TT is irrelevant and should not be the criteria. Too many factors influence TT.

[strive2thriveWBAM]

Kelkel, I have tried to read the majority of this thread, as well as the LOW T thread with the system admin. I decided to ask you as you as you are very thorough in your responses. I am only 20, almost 21. I have been researching low t, as I have had issues since puberty, but thought it would change between then and now. It has only gotton worse. Could it be genetic? My father had the same issues since he was 16.. Anyways, I have gotton my recent bloodwork last week, and my total testosterone is at 243. To reiterate, I am 20 years old. I feel down and have basically struggled to get through a day for the last 3 or so years. Also, since Highschool during wrestling season I weighed 180, lean. Sr Year I continued to slowly lose weight( I'm 5"11) I graduated and continued working out and eating right, (went to school for exercise science, and study bodybuilding ed). At 18, I was slowly losing weight and I felt like an old man... I did research and I used low dose testosterone alone (350cyp week). I weighed 205 after a couple months. I felt great for the first time in a very long time. I could actually get an erection and keep it, I didn't feel like I was wasting away, my depression disappeared, I slept amazing, and I enjoyed working out and didn't have to force myself to. I actually looked forward to it. I also didn't need 3 naps in a day to make it through! EVERYTHING CHANGED for the better it seemed. After 16 weeks I had to come off. I did PCT correctly and had no side effects. After about 3 weeks, I was back to ground zero, except weight, (which has slowly declined back to 185..) For the last two years, I have fought an uphill battle to gain weight.. Forcing myself to eat, forcing myself to work out, FORCING MYSELF TO ENJOY LIFE. I hate it. So I finally saw a doctor. He saw my T level and said its in the normal range... WTF. 243 is not normal for a 20 year old. I live in TX, near dallas and am very tempted to go see you guys. Would I be cared for despite my age? I also have my recent bloodwork on hand. My cholesterol is also high and my cardiologist says TRT would benefit me greatly, in more ways than just my vitality. She is actually the one who said I need to find a doctor who will prescribe it and watch my levels.. Most people cant believe I have low t looking at me, because I look to be in good health. But they don't see my sex life, my depression, or the way I have to force myself to take on the day, eating, and lifting...

My question is basically this.. Can I take my recent bloodwork to your dallas location, be honest with the doctor, and expect help? I also want to hear your opinion on my situation.. my family is normally taller than me, and had an average weight of 220 at my age. All very fit and athletic.. I am not sure if low t is the culprit for all of my issues, but I just look back at how I felt while ON and it was night and day difference in it all....

Thanks for your time, It is much appreciated...

[kelkel]

Very sorry to hear of your situation. If you have BW can you list what you have here with ranges please? Need to see LH, FSH, Total and Free T, prolactin, cortisol and everything thyroid. Now, if you do not have these then you need more BW. Most docs, cardiologist's or not, do not really know hormones unless they take an interest in it. Use the BW list at the top of this thread. Many things cause low T and good BW can clue us in with where to look.

At your age you need to find the cause, not band aid it with TRT. I know you don't want to hear that or to wait but life is long and it's important. Seeing your BW can guide us as to whether the issue is pituitary related (secondary hypogonadal) where an MRI will help, or testical related (primary hypo) where an Ultrasound may help determine if there's a varicocele or something impeding testosterone production.

Thyroid is important as being hypothyroid will cause hypogonadism. Too many doc's use TSH alone as their indicator on BW and by itself it's a weak indicator of thyroid health.

When it comes to LowT.com I'm sure they'd need a medical opinion as to why T is low for them to treat someone at such a young age. You can imagine the reasons why. Don't know where you're from but it would be worth the trip to one of the top doc's in the country such as Crisler, etc.

Glad you came here. Post up what you have please (important ones.)

Kel

[strive2thriveWBAM]

Need to see LH, FSH, Total and Free T, prolactin, cortisol and everything thyroid. Now, if you do not have these then you need more BW.



Glad you came here. Post up what you have please (important ones.)

Kel[/QUOTE]

Thanks for the quick response. I have
Free test 7.21
SHBG=11

That's all Ive got...... I guess I need more bw done. This was just basic, and more specific to a cardiologist. It is very apparent, from what you said, that I (and my doctor) will need a more comprehensive bw panel to find an underlying issue, if there is one.

[kelkel]

No good without ranges as labs are different.
But shbg is low.

Use the list at the top of this sticky, making sure you get an all inclusive thyroid panel.

[MK1]

Just got off the phone with my PCP's assistant. I ha left a message about wanting to order labs and was specific about what I wanted. I used the follow up lab work at the beginning of this thread. She was confused as to what I was ordering. Hopefully all will work out. I'm about 8 weeks in and I feel really good as far as energy level but haven't lost any belly fat not really noticeable in the gym either.

[kelkel]

Just be patient and give it a bit more time. You didn't put the belly fat on overnight and it won't come off overnight! But you will love the effects of a properly dialed in protocol. It will do amazing things for you in conjunction with proper nutrition and training.

[MK1]

Thanks Kel
You are really positive! I'll clean up my nutrition and hit the gym harder and cut out some beers in the next few weeks also. Thanks

[Cam2012]

great info

[MBOS]

BW list is awesome kelkel, will use from this point on.
Regards,

[RickyReed]

You should go to your primary care doctor and be tested and then they should give you the shots there at least that is what I had to do

[kewe]

Besides the above - is there a guide on what questions that I should ask? I have an appt on Monday

[kelkel]

Your main concern should be a proper diagnosis. Meaning do you really need TRT or is there a causative factor that is reversible that would help to restore normal function. Many things can cause low T including Hypothryoidism, pathologies, trauma, cortisol or prolactin issues. To many doctors simply look at T levels alone to determine if therapy is needed. That said, thorough blood work is step one. There's also a simple "Adam" questionnaire you can find on line which is a guide as to whether TRT may be needed or not.

To me, if it's determined via BW, how you feel, and consultation with your doctor that you do need TRT then one of the most important questions is will your doctor treat you by how you feel, not by numbers on a chart. Also will they treat with testosterone (whatever form,) HCG and an AI if needed. If they say they won't issue HCG / AI's it's time to find a more knowledgeable doctor. It's why we recommend calling and asking one of the nurses / staff that simple question. Why waste your time with an appointment if it's ultimately useless.

Take some time and read the sticky threads at the top of this forum. Write down questions that you have so you don't forget. This is a serious, life changing endeavor and not to be taken lightly so do your homework. Nothing worse than leaving a doc appt and realizing you forgot to ask an important question! I'd also recommend picking up Nelson Vergel's book "Testosterone A Man's Life" and reading between now and Monday. That or Abraham Morgantalers "Testosterone For Life." Easy reads that will greatly help you.

[MBOS]

Kewe, almost feel silly jumping in as I've not been around here near as long as these guys and don't pretend to have near the knowledge. I offer insight as a newer member, at 54 years old. If I could start this Dr issue back at the beginning, the moment I was diagnosed I would have contacted the LOWT Dr's listed on this site. It is very difficult to find ONE Dr who will handle T, HCG and Anastrozole. I'm running into the exact roadblocks all these very knowledgeable guys talk about as far as ignorance in treating the whole problem.
My GP issues T, I go to a Nurse Practioner for HCG, Urologist is sending me to my 2nd Endo (fired my first one) to explore and treat any Estrogen related issues, DAMN!! If this Endo doesn't work out I can assure you, I will find a way to afford the $199 per month and make the 2 1/2 hour drive to my closest clinic in Nashville. If it weren't for the fact that my insurance pays all but $10.00 of my T script now I'd already be on my way.
If you choose to try and find a one stop shop rather than these clinics, get your track shoes on and good luck sir.
Regards,

[kelkel]

Kewe, almost feel silly jumping in as I've not been around here near as long as these guys and don't pretend to have near the knowledge. I offer insight as a newer member, at 54 years old. If I could start this Dr issue back at the beginning, the moment I was diagnosed I would have contacted the LOWT Dr's listed on this site. It is very difficult to find ONE Dr who will handle T, HCG and Anastrozole. I'm running into the exact roadblocks all these very knowledgeable guys talk about as far as ignorance in treating the whole problem.
My GP issues T, I go to a Nurse Practioner for HCG, Urologist is sending me to my 2nd Endo (fired my first one) to explore and treat any Estrogen related issues, DAMN!! If this Endo doesn't work out I can assure you, I will find a way to afford the $199 per month and make the 2 1/2 hour drive to my closest clinic in Nashville. If it weren't for the fact that my insurance pays all but $10.00 of my T script now I'd already be on my way.
If you choose to try and find a one stop shop rather than these clinics, get your track shoes on and good luck sir.
Regards,

Very sad that so many physicians are behind the times with proper treatment protocols. Remember, most doc's only receive a handful of hours of training in hormones so it's up to them to further their knowledge, and so many simply don't and rely on old school dogma that's been debunked by modern medical science. That said, insurance covering things is always the way to go but if that doesn't work LowTestosterone.com is definitely the go to site.

[Annie Var]

My test was 1 .2 above the legal limit to subscribe test too. that's still extremely low. trying to find a DR in Australia the police capital of the world is almost impossible they all to scared to subscribe HRT unless your on ur death bed. I found a clinic thank god that cost a fortune but it turned my life around. Low test in a male, id rather be dead then go back to that life and they wonder why the black markets flourish for some of us its just quality of life.

[kelkel]

Way to much emphasis is put on numbers on a scale and should be on how you feel. Welcome to the forum Annie Var...

[NACH3]

Does this clinic provide HGH Therapy?... I pretty sure it was mentioned by KelKel said up top but brief... Thank you for your feedback!

[JennyHaskins]

This is a good idea.

[blanten]

Kelkel,
I have tried to read the majority of this thread, as well as the LOW T thread. I decided to ask you as you as you are very thorough in your responses. I just turned 28 im 6ft 1 215 lbs. I have been researching low t recently, as I have most of symptoms. Low libido, decreased energy and fatigue, irritability. What has been affecting me most is insomnia, depression, lack of motivation, focusing and concentrating. Plus ive put on 30 lbs in the last year, mostly belly fat. Ive recently have had to take a break from college because of these symptoms. Anyways, I received BW earlier this morning….

TOTAL TESTOSTERONE 188.
tsh 2.02
THYROID PANEL
T3 UPTAKE 35
T4 4.8
FREE T4 INDEX 1.7

I had more BW for follow up before I left my PCP today and will get the results Friday morning. What info should I be expecting to receive? What other info do I need to post from my initial BW I received this morning?

Thanks

blanten

[thebark]

Well I just called the 2 "Low T" clinics here in Columbus, Ohio. All they check is your T score and PSA. Thats IT.....seems even the Dr`s specializing in this treatment won`t do a full panel.

[kelkel]

Go to LowTestosterone.com - $199 All-Included Testosterone Treatment. You'll be treated properly.

[GetUpandLift]

Hi, I've been to my local doc and an endo and I am not seeing these different values "LH, FSH, and everything thyroid" on my Labcorp blood tests.

These are the different panels my docs ran on me for the low testosterone thing:

NMR LipoProfile (LDL, HDL)
CBC with Differential/Platelet (has 23 different words with values)
Basic Metabolic Panel (11 different things)
Hepatic Function Panel (7 different things)
Testosterone Free and Total
Hemoglobin A1c
Thyroxine (T4) Free, Direct, S
Cortisol
TSH
Vitamin B12
Prolactin

Do I need to do all of the testing you mentioned still? I just turned 27 and I was told by the endo that at 304 Total Testosterone on a 345-1197 scale, that I am "normal." I made another appointment with my family doctor, but I am scared that none of these doctors know what they are talking about. My family doctor was talking about getting a testicle ultrasound as well, but ended up just referring me to the endo that couldn't help me...

Would I be able to go to my family doc and ask for all of these other tests to be ran? My test was 204 the first time I went in when I wasn't fasted, but when I went back in and I fasted, it was 304. I'm not sure why that made a difference.