Finding a TRT Physician

[kelkel]

Hi Getup!

The BW put together at the top of this thread is more comprehensive than what your doc pulled and geared to check the things that can impact a males testosterone levels. Hypothyroid, elevated cortisol or prolactin can all impact testosterone levels. I am glad he pulled an NMR Lipo Profile as it's a great way to know your LDL Particle size which is crucial in cholesterol.

At 27 years old your testosterone should be much higher. For your endo to tell you this is simply wrong in my opinion. Remember, most doc's just don't know hormones as they don't have training in them. The title "Endo" does not mean that they do know them. The reason LH & FSH are important is that they are indicators of pituitary function. This is where testosterone production begins basically. LH and FSH signal your testicals to produce testosterone and sperm, respectively. If these signals are weak you'll have low testosterone. This is why they are important to know.

If they're low then something is impacting them negatively and you then have to find out what. One indicator on your blood work could be TSH. If it's high then it's an indicator (albeit weak) of hypothryoidism which can cause hypogonadism. More thyroid panels should be pulled at this time. Elevated cortisol can suppress T levels as well as elevated prolactin. If prolactin is too high then an MRI should be performed for pituitary adenoma's, but lets not get ahead of ourselves here. Other things can cause low T as well, such as trauma, medications, varicoceles, etc.

So, if your LH is low your T will be low. If your LH comes back high and you have low T then the problem is testicular related and the ultrasound you mentioned should be performed.

What are the levels and ranges for:

TSH
Prolactin
Cortisol
T4 free

[GetUpandLift]

Hi Getup!

The BW put together at the top of this thread is more comprehensive than what your doc pulled and geared to check the things that can impact a males testosterone levels. Hypothyroid, elevated cortisol or prolactin can all impact testosterone levels. I am glad he pulled an NMR Lipo Profile as it's a great way to know your LDL Particle size which is crucial in cholesterol.

At 27 years old your testosterone should be much higher. For your endo to tell you this is simply wrong in my opinion. Remember, most doc's just don't know hormones as they don't have training in them. The title "Endo" does not mean that they do know them. The reason LH & FSH are important is that they are indicators of pituitary function. This is where testosterone production begins basically. LH and FSH signal your testicals to produce testosterone and sperm, respectively. If these signals are weak you'll have low testosterone. This is why they are important to know.

If they're low then something is impacting them negatively and you then have to find out what. One indicator on your blood work could be TSH. If it's high then it's an indicator (albeit weak) of hypothryoidism which can cause hypogonadism. More thyroid panels should be pulled at this time. Elevated cortisol can suppress T levels as well as elevated prolactin. If prolactin is too high then an MRI should be performed for pituitary adenoma's, but lets not get ahead of ourselves here. Other things can cause low T as well, such as trauma, medications, varicoceles, etc.

So, if your LH is low your T will be low. If your LH comes back high and you have low T then the problem is testicular related and the ultrasound you mentioned should be performed.

What are the levels and ranges for:

TSH
Prolactin
Cortisol
T4 free

Hi again,

Thank you for all of the information. I am going back to my regular doctor tomorrow.

He did mention my Cortisol level was a bit high, but he also mentioned this was most likely due to the fact that I had the flu with bronchitis when I first got the blood test. I tested again a month later and the cortisol level went way down, but is still considered a bit high. I have a high stress/anxiety level but I'm not sure if that has something to do with that as well.

I just got some blood tests back from last month and noticed FSH was tested on this test, but it doesn't say a range that it is supposed to be in. Here are my results:

FSH- 1.6 (Unknown)
Prolactin - 11.0 (3.5-19.4 scale)
Cortisol - 26.9 (2.3-19.4)
Free Test - 55.4 (35-155.0)
Total Test- 245 (250-1100)
LH- 1.5 (Unknown)
TSH- 3.42 (.35-4.94)
T4 Free- .9 (.7-1.5)

Some other notes:

Basic Metabolic Panel all numbers normal
Hepatic Function Panel all normal
CBC all normal
Lipid Panel - ldl-P a bit high (1754 on a <1000 scale), small ldl-P high 1590 on a <527 scale)





Hopefully this helps? Please advise. Thank you

[GetUpandLift]

Kelkel, are you still there? I posted my bloodwork above.

Also to update, I visited my family doctor again yesterday and he is very pissed off at what the endo said. He said that he is going to give him a call and see what the actual notes of my appointment with the endo says and then get back to me. He thinks the next step is going to be a cat scan of the pituitary gland or putting me on some testosterone gel.

From all of the reading on that testosterone gel, I don't really like the thought of it, but I think that's all this doctor prescribes. Would it be okay to do the gel? What about doing testosterone in general based off of my bloodwork above?

I played a lot of sports growing up (football, basketball, baseball) so who knows maybe my testicles are messed up. If they are, are they easily fixed or do you just have to go on testerostone?

The doctor said he wants to put me on the gel to see if making my levels go up, makes me feel a lot better. I currently like to sleep most of the day on my off days from work, feel depressed, have anxiety, no sex drive, hard to keep erections, etc etc. It is not a fun way to live life so I really hope I get this figured out. He said that he could always take me off of the testosterone if it doesn't work so that's why he is thinking about trying it, depending on what the endo says.

Please help. Thanks

[VegasTrader]

I'm new to this forum and need to get some help in finding a decent doc or clinic in Vegas where I can get test and hgh treatment combined.
I went to a couple clinics and when I don't sign up for the $1500 quarterly program doc or tech or whoever is in the room with me...gets all pissed off
there has to be a better clinic here in Vegas

[kelkel]

I'm new to this forum and need to get some help in finding a decent doc or clinic in Vegas where I can get test and hgh treatment combined.
I went to a couple clinics and when I don't sign up for the $1500 quarterly program doc or tech or whoever is in the room with me...gets all pissed off
there has to be a better clinic here in Vegas

Check out LowTestosterone.com - $199 All-Included Testosterone Treatment as even if not in you're immediate area they'll fly you in for free.

[mussina123]

noticing you post a lot of awesome info man, i'll be reading up, thanks for the good information!

[kelkel]

My thought would be as it relates to metabolic syndrome. Yes, they are rare and to find out actual GH levels you'd need an arginine stimulation test.
Rising IGF-1 is nothing to worry about. Be happy. It's why guys run GH.

[Chauffeur]

My thought would be as it relates to metabolic syndrome. Yes, they are rare and to find out actual GH levels you'd need an arginine stimulation test.
Rising IGF-1 is nothing to worry about. Be happy. It's why guys run GH.

Got it, thanks man!

[Xphanial]

Hi Guys,
whats your advice on finding a good doctor in Australia Victoria?
I've had 3 blood tests, all well below average (175) and the endo just brushed it aside.
Any help will be very appreciated.

[Simon1972]

Hi Guys,
whats your advice on finding a good doctor in Australia Victoria?
I've had 3 blood tests, all well below average (175) and the endo just brushed it aside.
Any help will be very appreciated.

start a new thread and post up your bloodwork.

[Chauffeur]

My thought would be as it relates to metabolic syndrome. Yes, they are rare and to find out actual GH levels you'd need an arginine stimulation test.
Rising IGF-1 is nothing to worry about. Be happy. It's why guys run GH.

Kelkel, just wanted to update you since I've received my lab work, and have a couple of questions that I'm hoping you can help me answer.

My IGF-1 looks great at 228 (88-246 ng/ml). I'm very pleased with that number. Although I have no baseline to compare these results to, I believe that I can thank my TRT protocol for allowing me to achieve such a healthy level.

Would there be any benefit (or detriment) to peptide use (GHRP, Ipam, Sermorelin, etc.) for somebody with a healthy IGF value?

I really have no interest in the potential gym benefits of peptide use, but am more interested in the potential for improved sleep and connective tissue strength.

I've had a nasty sleep disorder for the last decade or so and to be honest, it's reached critical mass. The only treatment that has been remotely successful for me has been prescription sleep aids, but I realize that this is not a sustainable way to deal with my sleep disorder.

I also had a pretty substantial shoulder repair a couple of years ago, and my level of recovery is not what I had hoped it would be. I've been rehabbing it endlessly, but it still limits me quite a bit.

I'm kinda grasping at straws at this point, looking for any possible way to help regain normal function.

In your opinion, are peptides a viable option for somebody like me? It's tough for me to separate the facts from the bro science when researching them.

[kelkel]

Chauffeur it sounds like you'd be a perfect candidate for TB-500. Have you read Bass' log on it?
Yes, that's a great IGF-1 level. I'd have to run 1 iu of GH to attain that myself. I'm jealous.
Have you looked into or tried Melatonin? Seems obvious but I wanted to throw it out there anyway.

Melatonin - Scientific Review on Usage, Dosage, Side Effects | Examine.com

[Chauffeur]

Chauffeur it sounds like you'd be a perfect candidate for TB-500. Have you read Bass' log on it?
Yes, that's a great IGF-1 level. I'd have to run 1 iu of GH to attain that myself. I'm jealous.
Have you looked into or tried Melatonin? Seems obvious but I wanted to throw it out there anyway.

Melatonin - Scientific Review on Usage, Dosage, Side Effects | Examine.com

TB-500 has definitely crossed my mind, but it doesn't look super cheap to use it for any length of time. I'm just a public servant, so my salary doesn't allow a ton of room for the finer things in life.

I recall reading somebody's TB-500 log awhile back, but I can't remember who's it was. If memory serves me, the poster didn't seem to think it was as helpful as it's made out to be.

Do you have a link to his thread?

I'm pretty excited about my IGF-1 value too! I was pleasantly shocked by it.

Yea man, I've tried melatonin many times to no avail. I still take it from time to time with the hopes that I'll start responding to it. No dice.

I've tried quite a few OTC sleep aids over the years and nothing has worked. I kinda gave up searching for a panacea that just may not exist for me. Being dependent on prescription sleep aids is starting to take its tole on me for sure. Something's got to change.

[kelkel]

Here's Bass' Log:

http://forums.steroid.com/igf-1-lr3-...tb500-log.html

Know that Melatonin can improve IGF-1 levels. Not that you need it!
Have you ever considered a sleep study?

[Chauffeur]

Here's Bass' Log:

http://forums.steroid.com/igf-1-lr3-...tb500-log.html

Know that Melatonin can improve IGF-1 levels. Not that you need it!
Have you ever considered a sleep study?

Thanks for the link, I'll check it out tonight when I've got some more free time.

I've had a few sleep studies. Two of them prior to TRT showed no abnormalities. I decided to have a third one ~5 months into TRT when I started showing signs of apnea, which was confirmed by the sleep study. I now use a CPAP machine and the apnea is very well controlled.

I still struggle to fall asleep, and to stay asleep though. I use the CPAP basically because I know it's good for me, but I don't feel any different/better most mornings.

[kelkel]

I can only assume you're doing everything else correct, right? Off caffeine in the evenings, electronic's, etc.?

[Chauffeur]

I can only assume you're doing everything else correct, right? Off caffeine in the evenings, electronic's, etc.?

Yup. I'm pretty good about that sort of stuff.

It doesn't help that my work schedule requires really odd hours and long stretches of minimal/no sleep, but I had these issues long before I got into the fire service.

My work schedule certainly isn't helping though.

I've always been kinda weary of peptides. Many of them seem to be surrounded by a fair amount of bro science. I also don't love the idea of injecting things that don't come from the pharmacy.

At this point, I'd be willing to give anything a chance to help my sleep issues though. Even if it was brewed in some dude's bathtub.

[Chauffeur]

Just read Bass' TB500 log. He says:

"sadly my conclusion TB didn't do shit for me!"

You trollin me Kel?!

Kidding. Looks like TB500 might not be the peptide for me though.

[kelkel]

Well damn, I did not know it ended that way for him! That just sucks then.

[kelkel]

Your numbers sound way off Ricky. Example, the normal range for testosterone via Labcorp is 348 - 1197. You're way above that. Are you running testosterone now? The big deal to your doctor is maintaining her license. They actually do occasionally investigate these things.

[Xphanial]

Hi guys,
From Australia and just need some advice with TrT.
Now in Aus the total testosterone range is 8.3-30.2 (thats 225-725 Free test)
I've had 3 tests now that have all indicated that I am at 7.4-7.6 (175-198 Free test). The first endo I saw Fobed it off as I am too young at 26 and I wouldn't be able to have kids if I was treated, nothing else was really said on the subject :/ at that point I had no idea what to do.
So after that I went to a sports medicine clinic and he was more than happy to help me but in stead of doing some sort of trt he put me on Sarms, cjc/ghrp6 and hcg............. that didn't go down to well ether after 3 months and no change. so I've gone to another Endo (this time a woman from a great background in the field) long story short, tests show that everything is running as normal, all hormone lvls are where they should be but my total test is still at 7.4, she says it is most likely a gland issue and wants me to get an MRI to see if there any discrepancy's. The kicker is though, thanks to new laws passed the Level range for TrT has been lowerd from 8.0 to 6 and under. So If it isn't a gland issue I'm left with very little options
any advice on what I can do ?

[kelkel]

Hi Xphanial. Favor please. Copy and paste this over to a new thread in this forum. That way you'll get a much broader response from the members.

Thanks,

kel

[Xphanial]

Thanks Kel, Have done.

[nomdeplume]

I want to have all the values you mentioned checked but I don't know where to get it done or how to ask for it. Is blood work à la carte in that I would pick and choose what I want tested or is there a proper "term" to use telling doctors what I would like tested. On a side note, I called the number at lowtestosterone.com to ask about their blood work and I was told that they are not currently accepting any new patients.

[kelkel]

You can print the list and request your doctor script them for you if you're having insurance cover it. If not, you can look at places like Discounted Labs .com or Private MD Labs . com. (have to type them that way or the filter blurs them out.) I'm trying to find out about LowT myself.

[nomdeplume]

Thank you for the site. I went to discounted labs and a chatted with a "live sales agent." I copied and pasted your list and the person suggested their pre TRT panel ($250) which I will paste at the end. The guy said to hold off on Prolactin and DHT for later. My question is: Is this list good enough or would I be missing some important tests?


- LH and FSH (Pituitary hormones that stimulate testicular cells that can help diagnose primary (testicular) or secondary hypogonadism)
- Total and free testosterone
- Prostatic specific antigen (PSA) (TRT is contraindicated for PSA equal or above 4.0)
- Estradiol (sensitive)
- Thyroid stimulating hormone (TSH)
- Comprehensive Metabolic Panel (CMP) (Glucose, electrolytes, liver/kidney functions)
- Comprehensive Blood Count (CBC) (Immune cells, hematocrit)

[kelkel]

It's a great start! Go with it and when received post it up in the forum and we'll evaluate it. There are many things than can suppress testosterone and LH / FSH will show pituitary function which is crucial. Thyroid issues can cause hypogonadism. TSH is a weak indicator but will help in determining to get further panels pulled. Let's see how they come back and then you can move forward with a few other tests if needed at that time.

[Macros]

I got two blood tests. My total test came in at 434 and 546 ng/dL. My free test came in at 6.2 and 13.7 pg/mL. My family doc said he would put me on TRT using gel and I said I didn't want the gel bc it was too expensive and I didn't want it to come in contact with my young daughter. He said he couldn't prescribe injections unless I went to an endocrinologist. I also asked my doc if he would prescribe any HCG or PCT if I did use the gel and he said no. He said if I experienced shrinkage that is my body's way of telling me I didn't need the extra test.

I just want to know if all doctors are this clueless and if there is anyway I could be prescribed an appropriate TRT regimen given my test numbers I listed above?

[kelkel]

Hi Macros,

What is the range on your Total T and Free T?
Are you in the states?
Any doc can prescribe injections. Yours is apparently uncomfortable with them.
Totally ridiculous theory regarding HCG and shrinkage.

Unfortunately many doc's don't know hormones. I can't really answer your last question until I see your ranges. That said, how old are you? Also, if possible, post up your BW as many things can suppress T levels that are fixable. Always best to rule out possible contributing factors before embarking on a TRT regimen.

[Macros]

Hi kelkel

I'm 30 yo 5'9" 170lbs. I've been training hard and consistently for 10 years. I have always eaten healthy but for the past 5-6 years I've been extremely disciplined and smart with my diet. My problem is I haven't gotten the results I would expect from all of my efforts and I was also having some symptoms that I thought could be linked to low testosterone after I did some research. I got 3 blood tests (which were not full panel and I realize now that I should have asked for a better tests) here are my test results:

Test 1(November): total - 582 ng/dL; free - 6.7 pg/mL
Test 2 (December): total - 601 ng/dL; free - 19.6 pg/mL
Test 3 (January): total - 539 ng/dL; free - 13.3 pg/mL

Ranges: total: 348-1197; free: 9.3-26.5

My doctor said these levels are not necessary "low" but he did say he would prescribe me gel. I know they might not be extremely low but they are low enough to have a noticeable effect on my body composition, mood, libido and energy level.

I have an appointment with another doc on Saturday. But I had a few questions before starting a TRT regimen if he decides to put me on one:

Would I ever be able to do a cycle like the suggested first cycle while on TRT?

If yes, would I need to take a break from the TRT and run pct before starting the suggested first cycle?

If I did the suggested first cycle would I need to run pct before starting TRT again?

Thank you very much

[kelkel]

Hi Macros,

Your serum T fluctuations are relatively normal. The jump from 6.7 in FT to almost 20 is odd.
Don't judge by serum T. Always judge by FT as that is what works for you.

You really need to get the following from this new doc is possible:

Full thyroid panel (not just TSH)
Prolactin
Cortisol
SHBG
LH & FSH

LH and FSH will show pituitary function and help you to assess things further. To be honest, your December numbers, particularly the FT is not bad at all. Whether there's something slightly suppressing your overall T can only be determined by the correct BW. Main thing is to not be treated like you're a number on a chart. Be treated based on how you feel and the symptoms you present. The BW is a guide, not the ultimate judge.

A cycle can be in your future but you need to figure this all out first. If you end up on TRT then you really need to give it time to work as the elevated levels can make a big difference in your progress. It also takes time to get dialed in which may require some frequent BW, and you don't want to screw things up with your doctor and lose trust. To your question, PCT is never needed on TRT.

Don't get ahead of yourself but in the AAS Q & A Forum is a "Successful First Cycle Sticky thread. Read it when you can. It's very well written and will answer many of your questions.

[Macros]

Kelkel you are awesome. I very much appreciate your answer, opinion, and advice. You and this forum have helped me tremendously as I am new to the AAS world and have been trying to do research and gain knowledge. Also I think I am a legitimate candidate for TRT even if I may not be a typical candidate. I have read the "successful first cycle" sticky and it's good to know I could potentially run something like this down the road if my doctor does put me on TRT - thank you for clearing that up. I will post my bw results from my upcoming visit.

Thank you again!

[kelkel]

Glad to help. Post them up in a separate thread so more members will chime in as well.
If possible, check your Vit D level as well. It's actually a hormone and can help suppress SHBG and thus result in better FT levels. Most are low in N. America so it's a good item to track.

[Macros]

Kelkel I hope you are well. I wanted to check in and let you know I had my doctors appointment last Saturday and I'm still waiting on the bloodwork. I scheduled a follow up appointment to go over the bw in 2 weeks. The good news is it's a full panel test so I'll have good results to post. The doctor spent some time talking me to and I really liked him. He is definitely progressive and he should be able to help. He works at a rejuvenation clinic and said he has worked with some bodybuilders such as Shawn Rhoden and Guy Cisternino. the doctor also said he is on TRT himself. I don't know if it seems like a shady establishment or if it's the perfect way to get what I need under doctor supervision. I asked him about HCG and that was the only downside of the visit. He said he does not use HCG while on exogenous test because he said it doesn't stimulate the testes. I told him all I knew about HCG and also mentioned the other benefits I knew about such as how it can combat fatigue and stress, betters your mood, has a role in energy, reduced cardiovascular risk, immune stimulation, and betters memory but he still disagreed. I guess my question is - if he puts me on test could I run my own HCG on the side?

I will post the bw after my follow up.

Thanks!

[kelkel]

Well, for as much as he knows he's misinformed when it comes to HCG. It's even on many HCG package inserts as a viable use for Hypogonadic Hypogonadism. Let me see your BW when you get it. I'll be off site most of next week so be patient please.

Here's a small quote from a study regarding fertility in the hypogonadal male that deals with the effectiveness of HCG from 2015:

A known critical element in the development of healthy spermatogenesis is high intratesticular testosterone.13 In men using exogenous testosterone, these levels can be greatly diminished. Intramuscular human chorionic gonadotropin (hCG) therapy is an option shown to protect against, or at least to diminish, the impact that exogenous testosterone has on intratesticular testosterone levels. In a randomized, controlled trial of 29 healthy men randomly assigned to four groups, testosterone enanthate was given 200 mg per week plus either intramuscular saline, 125, 250, or 500 IU hCG every other day. Sperm, intratesticular testosterone levels, and gonadotropins were measured at day 0 and day 21. Intratesticular testosterone levels were suppressed by 94% in the placebo group, 25% in the 125 IU hCG treatment group, and 7% in the 250 IU hCG treatment group, and they were increased 26% from baseline in the 500 IU hCG treatment group.13 Thus, even with supraphysiologic doses of testosterone replacement, healthy levels of intratesticular testosterone were maintained by low-dose hCG therapy.

[Macros]

Kelkel this is great! Thank you for proving sound scientific backup. I will bring this info with me when I meet the doc for my follow up. Also I will post bloodwork in a separate thread so more members can chime in. No worries about the delay, I won't be going back in until the first week of April. Enjoy the time away!

[bioshocked]

Read a lot of threads on this forum and others. I can't find a search function for this forum though. Since this is a sticky thread, I will start here. Never been on any hormones before. Short history is my T has been 450 or lower since I started checking it in my early 30's. I am now 39. Last year it was 390 and just a few weeks ago it was 429. I think my new bed helped as I am sleeping better with my new bed.

I asked my primary Dr and he is anti hormones. So I am looking for a different Dr. I checked out a local clinic, but the cost is insane. Given this is a long term process, I don't even want to get started with them.

One site said I should call compound pharmacies and ask for a TRT doctor. That has actually helped a lot, but I still haven't found that I think is the best option for me.

From what I have read in the rules and other people asking, I am trying to find a Dr in Phoenix that allows self injections at home and is ok with maintaining a T range in the 800-1200 range. One Dr I found says he only goes up to 700. I don't know what I need, but I don't want to be too limited right from the start.

Should I have my own thread for this question?

[kelkel]

Hello bios! Yes, start your own thread in the HRT Forum and maybe a member who lives in your general area can clue you in to a good one. Also, be sure you obtain full BW as listed at the top of this thread. This way you can see if there's anything else suppressing your T production that can be corrected. When it comes to "numbers," always go by your free T level. Total T really means nothing if all your FT is bound up.

Welcome to the forum!

[bioshocked]

Hello bios! Yes, start your own thread in the HRT Forum and maybe a member who lives in your general area can clue you in to a good one. Also, be sure you obtain full BW as listed at the top of this thread. This way you can see if there's anything else suppressing your T production that can be corrected. When it comes to "numbers," always go by your free T level. Total T really means nothing if all your FT is bound up.

Welcome to the forum!

Thanks. I have gone ahead and started my own thread below. Which is more of asking if I should even go down this road at all. Includes some lab numbers as well.

forums.ster*id.com/hormone-replacement-therapy-low-testosterone-treatment-anti-aging/579885-doesnt-seem-low-should-i-even-go-down-road.html

Being new it won't let me post a link to another thread on this same forum. lol. So you will need to correct the link to use it until I have enough posts.

[kelkel]

Sounds like he's just operating to his own knowledge level, which is limited in this area. To say he doesn't believe in hormone therapy would make me run from his office. What other medical therapies does he not believe in? What if the loss of hormones is tumor or trauma related? Would he agree to it then? I imagine if he developed a pituitary tumor that shut down his own T production he'd be on TRT in a heartbeat.

A doctor ignoring a simple bio-identical medicine is frightening. He needs to crack open a book and do some reading.