Finding a TRT Physician

[bioshocked]

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.

Well, he certainly isn't here to defend himself. I would think that if the cause for hormone treatment was tumor or trauma related, etc. That those patients would have different symptoms than me and likely much lower levels than my 390. His comments to me, which I don't remember verbatim, is that he doesn't believe that I need hormone treatment and that if I needed it, he would refer me as he doesn't do that. His staff was also relaying some on this info as I tried to dig deeper into this comment later.

[kelkel]

Oh I'd love to debate him on the efficacy and ethics of it all. Be fun. Pituitary tumors are not that uncommon (I have one) and trauma can be from a simple accident or sports related injury that slowly impacts your endogenous production. The symptoms are basically the same.

At least he'd refer you for the treatment, which is good if he's not comfortable administering it. Best thing, you're here self-educating.

[majoro4]

My doc tells me my test is within normal range for a man my age. My wife is not what a man my age usually marries, so I need the test level to be within the range of a 42 year old. Anybody know anybody in Tampa I should see?

[kelkel]

My doc tells me my test is within normal range for a man my age. My wife is not what a man my age usually marries, so I need the test level to be within the range of a 42 year old. Anybody know anybody in Tampa I should see?

Google and A4M Doctor Finder and search by zip code.

[Blazini]

Thanks for the post about the doc finder on A4M. I have a decent amount of blood work that I will be posting on the forum for some advice and analysis. I would really like to get to the bottom of this low total T I face.

[kelkel]

Do you have any labs you can post? With ranges? Be more helpful if we knew exactly what we were dealing with.

Welcome to the forum major!

Also, if you would paste your post in a new thread in this forum you'd get many more responses.

[Backinsocal]

wow ok

[The_Crawfish]

Pretty sure Crisler has a center in Tampa...no doubt where I'd be going if that's where I lived.

[kelkel]

Pretty sure Crisler has a center in Tampa...no doubt where I'd be going if that's where I lived.

You know you are correct. He just jumped in with Defy Medical.

[beginner91]

I am 25 years old and currently have very low test. I have done only 1 cycle till date consisting of test e, dbol and anavar. did pct using nolvadex, clomid and hgc.
2 years later my results are

RESULTS :
Reference Range
TT - 216 ng/dl 400-1080
FT - 6.5 pg/ml 4.25 - 30.37
E2 - 27.4 pg/ml 0 - 56
FSH. - 2.86mIU/ml 1.5-12.4
LH. - 4.15.mIU/ml 1.7-8.6
Prolactin. - 17.69 ng/ml 4- 15.2

[kelkel]

Interesting numbers 91. My first observation is that your prolactin is elevated and will suppress GnRH and thus LH function, which will result in lower T levels. How much suppression is unknown. Issue right now is we don't know where your Lh would be if prolactin was lower. Further, is there anything else effecting you such as a thyroid issue. It's why full blood work is so crucial in determining where your focus needs to be.

[beginner91]

Interesting numbers 91. My first observation is that your prolactin is elevated and will suppress GnRH and thus LH function, which will result in lower T levels. How much suppression is unknown. Issue right now is we don't know where your Lh would be if prolactin was lower. Further, is there anything else effecting you such as a thyroid issue. It's why full blood work is so crucial in determining where your focus needs to be.

Thankyou Kelkel. I think my first step should be getting down prolactin levels and then do bloodwork again. I dont have any symptoms of thyroid. If my LH is in normal range does it means that my test levels are suppressed for life; but again my prolactin is high so there is some hope of getting my test levels back although not at pre cycle levels but atleast in normal range. And also can you tell me what effect my current bloodwork has on my fertility.

[FrancoIsAChild]

Interesting numbers 91. My first observation is that your prolactin is elevated and will suppress GnRH and thus LH function, which will result in lower T levels. How much suppression is unknown. Issue right now is we don't know where your Lh would be if prolactin was lower. Further, is there anything else effecting you such as a thyroid issue. It's why full blood work is so crucial in determining where your focus needs to be.

Hi Kelkel,

I noticed you're an active member. I posted a thread recently in the HRT subforum and wanted to know what your advice would be?

(Unfortunately I can't post the link here as I'm a new member)

Thank you!

[kelkel]

Definitly was some horrible advice. Well, the entire 7 months was bad so a week or so more makes no difference. You need to have the HCG, Clomid and Nolvadex "in hand" and then start the Scally Power PCT Protocol. Just google it and follow what it says. It's your best chance for recovery at this point. About 8 weeks after pct ends you then need full blood work. Be sure to include a hormone panel and LH/FSH which shows pituitary function.

[Rob L]

Just made a whole list of questions for my doc from this and a couple other posts. Really helpful stuff, guys.

[kelkel]

Glad it helped Rob. Always try and know the answer before you ask if possible. Within a couple questions you'll know whether your doc is on top of HRT or not and can save you months on a poor protocol.

[Jackboned]

Fantastic information. Thank you so much!

[kelkel]

Don't know any off the top of my head. Try the A4M Doctor Finder (google it) or call Defy Medical.

[FreeT]

Hi brothers,

First and foremost, let me say thank you to the amazing mods and members who contribute.

I feel baffled on what BW to get done as I see different lists everywhere I look. Perhaps someone could shed some light?

• I am in my early 30s and I've had 95% of low T symptoms on and off for ~8 years.
• All my previous standard BWs were within normal ranges (tested negative for diabetes, vitamin deficiency, etc.).
• I've never been on an AAS cycle.
• I'm normal weight and eat a balanced lean diet with lots of veggies, little carb (10-20%) and no sugar.
• No other medical conditions other than a minor variococele in left side.

Which of following values would you consider "a must check" in my case, and is my doctor missing anything crucial?

CBC
CMP - N/A
Creatinine (serum) - Added by Doc
Cortisol Plasma / Serum - Added by Doc
Complete Urin Analysis - Added by Doc
DHEA-S
DHT - N/A in my country
Estradiol - is it useless if 'sensitive assay' is not available?
FBS (Fasting Blood Sugar) - Added by Doc
Free Testosterone - N/A in my country
Free T3
Free T4
FSH
LH
Lipid Panel
PSA Total
SHBG
SGPT - Added by Doc
TSH
Total Testosterone
Uric Acid - Added by Doc
Vitamin B12

I personally hate drawing blood as I feel super dizzy afterwards, and the costs here are also very high, so I want I'd love to eliminate as many tests as possible without risking missing out on essential data of course.

Many thanks

[kelkel]

Total T
SHBG
E2 Sensitive. (yes, stantard estradiol can be worthless)
Prolactin
Cortisol
LH
FSH
Thyroid panel to include TSH, FT3, FT4 and Antibodies

Then go from there.

[FreeT]

I just got back some of my results and I was a bit surprised to see that I am actually in the upper range of Total T, with all the symptoms I experience. However I will still need to get the Free & Bioavailable T before drawing any conclusions, which will take the lab about a month to get back (they had to send it pretty far).

All other tests except for Estradiol were somewhere in the middle of the reference ranges. My Estradiol seem to be low according to their reference range. I know this is not the best test for checking Estradiol, but they do not have anything else available where I live. I will definitely go abroad to do the E2 Sensitive plus SHBG asap. For now, what is your first take on it? I read few articles about how low Estradiol in men actually can cause very similar symptoms to low T. Considering I have near 100% of the symptoms, what is usually the action plan for doctors in this case? I've heard about how TRT can do the trick even if T is already high, since it allows for more T to convert to E2.

Test:..............................Value:......... ..........Ref. ranges:
T Total (ECLIA)................8.36.....................2. 8 - 8 ng/mL
Estradiol III (ECLIA?).......15.16....................25.80-60.70 pg/mL


Would love to hear any thoughts, stories and experiences.

[kelkel]

Are you a very lean person?
Most doctors seeing your numbers would do nothing but send you home, despite how you may feel.
You need to push your doc to track down why you present with the symptoms you do.

[FreeT]

Thanks for your replies kelkel!

Being ectomorph following a very strict diet, I probably look leaner than I am at 158 lb / 6', but I do have lots of subcutaneous fats around the waist. I noticed I easily put on such fat storage even if I don't deviate from my strict diet. My diet mostly consist of lean meat, vegetables, whole grain carbs and good fats such as lots of omega 3 rich foods and coconut oil.

I've pushed many doctors to test me for everything possible since 2008 but they eventually gave up on me and I did my best to live with this chronic fatigue. Having worked hard since and saved more money, I decided to make it my main priority to fix this at last as 2/3 months are devastating (well being wise). I'm otherwise a happy person, loving what I do and life is overall good. It makes no sense that I am constantly drained.

Anyway I'm not going to turn this into a long self pity book and bore you. I'm just thankful for any guidance since 99% of doctors and physicians don't know what they're doing. The best advice I've ever gotten for other injuries/issues have been from communities such as this one and from youtube bloggers :-)

Any other tests recommended? So far the results are looking good, except for the low E2. Would it be a stupid thing to push my doc to try me on TRT for a while? I obviously don't want to mess up my natural production if my values are good, but it might be worth a shot (hehe) if it potentially could help and if it's possible to carefully test it for a little while.

[kelkel]

Low E2 can cause symptoms similar to adrenal fatigue or low T like you mentioned. Whether your level of estrogen is to low for you remains to be seen. What also remains to be seen is whether the test you had was accurate. If it's not a Sensitive Assay it can be way off. Caveat is that it normally err's on the high side though. If it is proven to be low you could try eating foods known to help increase estrogen such as anything with soy, grapefruit, try google for some more as that's all I can think of off the rop of my head.

More BW is always where you start. I lean toward adrenal fatigue at the moment but I'm not a big fan of that diagnosis. There have been a few others here over the years that have presented with similar symptoms to you and ended up (after much time and effort) being diagnosed wth AF.

[FreeT]

Ok so I managed to get my cortisol checked out at last too. This is probably a stronger indicator right?

Value (ug/dl): 22.81 at 8 AM.............Reference: (7-10AM): 6.2 - 19.4

Value (nmol/L): 629.237 at 8 AM........Reference: (7-10AM): 171.00 - 536.00

I have no idea how it can show at this level. I am sleeping properly, not a stressing much at all. My workout is light (every other day, 4 sets per muscle group).

Time to see the doctor again I guess

[kelkel]

Yes, that's high. You need to stay on top of that. Retest as well. Again, it may be adrenal related. Cortisol over time will suppress T levels both at the pituitary and gonadal axis.

[FreeT]

Yes, that's high. You need to stay on top of that. Retest as well. Again, it may be adrenal related. Cortisol over time will suppress T levels both at the pituitary and gonadal axis.

You're probably right, I've heard that several times too.

So my Free and Bioavailable Testosterone test results just came back. I am no doctor but I'm pretty sure it's far from optimal having high total and lower range of free/bio combined with high cortisol :P

Test____________________ Value ____________ Ref. ranges (age 20-35)
Bioavailable Testosterone____ 1.18 ng/mL _______ 1.00 - 3.70
Free Testosterone__________ 13.2 pg/mL _______ 8.3 - 40.1

What's your take on this?

Additionally, I also did another cortisol test while using a drug prescribed by the doctor to suppress cortisol and the results seemed "okay" according to him.
For now I am resting more from the gym in case I am overtrained somehow. Will retest cortisol again soon.

Thanks for the tips!

[kelkel]

Sorry I'm late seeing this. Wasn't really on much over the weekend and working now. I will get back to this later today but need to re-read prior posts first.

[kelkel]

The results don't make much sense when compared to your Total T in post #260.
Question, do you snore? I ask as I'm curious whether this could be related to sleep apnea?

[FreeT]

Sorry I'm late seeing this. Wasn't really on much over the weekend and working now. I will get back to this later today but need to re-read prior posts first.

No worries, I'm just appreciative of getting any reply.

The results don't make much sense when compared to your Total T in post #260.

So would you agree my bioavailable is a bit lower than it normally would be with such high total?
Perhaps my SHBG is high? I spent the whole day yesterday reading about SHBG and how one can bring it down slightly by supplementing extra of Vitamin D, I will give it a shot at least. I also saw some interesting information on the "good ol' Stanozolol" which apparently even in micro dosage can bring down SHBG. But before turning my body into a lab, I will try everything else first, including getting a test for SHBG abroad.

Question, do you snore? I ask as I'm curious whether this could be related to sleep apnea?

I asked my girlfriend and she says no, I rarely make a sound at all.
Myself I have noticed that I wake up randomly in the middle of the night and go to the bathroom (1-2 times per night), I never used to do this before. However, this might just be due to the high cortisol right?
I go to bed at the same time (12) and wake up at the same time (8) every day (7.5-8h sleep). I follow this religiously even on weekends, just to eliminate any self-brought sleep cycle issues from the equation.

[kelkel]

No worries, I'm just appreciative of getting any reply.


So would you agree my bioavailable is a bit lower than it normally would be with such high total?
Perhaps my SHBG is high? I spent the whole day yesterday reading about SHBG and how one can bring it down slightly by supplementing extra of Vitamin D, I will give it a shot at least. I also saw some interesting information on the "good ol' Stanozolol" which apparently even in micro dosage can bring down SHBG. But before turning my body into a lab, I will try everything else first, including getting a test for SHBG abroad

Probably yes. Whenever there are T value issues shbg should be monitored. Yes to Vit D. I run 10K iu's per day but it's always based on Lab work. Take it with meals as it's fat soluble and absorbes better that way. I keep mine around the 80's on a scale of 30-100. I'm familiar with Stanozolol and Anavar to lower shbg. But remember you are not on TRT yet so implementing this could be detrimental over time even at a low dose.



I asked my girlfriend and she says no, I rarely make a sound at all.
Myself I have noticed that I wake up randomly in the middle of the night and go to the bathroom (1-2 times per night), I never used to do this before. However, this might just be due to the high cortisol right?
I go to bed at the same time (12) and wake up at the same time (8) every day (7.5-8h sleep). I follow this religiously even on weekends, just to eliminate any self-brought sleep cycle issues from the equation.

Well that's good then. Unless she's a heavy sleeper and doesn't hear you! Yes, it can be somewhat related to cortisol / adrenal issues. Or PSA - BPH

[FreeT]

Yes, it can be somewhat related to cortisol / adrenal issues. Or PSA - BPH

PSA test came back at 1.05 (Ref < 4.00).

You never gave your input on my free and bioavailable T . Do you think it's low enough to cause my symptoms (since it's very individual)?

I had my blood drawn again today to check my electrolytes and CRP. I am going to continue as advised by you regarding Cortisol. I will next ask for a 24h Free (urine) test. Cushing's would really suck, but I rather find SOMETHING that can be treated as I now feel like a broken zombie 95% of the time.

[FreeT]

Sorry I'm late seeing this. Wasn't really on much over the weekend and working now. I will get back to this later today but need to re-read prior posts first.

No worries, I'm just appreciative of getting any reply.

The results don't make much sense when compared to your Total T in post #260.

So would you agree my bioavailable is a bit lower than it normally would be with such high total?
Perhaps my SHBG is high? I spent the whole day yesterday reading about SHBG and how one can bring it down slightly by supplementing extra of Vitamin D, I will give it a shot at least. I also saw some interesting information on the "good ol' Stanozolol" which apparently even in micro dosage can bring down SHBG. But before turning my body into a lab, I will try everything else first, including getting a test for SHBG abroad.

Question, do you snore? I ask as I'm curious whether this could be related to sleep apnea?

I asked my girlfriend and she says no, I rarely make a sound at all.
Myself I have noticed that I wake up randomly in the middle of the night and go to the bathroom (1-2 times per night), I never used to do this before. However, this might just be due to the high cortisol right?
I go to bed at the same time (12) and wake up at the same time (8) every day (7.5-8h sleep). I follow this religiously even on weekends, just to eliminate any self-brought sleep cycle issues from the equation.

[kelkel]

Sorry about that. Yes, it's low enough. Just because it's "in range" does not mean all is well and don't let a doctor tell you that. It may be fine for some but simply not enough for you. You're not a number and should be treated based on how you feel and the symptoms you present. Any doc that dismisses how you feel based on a lab result is doing you an injustice.

Great PSA. Jealous. Stay strong, post up your BW when received.

[FreeT]

Many thanks, buddy!

Just for the heck of it, I had an ECG plus checked my Calcium, Sodium, and Potassium.
My electrolytes seem okay being in mid range but my ECG results state bradycardia at rate 55. I might add that I do not do a lot of cardio. Not sure what to make of that.
Additionally, I was recommended by a guy in another forum to check my morning temperature straight after waking up, so I did. I have 36.4 and 36.2 so far.

[FreeT]

By the way Mr kelkel,

I saw in another post when searching the forum, that you supplement with DHEA.
In a few studies, DHEA supplementation shows the ability to lower cortisol and even lower SHBG (more unreliable though).

Any personal experience with this?

Sounds like it could benefit me quite well. Just gotta find a quality micronized DHEA somewhere online.

[kelkel]

I have Bradycardia as well and I've never done cardio. Doc says it's due to my lifestyle and workout regimen. No worries.
Your temp is fine. No one is perfect there. It's normal to range a bit. Many things influence this - thyroid, pituitary, adrenals.....
DHEA's good stuff, if you need it. I never say it lower cortisol much, shbg a little. Remember though your body will shunt it where it feels it needs it.

https://www.ncbi.nlm.nih.gov/pubmed/9876338

I've taken it more so than not, although I've never felt a difference either way.

[FreeT]

I have Bradycardia as well and I've never done cardio. Doc says it's due to my lifestyle and workout regimen. No worries.

Alright, phew. Having shortness of breath quite a lot, it got me a bit worried.

Your temp is fine. No one is perfect there. It's normal to range a bit. Many things influence this - thyroid, pituitary, adrenals.....

Exactly! This is the very reason the guy was suggesting me to test it, since especially the thyroid, despite having withing normal blood work ranges, can cause the basal temperature to go down. What other tests do you suggest for checking the adrenal and pitutuary glands to safely rule out Cushing's, tumors, etc? It seems to be quite complicated and misleading when checking online. Since my endocrinologist just shrugs off my high cortisol, I need to educate myself further.

DHEA's good stuff, if you need it. I never say it lower cortisol much, shbg a little. Remember though your body will shunt it where it feels it needs it.

Cool, I will give it go after I've checked my SHBG.



Yesterday I had the best day in about 2 months, energy wise. My energy level was 4 to 4.5 out of 5 throughout the whole day, without even taking a nap. I haven't changed anything since the day before. I had a very light workout of my upper body the day before.

Then yesterday evening, I had a leg workout, but only a light one since I've been on a recuperation week. Today I am absolutely destroyed. I have a massive brain fog, lethargy, confusion and physical fatigue. My legs also feel like a pair of bruises.

This has happened many times before, but usually after a heavy leg workout.

What does this indicate? I can only think of overtraining myself, but why only after leg workout? And is it possible after just 1 short, light workout after taking 1-1.5 weeks off?

I am perplexed right now.

[kelkel]

Well with thyroid you can still be "in range" but have issues. Most ranges labs use for TSH (for example) are old and to broad. A more modern range is .3 - 3.0 from memory. Your TSH could be near the top of the old range yet your T4 near the bottom but still in range and most docs will say you're fine when you actually may be subclinical hypothyroid. Thyroid's quite complicated and not my fav topic for sure. Any thought of issues and you should be pulling TSH, FT3, FT4, Antibodies and RT3 at a minimim.

For the pituitary your pretty much evaluating LH/FSH as well as prolactin. If LH/FSH is suddenly crushed and/or prolactin abnormally elevated then an MRI would be in order.

Re adrenals I have a good article saved. Let me find it.

Here it is:

https://adrenalfatiguesolution.com/t...renal-fatigue/

[FreeT]

Re adrenals I have a good article saved. Let me find it.

Indeed a pretty good article on the testing.

I found this solid article today on OTS: (I cannot post URL yet so just google 'alphamaleinstitute overtraining syndrome').
I'd say I feel somewhere in between stage 2 & 3.

Could my issue be this simple? Considering I am not cycling, perhaps I have been pushing myself too much in the gym the last year. Prior to when started feeling like dog shit, I did heavy lifting 3/4 days, with no recuperation week every 2 months. Although, I never did many set per muscle group (4-5 only), I did something like:

Day 1: Chest, Triceps, Abs.
Day 2: Back, Biceps, Forearms.
Day 3: Shoulders, Legs, Calves.
Day 4: Rest or repeat.
Day 5: Repeat.

Thoughts?