aka, "the difference between an idiot doc and a doc who has a clue."
So, I am already on a testosterone replacement therapy (TRT) program, "of sorts", it'll become more apparent later on in this post.
So, I'm 38 years old, married for 3.5 years, and I have low natural T. I first found this out about 5.5 years ago when I went to a primary care physician (PCP) for a checkup and investigation into possible sleep apnea. When the bloodwork came back, I got a call from his assistant saying my T level was "a little low," and he prescribed me Testim gel 1x/day (don't remember the dosage), and told me to get bloodwork again in a week or two. Didn't explain to me anything at all, but just prescribed it. I tried it for a week or so, didn't notice any difference, stopped using it thinking "I'm a guy. I don't need steroids!"
Well, 5 years later, the wife and I are trying to get pregnant. Libido and performance have fallen off a cliff as of late. I've put on weight (in the wrong places), and am now carrying around a "kegger" where there was once a bit of a "beer belly". I tell the wife that I suspect I may have low T (I never told her about the diagnosis 5+ years ago) and tell her I'm going to go find a doc to talk to about it. This is a big step for me, since I hadn't been to a PCP since the last PCP. (I still go to my pulmonoligist for my sleep apnea annually though).
I then go to this new PCP and get the physical. He's not happy with my weight. Immediately asks me if I wanted to do bariatric surgery (mind you, except for some VERY mild hypertension, all of my bloodwork is good and my general health is good). I tell him "no", but that immediately sets off some red flags. I tell him that I suspect I may have low T and would like to look into TRT. He tells me something like "well, it may or may not help, because fatty tissue metabolizes T differently, but we can look into it." Anyhow, he runs the blood tests and they come back with a TT=206 ng/dL, which he called "a little low". Based upon all the information I could find, I should be in the TT=600 range at 38. 206 is low even for someone in their 70's. I also read up on various protocols and how T alone is NOT a good idea. The protocol I found (on a different forum) started with 100mg injected T/week + hCG + AI.
So I go back to the doc's office, and we talked a bit. He immediately asks if I considered bariatric surgery again. (RED LIGHT!). That immediately pissed me off, since I already gave him my reasons why I didn't feel I wanted/needed it in my last visit. We talked about the T replacement, and I showed him an article I had found (on t-nation's T replacement forum) which explained the reasoning for why T alone is a bad idea.
So he gets ready to walk out the door to write the scrip, and I ask him, "Well, what are you going to prescribe?"
"Well, I was going to start you out on a gel."
"Well, aren't gels counterindicated if you shower a lot (I do, typically 2/day) and/or sweat a lot (I do, I workout 4x/week + drive a truck in TX with no A/C), and also aren't they expensive, messy, and hit-or-miss wrt absorption amounts?"
I then showed him the article I printed out. His first words, "I don't do injections," He looks through the article a minute or two, and walks out the door saying "Give me a few minutes."
He pokes his head into the room and asks "why do you want this?" I had already told him that I lift weights for exercise, and I mentioned (much to his disapproval) that I like lifting the heavy stuff. Hey, it's fun and I'm a bit crazy, I know. I tell him about my libido problems, and how I'd like to try to get back to a healthy body composition, and the low T is definitely not helping that at all. He leaves again for a minute or two to confer with a colleague.
He comes back in with a syringe of 200mg of Test (mind you the protocol I showed him said 100mg/week divided into twice weekly injections, and the reasons for it). He immediately starts to pontificate how "This is a controlled substance. Weightlifters can increase their lifts by 20% with this stuff." MAJOR red flags.
I asked him about the Aromatase inhibitor (AI) and hCG. He says, "oh, you've heard about the hCG diet?"
"No... but if my wife and I are trying to get pregnant, shouldn't we be using something to sustain my normal function... and what about the possibility of testicular atrophy on T alone"?
"I don't prescribe hCG. If your wife's not pregnant in a couple months we can do a semen analysis."
"Okay, well, what about the AI? My body composition suggests that I'm already converting T to E2 at a higher than normal rate. Wouldn't more T just make my symptoms worse?"
"I don't test for E2. I go by symptoms. If you're not feeling better in a couple months we'll change your dosage." He then walks over to me with the syringe and says "Prepare to go through puberty all over again."
At this point I'm extremely uncomfortable and tell him this. He then leaves the office and confers with one of his colleagues (a reproductive endocrinologist) and gives me his card. He says that he isn't comfortable with what I'm asking, (the FIRST thing that didn't piss me off all visit), but he'll refill my prescriptions if the other doc writes them.
So, I call his colleague, "We don't do that... but we do refer patients to this other doc, a male urologist" So I set up an appointment with the urologist.
At the urologist appointment, we discuss what's gone on already, and I tell him about my reservations with my PCP. He hears that the wife and I are trying to get pregnant and says "Well, that certainly changes all of our options," and that made me feel much better about things already. We had a frank discussion, and he suggested that the protocol I showed him would be a viable alternative to sustaining some level of sperm production, but he wouldn't recommend ANY exogenous T while we're trying to get pregnant. He ran some additional tests and came back with (among other things):
TT=278ng/dL
Free T=4.3pg/mL LOW
Estradiol=56.6pg/mL HIGH
Not surprising. Idiot doc #1 would have even seen the E2 level was high if he'd bother to do the test. So the urologist starts me on Arimidex at initially .5mg/day and calls for a 8-week followup.
At the 8-week followup, we discussed how things are doing. It turns out that through a bit of trial and error I found that a .25mg/day dose of Arimidex seemed to give me the best results (that's as low as I tried, but the results were VERY good), as I found I had significantly improved libido, performance and sexual enjoyment. The doc also ran a semen analysis and said that there's no reason my wife shouldn't be able to get pregnant (at least from my end), and with the improved performance THAT isn't a factor either (part of the reason that we've been trying and failing for 6 months is that some days I just can't/don't want to do it.) He didn't immediately have the latest test results, but on my way home his office called me with them:
TT=~470 ng/dL
FT=~11 pg/mL
Definite improvements. We also discussed the T+hCG+AI protocol again, and he said that it is a good start, and he can get me started on it once my wife is pregnant. However, he suggested that I contact my health insurance provider and ask about the hCG because it can be rather expensive. I called the insurance company and they wouldn't even give me a PRICE until I had a prescription in hand, because it may or may not even be covered, depending on whether they think I need it or not... grr. My insurance will cover the Anastrozole (which I'm on) and the Test-E or Test-Cyp at very reasonable rates though, so that's good.
However, how much does hCG even cost, and if my insurance doesn't cover it and I have a prescription for it, what's the best way for me to get a hold of it legally?
(I know this is a long first post)
So, I am already on a testosterone replacement therapy (TRT) program, "of sorts", it'll become more apparent later on in this post.
So, I'm 38 years old, married for 3.5 years, and I have low natural T. I first found this out about 5.5 years ago when I went to a primary care physician (PCP) for a checkup and investigation into possible sleep apnea. When the bloodwork came back, I got a call from his assistant saying my T level was "a little low," and he prescribed me Testim gel 1x/day (don't remember the dosage), and told me to get bloodwork again in a week or two. Didn't explain to me anything at all, but just prescribed it. I tried it for a week or so, didn't notice any difference, stopped using it thinking "I'm a guy. I don't need steroids!"
Well, 5 years later, the wife and I are trying to get pregnant. Libido and performance have fallen off a cliff as of late. I've put on weight (in the wrong places), and am now carrying around a "kegger" where there was once a bit of a "beer belly". I tell the wife that I suspect I may have low T (I never told her about the diagnosis 5+ years ago) and tell her I'm going to go find a doc to talk to about it. This is a big step for me, since I hadn't been to a PCP since the last PCP. (I still go to my pulmonoligist for my sleep apnea annually though).
I then go to this new PCP and get the physical. He's not happy with my weight. Immediately asks me if I wanted to do bariatric surgery (mind you, except for some VERY mild hypertension, all of my bloodwork is good and my general health is good). I tell him "no", but that immediately sets off some red flags. I tell him that I suspect I may have low T and would like to look into TRT. He tells me something like "well, it may or may not help, because fatty tissue metabolizes T differently, but we can look into it." Anyhow, he runs the blood tests and they come back with a TT=206 ng/dL, which he called "a little low". Based upon all the information I could find, I should be in the TT=600 range at 38. 206 is low even for someone in their 70's. I also read up on various protocols and how T alone is NOT a good idea. The protocol I found (on a different forum) started with 100mg injected T/week + hCG + AI.
So I go back to the doc's office, and we talked a bit. He immediately asks if I considered bariatric surgery again. (RED LIGHT!). That immediately pissed me off, since I already gave him my reasons why I didn't feel I wanted/needed it in my last visit. We talked about the T replacement, and I showed him an article I had found (on t-nation's T replacement forum) which explained the reasoning for why T alone is a bad idea.
So he gets ready to walk out the door to write the scrip, and I ask him, "Well, what are you going to prescribe?"
"Well, I was going to start you out on a gel."
"Well, aren't gels counterindicated if you shower a lot (I do, typically 2/day) and/or sweat a lot (I do, I workout 4x/week + drive a truck in TX with no A/C), and also aren't they expensive, messy, and hit-or-miss wrt absorption amounts?"
I then showed him the article I printed out. His first words, "I don't do injections," He looks through the article a minute or two, and walks out the door saying "Give me a few minutes."
He pokes his head into the room and asks "why do you want this?" I had already told him that I lift weights for exercise, and I mentioned (much to his disapproval) that I like lifting the heavy stuff. Hey, it's fun and I'm a bit crazy, I know. I tell him about my libido problems, and how I'd like to try to get back to a healthy body composition, and the low T is definitely not helping that at all. He leaves again for a minute or two to confer with a colleague.
He comes back in with a syringe of 200mg of Test (mind you the protocol I showed him said 100mg/week divided into twice weekly injections, and the reasons for it). He immediately starts to pontificate how "This is a controlled substance. Weightlifters can increase their lifts by 20% with this stuff." MAJOR red flags.
I asked him about the Aromatase inhibitor (AI) and hCG. He says, "oh, you've heard about the hCG diet?"
"No... but if my wife and I are trying to get pregnant, shouldn't we be using something to sustain my normal function... and what about the possibility of testicular atrophy on T alone"?
"I don't prescribe hCG. If your wife's not pregnant in a couple months we can do a semen analysis."
"Okay, well, what about the AI? My body composition suggests that I'm already converting T to E2 at a higher than normal rate. Wouldn't more T just make my symptoms worse?"
"I don't test for E2. I go by symptoms. If you're not feeling better in a couple months we'll change your dosage." He then walks over to me with the syringe and says "Prepare to go through puberty all over again."
At this point I'm extremely uncomfortable and tell him this. He then leaves the office and confers with one of his colleagues (a reproductive endocrinologist) and gives me his card. He says that he isn't comfortable with what I'm asking, (the FIRST thing that didn't piss me off all visit), but he'll refill my prescriptions if the other doc writes them.
So, I call his colleague, "We don't do that... but we do refer patients to this other doc, a male urologist" So I set up an appointment with the urologist.
At the urologist appointment, we discuss what's gone on already, and I tell him about my reservations with my PCP. He hears that the wife and I are trying to get pregnant and says "Well, that certainly changes all of our options," and that made me feel much better about things already. We had a frank discussion, and he suggested that the protocol I showed him would be a viable alternative to sustaining some level of sperm production, but he wouldn't recommend ANY exogenous T while we're trying to get pregnant. He ran some additional tests and came back with (among other things):
TT=278ng/dL
Free T=4.3pg/mL LOW
Estradiol=56.6pg/mL HIGH
Not surprising. Idiot doc #1 would have even seen the E2 level was high if he'd bother to do the test. So the urologist starts me on Arimidex at initially .5mg/day and calls for a 8-week followup.
At the 8-week followup, we discussed how things are doing. It turns out that through a bit of trial and error I found that a .25mg/day dose of Arimidex seemed to give me the best results (that's as low as I tried, but the results were VERY good), as I found I had significantly improved libido, performance and sexual enjoyment. The doc also ran a semen analysis and said that there's no reason my wife shouldn't be able to get pregnant (at least from my end), and with the improved performance THAT isn't a factor either (part of the reason that we've been trying and failing for 6 months is that some days I just can't/don't want to do it.) He didn't immediately have the latest test results, but on my way home his office called me with them:
TT=~470 ng/dL
FT=~11 pg/mL
Definite improvements. We also discussed the T+hCG+AI protocol again, and he said that it is a good start, and he can get me started on it once my wife is pregnant. However, he suggested that I contact my health insurance provider and ask about the hCG because it can be rather expensive. I called the insurance company and they wouldn't even give me a PRICE until I had a prescription in hand, because it may or may not even be covered, depending on whether they think I need it or not... grr. My insurance will cover the Anastrozole (which I'm on) and the Test-E or Test-Cyp at very reasonable rates though, so that's good.
However, how much does hCG even cost, and if my insurance doesn't cover it and I have a prescription for it, what's the best way for me to get a hold of it legally?
(I know this is a long first post)
