Advice on doctor selection

[Chiefy]

Good afternoon guys, I'm hoping you may be able to help point me in the right direction with my treatment. I'll try to keep it brief because I know posts like mine are a dime a dozen around here, but I'll happily provide more information if you need it.

I'm a male in my early thirties who's been experiencing many of the symptoms of low testosterone. Extreme fatigue, loss of libido, sexual dysfunction, muscle soreness, mental fog, etc. The symptoms have become intolerable and my quality of life has suffered greatly.

I've had 3 rounds of bloodwork and seen my primary care physician, an endocrinologist, and a urologist. All of them have been dismissive of my symptoms and assured me that my bloodwork looks normal for a guy my age. I'm not as well versed on this stuff as most of you, does this look normal?

Total testosterone has come back as follows:

259 (241-827)
304 (250-1100)
311 (241-827)


Free test was only tested twice:

1.2 (.8-1.8 ng/dl)
67.8 (35-155 pg/ml)


LH, FSH, prolactin, SHBG, TSH and everything else that tested was within normal ranges so I'll spare you the details unless you'd like more detail.


What should be my next move? I feel like my age is preventing doctors from taking my situation seriously and I'm only being treated like a number. How do I go about finding a doctor who will at least consider the possibility that testosterone is causing this?

My doctors have ruled out just about every other potential cause, but are unable to give me any real information as to what is causing my symptoms. I'm no doctor, but I'm fairly convinced that my testosterone is at the root of this.

Should I just suck it up and seek care at a TRT clinic? Money is tight, but I suppose I could make it work if it meant that I didn't have to feel like complete garbage all the time.

Any advice as to where I should go from here?

So much for keeping it short, thanks for reading.

 

[Megatron28]

How old are you? And please post all your blood work results -- the most recent ones -- including LH and FSH. Seeing the whole picture is helpful.

Ow about medical history. Any prohormones or steroid use? Any testicle or head trauma? Diseases? Etc. Anything that might be relevant.

My first thought is that you might want to try a "restart" but let's see your responses to above.

Also, read the Sticky Thread called Basic TRT Overview that I wrote up in this forum. That will help you understand what we are talking about.

 

[Chiefy]

Thanks for the reply. I'm 32 years old. Each round of blood work involved different tests because they were from different doctors, who had different views of where we should be looking for a diagnosis. I didn't really know a whole lot about what should actually be tested so I kinda trusted them to make the right decisions. They certainly aren't ideal and may be considered incomplete, but it's all I've got right now.

October 2013:

Total test - 259 - (241-827 ng/dl)
T4 Free test - 1.2 - (.8-1.8 ng/dl)
TSH - 1.40 - (.40-4.5 mIU/L)
Hemoglobin - 5.5 - (<5.7%)
Vitamin D, 25-OH, total - 32 - (30-100 mg/dl)


March 2014:

Total test - 304 - (250-1100 ng/dl)
Free test - 67.8 - (35-155 pg/ml)
Creatine kinase - 80 - (55-170 U/L)
WBC - 4.2 - (3.6-9.6)
RBC - 4.87 - (4.35-5.67)
Hemoglobin - 14.4 - (13.1-17.1)
Hematocrit - 42.5 - (39.5-50.3)
Platelet count - 222 - (150-440)
Sedimentation rate - 3 - (0-14 mm/hr)
Prolactin - 5.5 - (2.1-17.7 ng/ml)
SHBG - 29 - (10-50 nmol/L)


April 2014:

Total test - 311 - (241-827 ng/dl)
LH - 2.4 - (1.5-9.3 mIU/ml)
FSH - 3.2 - (1.6-8 mIU/ml)
Glucose - 80 - (65-99 mg/dl)
Protein total - 8.1 - (6.1-8.1 g/dl)
Globulin - 2.8 - (1.9-3.7 g/dl)

The rest of the bloodwork done in April involved testing me for various diseases such as hepatitis, HIV, Lyme disease...all of which were negative. Again, I realize that my panels aren't ideal but this is what I've got.

No medical history besides a couple of broken bones as a kid. I've always been a healthy dude. Played sports all of my life and fitness has always been a priority for me. I have yearly physicals for work and I never have any issues there, doctor always tells me that I'm in great health.

I've never used steroids but used a prohormone for a couple of weeks when I was 17 or 18. Not the best decision I've ever made but I was young, dumb and Andro seemed like a smart idea at the time. I stopped taking it because it made one of my testicles hurt...I remember the pain being very intense. I saw a doctor who did an ultrasound and some bloodwork but didn't find anything out of the ordinary. I wish I had the results from all of that but it was so long ago that it's been lost in the shuffle. I can't help but think that my current situation is related to prohormone use, no matter how brief it was.

I was an athlete, so I took my share of nut shots over the years, but it was never anything extreme. No swelling, discoloration, lasting pain, etc. No head trauma that I can recall.

Whew, hopefully you're still with me after all that! Let me know if you need any more information, and I will read that thread tonight.

Thanks!

 

[Megatron28]

If I were you I would try doing what is known as a Restart. You are borderline Secondary Hypogonadal (Low T along with normal LH/FSH). Your Total Test is very low for your age. I don't see anything on your bloodwork to point to why. So a restart will try to get your HPTA working again. I know I am throwing a lot of terms at you, but they are explained in the Sticky I referenced.

Find an endocrinologist that is willing to work with you and do a restart. At age 32 you are a little young to give up and hop on TRT for the rest of your life. A restart will involve running HCG for a little while for your testicles and then trying Clomidnto get your pituitary working better. But there can be different approaches to this so discuss it with your doctor. If you can't find a good one, a lot of the guys here have gone through Increase My T (IMT). They have a lot of experience in getting guys restarted. They will find the best restart protocol for you. Their ad should be found on the right hand side of your screen. At the very least, give them a call and talk to them.

Do your reading and come back and start firing away with the questions. . Lots of guys here have gone through the same thing you are experiencing.

 

[jozifp103]

If I were you I would try doing what is known as a Restart. You are borderline Secondary Hypogonadal (Low T along with normal LH/FSH). Your Total Test is very low for your age. I don't see anything on your bloodwork to point to why. So a restart will try to get your HPTA working again. I know I am throwing a lot of terms at you, but they are explained in the Sticky I referenced.

Find an endocrinologist that is willing to work with you and do a restart. At age 32 you are a little young to give up and hop on TRT for the rest of your life. A restart will involve running HCG for a little while for your testicles and then trying Clomidnto get your pituitary working better. But there can be different approaches to this so discuss it with your doctor. If you can't find a good one, a lot of the guys here have gone through Increase My T (IMT). They have a lot of experience in getting guys restarted. They will find the best restart protocol for you. Their ad should be found on the right hand side of your screen. At the very least, give them a call and talk to them.

Do your reading and come back and start firing away with the questions. . Lots of guys here have gone through the same thing you are experiencing.

IMT is great. They are very responsive and extremely knowledgeable on proper restart protocols and TRT protocols. They dont just give you a prescription and hope it works, they personalize every program and monitor you the whole time. I'm 24 with T levels close to yours and no doctor or specialist would even acknowledge that I could possibly have low test even with bloodwork to show. I called IMT and was on trt within a week. I may have jumped the gun not trying a restart, but i made my decision and am happy with it.

 

[Chiefy]

Sounds like I've got a fair bit of research to do. I'll look at the threads here and figure out my next move.

I'd really prefer to do this through a doctor that participates with my insurance, but I'm starting to feel like that's going to be harder than expected.


Thanks.

 

[Megatron28]

If you don't have a relationship with a doc it can be hard. I do TRT through my GP that I have been seeing for the last 17 years so we have a good relationship. If I had to find a new doc I would probably be on the phone with IMT.

 

[Chiefy]

In your opinion, why is it so difficult to find a doctor outside of one of these programs?

There seem to be many programs advertised online, and all of them use doctors that treat low testosterone with relative frequency. Why is it that their doctors treat this a certain way, but it's so different than the majority of healthcare providers?

 

[Megatron28]

In your opinion, why is it so difficult to find a doctor outside of one of these programs?

There seem to be many programs advertised online, and all of them use doctors that treat low testosterone with relative frequency. Why is it that their doctors treat this a certain way, but it's so different than the majority of healthcare providers?

That's a question that could have its own thread -- and actually has over the years. But I will simply say this. There are good docs out there that want to help you. Not all docs are versed in the most current and best TRT protocols though. The best thing you can do is find a doc that is willing to listen and think. And you need to become very versed in TRT protocols and the HPTA so that you can advocate for yourself. You need to become an expert in TRT.

 

[Chiefy]

That's a question that could have its own thread -- and actually has over the years. But I will simply say this. There are good docs out there that want to help you. Not all docs are versed in the most current and best TRT protocols though. The best thing you can do is find a doc that is willing to listen and think. And you need to become very versed in TRT protocols and the HPTA so that you can advocate for yourself. You need to become an expert in TRT.

It looks like I'll be taking a somewhat unorthodox approach to doing this. Most doctors just don't get it, and I just can't justify doctor shopping for an extended period of time in the hopes of finding one who does.

I made an appointment to meet with a pharmacist a few hours away from where I live. He runs a compounding pharmacy which does a lot of work with BHRT, for men and women. They don't participate with my insurance, but it seems like that's pretty common for these places. Basically I meet with him and show him my blood work, and I assume that he will send me for some more detailed blood work. He works with doctors all over my state that use BHRT so hopefully I'll be able to get set up with one a little closer to home.

From what I've heard about this guy, he spends most of his time at seminars regarding this type of treatment and is considered to be well versed on new research when it comes to TRT. When I spoke to his assistant, she explained how the pharmacist is a great guy and will actually listen to my story. It appears that he's kind of a middle man. I have no idea how to find a competent doctor, and it sounds like he works with many of them. At this point I'm ok with paying him $200 to point me in the right direction.

Obviously this brings business into his pharmacy. The woman I spoke with was able to give me a ballpark figure for monthly medication costs if I end up needing treatment...$40-$75/month is the typical cost, but it depends on what the doctor orders.

This price seems to be a bit better than most of the other companies I've seen online, but I imagine that there will be some other expenses that I haven't discovered yet.

What's your opinion on programs like this one? Am I setting myself up to get screwed out of money at some point? I know that you and many others here are loyal to companies like IMT, but does the road I'm heading down make sense to you?

Any opinions or advice would be greatly appreciated.

 

[Megatron28]

It looks like I'll be taking a somewhat unorthodox approach to doing this. Most doctors just don't get it, and I just can't justify doctor shopping for an extended period of time in the hopes of finding one who does.

I made an appointment to meet with a pharmacist a few hours away from where I live. He runs a compounding pharmacy which does a lot of work with BHRT, for men and women. They don't participate with my insurance, but it seems like that's pretty common for these places. Basically I meet with him and show him my blood work, and I assume that he will send me for some more detailed blood work. He works with doctors all over my state that use BHRT so hopefully I'll be able to get set up with one a little closer to home.

From what I've heard about this guy, he spends most of his time at seminars regarding this type of treatment and is considered to be well versed on new research when it comes to TRT. When I spoke to his assistant, she explained how the pharmacist is a great guy and will actually listen to my story. It appears that he's kind of a middle man. I have no idea how to find a competent doctor, and it sounds like he works with many of them. At this point I'm ok with paying him $200 to point me in the right direction.

Obviously this brings business into his pharmacy. The woman I spoke with was able to give me a ballpark figure for monthly medication costs if I end up needing treatment...$40-$75/month is the typical cost, but it depends on what the doctor orders.

This price seems to be a bit better than most of the other companies I've seen online, but I imagine that there will be some other expenses that I haven't discovered yet.

What's your opinion on programs like this one? Am I setting myself up to get screwed out of money at some point? I know that you and many others here are loyal to companies like IMT, but does the road I'm heading down make sense to you?

Any opinions or advice would be greatly appreciated.

It seems unethical for him to charge you $200 for an "introduction". That part makes me nervous. Otherwise, I often recommend talking to your local pharmacist to find out which docs in your area write scripts for Testosterone, AI's and HCG to men for TRT.

I don't personally use IMT, but I would definitely call them if I wasn't going through my doctor that has treated me for probably the last 17 years. There is no harm in picking up the phone and talking to them. Lots of guys here have had great success with them.

 

[Alpin]

That's a low LH u have. You might very well respond to clomid or HCG and not need full out TRT just yet.

 

[Chiefy]

It seems unethical for him to charge you $200 for an "introduction". That part makes me nervous. Otherwise, I often recommend talking to your local pharmacist to find out which docs in your area write scripts for Testosterone, AI's and HCG to men for TRT.

I was able to get some clarification of how the process works. I bring all of my lab work to this expert/pharmacist at the compounding pharmacy who then writes up a recommendation for BHRT treatment, or whatever treatment is deemed necessary. That information is then given to my doctor, who works closely with this pharmacy, for review. The doctor may tweak it a bit if necessary, but then writes the actual prescription to be filled by the compounding pharmacy after meeting with him and having a physical exam plus any necessary blood work.

It's kinda paying for an introduction, but this pharmacist supposedly has an advanced knowledge of hormones and bioidentical treatments. People really seem to swear by this guy. Obviously he wants more business for his pharmacy, but he sounds like a smart/reputable guy so far.

I went to a different compounding pharmacy and asked for a list like you suggested. Every single person on the list was working for some type of anti-aging clinic, you know, the ones that charge an insane amount of money to be seen/treated. Other local pharmacies didn't want to give out that type of information.

That's a low LH u have. You might very well respond to clomid or HCG and not need full out TRT just yet.

Thanks for the insight, it would be nice if that ends up being the case.

Why would this number be considered low if it's within the normal ranges?

 

[Alpin]

Its considered "low normal" at the level you have.
The text book diagnosis for "hypogonadotropic hypogonadism" is low to low normal LH & FSH. Which you have. Your FSH aint half bad.
I dont know much about u but some lifestyle changes could be in order to help u raise some T.
Eat right, zinc, high quality vit. E, get a sleep study done, workout and drop weight if need be.
I had LH of 3 with 500 TT and did very well on HCG.
U might be in luck if u try a restart and or atleast HCG or clomid monoprotocol.

 

[Alpin]

Btw my TT hit 1000 ng/dl with 10000 iu of HCG a week and ADEX. ( divided into 3 doses)

 

[Chiefy]

Wow that would be ideal if I was able to correct this with a relatively easy fix like that. It's definitely something that I will bring up when I meet with my new doctor.

In terms of lifestyle changes, I don't mean to sound like a douche bag, but I'm damn close to leading the healthiest lifestyle possible. I'm not overweight, my diet is great, I take my vitamins, I don't drink alcohol often, no illicit drug use, fitness has always been a priority for me.

I'd definitely like to have a sleep study though. Ever since I started having these symptoms, my sleep hasn't been what it once was. I usually get ~7 hours per night, but there are times where I'm up and down all night. I also have been working out less than I used to. The extreme fatigue that I'm experiencing often leaves me borderline incapacitated, so it's tough to get off the couch let alone to the gym. I'm sure both of those factors have affected my testosterone levels to some extent.

 

[IMT staff]

if you don't get this sorted out let us know.

 

[Chiefy]

if you don't get this sorted out let us know.

Maybe I missed it, but is there a place on the website that lists your locations?

Full disclosure, I was actually more interested in a different clinic that I found online because they are reasonably close to where I live and the prices seemed a bit better. If IMT was closer I would consider it though.

 

[IMT staff]

I doubt the prices are comparable, you have to look at what your getting for the price. We have over 600 physicians in our network to perform physical exams. So we have someone close to you. We do not have locations per say, they are the doctors locations that join our network.

If people say they are less expensive than us, I doubt the level of treatment is the same. $250 a month is as cheap as it gets.

the all inclusive deals that advertise 199 a month and what not always have a catch. If our programs matched theirs it would be $150 a month. We don't think its fair to charge someone the same as the other, even though the cost for their program maybe less. With us, you only pay for what you need to get dialed in.

Good Luck on your search.

 

[Chiefy]

I doubt the prices are comparable, you have to look at what your getting for the price. We have over 600 physicians in our network to perform physical exams. So we have someone close to you. We do not have locations per say, they are the doctors locations that join our network.

If people say they are less expensive than us, I doubt the level of treatment is the same. $250 a month is as cheap as it gets.

the all inclusive deals that advertise 199 a month and what not always have a catch. If our programs matched theirs it would be $150 a month. We don't think its fair to charge someone the same as the other, even though the cost for their program maybe less. With us, you only pay for what you need to get dialed in.

Good Luck on your search.

Interesting. Forgive my ignorance, I'm just very new to all of this, what type of "catch" are you referring to?