How-to: Doctor shop

[Pantalones]

Throughout the forums I've seen a lot of guys talk about how their doctor just doesn't get it. Doctors who are scared their patient will abuse the substances some of them need to function properly and feel normal. There are many, many doctors out there uneducated about Hormone Replacement Therapy (HRT), and it is unfortunate, but on the flip side, there are also enough Hormone Replacement Therapy (HRT) competent doctors to go around. This of course, assuming you know where to look.
First topic of debate: Endocrinologists
You'll see A LOT of guys go down this road, and quite frankly, its not their fault. Many of them are referred by their physician who really doesn't feel like they have the ability to properly diagnose and handle various hormonal situations. The problem with a lot of Endos is that they'll do the proper testing, or at least some of it, but they tend to hold back on writing prescriptions. I feel many of them follow the AACE's strict guidelines religiously, leaving no room for proper TRT protocols. The majority of endocrinologists just do not educate themselves on hormone replacement, and this makes dealing with them difficult.

Urologists: I've yet to really hear a success story between a TRT patient and a urologist. I know it easy to think, hmm this guy deals with issues of the male genitalia, he could probably help me..and some are even referred to urologists by their physicians. For the most part, this is NOT the right route to go, and you'll see the same theme replayed as what goes on at the Endo. Basically just a lack of knowledge in hormone replacement.

Both Endocrinologist and Urologists tend to care about your numbers, and not exactly how you feel. I'd like to discuss a third, and IMO, the best option when it comes to hormone replacement.

Internists (Doctors of Internal Medicine)
So far out of the doctors I would consider knowledgable in testosterone replacement therapy (TRT), the majority of them specialize in Internal medicine. There are amazing docs out there, but the majority of the good ones I've come across are internists. Believe it or not they tend to be the most thorough and educated, FAR more than an endo. I'd recommend you go to ratemds and search for internists in your area. Each will be given a rating, and read the comments to see if you want to get an idea of the kind of person he/she is. Many might disagree, but I believe internists truly focus on how you feel, and take that into account a long with the numbers. This allows you to find the levels that work for you, and to optimize your health.

Independent of whether your doctor is an endo, uro, or internist, he/she should at least be competent enough to do a comprehensive hormone panel, of which includes the following:

--> Cortisol
--> Prolactin
-->A thyroid panel (T4, T3, TSH)
--> a complete blood count
--> a red blood count
-->a lipid panel
--> Total and free testosterone
-->Sex hormone binding globulin
-->DHT
-->LH
-->FSH
-->E2
-->Vitamin D levels (not necessary, but certainly shows a great competency)
-->Insulin like growth factor (IGF-1)


After the initial blood work is in and if they decide to treat you, you need to make sure they do a thorough follow-up and closely monitor how you feel. This is a sure sign of a truly competent Hormone Replacement Therapy (HRT) doc, and one you will likely keep for a very long time.

**Remember to use ratemds or some sort of physician rating website when considering shopping for a new doc.

** I am not saying that all endos and uros are bad, and that all internists are good. Nor am I saying that TRT clinics aren't a good choice as long as you can afford it. This is just what I've found out from being on testosterone replacement therapy (TRT), and what I'd like others to know.

 

[wesmar]

My psychiatrist was the one who got me on testosterone replacement therapy (TRT) the first time I was on it. He thought it would help my mood, confidence and energy level. Having had depression, low confidence and low energy for years he thought it might help and it did. The urologist I saw couldn't believe that my psych doc put me on it with a level of 326 (I think).

 

[NoPain]

My psychiatrist was the one who got me on testosterone replacement therapy (TRT) the first time I was on it. He thought it would help my mood, confidence and energy level. Having had depression, low confidence and low energy for years he thought it might help and it did. The urologist I saw couldn't believe that my psych doc put me on it with a level of 326 (I think).

Hey man. I came across your post searching for help about your psyciafrist putting you on testosterone replacement therapy (TRT) and was wondering if you would mind answering some questions. Im hoping to be on testosterone replacement therapy (TRT). Ive been on antidepressants for years but find out i have low (but normal) t levels). I recently ran my first cycle and i felt like i didnt need antidepressants any more.

Anyway, a few questions:
did you have to ask cor it or did they offer it?
Does anyone monitor your labs? What type of doc? I think you mention a uro does?
Are you on antidepressants and if not, were you? Did testosterone replacement therapy (TRT) help get you off them? My main goal is to get off them. I honestly dont thi k im depressed. I just feel shitty.

Sorry, i know this is a bit personal for someone who never posts. If you dont want to deal with this i fully understand. Thanks for reading.

 

[Rix]

I have a urologist. As far as I can tell, his main line of business is vasectomy reversal, but he also has a sideline in andrology. It took me a REALLY long time on google to find him - hours and hours, and I'm good with google. (after getting prescribed crap by a local internist) I finally found an obscure journal article he wrote in an insurance journal arguing for TRT to reduce overall cost. He does the whole shebang and would read the labs; however, probably the collective wisdom on this board is probably better.

Key google terms that might find a good doctor:
"Men's Health Center"
"American Society of Andrology"
"Hypogonadism"
"Testosterone Replacement"
"Andropause"
"A.D.A.M" (Androgen deficiency in the aging male)

Before you show up at the first doctor, got to privatemdlabs and get the female hormone panel for $60. You might not need testosterone replacement therapy (TRT), but you want someone who does it for a living to tell you if you do or don't. A GP/Internist probably sees a couple a year, and doesn't have the focus on the problem you need.

Now that you've found a doc, you are ready to rock. Ask the doc "I read that some people need AI's with testosterone replacement." If the doc looks at you blankly, get a new doc.

 

[Seeker2]

My psychiatrist also originally ordered the blood work for testosterone levels and now I'm seeing a regular doctor for the same thing. This week I should know after another lab result if I will go on the TRT.