Suspected low T - advice on speaking to GP
- Thread starter BigStu81
- Start date
BigStu81
New member
Have emailed the NHS England complaints team stating that I'm disappointed that I've been fobbed off despite my results being within the range that many NHS trusts will investigate and treat (and linking them to an NHS guidelines doc which states that 'borderline' patients should be investigated for TRT if 'young' and exhibiting symptoms). The document said that <7nmol is hypergonadal and that 8-12nmol is also a possible candidate and should be retested.
I doubt it will get much attention but may put me in a better position to request that they treat me once I've got the right treatment in place with a private doc.
Have deleted from above as maybe better not to have it on the internet for now (I mentioned that I'd spoken to a lot of people with same condition online and wouldn't want some smartass doc googling it and then fobbing me off for taking advice from 'steroid abuse' sites or something - I'm probs just being paranoid).
I doubt it will get much attention but may put me in a better position to request that they treat me once I've got the right treatment in place with a private doc.
Have deleted from above as maybe better not to have it on the internet for now (I mentioned that I'd spoken to a lot of people with same condition online and wouldn't want some smartass doc googling it and then fobbing me off for taking advice from 'steroid abuse' sites or something - I'm probs just being paranoid).
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BigStu81
New member
Ok guys, need some advice now...
Going to book an appt with my GP and show him the following:
Shared Care Guideline for Testosterone Supplementation (this is published by the NHS so will be hard to dispute)
- <8nmol/l is consistent with a diagnosis of hypogonadism
- 8-12nmol/l could be hypogonadal and can be considered for a trial of testosterone replacement therapy (TRT). Hypogonadism is more likely to be present with a testosterone <10.4nmol/l.
- >12nmol/l subject is not hypogonadal.
barnsleyccg.nhs.uk/CCG%20Downloads/Members/Medicines%20management/Shared%20care/Testosterone_SCG_Nov_12_monitoringupdateDec12.doc
Testosterone deficiency in the younger patient
(Published by a specialist who consults for the NHS and has run a sexual dysfunction clinic for 25 years)
I am seeing an increasing number of young apparently 'healthy men' with symptoms of low testosterone and borderline levels - i.e. below 12 nanomoles per litre but not as low as 8 which has traditionally been the level that doctors will recognise the problem and proceed to treat.
I sadly see many young men who have been diagnosed incorrectly as suffering from stress or depression as a cause of their symptoms, when the problem is actually due to testosterone deficiency.
One of the main problems is when a GP orders a blood test. The 'normal'range is given as 8-30 nmol/L by the lab, this is without any mention of age or symptoms, therefore making it likely that the patient will be 'dismissed' as having a normal level. This is despite the fact that there are now several guidelines including the latest which has just been revealed from the International Society of Sexual Medicine which states that a level between 8-12 warrants investigation for treatment.
For many men with symptoms of testosterone deficiency confirmed by low levels - under 12 - it is not always clear why this occurs, but of course I will search for plausible causes through the use of my medical history taking examination and also relevant blood tests.
I actually believe that testosterone deficiency - like underactive thyroid - is a quite common condition and as we say, common things occur commonly.
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I also have several clinical studies placing my level marginally below that the the average bracket for 85-100 years olds.
Going to book an appt with my GP and show him the following:
Shared Care Guideline for Testosterone Supplementation (this is published by the NHS so will be hard to dispute)
- <8nmol/l is consistent with a diagnosis of hypogonadism
- 8-12nmol/l could be hypogonadal and can be considered for a trial of testosterone replacement therapy (TRT). Hypogonadism is more likely to be present with a testosterone <10.4nmol/l.
- >12nmol/l subject is not hypogonadal.
barnsleyccg.nhs.uk/CCG%20Downloads/Members/Medicines%20management/Shared%20care/Testosterone_SCG_Nov_12_monitoringupdateDec12.doc
Testosterone deficiency in the younger patient
(Published by a specialist who consults for the NHS and has run a sexual dysfunction clinic for 25 years)
I am seeing an increasing number of young apparently 'healthy men' with symptoms of low testosterone and borderline levels - i.e. below 12 nanomoles per litre but not as low as 8 which has traditionally been the level that doctors will recognise the problem and proceed to treat.
I sadly see many young men who have been diagnosed incorrectly as suffering from stress or depression as a cause of their symptoms, when the problem is actually due to testosterone deficiency.
One of the main problems is when a GP orders a blood test. The 'normal'range is given as 8-30 nmol/L by the lab, this is without any mention of age or symptoms, therefore making it likely that the patient will be 'dismissed' as having a normal level. This is despite the fact that there are now several guidelines including the latest which has just been revealed from the International Society of Sexual Medicine which states that a level between 8-12 warrants investigation for treatment.
For many men with symptoms of testosterone deficiency confirmed by low levels - under 12 - it is not always clear why this occurs, but of course I will search for plausible causes through the use of my medical history taking examination and also relevant blood tests.
I actually believe that testosterone deficiency - like underactive thyroid - is a quite common condition and as we say, common things occur commonly.
------------------------------------------------------------------------------------------------
I also have several clinical studies placing my level marginally below that the the average bracket for 85-100 years olds.
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BigStu81
New member
I'm confident he may offer a referral but have a few concerns:
- I've read of many endocrinologists who have stubbornly refused to treat people above the 200 range, even after referral from GP. Am I better to go private and then come back armed with a letter from private doctor?
- Will NHS be unlikely to prescribe an aromatase inhibitor? I've heard of people just being given test and nothing else, and others having to really fight to also have an AI or having the NHS try to withdraw it on suspected basis of cost.
- If NHS refuse to treat, will this make it harder to get a private prescription?
- How likely are they to seriously consider a private doc's recommendation?
- What should I be looking at treatment-wise? Testosterone, AI, HCG???
- How quickly might my sex drive improve?
I don't mind paying to expedite the process for several reasons. Firstly, I've just found out my job may be at risk due to company restructure. I feel I'm fairly safe as bid management is already fairly stretched compared to HR etc. But if I have to competitively reapply for my job I want to have all my energy etc and not be underperforming due to fatigue.
Secondly, I may still be able to rekindle my relationship - we 'put it on hold' for a few weeks due to me moving house and being really busy etc (she thought stress was causing my lack of sex drive) and I haven't picked it back up after six weeks - I'd rather she put it down to stress than think I'm impotent and maybe tell the other girls we work with (my colleagues are mainly female). If I can get my mojo back then there still may be a chance to resolve things as she's still flirting hard.
- I've read of many endocrinologists who have stubbornly refused to treat people above the 200 range, even after referral from GP. Am I better to go private and then come back armed with a letter from private doctor?
- Will NHS be unlikely to prescribe an aromatase inhibitor? I've heard of people just being given test and nothing else, and others having to really fight to also have an AI or having the NHS try to withdraw it on suspected basis of cost.
- If NHS refuse to treat, will this make it harder to get a private prescription?
- How likely are they to seriously consider a private doc's recommendation?
- What should I be looking at treatment-wise? Testosterone, AI, HCG???
- How quickly might my sex drive improve?
I don't mind paying to expedite the process for several reasons. Firstly, I've just found out my job may be at risk due to company restructure. I feel I'm fairly safe as bid management is already fairly stretched compared to HR etc. But if I have to competitively reapply for my job I want to have all my energy etc and not be underperforming due to fatigue.
Secondly, I may still be able to rekindle my relationship - we 'put it on hold' for a few weeks due to me moving house and being really busy etc (she thought stress was causing my lack of sex drive) and I haven't picked it back up after six weeks - I'd rather she put it down to stress than think I'm impotent and maybe tell the other girls we work with (my colleagues are mainly female). If I can get my mojo back then there still may be a chance to resolve things as she's still flirting hard.
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If you're looking for more light reading on diagnosing hypogonadism:
http://www.menshealthboston.com/pdf/2011_Testosterone-Deficiency.pdf
http://www.menshealthboston.com/pdf...ynthesis-of-International-Expert-Opinions.pdf
These contain opinions from endocrinologists and andrologists, rather than random people off the Internet.
It's probably worth getting your free testosterone or SHBG checked, and in any case you might want to check levels first thing in the morning.
http://www.menshealthboston.com/pdf/2011_Testosterone-Deficiency.pdf
http://www.menshealthboston.com/pdf...ynthesis-of-International-Expert-Opinions.pdf
These contain opinions from endocrinologists and andrologists, rather than random people off the Internet.
It's probably worth getting your free testosterone or SHBG checked, and in any case you might want to check levels first thing in the morning.
BigStu81
New member
Been over at ukmuscle and everybody there is telling me to self administer. Said most clinics are a rip off (although I've read that the Leger Clinic is one of the best and cheapest in UK). I'm wary of this as I've never done a cycle and am not very knowledgeable. Also, there's a lot of conflicting info online.
Am I worrying too much? I feel like I'd prefer to have an expert on hand to discuss side effects etc...
Am I worrying too much? I feel like I'd prefer to have an expert on hand to discuss side effects etc...
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If you're looking for more light reading on diagnosing hypogonadism:
http://www.menshealthboston.com/pdf/2011_Testosterone-Deficiency.pdf
http://www.menshealthboston.com/pdf...ynthesis-of-International-Expert-Opinions.pdf
These contain opinions from endocrinologists and andrologists, rather than random people off the Internet.
It's probably worth getting your free testosterone or SHBG checked, and in any case you might want to check levels first thing in the morning.
The first link is from Dr Abraham Morgentaler. I consider him the foremost expert on TRT in the world.
BigStu81
New member
Thanks, I've printed the flow chart off to show to my GP. Although I'm obviously in a different country it should still compound the NHS guideline doc I've got which says 8-12 nmol should be investigated.
Decided I'm defo going to go see the Leger Clinic. I'm not comfortable with self-administering just yet. For starters, I don't even know where I'd get the gear. It's legal to own for self administration here in the UK, but you can't import it and don't think it's even legal to buy it online (although I could be wrong about this last bit).
Decided I'm defo going to go see the Leger Clinic. I'm not comfortable with self-administering just yet. For starters, I don't even know where I'd get the gear. It's legal to own for self administration here in the UK, but you can't import it and don't think it's even legal to buy it online (although I could be wrong about this last bit).
BigStu81
New member
Quick update...
Booked in with Doug Savage's asst for a callback to get appt. Also went back to my GP today armed with all the info above (NHS guidelines, printoff from Leger Clinic website about GPs often misdiagnosing as depression). He was very receptive and said "you've obviously got more time to research this than me."
I was honest about my plans to see Dr Savage but said I was also worried about the possibility of losing my job having just started private treatment - what if I had to stop treatment just as things were improving and then go for job interviews feeling even worse than before? Explained possibility of rekindling relationship too.
I also mentioned that I'd found Geoff Hackett who is only halfhour away and would've gone to see him if it weren't for the fact that his private consultations are through Spire who look expensive. My GP said "ok, go and see this Doug Savage and get him to write to me. If it looks reasonable we'll refer you to Geoff Hackett on the NHS or if not to another sexual medicine expert." He said that a lot of people do it this way initially to get things moving (I said "oh really, I didn't know that" haha).
So things are looking promising. My only thoughts are whether I'll be likely get a referral to a consultant 30 mins away - I'm near Halesowen and he's in Sutton Coldfield. I wouldn't want to get referred to some muppet endo instead who doesn't treat people above 200ng/dl. I asked whether I'd likely be able to get a referral to Hackett and he said there are lots of knowledgable guys in the NHS but maybe get Savage to suggest it in his letter. I know Dr Savage has written to people's GPs before, but would he be so keen to do so if it meant losing a private patient to another consultant? I don't know whether he would normally stay as the consultant after one's GP agrees to comply or whether it would be transferred to somebody more local...?
Booked in with Doug Savage's asst for a callback to get appt. Also went back to my GP today armed with all the info above (NHS guidelines, printoff from Leger Clinic website about GPs often misdiagnosing as depression). He was very receptive and said "you've obviously got more time to research this than me."
I was honest about my plans to see Dr Savage but said I was also worried about the possibility of losing my job having just started private treatment - what if I had to stop treatment just as things were improving and then go for job interviews feeling even worse than before? Explained possibility of rekindling relationship too.
I also mentioned that I'd found Geoff Hackett who is only halfhour away and would've gone to see him if it weren't for the fact that his private consultations are through Spire who look expensive. My GP said "ok, go and see this Doug Savage and get him to write to me. If it looks reasonable we'll refer you to Geoff Hackett on the NHS or if not to another sexual medicine expert." He said that a lot of people do it this way initially to get things moving (I said "oh really, I didn't know that" haha).
So things are looking promising. My only thoughts are whether I'll be likely get a referral to a consultant 30 mins away - I'm near Halesowen and he's in Sutton Coldfield. I wouldn't want to get referred to some muppet endo instead who doesn't treat people above 200ng/dl. I asked whether I'd likely be able to get a referral to Hackett and he said there are lots of knowledgable guys in the NHS but maybe get Savage to suggest it in his letter. I know Dr Savage has written to people's GPs before, but would he be so keen to do so if it meant losing a private patient to another consultant? I don't know whether he would normally stay as the consultant after one's GP agrees to comply or whether it would be transferred to somebody more local...?
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halfwit
I like turtles.
That's great that things are starting to fall in line for you. Sadly, it's just about being persistent and sticking to your guns.
You'll be a new man in no time!
Men's Health Boston is run by Dr. Morgentaler, and I pulled down both the papers from their research and publications page. He's a co-author on the second as well. There are a few more bits and pieces here:
Publications
BigStu81 I'd suggest looking into both depression and hypogonadism as potential problems. There is a relationship between them, and I recall reading that low free T can lead to mood disorders. I think that there's a tendency on boards like this to see all health problems as being hormonal, but it's often not as simple as all that.
That said, low T can exacerbate problems with loss of libido on SSRIs. So you might want to bear that in mind if your doctor offers them to you. The best treatment for depression is talking therapies, such as CBT.
Take a look at BigNoKnow's YouTube channel, as he suffers both.
https://www.youtube.com/user/bignoknow
Depression can cause impotence and loss of libido. But it can also cause you to think that it's a bigger issue than it is. I'd second your doctor's suggestion of explaining the problems you're having, and having a relationship might actually shore up your mood.
Good luck. The NHS isn't the most efficient of providers, so it can be slow to get something out of them.