Talking to my PCP about TRT

[MeanGreen]

Last December, I asked my PCP to include a hormone panel on the bloodwork for my annual check-up. He does and I paid for that part out-of-pocket. During the physical he tells me that my test, while low, is fine (as it seems all doctors do).

As time goes by I notice I am more achy, tired, moody, easily irritated, trouble focusing. Poor sleep.

This summer I started experiencing ED issues with staying hard and climaxing (not getting hard) while having sex with wife. Called the PCP and he gives me a prescription for Viagra.

This month, I decided to get tested by a wellness clinic. They find my TT at 360 and of course want to start me on a protocol or 200mg test cyp, hcg and ai. I am currently seriously contemplating it.

I have my next annual check up in December (about 2 months away).

I am wondering if I should wait for my next check-up (including bloodwork with hormone panel again), and discuss my intentions of going on TRT (bringing my lab results from this month in with me).

From having him as my PCP for a number of years, I imagine he will try to talk me out of it.

 

[Mprtz]

I'd certainly re-test and make sure it's in the morning. Your T isn't that low... going on TRT is tempting but consider the commitment you're making... how old are you?

If you go on TRT with a clinic and against your PCPs advice, you will always have that in the back of your mind. There is potential for regret once the novelty wears off, especially if you have problems and on 200mg per week it's very possible to start having problems (though this is of course an individual thing).

Usually T has to be quite low (a lot lower than yours) to result in ED. What if you go on TRT and it doesn't fix your problems? I'm not trying to talk you out of it, just make sure you're doing it for the right reasons and with your eyes wide open - especially if you're on the younger side (under 50 from my perspective).


Just my $0.2

 

[cybrsage]

Going on TRT did not fix my ED issues, which are the same as yours. I would, at times, be at the brink of ejaculation and it would be as if a switch turned off and it would suddenly go soft. Quite frustrating. I would ask him to move you to Cialis. Tell him it both lasts longer than Viagra, meaning you can be ready at any time in the next two days AND it helps lower blood pressure, so you would like to try it. While it helps me some, it is not enough. I need to be on TRT to give me the desire for sex, Cialis to make me physically able to have sex, and take PT-141 (a peptide) to energize the electrical pathways to allow the process to proceed normally from start to end. Sometimes that does not even work, so I am looking into the psychological side of things as well.

Your test level is highest first thing in the morning, so a 360 could be below 300 by evening. Still, do a lot more talking to your doctor because once you go on TRT it is for life.

 

[MeanGreen]

I'd certainly re-test and make sure it's in the morning. Your T isn't that low... going on TRT is tempting but consider the commitment you're making... how old are you?

If you go on TRT with a clinic and against your PCPs advice, you will always have that in the back of your mind. There is potential for regret once the novelty wears off, especially if you have problems and on 200mg per week it's very possible to start having problems (though this is of course an individual thing).

Usually T has to be quite low (a lot lower than yours) to result in ED. What if you go on TRT and it doesn't fix your problems? I'm not trying to talk you out of it, just make sure you're doing it for the right reasons and with your eyes wide open - especially if you're on the younger side (under 50 from my perspective).


Just my $0.2

I'm 45. Your response is exactly what I've been thinking about lately in contemplating this decision.

 

[MeanGreen]

Going on TRT did not fix my ED issues, which are the same as yours. I would, at times, be at the brink of ejaculation and it would be as if a switch turned off and it would suddenly go soft. Quite frustrating. I would ask him to move you to Cialis. Tell him it both lasts longer than Viagra, meaning you can be ready at any time in the next two days AND it helps lower blood pressure, so you would like to try it. While it helps me some, it is not enough. I need to be on TRT to give me the desire for sex, Cialis to make me physically able to have sex, and take PT-141 (a peptide) to energize the electrical pathways to allow the process to proceed normally from start to end. Sometimes that does not even work, so I am looking into the psychological side of things as well.

Your test level is highest first thing in the morning, so a 360 could be below 300 by evening. Still, do a lot more talking to your doctor because once you go on TRT it is for life.

Yeah I was tested first thing in the morning. I'm going to go again though soon.

What do you mean by PT-141 to energize the electrical pathways to allow the process to proceed normally from start to end?
Kinda lost me there.

 

[2knives]

Sometimes it is as simple as going to the gym with your bride and training with her.
Or doing some sort of thing that is exciting.
The same old same will not be mentally or physically stimulating.
It might be as simple as that.

 

[Virginian]

I would look for and try other alternatives before starting TRT. It becomes a hassle after a while with frequent injections, doctor visits, and labwork and it may not solve your problems. Also, once you start your natural T production could be shut down forever meaning there is no backing out if you find it doesn't work for you.

That said, I am on TRT and I love it. I started 2 years ago (at age 70) with a T level of about 270. With TRT I have greater muscle size and strength, less fat, and more energy. I also moved out of osteoporosis, which was my doctor's reason for suggesting it. I am not sure it did much for me sexually. Possibly a little greater interest, possibly not.

I would also be careful about TRT clinics. They are expensive and just want your money. A starting dose of 200mg/week is a lot unless you are a really big guy.

 

[cybrsage]

What do you mean by PT-141 to energize the electrical pathways to allow the process to proceed normally from start to end?
Kinda lost me there.

I stole this directly from RUI:

PT-141 (Bremelanotide) is an analog of a Melanotan peptide chain and has been found to not just increase blood flow to genital areas but also to have libido enhancing qualities as well. This compound is being researched for the possibility to treat not just erectile disorders, but sexual arousal dysfunction as well. There has not been a peptide (or any compound for that matter) to have been found so promising in raising sexual arousal in male AND female test subjects, until now.
iPT-141 10mg

From Wikipedia:

Unlike sildenafil (Viagra) and other related medications, it does not act upon the vascular system, but directly increases sexual desire via acting in the brain.

Bremelanotide appears to stimulate sexual desire and arousal completely or mostly via activation of the MC4 receptor (the MC3 receptor may also be involved). It modulates inflammation and limits ischemia via activation of the MC1 and MC4 receptors.

According to Palatin Technologies' original 2003 patent for bremelanotide, it possesses approximately 50 times the potency of melanotan II as an inducer of erection in male rats.

https://en.wikipedia.org/wiki/Bremelanotide

 

[MeanGreen]

I stole this directly from RUI:

PT-141 (Bremelanotide) is an analog of a Melanotan peptide chain and has been found to not just increase blood flow to genital areas but also to have libido enhancing qualities as well. This compound is being researched for the possibility to treat not just erectile disorders, but sexual arousal dysfunction as well. There has not been a peptide (or any compound for that matter) to have been found so promising in raising sexual arousal in male AND female test subjects, until now.
iPT-141 10mg

From Wikipedia:


https://en.wikipedia.org/wiki/Bremelanotide

Wiki says it has been developed for female sexual dysfunction, but I can see how it would held a male as well. At this point, is it prescribable by a doctor?

 

[MeanGreen]

Well, I made an appointment to see my PCP on Tuesday.

Gonna lay it all on the line with him. Describe all my symptoms, show him my
labs from Oct 1st (from wellness clinic). Tell him I'm considering TRT and see what he says.

I won't tell him just yet that I've met with a wellness clinic and they have suggested
a TRT protocol.

I'll wait to see how he reacts first.

 

[MeanGreen]

UPDATE: So I went to my PCP. Told him all my symptoms and waited to see what he would say. He suggested they could be "caused by a number of things including lyme disease, hormones, sleep apna...." He orders a bloodtest, which I went in for the next morning. He calls me this afternoon to say all tests came back normal and that my TT is 576, almost the same as last year. WTF?!?

How can my TT be 360 on Oct 1st and 576 on Oct 21st?? Is that even possible?

Both were done at 8:50am. I fasted for the first one which was much more extensive. PCP said I didn't have to fast for his which shows TT only.

Btw, I haven't showed my PCP the bloodtest showing 360 yet. Plan on asking him these same questions.

 

[AverageMan]

UPDATE: So I went to my PCP. Told him all my symptoms and waited to see what he would say. He suggested they could be "caused by a number of things including lyme disease, hormones, sleep apna...." He orders a bloodtest, which I went in for the next morning. He calls me this afternoon to say all tests came back normal and that my TT is 576, almost the same as last year. WTF?!?

How can my TT be 360 on Oct 1st and 576 on Oct 21st?? Is that even possible?

Both were done at 8:50am. I fasted for the first one which was much more extensive. PCP said I didn't have to fast for his which shows TT only.

Btw, I haven't showed my PCP the bloodtest showing 360 yet. Plan on asking him these same questions.

Your Dr is correct - you don't need to fast for a testosterone test.

I had 3 Testosterone tests - 2 were close to the same value (170-190) and one was over 100 points higher (303). Your natural T does fluctuate a bit and depends on a number of factors (quality of sleep, physical fitness level, diet, etc.).

For me, the really ironic point was my lowest T number was after starting Androgel. The dr was baffled and switched me to Cypionate shots.

 

[MeanGreen]

Your Dr is correct - you don't need to fast for a testosterone test.

I had 3 Testosterone tests - 2 were close to the same value (170-190) and one was over 100 points higher (303). Your natural T does fluctuate a bit and depends on a number of factors (quality of sleep, physical fitness level, diet, etc.).

For me, the really ironic point was my lowest T number was after starting Androgel. The dr was baffled and switched me to Cypionate shots.

Unfortunately, my fluctuation goes from borderline low T 360 to mid range 576 no need for TRT. Don't know how to proceed. Ugh!

 

[Therealkozmo]

where is your sleep study?
diet and stress and emotional issues lower testosterone
overtraining can cause these issues.
Look into that..I know it can feel hard to change your lifestyle for health however it is sometimes needed

 

[MeanGreen]

where is your sleep study?
diet and stress and emotional issues lower testosterone
overtraining can cause these issues.
Look into that..I know it can feel hard to change your lifestyle for health however it is sometimes needed

Diet is on point. Eating clean 6 meals per day at maintenance. Training is on point. Heavy split routine 5 on/2 off. Job is not stressful. Only lifestyle change I can think of is a divorce. Lol!

Doc suggested sleep study next. I get about 7-8 hours per day, although mattress is old and I toss and turn a lot. Can sleep issues really sway T levels 210 points?

 

[cybrsage]

Wiki says it has been developed for female sexual dysfunction, but I can see how it would held a male as well. At this point, is it prescribable by a doctor?

No, and it is not legal for human consumption either. It IS legal to buy and possess, though.