T Nation

28 y/o Low T. Doctor wants more bloodwork.


#1

In your case/thread opening post:
-age 28
-height 5'11
-waist 33
-weight 185
-describe body and facial hair Normal
-describe where you carry fat and how changed No fat just some around midsection
-health conditions, symptoms [history] No health symptoms except fatigue, absolutely no libido, lack of energy, no desire to workout.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever Never been prescribed anything
-lab results with ranges
-describe diet I eat a high protein, complex carb and moderate fat diet.
-describe training I train 2/3 times per week, 1/2 other days of cardio. Basic weight lifting routines.

Over the past few years my sex drive really started to go down. It really affects my sex life and everything going on motivation wise. I stopped getting morning erections, had really no desire whatsoever for sex and a lack of wanting to go out and take on the world if you will.

I went to my primary doctor to discuss this, we agreed on having bloodwork drawn regarding testosterone.

HEMOGLOBIN A1C 4.0 - 6.0 % 4.9
WHITE BLOOD CELL 4.5 - 11.0 x10 3/uL 6.2
RED BLOOD CELL 4.50 - 6.00 x10 6/uL 4.79
HEMOGLOBIN 13.9 - 16.3 G/DL 14.0
HEMATOCRIT 42.0 - 52.0 % 41.5
T4, FREE 0.60 - 1.10 NG/DL 1.49
T3, TOTAL 87 - 178 NG/DL 69
TBG 14.5 - 32.0 MCG/ML 3.5
TESTOSTERONE 170.00 - 780.00 NG/DL 35.82

With these results I was sent to a urologist within the practice for further evaluation.

Today I visited this doctor, I tried speaking about treatment and what options I have, he said he will not talk treatment with me and wants to re do blood work. I explained I already had the same tests he wants done a month ago but he wants it to happen again. I felt the doctor was very prejudice towards me because I'm not an older man and I'm a younger person who is in decent shape. The doctor then asked me a few weird questions such as " have you ever bought steroids from someone sketchy in the corner of a gym"? I felt insulted, I called my primary doctor who is helpful but doesn't know much about hormones and she suggested I get the bloodwork and report back to her.

I feel like I'm being jerked around, the urologist wanted blood work and an MRI of my thyroid I believe. I'd really prefer not to wait 2 months between appts and not pay for all this blood work. Is this common? Or should I see someone else who will help?

Thanks guys.


#2

[quote]warren123 wrote:
In your case/thread opening post:
-age 28
-height 5’11
-waist 33
-weight 185
-describe body and facial hair Normal
-describe where you carry fat and how changed No fat just some around midsection
-health conditions, symptoms [history] No health symptoms except fatigue, absolutely no libido, lack of energy, no desire to workout.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever Never been prescribed anything
-lab results with ranges
-describe diet I eat a high protein, complex carb and moderate fat diet.
-describe training I train 2/3 times per week, 1/2 other days of cardio. Basic weight lifting routines.

Over the past few years my sex drive really started to go down. It really affects my sex life and everything going on motivation wise. I stopped getting morning erections, had really no desire whatsoever for sex and a lack of wanting to go out and take on the world if you will.

I went to my primary doctor to discuss this, we agreed on having bloodwork drawn regarding testosterone.

HEMOGLOBIN A1C 4.0 - 6.0 % 4.9
WHITE BLOOD CELL 4.5 - 11.0 x10 3/uL 6.2
RED BLOOD CELL 4.50 - 6.00 x10 6/uL 4.79
HEMOGLOBIN 13.9 - 16.3 G/DL 14.0
HEMATOCRIT 42.0 - 52.0 % 41.5
T4, FREE 0.60 - 1.10 NG/DL 1.49
T3, TOTAL 87 - 178 NG/DL 69
TBG 14.5 - 32.0 MCG/ML 3.5
TESTOSTERONE 170.00 - 780.00 NG/DL 35.82

With these results I was sent to a urologist within the practice for further evaluation.

Today I visited this doctor, I tried speaking about treatment and what options I have, he said he will not talk treatment with me and wants to re do blood work. I explained I already had the same tests he wants done a month ago but he wants it to happen again. I felt the doctor was very prejudice towards me because I’m not an older man and I’m a younger person who is in decent shape. The doctor then asked me a few weird questions such as " have you ever bought steroids from someone sketchy in the corner of a gym"? I felt insulted, I called my primary doctor who is helpful but doesn’t know much about hormones and she suggested I get the bloodwork and report back to her.

I feel like I’m being jerked around, the urologist wanted blood work and an MRI of my thyroid I believe. I’d really prefer not to wait 2 months between appts and not pay for all this blood work. Is this common? Or should I see someone else who will help?

Thanks guys.[/quote]

Just judging by your description, not only are you being jerked around by this guy, but you will continue to be. Doc’s can be real dicks. Honestly, that’s why I’ve started to do it on my own. I just don’t want to deal with the F’n attitudes. I just want to feel like I should. They act like that’s some sort of a crime.

Keep looking, but url’s and endo’s do not have a good reputation.


#3

[quote]Fat Boy 33 wrote:

[quote]warren123 wrote:
In your case/thread opening post:
-age 28
-height 5’11
-waist 33
-weight 185
-describe body and facial hair Normal
-describe where you carry fat and how changed No fat just some around midsection
-health conditions, symptoms [history] No health symptoms except fatigue, absolutely no libido, lack of energy, no desire to workout.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever Never been prescribed anything
-lab results with ranges
-describe diet I eat a high protein, complex carb and moderate fat diet.
-describe training I train 2/3 times per week, 1/2 other days of cardio. Basic weight lifting routines.

Over the past few years my sex drive really started to go down. It really affects my sex life and everything going on motivation wise. I stopped getting morning erections, had really no desire whatsoever for sex and a lack of wanting to go out and take on the world if you will.

I went to my primary doctor to discuss this, we agreed on having bloodwork drawn regarding testosterone.

HEMOGLOBIN A1C 4.0 - 6.0 % 4.9
WHITE BLOOD CELL 4.5 - 11.0 x10 3/uL 6.2
RED BLOOD CELL 4.50 - 6.00 x10 6/uL 4.79
HEMOGLOBIN 13.9 - 16.3 G/DL 14.0
HEMATOCRIT 42.0 - 52.0 % 41.5
T4, FREE 0.60 - 1.10 NG/DL 1.49
T3, TOTAL 87 - 178 NG/DL 69
TBG 14.5 - 32.0 MCG/ML 3.5
TESTOSTERONE 170.00 - 780.00 NG/DL 35.82

With these results I was sent to a urologist within the practice for further evaluation.

Today I visited this doctor, I tried speaking about treatment and what options I have, he said he will not talk treatment with me and wants to re do blood work. I explained I already had the same tests he wants done a month ago but he wants it to happen again. I felt the doctor was very prejudice towards me because I’m not an older man and I’m a younger person who is in decent shape. The doctor then asked me a few weird questions such as " have you ever bought steroids from someone sketchy in the corner of a gym"? I felt insulted, I called my primary doctor who is helpful but doesn’t know much about hormones and she suggested I get the bloodwork and report back to her.

I feel like I’m being jerked around, the urologist wanted blood work and an MRI of my thyroid I believe. I’d really prefer not to wait 2 months between appts and not pay for all this blood work. Is this common? Or should I see someone else who will help?

Thanks guys.[/quote]

Just judging by your description, not only are you being jerked around by this guy, but you will continue to be. Doc’s can be real dicks. Honestly, that’s why I’ve started to do it on my own. I just don’t want to deal with the F’n attitudes. I just want to feel like I should. They act like that’s some sort of a crime.

Keep looking, but url’s and endo’s do not have a good reputation.
[/quote]

Thanks bud, it’s just been discouraging with this whole process.


#4

It’s entirely appropriate for the doc to want another set of labs. It’s also appropriate for him to ask about exogenous AAS use. Finally, as your thyroid labs are abnormal, it’s appropriate for him to consider further workup for this.

He is a physician, not a dealer. It is to his credit that he wants to do an appropriate evaluation rather than simply handing you a script and pushing you out the door (which is what many of the so-called ‘good’ TRT docs do). If you want the benefit of his expertise, you need to allow him to proceed as he sees best. If not, you can always just buy stuff from someone sketchy in the corner of a gym.


#5

[quote]EyeDentist wrote:
It’s entirely appropriate for the doc to want another set of labs. It’s also appropriate for him to ask about exogenous AAS use. Finally, as your thyroid labs are abnormal, it’s appropriate for him to consider further workup for this.

He is a physician, not a dealer. It is to his credit that he wants to do an appropriate evaluation rather than simply handing you a script and pushing you out the door (which is what many of the so-called ‘good’ TRT docs do). If you want the benefit of his expertise, you need to allow him to proceed as he sees best. If not, you can always just buy stuff from someone sketchy in the corner of a gym.[/quote]

If the doctor wants to know about exogenous AAS use, then why doesn’t he just ask it in that way? It’s not a tough question, “Have you ever used exogenous testosterone or ‘performance’ steroids?” There, that wasn’t too tough, was it? No, though, that’s not how they go about it. They have this somewhat bizarre paternal/judgmental mindset. So they ask about someone ‘sketchy’ in the corner of a gym.

If he has questions about possible thyroid issues, then let’s frame it as that. We know that we need to address all of the different systems. Let’s just have a decent conversation on the matter.

Few of us go to a doctor looking for a drug dealer. What we go to a doctor for is because we know we aren’t feeling how we should. So you take some tests and (in my case) the doctor says, “Hey, you’re good! Your total Test is 290 and that’s in range.”

When I push further, I get, “Well, do you have ED? Are you constantly depressed?” No, I don’t have ED, and, in general, I’m a fairly positive person. “Well”, he says, “We treat the patient, we don’t treat the number.”

Bullshit. If my blood pressure was 190/120, you bet your ass they’d be treating the number. If my HbA1c was 10.0 and fasting blood glucose was 150, they’d treat the number. If my cholesterol was 300, regardless of how ‘good’ I felt, he’d be pushing a statin on me. The whole idea of having the numbers there lends itself to the concept that there are ‘better’ and ‘worse’. Testosterone is just something that they’ve set the bars so wide on as to make it nearly meaningless.

Like I said, I’m a fairly positive person, but when my T is up, I feel better. It’s not that I feel ‘bad’ before, but I feel ‘good’ when it’s higher. Why is that such a difficult concept to deal with? Call it a placebo, call it anecdotal, call it clinical evidence…I don’t care what you call it. What I call it is a way for me to be a better husband, a stronger man, and a more pleasant person to be around.

What does my doctor question? Well, he has philosophical questions as to whether or not he ‘should’ help a middle-aged guy feel younger. “Aches and pains are part of getting older and it’s not really my job to try to change that.” Yes, that’s almost an exact quote. Yet, if I went in there and said my dick didn’t work and I was depressed, he’d have no issue stuffing me full of Viagra and Zoloft.


#6

Labs: Its good to know that you are not been misled by a lab error in this situation.

More labs:
TT
FT
E2
prolactin
AST/ALT <<<<<<<<<< NO NOT START TRT BEFORE THIS, determine if primary or secondary hypogonadism
TSH
fT3 [not T3]
fT4 [not T4]

Blood seems thin: Get an occult blood test to rule in/out a GI bleed.

Thyroid: You can get an accurate measure of your overall thyroid function by checking your body temperatures. Check when you first wake up AND mid-afternoon. If you have not been continuously been using iodized salt, an iodine deficiency can lead to thyroid hormone problems.

Total T3 is low and so is TBG. Your metabolic rate is controlled by how much fT3 gets into your cells. We have no idea what your fT3 and fT4 levels are.

Collective experience here is that urologists are very useless at TRT and many endo’s are also useless. We often use the term “idiots”. So you may need to read the ‘finding a TRT doc’ sticky, there are 7 stickies in all. You were referred to the urologist for business reasons, not because of skills or expertise.


#7

[quote]Fat Boy 33 wrote:

If the doctor wants to know about exogenous AAS use, then why doesn’t he just ask it in that way? It’s not a tough question, “Have you ever used exogenous testosterone or ‘performance’ steroids?” There, that wasn’t too tough, was it? No, though, that’s not how they go about it. They have this somewhat bizarre paternal/judgmental mindset. So they ask about someone ‘sketchy’ in the corner of a gym.
[/quote]

Agree that it’s unnecessary (and counter-productive) for a doctor to ask questions in a manner that comes across as judgmental and/or insulting. (Some folks have poor people-skills, and docs are no exception.)

Not sure to whom you’re referring by ‘us,’ but on this subforum the prevailing attitude is that most doctors (aka “idiots”) are an inconvenience at best, and a necessary evil at worst. Most posters here are counseled to insist their doctor draw certain labs, and to demand that specific drugs (with particular dosing parameters) be prescribed. If the “idiot” won’t comply, posters are urged to doctor-shop until they find one who will. And a doctor who simply gives a pt what s/he wants meets my definition of a dealer.

Symptoms are not included in the diagnostic/treatment criteria for essential HTN, diabetes and/or hypercholesterolemia because they (symptoms) are not relevant to the disease process (until/unless the process is very advanced). OTOH, symptoms ARE a part of the diagnostic/treatment criteria for hypogonadism–they ARE relevant to determining whether the disease is present in a particular individual. And by what currently is considered the standard of care, ‘I want to feel younger’ is not one of those diagnostic criteria. Neither is ‘I feel better when I’m on it.’

There are many drugs that produce an enhanced sense of well-being. Should ‘I feel better when I’m on it’ be considered legitimate as a sole diagnostic criteria for all of them?

[quote]
What does my doctor question? Well, he has philosophical questions as to whether or not he ‘should’ help a middle-aged guy feel younger. “Aches and pains are part of getting older and it’s not really my job to try to change that.” Yes, that’s almost an exact quote. Yet, if I went in there and said my dick didn’t work and I was depressed, he’d have no issue stuffing me full of Viagra and Zoloft. [/quote]

To the contrary, if you went in and said ‘I have ED, and I’m depressed,’ and your T levels were low, most docs would be happy to consider TRT.

But as mentioned above, ‘I want to feel younger/better’ is not among the criteria needed to establish a diagnosis of clinical hypogonadism. Further, if the I-want-to-feel-younger/better pt’s T level falls within the normal range, prescribing TRT becomes even more problematic from the physician’s perspective. A physician can lose his/her license if the medical board finds that s/he is prescribing test (or any other med) inappropriately.

In short, a reluctance to prescribe TRT to individuals who do not meet established criteria for hypogonadism has a lot more underlying it than mere ‘philosophical concerns.’


#8

“‘I want to feel younger/better’” means someone is feeling old with low energy. A good diagnostician would pick up on that and ask questions to get more specific information.

Warren,

HEMOGLOBIN 13.9 - 16.3 G/DL 14.0 <-- looking low
HEMATOCRIT 42.0 - 52.0 % 41.5 <-- low for a male
T4, FREE 0.60 - 1.10 NG/DL 1.49 <-- is high or range not correct?
T3, TOTAL 87 - 178 NG/DL 69 <-- LOW!!!

Please see my prior post with other concerns.

===
nice hijack guys!


#9

[quote]EyeDentist wrote:

BLAH, BLAH, BLAH, BLAH, BLAH…

[/quote]

Without going into too much detail, I had a big health issue I was born with. At the age of 37 I had to have a big surgery to take care of it. At the time, the doctors asked me, “Are you showing any signs of this problem?” and they listed several things. I didn’t have any of them. The ‘numbers’ were completely out of whack, though, so I had the surgery. Now that I’ve had the surgery, I’ve realized things that I thought were ‘normal’ were actually signs of my serious problem. I just didn’t know. It was something I was born with. I didn’t know any difference, so to me, I felt ‘normal’. The decline was too gradual to stand out by itself.

Most doctors are the same way with HRT. Patients don’t really know what ‘good’ feels like. They know how they feel and they suspect it’s not really optimal, but they have no real proof or frame of reference. Most doctors, apparently like yourself, preach a rigid dogma and inform their ‘idiot’ patients to fall in line. News flash, pal, we aren’t all idiot patients. Some of us have done our research and that research is often quite a bit more than a doctor has done on the same subject. When a doctor’s protocol is 1 or 2 shots of month of T Cyp., they don’t know what they’re doing. When they ignore A.I.'s, they don’t know what they’re doing. When they act like HCG is hocum or, conversely, put you on 5000 iu a week, they don’t know what they’re doing. They simply haven’t done the research. It doesn’t mean they’re ‘idiots’ per say, but it does mean they are ignorant of ‘real world’ best practices.

So you get what we have here. A group that through trial and error, research and personal experimentation have arrived at an approach that is relatively easy and often more effective than the average doctor’s dogma. You may think it’s some sort of wild-west craziness, but it’s actually quite controlled and reasonable. If you’ve got issues with it, then poke holes in the actual approach. Show us (and since you need a definition of ‘us’, let’s just call it the low-T gang on this board) a better way and explain it. If you’re worried about doctor’s board issues, then use hypothetical cases. Theory is great, but in the real world, practical experience trumps it every time.

This is a situation where the hands-on experience is beyond the clinical recommendations. I don’t claim to be a doctor. I don’t give doctor’s advice. I have a layman’s understanding of a man’s hormonal system, but I don’t have to be able to know the endocrine system forward and backward be able to figure out how to have pretty damn good results. Guess what Jack, plenty of woolly mammoth’s were brought down by cavemen, too.


#10

It should also be said that for a drug to get cleared by the FDA it has to be created specifically to address a known medical issue. If a company produced a drug which gave you 25 IQ points, David Hasselhoff’s teeth and an extra inch on your schlong with no unwanted effects it would not be approved. None of these are a known medical condition, so the drug would be shelved. They would then have to invent some sort of ‘problem’ that this drug helps and then horrible, unethical doctors would prescribe it for the off-label use which is was originally created for.

So we’ve also got this to overcome as well.

Ironically, once we have some malady to fix, the drug can made that doesn’t really help the issue much, cause all sorts of other problems and still get released and handed out like gum-balls. I guess it comes down to who’s greasing the wheels.


#11

To a significant degree, this subforum is populated by overweight, out of shape, unhappy middle-aged men seeking both medical absolution for their state (‘I’m fat and out of shape because I have low T’, when in fact the opposite is usually the case), and a Magic Bullet to fix it. Very few know anything about TRT other than what they’ve picked up here, resulting in a bro-science echo chamber in which discussants confirm for one another the accuracy of info they got from the same source. (And I assure you that much of what is accepted as medical fact on this subforum is pure hokum.) They dispense potentially life-threatening medical advice to individuals they’ve never met, much less examined. There is nothing “controlled and reasonable” about this process.


#12

I’m with EyeDentist on this one.

Actually, it sounds like the urologist was being rather careful. Newsflash: repeating bloodwork for the dx of an endocrinopathy is a pretty accepted standard of practice to avoid error. Because god forbid you get an iatrogenic hormone insufficiency because of an overly aggressive attitude towards treatment (and iatrogenic causes of endocrinopathies are pretty common).

I don’t think it’s unreasonable to want another set of labs anyway. I can think of a lot of valid reasons why he might.

You know, being a doc isn’t as simple as ordering a bunch of tests and saying, “well, x, y, and z fall outside the reference range. Looks like we better treat 'em!”


#13

I’m also with eye dentist. Let the doctors be doctors. Pts dictating care is a horrible idea. Doctors have only 12-16 years of schooling. Men think reading this forum replaces a endocrinologists background? I also find this sub forum at times unethical. I’d bet doctors would be apt to rx if they didn’t have people coming in with memorized scripts to get on test. 28 years old is along time to be doing injections. If I was 28 I’d want the tests redone diabetics and test users lots of needles.


#14

[quote]EyeDentist wrote:
To a significant degree, this subforum is populated by overweight, out of shape, unhappy middle-aged men seeking both medical absolution for their state [/quote]

So it sounds like you come here specifically to pass judgement, discredit our efforts and feed your ego. Shame on you Sir.


#15

[quote]sweet-t wrote:

[quote]EyeDentist wrote:
To a significant degree, this subforum is populated by overweight, out of shape, unhappy middle-aged men seeking both medical absolution for their state [/quote]

So it sounds like you come here specifically to pass judgement, discredit our efforts and feed your ego. Shame on you Sir.[/quote]

The point of my comment above was to highlight the deeply flawed and potentially deleterious nature of what goes on in this subforum. I passed judgment on the process, not the individuals themselves. As a middle-aged man who has lost ~90# in the past 8 years, I know what it means to be fat, unhappy and desperate.


#16

[quote]EyeDentist wrote:

The point of my comment above was to highlight the deeply flawed and potentially deleterious nature of what goes on in this subforum[/quote]

Just for fun, substitute this subforum with many practices.

Warren123. I promise that’s my final contribution to the derailing of your thread.


#17

I am not looking to argue either way but I do have to state this about this forum:

This forum saved me immense amount of time getting my TRT protocol tuned in. When I started the journey, my first doc wanted to put me on a ONCE A MONTH T shot. Doctor or not, 12 years of school or not, that is pure fucking ignorance. If he is not versed in TRT, that doc should not be prescribing the treatment. I can’t imagine the roller coaster ride I would have to endure and how long if I had not come here and received advice from NON doctors.

I immediately fired my doc and found a better one who knows what’s going on just as the stickies suggested. I am immensely greatful for that as well. You call that doctor shopping or looking for a dealer or whatever. I feel better, I saved time and money, bottom line.


#18

While I (obviously) don’t care for Eyedentist’s point of view, I do think it’s a reasonable discussion to have. I’ll start another thread sometime today so we don’t derail this one further.


#19

I’ve decided to get the bloodwork redone and go with it from there. I was just unhappy with the way the endo spoke down and judged me. If others come in looking for scripts and that causes a prejudice to anyone under 35 that’s not cool to be that way.

Thanks to everyone who contributed, hopefully I can get this all figured out and help with the way I feel. After seeing the endo for a few days I was miserable as I felt like no one wanted to help. My biggest issue is my primary ordering the bloodwork, getting the results and saying I should be treated only to go in and be spoken down to and told the bloodwork wasn’t good enough (but if my numbers were “normal” I’d be sent on my merry way). I was just uncertain if protocol is multiple drawings or I was being jerked around for them to get me to do things that were unnecessary. My primary said id be treated, I show up to the referral and get spoken to un an unprofessional manner.


#20

More the merrier on bloods. Make sure you get copies of all results. As you research and learn, you will be able to refer back before discussing concens with your Doctor.