T Nation

32 and Need Advice

I will try to keep this short, but I need some solid advice.

Have had anxiety (panic attacks) for the past 10 years and depression and bitchy mood has increased over the past year. Almost zero libido, but that could be the SSRI I am on. Been on all the common SSRIs. Looked into bloodwork last year and found my T was low.

Free T- 44.3 pg/ml
Total T- 279 ng/dl
Bioavailable- 94.9 ng/dl

Second test confirmed the diagnosis. Prescribed Androgel and started at 2 pumps per day. Then increased to 3. Then to 4 (max dose). All my T levels remained stagnant the entire time.

Finally went to see an Endocrinologist who pretty much shrugged me off because I am a bigger guy (6’5’’ 225). Doc said I would need to go off the Androgel for 6 months so that he could run a “proper” blood panel (he wouldn’t even look at the results from my prior 4 tests).

Long story short, I am looking for a new Endocrinologist but they are hard to find. In the past year my lifting motivation has severely decreased, if it wasn’t for caffeine I probably wouldn’t even exercise. At 32 I feel like I need a nap after work even if I get 8 solid hours of sleep and eat semi-clean. Take multivitamin, extra vitamin D, and fish oil every morning.

If I cannot find an endocrinologist, should I try an out of network doctor or an anti-aging clinic? Try a urologist? At this point I don’t care if I need to spend some out of pocket money to see if bringing my T up will improve my life.

Any other suggestions or advice would be greatly appreciated.

Where do you live?

You can try a urologist. Mine does my trt.

You can call busy compounding pharmacy in your area and ask who they suggest . They know which Dr prescribe testosterone and HCG.

You can also call Drs offices and try to get a nurse and ask how the Dr handles trt. Do they make patient self Inject? Do they prescribe Injections?

You should be able to tell with the responses.

You also need full lab work up.
Even the Endo you see can order. Just to get labs even if they may not treat. You need to insist on the labs. You can have disease making you lOw t. Like pituitary or testicular tumor. Or adrenal fatigue. Or diabetes.
Plus you want baseline before your start trt.

Do lab in am after a good night sleep within 1 hour of getting up
Get
Thyroid panel
Metabolic panel
Lipid panel
CBC
Am cortisol
Acth
Ferritin
A1c
Igf
Total t
Free t
LH
FSH
Estradiol
Prolactin
Shbg
Dhea-s

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I’ll second everything above. I have no personal experience with psych drugs, but it seems many with low T symptoms get them prescribed instead of test, or without considering test. I do know some who were able to stop SSRIs after starting TRT. Your levels are very low, for any age.

You might look for an anti-aging, low T, type of clinic. Look around at the gym, an older guy that looks pretty good may be on test, I would even say likely is. Ask them who they see and what they do. The compounding pharmacy source is a great idea as well.

Good luck.

Depending on which SSRI you are referring to, some do cause low testosterone and some men are put on these SSRIs for depression and anxiety when low testosterone is the cause. There’s a lot of ignorance within mainstream medicine all things related to sex hormones and often men are put on these SSRIs when they actually have undiagnosed hypothyroidism and or low testosterone.

Add to that that all the references ranges are seriously flawed (human nature) and many men slip through the cracks and are told they are normal when in fact they are not normal.

Your experience with endocrinologists is typical, my endocrinologists never tested LH and FSH and most are just barely comprehending what it is they are supposed to be doing because they have no knowledgeable or training. Urologists are a little better, but not by much.

Endocrinologists typically have a poor understanding anything related to sex hormones and grab at straws to determine low T status, like you have chest hair or a full beard, therefore you don’t have low T, completely absurd and untrue and just want to get rid of you.

There are some doctors that will refuse to prescribe TRT do to all the negativity surrounding TRT and would wish you to get out of their office.

All of this negativity comes from seriously flawed studies decades ago that blames TRT for prostate cancer in men and doctors are taught in medical school give a man TRT, he will get prostate cancer. Add to this the FDA including a warning label about TRT and cardiovascular disease and strokes, which is starting to make them look like they jumped the gun on incomplete flawed data.

You can continue playing the doctor lottery or you can seek competent doctors who have been doing this for awhile and have lots of clinical experience.

Defy Medical is such a place, it’s a telemedicine anti-aging clinic with an impressive reputation. I would start TRT without introducing other chemicals and start TRT in isolation, you can dial in fast avoiding all the other crap and add HCG later if you wish.

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Thanks for taking the time to reply. I have been on SSRI’s for quite some time, and I have distinctively noticed in the past year or so that I have to force myself to lift or exercise, sleep in way too long on the weekends, and have overall become complacent in my life, not to mention zilch for libido.

I had a referral to an endocrinologist and will ask for a full blood panel.

I will also look into Defy Medical.

Thanks for taking the time to reply. Appreciate the advice.

Thanks for the reply. When I see the endocrinologist should I ask specifically for a “full panel” or is there other terminology I should be referring to?

Sometimes they use panel or profile interchangeable.

I would write out the list or print it.
They make think it’s too many tests but just say I want to cover my bases and get baselines numbers. If he says again you really don’t need them . Just repeat and say I really would like them it’s non invasive…

Add dht too

If you doctor doesn’t at least check total testosterone and free testosterone, then a diagnosis isn’t possible without checking the bioavailable free testosterone. Once low testosterone is confirmed more tests will be needed. Total testosterone is bound to SHBG and therefore not bioavailable, so this lab value by itself is useless.

I am noe going to defy medical thanks to systemlord. I’ve been a guinea pig I feel like for a year. This place seems to be great and its all ovee the phone. I suggest at least giving them a call. It can’t hurt.

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You can easily tell over the phone that Defy Medical office staff understand what most endocrinologists don’t about TRT, they are well informed.

Just made that same decision myself bud. From the conversations I had with the guy doing the intake process, they seem very knowledgeable. It will be a relief to have a doctor that can actually answer any questions I may have. Been the other way around with my pcp.

Good deal man. I can’t wait to talk to the doctor myself. I feel like I’m actually gonna get help