33 yo Hypogonadic Looking for Good TRT Dr

Pharma / TRT Testosterone Replacement
1

Hi all, this is my first post in this forum but I have been lurking in forums that discuss TRT. What brings me here is that I am frustrated with my current TRT regimen and my doctor. First off, I have no interest in bodybuilding. I am a hypogonadic male who wants to improve his quality of life and up his libido. I am very interested in finding a good and reliable TRT doctor that takes insurance and knows what he is doing.

Some background first:

Age 33 y/o
Height 5’11
Weight 172
Slender frame (think cyclist)
Lots of body/facial hair (think Mediterranean)
Body fat 15-20%, mostly around the belly

Health conditions: hypogonadic symptoms manifesting via ED (can get erection but not maintain it), lack of morning wood, sagging libido, low energy levels, difficulty in concentrating on tasks, etc… sometimes the ED and low libido gets bad enough that it causes problems in my marriage.

Diet: Pretty normal, trying to eat healthy and get enough protein through chicken, fish, and meats. Eat lots of fruit, but few veggies. Keep junk food to a minimum.

Exercise: Road cycling is my primary sport, although I hit the gym to do some strength training, stretching, or muscle toning. No bodybuilding.

My Story:

I was diagnosed with hypogonadism in late 2010 when I went to an urologist for ED/libido issues. The urologist checked my testosterone, and it turned out to be low: 307 in a range of 300-1000 ng/ml. The urologist said “although it is within the normal range, I feel it is too low for your AGE, so I will put you on TRT.” Put me on the Testim 1% gel that came in tubes (50 mg in 5 g tubes).

At that point, I was happy to have a solution and I religiously used Testim daily, and it brought my T levels up into the 500+ range (after an initial peak of 728 three weeks into it). My libido was better, ED was very minimal. Started to get morning wood back, not every day, but rather 3x a week, more or less. My right testicle shrunk somewhat, but my left testicle’s size stayed the same, if not gotten a bit larger. Asked my doc about that, and he was surprised that my left nut didn’t shrink, and didn’t know what to say about that.

However, the more time I went by, the more learned about TRT and I didn’t realize that it was for life. I thought it was a temporary solution and I wish that the urologist further investigated into WHY my T levels was low in the first place. I also learned that it might be better to run HCG and AI while on TRT, both of which I am NOT currently running.

I was on Testim for almost two years, and then my insurance (damn insurance!!!) changed their drug list and started denying Testim. I refused to pay $400/mo, so I stopped taking Testim for a month. Then I went to the doctor with my concerns about a) insurance, b) fertility, so he prescribed me tamoxifen to try to “restart” my HPTA system. He did a full battery of tests after having been off T for a month and here are the labs:

LABS AFTER BEING OFF TRT FOR 1 MONTH, BEFORE TAKING TAXOMIFEN (aka Nolvadex):

FT 7.33 ng/dl (no ranges given?)
TT 334 ng/dl (300 - 1000)
E2 5 ng/dl (0.5 - 5.0)
DHT 199 pg/ml (106.0 - 719.0)
LH 2 mIU/ml (6.0 - 19.0)
FSH 3 mIU/ml (4.0 - 10.0)
DHEA-S 2369 ng/ml (1419 - 3867)
SHBG 27 nmol/L (10 - 55)

Hemoglobin 14.7 g/dl (13.0 - 17.0)
Hematocrit 42.8 % (37.0 - 49.0)
IGF-1 169 ng/ml (109-307)
Prolactin 14.2 ng/ml (3.0 - 30.0)

Cholesterol 190 mg/dl (<200)
Triglycerides 72 mg/dl (<150)
HDL 59 mg/dl (>39)
LDL 117 mg/dl (<100)
LDL/HDL Ratio 1.98 (<3.55)

That was 5 months ago. Then I took taxomifen for 2 months, and my nuts returned to normal size and hardness. But the ED/low libido black cloud came back, and now I’m on Androgel. But I don’t think it is working as effectively as Testim has worked for me. My right testicle is a bit smaller again, but not as small as before when on Testim. I don’t think my skin is absorbing Androgel like it’s supposed to.

I’m a little frustrated with my current urologist as I don’t think he knows everything about TRT (no HCG or AI?!?!) and his office doesn’t communicate with my insurance well, resulting in denied claims or Rx delays at the pharmacy. He also drops the ball on the labs a lot.

I have an appointment with him tomorrow, and I’m thinking I’m going to give him one more chance while I ask about AI and HCG and more detailed lab tests.

But if I’m not satisfied with how it goes, is there a Houston-based TRT doctor who knows what he’s doing and also takes insurance? I have Blue Cross.

What about TRT clinics? Like the Low T Center that just started in 2010 and opened a new facility literally 2 minutes from my home. Link: http://www.lowtcenter.com/ Are there others like this?

2

Have you tried any over the counter stuff to boost your natural test levels prior to TRT, like tribulis? Some places like age clinics will probably prescribe what you want, but will probably want to administer shots and charge you for visits. I am about the same age as you, and my doc also put me on androgel six month ago, I quick cold turkey a weeks ago, it sucks but I want to make sure that I exhaust all natural options.

Did you doc diagnosed secondary or primary hypogonadism? As far as low libido, you tried cialis? It worked wonders in my case, especially while I am trying to have my natural test levels boosted up.

If you are set on TRT, why not shots? They are cheaper. Hcg and AI can be obtained via research chemicals too, same for the cialis that I mentioned.

3

I haven’t tried any OTC stuff to boost natural test levels. Isn’t it too late for that? Once you start TRT, it’s for life, right?

I’n not sure about primary vs secondary, I think secondary because I’ve had no injuries or trauma to my testicles and my uro doesn’t seem to think that something’s wrong with my pitiuary gland. But I will ask him today.

I’ll also push to have my E2 tested today, because I think it is too high, undermining my current TRT treatment. Androgel is not helping.

Cialis? Yes I tried that before my uro put me on TRT, and I hated it. I got strong sides, like headache, flushing in my face, and feeling like a zombie. Couldn’t even get into a sexual mood.

Injections? I’m open to having injections, but only if I can pin myself - that way I save on copays. Would using the Gel while taking AI and maybe HCG work as well as a TRT protocol that involves injections?

How do you obtain HCG and AI as research chemicals? Do I need a Rx for those? I know anastrozole is pretty cheap, but how much does HCG cost?

Sorry for so many questions, but I’m still learning and I’m trying to take control of my health care instead of being a passive patient at the mercy of insurance companies.

4

Once you are on trt, and you do not inject hcg, your body stops the natural production of test. This is something my doc failed to tell me. I was only on trt for 4 month, quit last week and it sucks, I imagine in your case you would need to run some kind of cycle similar to what pro bodybuilders use post cycle, serm + ai…

My doc also never checked primary vs secondary… I read here that some endo’s treat secondary with serm only… there are so many things that can mess up hpta, like thyroid issue, see skicky here, diet, over training, lack of sleep.

As far as cialis, what dosage did u do? 10mg works great for me… researh chemicals are done here in us, not for human use, so if u want to test it on your lab rat, check them online. Make sure you lookup reviews and reputation of the comany.

5

I’m starting to suspect a thyroid issue in my case. I’m going to ask for a full thyroid panel along with TT, FT, and E2.

I don’t remember the cialis dosage, it was a free sample for me to try so it was probably a starting dose.

I’m not sure about research chemicals, I’d feel more comfortable in getting a scrip for it. If that takes switching doctors, then I will switch.

6

Read these stickies:

  • advice for new guys - CAREFULLY
  • protocol for injections
  • the estradiol sticky

You should have had LH/FSH before TRT and at your age, some effort should have been made to find the problem and not treat the symptom: low-T.

When not on TRT and before SERM, your E2=5 was at top of the range. That is a serious problem that would be repressing your HPTA. You are seconary and the high range E2 might be a significant factor. With low T and high E2, one also has to consider a problem with the liver, a medical problem or drugs [OTC or Rx] is not allowing the liver to clear estrogens from your blood.

Your prolactin appears to be mid range, but is top of range at some other labs. That is worrying.

Has the urologist evaluated the teste that does not shrink for cancer?

7

U need to be off the gel completelly in order to get the complete male panel done. Your doc should be able to get you off the gel, if not search how bodybuilders finish their cycles, pct…

Research chemicals are what they claim to be, unfortunatelly rx system is so messed up people have to use that stuff or get it from some shady people…

Cialis is imo safer than trt when it comes to libido issues, remember that it was originally made as a heart medicine. I had similar symptoms from viagra, blood rush, foggy, headache, but cialis works way better… and if you will get off trt, your libido will be destroyed, ask your doc for some samples.

Good luck.

8

Postponed my appointment to Friday morning because the wait was too long and I had other things to do.

KSman, thanks for chiming in - you seem very knowledgeable about this stuff and it will be great to hear from you as I go through this process. I’ve been reading up on the stickies (lots of information!) and I have been learning a lot. I do wish I got tested on FSH/LH before TRT or investigated why my T was low before starting, I didn’t know any better at the time.

My E2 is definitely something that I am concerned about, and I might need an AI at least. Before I push for an AI, I will ask to get tested for liver function to see if there is something they can find. I’m not too concerned about the prolactin yet because it rises after orgasm, so testing prolactin 24-48 hours after orgasm might show high levels (according to the wiki link in one of the stickies).

Ultimately, I don’t know what I’ll end up being on after all this. I’ll post about how Friday goes and the next set of labs.

9

Ok so I’ve been doing a little legwork on finding a better TRT doctor that I will go see after my last appointment with the uro. Called a few compounding pharmacies, and got a list of names. Then I screened out the anti-aging clinics and doctors who don’t take my insurance. That got me down to two names. Looked at health grades and vitals websites to look at patient satisfaction graphs and read the patient reviews.

One name owns a family practice and specializes in wellness and preventative care. Has a pretty looking website with his picture on it, offers services one of which is HRT, has a “patient portal”, and has more reviews on vital.com (presumably has more patients). Has a score of 87% on patient satisfaction on health grades.

The other name, a GP/Internist, was given to me by TWO different compounding pharmacies, but appears to be less known and has no reviews given by actual patients. Has a score of 100% on patient satisfaction, but sample size is smaller. EDIT: I found him on his practice’s website, but it doesn’t say anything about HRT for men (only for menopausal women).

Should I start with the one who is better known, or the one who lays low?

10

Interesting. Let us know how that plays out. You are methodical!

11

Posting my body temps from last night through this afternoon:

9 pm: 97.8

Today
7 am: 98.1 (upon waking up)
12 pm: 97.7
4 pm: 98.0

Didn’t make it to 98.6, but it’s always freezing in the office.

12

I just tried to have sex with my wife and I couldn’t get it up. And she’s got a smoking hot bod. Now we’re both upset. Something is seriously wrong with me.

I’m miserable right now! I cannot wait to fix this damned thing! :frowning:

13

Dr Visit Update:

Saw my urologist this morning, had a lot to talk about. Reported that Androgel 1.62% is not helping. Energy levels OK, but libido and erections are down. Way down. Weak or zero morning wood.

Gave him and the nurse my requested bloodwork:

TT
FT
E2 sensitive assay
Thyroid panel (TSH, fT3, fT4, rT3)
Prolactin
Liver function tests to determine why my liver isn’t clearing E out of my blood

The urologist wants to increase my dose to 3 pumps a day instead of just 2. That was my cue to bring up the T → E issue. He agreed that it can happen. I told him that I’ve been doing some research on TRT and that I am concerned about my E levels, which is why I am asking for the E2, thyroid and liver tests.

I did not name anastrozole as a remedy to keep E2 down, because I wanted to see how he responded to my question: Is there any way to keep my estrogen down while taking testosterone?

He said, “Well, there is a drug called Amiridex (bingo!) but I need to do more research on it before writing a scrip for it. We’ll find out what your test results are and then we’ll go from there.” That’s it from the TRT front. He’ll call me with the results and depending on results, may ask me to come back in.

On insurance, whew - he told me he is ANGRY with insurance companies and about the whole T thing becoming a nightmare to prescribe. Even said that he feels he can’t practice the way he thinks is the right way to do because of insurance companies not wanting to pay for it, or wanting someone else (the patient) to pay for it. In his rant, he seemed genuinely frustrated about it all.

14

Have you talked about getting off androgel? I am on week 2 cold turkey, just taking over the counter test booster and I feel so much better, no longer tired and sleepy…

Some people have problems with gels, did the doc mentioned that?

As far as your sex drive, get a hold of some tadalafil research chem I mentioned, .5 ml oral syringe and welcome back your sex drive.
I got my shipment last week, its cheap and made in us… just don’t overdose from the start, .5 ml is about same as mid range pil 10mg…

Good luck, atleast your doc listens. I have to wait 2 more weeks just to talk to my doc…

15

Some more info on myself, which may or may not have anything to do with my low T.

  1. Body temps the last few days upon waking up is an average of 97.9 F. So I’m thinking thyroid isn’t a major issue, just need some iodine supp to give it a boost. I do eat iodized salt, but my current multivitamin doesn’t have iodine so I bought a new multivitamin.

This also has more B vitamins than the one I’ve been taking.

  1. I moved from a relatively cold climate to a warmer climate. I heard that your blood gets thinner when acclimating to a warmer climate. Is that true, and does it have the potential to mess up your hormones?

  2. Last year, my GP found that my white blood cell count was low (3.0-3.3 in a range of 4-11 on three different tests). 2 months before this discovery, I had a nasty case of a respiratory infection that took about 3 weeks to shake. It had gotten so bad to the point where I could not even speak or use my voice for a few days.

Even after feeling better and the infection gone, my WBC was still low, particularly the neutrophils. Got referred to a hematologist who said that I have neutropenia because the absolute neuts were low (1000-1100’s in a range of 1500-7800) while the other WBC types were fine. Hematologist ultrasounded my spleen, said it was fine, if not slightly enlarged but not enough to be a real concern.

Then he did a bone marrow biopsy with aspiration, and those tests came up with nothing. Nothing abnormal, that is. Hematologist completely baffled, wanted to just monitor. At this point, I was tired of the tests, so I didn’t schedule another appointment with him.

Fast foward to this winter, even when my wife and stepson got sick, I didn’t get anything worse than a couple days of sniffles. Maybe my WBC recovered. Or if it’s still low, obviously my body can still fight off infections just fine.

  1. I have a family history of type II diabetes. My dad had it, all of my uncles have/had it. I have a 50/50 chance of developing it later in life, depending on what my genetics are. My last fasting glucose test was 87, in a range of 65-99. So I’m not prediabetic yet.

I don’t know if any of the above have anything to do with 2ndary hypogonadism / low T levels. Any thoughts about that?

16

Low T, elevated E2 lead to estrogen dominance which leads to endothelial cell dysfunction and high blood pressure [syndrome-X aka metabolic disorder. And insulin resistance follows. TRT can reverse all of that to some extent.

Low T causes those problems. Low T can be age related or caused by something else. Some Rx or OTC drugs cause low T as well as possible liver problems.

When are you doing the lab work?

17

Waiting for the lab results, should come in this week. I’m anxious to see where the E2 is at. I’m almost hoping it’s high again, so it’d give me a strong case to push for an AI rx.

I haven’t been sleeping well, and my morning wood has been very weak.

You mentioned blood pressure… before I got on TRT, my BP was in the 140/85 range and my GP was concerned about it. But after getting on TRT, it got knocked down to 120/78 +/- a few points, and stayed there. That was a pleasant surprise and an unexpected good result of TRT, at least for me.

Now I just need to do something about my libido…

EDIT: Called the uro’s office to leave a message saying that I want to consider HCG because I want to have kids in the next 1-3 years.

18

As far as OTC drugs, I do take an Aspirin every now and then, especially after a long or fast paced bike ride to reduce muscle soreness.

19

Still waiting for results of Friday’s labs.

In the meantime, I’ve dug up my old liver function tests, one from 3 years ago pre-TRT and one from last year while on TRT (Testim).

One thing jumped out at me was the change in ALT values between those tests, and all the other values changed very little.

3 YEARS AGO - BEFORE TRT:
Urea Nitrogen 14 - Range: 7 - 25 mg/dl
Creatinine 1.07 - Range: 0.79 - 1.33 mg/dl
Albumin 4.8 - Range: 3.6 - 5.1 g/dl
Globulin 2.8 - Range: 2.1 - 3.7 g/dl
Albumin/Globulin 1.7 - Range: 1.0 - 2.1 calc ratio
Bilirubin 0.5 - Range: 0.2 - 1.2 mg/dl
Alkaline Phos 62 - Range: 40 - 115 u/l
AST 27 - Range: 10 - 40 u/l
ALT 44 - Range: 9 - 60 u/l

1 YEAR AGO - WHILE ON TRT USING TESTIM 1%:
Urea Nitrogen 19 - Range: 7 - 25 mg/dl
Creatinine 1.14 - Range: 0.79 - 1.33 mg/dl
Albumin 4.7 - Range: 3.6 - 5.1 g/dl
Globulin 2.6 - Range: 2.1 - 3.7 g/dl
Albumin/Globulin 1.8 - Range: 1.0 - 2.1 calc ratio
Bilirubin 0.5 - Range: 0.2 - 1.2 mg/dl
Alkaline Phos 52 - Range: 40 - 115 u/l
AST 30 - Range: 10 - 40 u/l
ALT 17 - Range: 9 - 60 u/l

Minor changes include urea nitrogen and creatinine, both went up slightly. Alkaline phos down slightly. Don’t know what that means.

Everything else stayed about the same, EXCEPT that ALT dropped from 44 pre-TRT to 17 on TRT. BIG change! What does that mean??

EDIT: I did take antifungal medication for my toe, twice in the past 3 years - maybe it affected my liver somehow.

20

Still waiting for the labs. (What’s taking them so long?)

Got impatient over the weekend, and bought some supplements. I heard good things about L-Arginine and Pycnogenol taken together, as well as Maca and Fish Oil. Been taking those for 3 days.

I’m always skeptical of supplements and didn’t think they would do much, but like I said I got impatient and I wanted to try something.

Well, to my surprise, the last 2 mornings (after taking L-Arg and Pycn), I got morning wood hard enough to hang a coat on. Libido still about the same.

I’m still anxious about my E2 levels, but seems like I’m on the right track with L-Arginine + Pycnogenol.