T Nation

At Wit's End, Dr. Refusing Treatment


#1

Hi all,

This is my first post here, and I apologize for being so negative. I need some space to rant and hope someone can help me out here.

I’m 31 yrs old living in Toronto,Canada where health insurance is covered by the Govt. This means that one cannot go and do his own blood work(even paid) as he wishes. This has turned out to be a major issue for me.

I’ve had symptoms of low T for a long time now. No energy, lack of concentration, no interest in sex and a mind that is always indecisive. I suffer from anxiety and have been in a major depressive episode for months now. Went to a doc who did regular labwork(CBC, Lipid, Liver fn, Thyroid,Anemia,Blood sugar,ECG, EEG …nothing Testosterone related though) and found nothing wrong.He diagnosed me with anxiety disorder and put me on anti-depressant and anti-anxiety medicines. None of that helped and my personal and professional life has been in a freefall since then. I’ve met psychologists and mental health counsellors but all that cognitive therapy isnt really helping me out.

After a lot of research, I asked for my testosterone levels to be tested and my doc flat out refused. He said that I’m 31 and have a beard so there’s no way my T levels will be low. Went to a couple of walk-in clinics where the doctors dismissed my request for blood work saying that its just my depression. A few of them gave me higher dose SSRIs for my anxiety.

With no other option, I searched hard and found a place where I could pay for blood tests. Paid almost 120$ for a Total Testosterone test only. Results came back at 10.9nmol/L which is like 314ng/L

Went back to my doc with this, and argued with him. He asked me to do it again (only total T… he would hear nothing of free T or LSH or FH).
Did it again and got a result of 11.2 nmol/L= 322 ng/L. The doc simply told me that these are in range and there is nothing to worry about. I tried my best to talk sense with him but he simply wouldn’t listen.

I tried going back to walk-ins again, but the doctors are least concerned about my T levels. Contacted Specialist TRTs - they have more than 6 months of wait time. There are some anti-aging places whom I tried to contact and frankly cannot afford their costs.

I am at my wit’s end now. My personal life has taken a serious toll and my marriage is on verge of breaking down. I quit 3 jobs in the last year and don’t know how much more I can take.

Since all my other bloodwork is normal, I’m certain that the low test could be the thing affecting me. I work out 4 times a week, and am fairly in decent shape. Am tired of taking SSRIs and want to quit them if I could.

The only way out I see now is to buy underground test and self medicate to see if it helps. I would gladly pay for pharma grade only if a doctor would assess and treat me. Sadly none of the docs I met would do so. I’m at a point where its either try out UG test or lose all control of my life.

What are my options here? Any help would be appreciated.


#2

Doctors are too quick to blame anxiety disorders as the primary cause of your issues, the problem with most doctors is the don’t even consider what could be causing the anxiety. There are many causes for anxiety, neurological, hormonal and behavioral. In other words if your bleeding simply put a bandaid on it to stop the bleeding without even looking into why you are bleeding. It seems that once you’ve been diagnosed with an anxiety disorder it will always follow you around whenever you go in for treatment, they will always pull it up and assume that’s the cause of all your problems and brush off all concerns. This is a disservice to you because they’re too lazy to figure out the why, in the end it all comes down to one thing, money.

Most will have erectile and libido difficulties in the 400 range and moderate venous leakage below that, the problem is doctors outside the USA are at a big disadvantage and most fall short in diagnosing low testosterone. The problem with these ranges is there taken from an obese, lazy population who rarely see the inside of a gym and live stressful lives which also lowers testosterone. There’s no much you can really do expect pray you eventually find a doctor who knows what he’s doing and understands male hormones.

If you argue that these SSRI’s do nothing for you perhaps they might open their eyes to the fact that since you haven’t addressed the cause of the symptoms, they remain. Eventually you find a doctor that’s reasonable and possesses critical thinking. Another thing, these labs ranges have no validity whatsoever, there a construct of the mind and are purely statistical. Any doctor who ignores your symptoms should find another line of work. Doctors are supposed to consider both the “labs” AND “the symptoms”, most fail this simple task believing these ranges represent normal ranges when in fact there purely statistical! They also ignore the the age of the person, a 90 year old with T ranges of 400 would great, but not for a 30-40 year old. Can you imagine where you’ll be once you reach 90 years old if things keep going in th

Our president has high T levels (446 ng/dL) than you do and he’s 71 years, have your doctors explain that one! They won’t be able to and that will be the eureka moment for them.


#3

I’m sorry to hear about your problem and I can empathize, I’m going through something quite similar over here in Winnipeg.

Based on your story I don’t think anybody can tell you what is causing your health problems, it could be a mood disorder, but it could just as easily be a hormonal imbalance. I met a urologist two months ago who gave me the same response as you got and my total test level was lower than yours. Luckily I have a very good GP and although she doesn’t feel comfortable prescribing me TRT just because of her lack of experience (yes she admitted that she doesn’t know something, a great sign!) but she agreed with me that my problem is likely hypogonadism. She referred me to a second urologist hoping as did that I would have a better outcome. Luckily the second urologist agrees with my and my gp diagnosis and prescribed me test replacement.

What I am trying to say is that I AM SORRY AND I UNDERSTAND WHAT YOU ARE GOING THROUGH. My best advise is to hang in there and keep hunting for a better doctor. It sounds to me like you need a better GP, go and find one. Interview the potential GP’s and see if they will be a fit for you. Another thing you can do is call pharmacies and ask them which doctors seem to be the ones prescribing testosterone replacement and then hunt down those doctors.

I was just having a conversation with an acquaintence last night about this and his unfortunate answer was that everybody he knows has taken it into their own hands and are self medicating. It’s not the best solution but it is a solution. A trial would in the least prove or disprove your issue.


#5

You need to stop wasting your time. Arguing with doctors and trying to convince them you need testosterone isn’t going to get you anywhere. Testosterone is tightly controlled in Canada so general practitioners and doctors at walk-in clinics aren’t going to even consider prescribing it to you if your labs fall within range - doesn’t matter how close you are to the low end or how you compare with the 70-80 year old guys. This is mainly because if they do, they have to justify it to the CPSO and it’s a huge headache that they’d rather just avoid.

Lab ranges are meaningless but they’re what doctors largely base their clinical decision making around and as inaccurate and frustrating as that may be, it’s not going to change. They say “You’re within range. There’s nothing to worry about.” because it’s extremely convenient for them to actually believe that.

Your TT is low, and you have multiple labs confirming that so that’s good. Now what you need to do is get on one of those waiting lists that are 6-9 months. Go to your family doc with the name of the clinic and doctor and tell him you want a referral. Get an appointment, pay the fee whatever it is, bring your previous labs with you, and talk to someone who wants to help you.

It sucks having to wait but six months is going to pass anyway, so it’s better for it to be six months later and actually getting somewhere rather than still suffering.

In the meantime, read the stickies and the rest of the stories from the guys on the forum, but understand that things are a bit different in Canada. Build your brain, take care of yourself, and know what you want when the time comes.


#6

Then again … (an alternate opinion) … you could either take a trip to the USA and use one of the labs that lets you test (and pay) for anything you want.

Another alternate while waiting for the specialists would be to use a urine hormone test (which I hope to try if the local hospital doesn’t do urine tests) … such as

https://www.amazon.com/ZRT-Panel-Basic-Metabolites-Test/dp/B01I3ZJEHI/ref=sr_1_4_a_it?ie=UTF8&qid=1510900530&sr=8-4&keywords=urine+hormone+test&dpID=515m8EkMdSL&preST=SY300_QL70&dpSrc=srch

The 14 Panel Basic Home Urine test assesses how a person is metabolizing a range of hormones, including:

•Estrogen Hormones: E2 (Estradiol)- produced mostly in ovaries and testes; the estrogen of youth, E1 (Estrone)- is the estrogen of menopause; E1 test results may be helpful in determining overall breast health, E3 (Estriol)- is the estrogen of pregnancy.

•Progestogen Hormones: Pgdiol(Pregnanediol)-produced in the corpus luteum of ovaries in menstruating women and found in the adrenals, APglone(Allopregnanolone)-affects nerve cell growth in the brain and plays a large role in nervous system functions.

•Androgen Hormones: D(DHEA)(Dehydroepiandrosterone)-located above your kidney’s; precursor for testosterone and estrogen, T(Testosterone)-produced in the adrenal glands, testicles, and ovaries; vital to both sexes, Epi-T(Epi-Testosterone)-metabolically inert and well-known in the context of sports doping, 5a-DHT(Dihydrotestosterone)-causes the body to mature during puberty.

• Glucocorticoid Steroid Hormones: F[GC](Total Cortisone)-produced from cholesterol in the 2 adrenal glands set on top of each kidney, Cr(Total Cortisol)-part of a feedback mechanism in the immune system which reduces certain aspects of immune function.

I just learned of this test, and I’m not in the USA until January, otherwise I would have already ordered it.

Good luck.


#7

Do you guys have access to home blood tests in Canada? In the UK we can have that done. I use a company called medichecks. They send you a blood test kit, you prick your finger and collect the blood. You post it back and they send you the results. I have had to do it this way.


#8

No that service is not available in Canada. I only know of one service that allows you to pay for tests, and it is extremely expensive ($200 for a single test).

In the end, the tests he wants need to be ordered by someone who is willing to take responsibility for the results. His best hope is a progressive family doctor or nurse practitioner.


#9

“International (incl. Canada) 5-10 days”

From the website of the test I wrote about.


#10

You need to search for clinics with sympathetic male doctors who specialize in TRT. Ignore your normal doc. You have the total testosterone of an average 80yo man.

With Google I found 3 clinics in Toronto that will help you. If you can’t afford them either make more money so you can, keep suffering or buy your own illegal stuff.

Good luck.


http://www.mensclinic.com
http://www.ontariomenshealth.ca/testosterone-and-andropause


#11

I’ve been hesitant to reply but…
If you go on TRT, your numbers aren’t going to be super high. And if they get high, the doctor will just lower the dose. If TRT puts you at 600 or so, you may gain some weight, have morning wood, and feel some better.


#12

There’s this thing called hierarchy of needs. Your testosterone levels are not anywhere near the foundation. Grow the fuck up, stop worrying about such frivolous things and start focussing on important things such as saving your marriage and getting a job. Low testosterone is not causing your marriage and employment problems and taking testosterone is sure as hell not going to fix anything. Fixing your career situation and your marriage just might fix your Test though.


#13

Dr. Komer in Burlington is a good doctor who can potentially help you. There’s another place I believe in Richmond Hill with good reviews. I think Komer charges $150 for the initial consultation which involves a questionnaire and a consultation with a nurse practitioner, whereas some of the other places charge monthly fees. I waited 10 months to see Dr. Komer but my understanding is that the wait list is much shorter now. Keep in mind if you see him that his primary interest in treating low testosterone is reducing the risk of cardiovascular disease, stroke, etc associated with it. He really opened my eyes to this and inspired me to do some of my own research surrounding it. I’m saying this to manage your expectations that this is not an “anti aging clinic” like you see in the USA. He’s trying to reduce your risk of dying from something that could have been prevented with healthy testosterone levels, which is fair enough for me. If you decide to go, he’s “Brief, Bright, Gone” - it will be a short visit as he’s absolutely jam-packed with patients. As for your blood test, he’s going to look at liver enzymes, hematocrit, total testosterone, total estradiol, PSA and DHEA. That’s it. If you go in with a print-out of one of the extensive blood panels you see on this forum, he’s just going to tell you no. Apparently the test for SHBG is like an extra $80 alone, it’s just not a reality in our publicly-funded health system. I’m not sure how he’d respond if you came in with your own bloodwork that you paid for independently, might be worth a try.

Anyway, I’d recommend him for sure. We’re lucky to have a physician in Ontario that’s supportive of testosterone replacement, they seem to be few and far between north of the border.


#14

Thank you everyone for your replies. I am in contact with the clinics mentioned above and will post updates as I have them.