T Nation

Doctor Seems to be Giving Me Some Bad Advice

I have switched doctors recently do to a move and seems I will have to continue looking for a competent doctor but wanted to check with the forum to ensure I am accurate in my thinking. Just got back from the visit and don’t know what to think about her advice.

First, I recently lowered my dose based on her request from 16mg daily to 14mg daily. I tried it for 3 months and felt horrible. Even after telling her that 98mg made me feel horrible she recommenced a new dose of 30mg 3 times a week while also taking Tribulus.

Her thoughts were

1 - Changing my dose from daily to 3 times a week would increase my LH back to normal levels, currently <0.2 L which is what I believe anyone on TRT will be at. Claims she has had patients using TRT once, twice or three times a week with normal LH levels. Is this possible?

2 - Even though I felt horrible ( night sweets, low energy, poor libidio) on 98mg a week, she claims lowering my dose to 90mg and start to take Tribulus that I would feel much better do to the affects of Tribulus. This seems hard to believe and not supported by any scientific studies that I have found.

3 - Prior to TRT my total Cholesterol was 169. While taking 16mg daily it was high up to 217 and dropped down to 206 while on the lower dose of 14mg daily. She believes lower doses of TRT will continue to lower my cholesterol. my LDL and Non HDL Cholesterol are also high and slightly out of range. High cholesterol is a concern for me as I am only 33 and a little alarmed by this recent change.

4 - She is concerned about high Dihydrotestosterone with my current levels of 90 (range 12-65 ng/dL)

5 - She is also concerned about Estradiol being out of range but I have read enough about that to no be concerned as I have had no symptoms.

The things she has told me aren’t adding up but I wanted to get the collective knowledge of this forum to bring some peace of mind to me and my wife to ensure we make the right decisions going forward. Thank you in advance.

I’d sure like to see those labs. Exogenous testosterone will be “seen” by the hypothalamus which will then shut down GnRH, which will shut down FSH and LH. No reason to check FSH and LH on TRT, but your <0.2 is normal.

Agreed. If Tribulus worked that well, no one would need testosterone.

What is your HDL level?

Higher E2 may help with your lipids. See it all the time.

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LOL dude. Did you check the license and make sure it was real? I thought failing Biology precluded being a medical doctor.

Haha, no. Maybe she was giving such an absurdly low dose that they weren’t fully shut down? I doubt it though.

Just another day of “dumb things doctors say”

Your doc is lying, there’s no way any of her patients have normal LH value on any protocol at any dosage. Your doc is also overly focusing on the numbers, the reference range were meant to be a guide post, nothing more.

The numbers don’t have to look perfect on paper, the clinical picture of the patient and lack of symptoms should be the treatment goal.

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My past two lipid labs. Higher readings were taken when on 16mg daily and slightly lower readings was when I was on 14mg daily. I know there are many other factors as well that control cholesterol. Diet and exercises has been the same during both testing periods.

Triglycerides are low and HDL looks good. I wouldn’t be too worried about these numbers.

Your lipids are fine. HDL levels are very good. Non HDL cholesterol is higher because total is.

Some of the more progressive (if that is the word, maybe up to date would be better) cardiologists I know rely more on inflammation markers for assessing coronary risk than lipids.

When age was further considered, U-curve associations were observed regardless of sex or age (Fig. 3), and the optimal TC range for survival was 210–249 mg/dL for each age-sex group, except for men at 18–34 years (180–219 mg/dL) and for women at 18–34 years (160–199 mg/dL) and at 35–44 years (180–219 mg/dL)

https://www.nature.com/articles/s41598-018-38461-y

See responses above.

What blood test can I get done to check inflammation. Below is another test result that is on the higher side that might doctor is concerned about in regards to heart health. Any additional blood tests you suggest I get done to get a better picture of my heart health. Thank you very much for the help.

high-sensitivity CRP
plasma ceramides
lipoprotein (a)

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Thank you very much for your help. I will look into getting those tests done and finding a new doctor.

LDL is a calculated number.

There are two methods to calculate LDL. Friedewald and Iranian methods.

Friedewald is basically Total - HDL - (Trigycerides/5)
For people with low Trigycerides, Friedewald gives an incorrectly high LDL number.

The Iranian method more accurately calculates LDL for those with low Trigycerides.

Keep in mind LDL is not actually measured unless you request the more expensive blood test.

Link to calculator for both methods…so, you can see the difference.

I wouldnt trust a female doc with TRT for men. She has no idea about how this works either. I fired my first doc because she had nothing good for me. You need more androgens. 98mg a week is enough to shut things down with no added benefits.