T Nation

Dr. Won't Put Me on TRT. Total T in 300s. Should I Pursue?

Hello all. I’m a 39 year old that’s felt like shit for nearly 20 years now. I think I initially did start feeling bad due to depression/anxiety/stress but don’t think that’s the issue any more. I’ve been on nearly every AD out there and Lexapro is the only thing I could tolerate and it didn’t help. At the beginning of my fatigue and feeling like shit issues I went through over a year and a half of extreme insomnia (2-3 hours of sleep a night, many times not sleeping for days), with other fucked up symptoms such as always feeling hot and night sweats every night that were like someone threw a bucket of water on the bed. I’ve fortunately been past that for a long time now, but I still just feel exhausted and like shit all the time. I can sleep 9 hours solid for many days in a row and still wake up feeling exhausted. I sleep with a CPAP, even though I borderline didn’t even need one. I’m 6 ft and 215 lbs now, which isn’t great, but I’m not morbidly obese or anything. I still exercise somewhat regularly. When I first started feeling bad I was 175 lbs, nearly ripped, and exercising regularly. Within the past decade I’ve gotten into great exercise routines for over a year at a time doing heavy lifting and cardio, and while I got down to 190 lbs several times, I never gained any energy or felt better, and made very little gains at the gym. This is what prompted me to first get my T checked 3/1/2013. My total T was 288, and free T 5.4. My doc did a comprehensive metabolic panel and everything else was normal. My doc started me on Testim gel and for the first time in a looong time I started to actually feel good. Gel wasn’t an option to me due to the dangers and the fact we were trying to get pregnant at the time (which my doc knew when she put me on it). I got transferred to a urologist, who put me on clomid. That got my total up to 662 and free wasn’t tested. I felt like absolute death on the clomid though and had to stop. Since we were trying to get pregnant there wasn’t really any other options. Fast forward to now. We’re done with kids, I’ve had a vasectomy, and still feel like shit so I decided to revisit testosterone and see a different urologist. Below is all the information from my blood panel. Total T was 462. He did not test free T, so I requested he check that. See below blood panel images for further T results.

My 2nd blood test came back 348 Total T and 5.6 free T. He did a 3rd test which came back 388 Total T and 9.5 free T. All test done were via LabCorp. Free T was the direct method. The doctor refused to treat me at these levels. I don’t want to be on TRT the rest of my life if I don’t have to but I’m at the point now where I’m desperate and willing to try about anything. Aside from feeling like shit there isn’t anything I’d change about my life right now. I’m pretty fortunate in every other way, but I just don’t even want to live any more (not suicidal, just have no zest for life). Every day sucks and is a struggle to make it through while feeling like shit and having no energy. Is this something I should pursue with those numbers or am I barking up the wrong tree?

After all the shit you describe that you are going thru and you think life long TRT is bad? You need to re-evaluate your priorities. TRT will definitely improve your life and once there, you wont want to go back. You need to get to a REAL TRT doc and start treatment right away. You just don’t know how good you will feel once you get your hormones right.

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You’re asking for trouble going to an ordinary doctor in the sick care system for which there is no doctor that specializes in TRT, none of my doctors would test Free T either and just do not give a shit to learn how to do TRT the right way.

You need a real TRT doctor because none you have access to will be able to affect much change in your life with regards to TRT, they will provide the script and you are left holding the bag testing missing labs and figuring out your own TRT protocol.

If you spend enough time on T-Nation you’ll see a wall of threads of men trying to figure out their own TRT protocol because doctors do not give a crap these days. The SHBG test is important for designing a protocol, high SHBG men do best on once weekly or twice weekly dosing, unless having difficulty lowering estrogen, then more frequent dosing may be needed.

Based on your Total T to Free T ratios, SHBG is elevated and one or two shots per week is needed, you may even need levels >800 to feel optimal and increase Free T to a healthy optimal range, something a managed healthcare doctors cannot allow do to being hogtied by narrow insurance guidelines which was created without proper knowledge.

Tests needed for balancing your TRT protocol while on TRT other than the 6 months check ups for CBC:

  • Total T
  • Free T
  • Estrogen sensitive
  • SHBG
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I don’t think life long TRT is bad if it indeed will help and is what I need. I’ll happily do it to feel good again. I’m just nervous about doing it if I don’t actually need it. There’s the numbers the medical community say are good (which I fall into), but testimonials from others saying those are wrong. I feel that this is a pretty important decision, as there’s seemingly no going back once I go down that road. I guess I’m hoping to hear from others with numbers in that range, or experience working with others in that range that it did help them and is worth it.

There are wrong, studies prove it, the lack of Free T testing only shows these managed healthcare doctors are ill prepared for TRT and knowledge is lacking. Why is that you ask, well it all goes back to 1941 Huggins & Hodges report: (1) Reducing T to castrate levels caused prostate cancer to regress, (2) Administration of exogenous T caused prostate cancer to grow.

When you look at the study you’ll see it’s based partly on women, men who were castrated who are in a separate risk category and on a single patient who was on TRT for only 14 days and later tested positive for prostate cancer. You do not get cancer in 14 days.

So doctors believe low testosterone is prostate cancer safe and high testosterone prostate cancer friendly and now understand part of the reason doctors fail to act and are so heartless denying a man the right to be a man ~ high testosterone.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction.

The increased risk for CVD when sexual dysfunction is present is do to those men having higher SHBG and lower Free T. Through your own prior testing shows Free T very low in relation to Total T which is bound to SHBG, Free T is the portion of testosterone that is free and is likely low as it was previously.

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I was there. Almost every one on this board was where you are right now. Get your self to a good doc who will listen to you and not your numbers. If you can’t find anyone locally, try Defy Medical. @systemlord can tell you about them

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Thanks studhammer. I’ve looked and looked and there doesn’t seem to be anyone locally I can work with. I’m in Athens, GA. Looking at Defy Medical now. Thanks for the info.

You’re not THAT far from Atlanta. I’m sure there are plenty there. Either way, I’ve heard great things about Defy

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Yeah depending on what part of Atlanta, it can be anywhere from 1.5 hours to 2 hours one way from me. That’s not too bad if I don’t have to go there a lot but can really suck if I do need to. Also don’t want to go to Atl just to see another doc that won’t treat me. I’ve heard many people mention defy and I lean more towards somewhere I’ve heard lots of good stuff about vs an unknown that’s still not terribly close to me. If anyone on here happens to have good experience with an Atlanta based provider that will definitely work with someone with the numbers I have, I’m all ears though.

My doc is based out of Atlanta and he prescribed me with total T of 550. If you want his info email me. Email in bio. I live in NYC and do it over the phone. Costs about $150/month

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After some searching I found multiple people on here recommending Dr. Forrest Smith in Roswell, GA, which is relatively close to me. She is no longer taking patients and is the director of the clinic now, but I made an appointment July 1st with her nurse practitioner that follows the protocols Dr. Smith setup. I’ll keep this thread updated with my experiences. Fingers crossed I may finally get some quality of life back…