T Nation

Frustrated with Kaiser. Bloodwork Not Low Enough for TRT?

T Replacement
#1

Hi all,
I need some help. I’m finally fed up with my Kaiser and their anti TRT outlook. For the better part of past three years I’ve been going downhill to nowhere fast. I seem to have all the symptoms of low T and no one at Kaiser wants to listen.
My first Kaiser doc wanted literally nothing to do with TRT. He thought my symptoms were just from stress and temporarily and would probably go away when I managed to lower my stress levels. He did not want to put in an order for labs to do some blood work. I left him and switched to another physician.
I did decide to save up and pay for my own lab work. I can’t remember all the numbers but I know my total T was around 400ish. Since this was nowhere near 250 I didn’t even bother to bring up my labs to new physician. After visiting her a few times and telling her about my symptoms, she decided to check for diabetes since my family has history of Type 2 diabetes. After the results she categorized me as pre diabetic and put me on Metformin 500mg BID. It helps control a little but hasn’t made a huge impact in the past 9 months. Just recently I decided to bring up the Low T and for some reason when I uttered the words Low T, I must have struck some strings that she completely went from smiling to serious and said NO. U don’t have low T. you are 32, that’s too young of an age and you don’t need to be concerned about that yet. She advised that if I feel like I have Low T, we can try some natural ways and then can revisit the topic in 6-9 months. Again she refused to order me blood work as she thinks it’s not necessary. I walked out of that office feeling like more sh!t and depressed than when I had walked in.
My work performance has been suffering and I’ve been lacking motivation at work and my manager has noticed it and decided to bring it up in a casual way. I told him about my symptoms and how my doctor doesn’t want to do anything about it. He recommended me to switch from my current doctor to his since his guy is much younger and is willing to listen.
Well I just got back from my appointment with the new physician and it was an overall positive experience compared to my previous physicians. He for one actually listed to all my symptoms and in the end he said he doesn’t think its Low T that’s the issue but it could be something else. He would like to rule out other things before even thinking of TRT. He ordered some blood work for me to check up on my diabetes and other things. I somehow convinced him to order me a hormone panel test and he actually agreed!!! He said if I can show him the numbers from the new blood work and if they are low than we can look into TRT and do something about it.

Now the only problem I have is I know my numbers weren’t anywhere near <250 total that Kaiser looks at. He wanted me to take the blood work next morning before 10am but I said I can’t as I need to go to work. I told him I can take it on my off Fridays so that would be the 21st in 9 days.
I’m here to ask and see if anyone has ever purposely tanked their own testosterone levels to convince Dr’s to try/start TRT? I’ve have been reading so many posts on this forums and others where guys are feeling like crap and after TRT they feel normal or better. I want to feel like normal again. I want to be able to satisfy my wife in bedroom more than just once a month. Things are dark in bedroom and “down there” and I don’t want to get to the point where we are on the brinks of a divorce or separation because I can’t feel like a real man or make her happy. She is been supportive so far but I don’t want to keep pushing my luck as one day it will run out if I don’t do something about it.

I’ve read Cy Wilson’s Your Doctor, Your Dealer and did some research on my own and most seem to say don’t sleep for two days prior to blood work, drink 4-6 beers and fap crazy to tank the T levels before the test. Unfortunately I don’t drink or smoke. I don’t like the taste or smell of beers. I think if I drank 1 or 2 beers I probably feel like I might puke. It’s the hops in beer that seem to affect the T. I’d much rather take a few shots of tequila or something else to drop the T but they don’t have hops in them. Also about faping…… Problem is I have almost no desire to fap. Like I have no mood to fap or any excitement for it. I can probably do it once before the test but can’t possible do 3-4 times before the test. Any help here would be much appreciated. Would fasting for 3-4 days straight might help? I know if I don’t eat at all, it should help lower my blood sugars so that way I won’t show high diabetic and him trying to justifying putting me on insulin treatment instead of TRT. I got a little over a week to prepare for this test and I don’t want to blow it. I can’t afford to go to these anti-aging clinics since out here they seems to be very expensive. I want to try and get on the treatment through Kaiser if possible.

I’m sorry for the essay but i don’t know what to do. I feel like this is my one opportunity to convince my new physician and want to make it right. Life SUCKS currently. I want to make it better, feel better.

#2

Highest T levels naturally are before 9 AM. That being said, they’re going to want at least two tests showing it low as a general rule. The other thing is, it might actually be something else causing the problem and you should let the doctor investigate. You do not want to mask some other problem. Find the actual problem and fix it. Your free T will matter more than your total T in regards to how you feel. Some guys are dandy at a total T of 400.
You test level could easily come back low without intervention. pre-Diabetes/Diabetes, low T are a package deal anyway. They all go to Metabolic Syndrome, which your doc will almost certainly discuss.

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#3

If you don’t remember the other test results than we will not be able to help, these test are needed in order for us to assist you. Total T value on it’s own does say much, we see guys in here all the time with very high Total T and abnormally low Free T, the portion that is circulating in the blood.

You must go private because there is no doctor in managed healthcare that specializes in TRT, these private clinics specialize in this area of medicine and are more informed than these sick care doctors. You can get TRT, just not from a clueless sick care doctor hogtied by the outdated guidelines.

I have Kaiser and they suck, my Kaiser endo’s are clueless and do not really care to learn about TRT and just prescribe my testosterone, I get consultants from a private clinic who directs my TRT protocols and prescribes other medicines as needed.

HMO’s are useless for TRT.

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

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.

#4

Im sure there are plenty of ‘self test’ kits online?..Test your own test levels or get a second opinion from a decent Doc!!

#5

True, pre-diabetes/diabetes, low T (ED) and other things related do sort of come in a package, that i know for sure. I’m living it. I just figured that if a low dose of Test C at 100mg/wk or lower, if that can help me loose weight and help with body fat % that i can’t seem to get rid of might help me go in a healthier direction.

Maybe i won’t do anything drastically and just let it happen and see what happens. If my Free T is on the borderline then i won’t probably get treated with Kaiser. I might end up going through a clinic and try low dose of TRT and see if that helps the situation. Maybe i can convince Kaiser to run my labs for me and i can always pay out of pocket for meds at Costco since they aren’t expensive. i guess i need to make a few phone calls around the clinics here and see if they allow scripts to be filled from outside pharmacies. I can have the Kaiser PCP treat me for all other things and go see a clinic for possible TRT depending on the results i get next Friday. I’ll read up more on benefits of TRT and how it helps with diabetic and gather more info to educate my new PCP. I’ll post the lab works when i get them so show how messed up my body is.

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#6

Your doc can write a script without running it past Kaiser. They either will or will not pay for it. You don’t even have to tell them if you pay out of pocket. Insurance has guidelines controlling what they pay for, not what you do or do not do. TRT is also all or nothing. There is no such thing as “Just a small dose”. You take enough or don’t bother. It will shut down your natural production at ANY dose, so you must make sure that you get enough to get your level right. It’s not a supplemental thing, it’s REPLACEMENT Therapy.

#7

by small dose i meant i wanted to start out at a lower dose and increase it up as required for optimal levels and maintain it there. I’ve been reading that sometimes clinics want to give a big full dose one shot at a time once a week but i was thinking more like twice a week and cut the giant dose in 1/2 to avoid the peeks and valleys that come with a higher dosage. Sorry i should have been more clear on what i meant by “small dose” thing.

#8

hey @systemlord unless i read or misunderstood that research/article you linked, a higher testosterone level was actually bad for guys with loss of libido and sexual performance correct? sorry was just tying to comprehend what i was reading on the article.

Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk. Their risk appeared to increase at a relatively higher testosterone level, and it reached a plateau at a testosterone level of 300 to 350 ng/dL. In contrast, the risk in those with no or less sexual dysfunction remained low at a higher testosterone level, and a threshold level of 425 to 475 ng/dL was associated with increased CVD risk. A similar pattern and threshold were identified in the analyses of the relation between testosterone and hsCRP.

#9

That is a good plan. It is a little easier on your system adjusting to a smaller dose rather than a big whammy of a shot if you’ve been low a while.

#10

I didn’t read the study, but I don’t see a high test number here anywhere. What are they carrying on about? Those are all crap low levels.

#11

It says, "In contrast the risk in those with no or less sexual dysfunction remained low at a higher testosterone level and a threshold level of 425 to 475 ng/dL was associated with increased CVD risk.

You are well below the threshold, unless your SHBG is <10, these levels are no good. SHBG greatly influences the balance between Total T and Free T, at the end of the day Free T matters.

#12

It sounds like more of a doctor issue than a Kaiser issue. I’m with Kaiser as well. I tested at a total T of 303 ng/dl and my doc had no concerns about prescribing TRT. Even the year before when I tested at 375 ng/dl he said it was low but probably not low enough that the insurance would cover it. I didn’t press him at the time but I suspect that if I had he would have agreed to write the prescription. The only issue that I had was getting the correct formulation that Kaiser would pay for. Only certain types of testosterone are on their formulary. My doc even suggested that if Kaiser were unwilling to pay for the gel (which he preferred and recommended) that he’d prescribe the injectable form and that’s cheap enough that I could pay out of pocket. Now all of that said, I don’t feel that he is by any means an expert on optimizing TRT as most doctors aren’t but he seems willing to listen and work with me.