T Nation

How to Approach My Dr?

I have switched doctor’s and am hoping he will go along with the protocol suggested on this site. I have been on androgel 1.62 for 2 months, 1 month test results TT 179, 2 month mark 189. I seriously feel like shit worse then when I started. I was in the 200’s then. Those numbers are in my peak after 2-4 hours after application so who knows what my lows are. My body is literally beginning to hurt.

I am going to see a new Dr. in a week because my old one only wanted to increase the androgel that was not working. She would have nothing to do would the shots. The new doc is a male, not sure of his age. I don’t want to come off like I know everything about TRT when I approach him, because I obviously don’t. I only know what I read and I want to feel better. Any suggestionson how to approach this with Him would be greatly appreciated. Thanks Nick

In your case/thread opening post:
-age 29
-height 6’ 1"
-waist 36
-weight 225-240 depending on the month
-describe body and facial hair No chest hair, Joe dirt Beard, A ton of leg hair
-describe where you carry fat and how changed stomach, but pretty even over my body
-health conditions, symptoms [history] Fatigue, Loss of Strength, Can’t get off the couch, Think slow, Irritated easy, no energy, no erections, no morning wood
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever Valium, Paxil
-lab results with ranges Only Total T right now 189 on three pumps of androgel 1.62
-describe diet [some create substantial damage with starvation diets] 3000-5000 calories a day, I have a fast metabolism.
-describe training [some ruin there hormones by over training] Was stength training every other day until I just felt to weak
-testes ache, ever, with a fever? Yes, no fever
-how have morning wood and nocturnal erections changed Morning wood? what’s that…

You’re 29? Find out what the problem is!

If they offer exo T as a therapy, call them a quack in public until you get your money back.

I am brand spanking new here, but I have low T as well and for the last 6 months been on Testopel. It has raised my T levels to the mid 900’s and has helped me have the energy to exercise and lose some weight. If you would like any more info or have any questions message me. As I said, I’m new to the site, and have used Testopel.
Good luck.
James

I go through the VA, I am a vet. 29 yes… I’ll be 30 in December. I just want to know what to say to him. I don’t want him to think im just trying to become a major athlete or something. I just don’t want to feel like shit. I don’t know what the problem is, Ive had a ton of blood test. All normal except low T and estrogen, but I don’t remember the numbers for estrogen.

I was just tested for TT, bio T, Estrrogen male panel, and LH, per what everyone said on this site. Still waiting on those results. What is exo T? I want the shot, hcg, and the ai, like the sticky suggest. Minus a little fat I am pretty stout, I just don’t want the doctor to get the wrong impression. So do I go in to a new Doc and demand what I want? Do I bring in the (sticky) paper and say I read about this and hope for the best? Im pretty depressed about the whole situation. I go on the 25th, so any adive would be much appreciated. I will post the other labs by then. Thanks

You will get a lot of good advice here. Most and the most knowledgeable will encourage you to seek out the cause of your low T, and to correct that before embarking on TRT. Many times just adding T will just mask what is really wrong and will further complicate it.

With that said, topicals are crap, if your doc prescribes one tell him that you are changing insurance in a month or so, and that your new plan will not cover the topical. The cheapest most economical method is injection and that is what he will have to give you. You can try for the HCG and AI, but a good starting point is the injectable T. Get the AI off the internet if need be. ***BUT…I would really encourage you to track down what is causing this first.

I go to the VA, I don’t have to pay anything because I am a disabled vet. I can’t think of anything that would be causing it. I had a 24 hour urion for my adrenals. I was good. Had all the thyroid test, I was good. Almost hyperthyroidism, but still within range. Anxiety issues. I can’t fix that. I have been working on it for 10 years. There is no cause except my balls don’t work. I have a large calcium deposit in one. I have had it checked by three urologist. It sticks out as a hard lump.

Nothing I can do about that. My balls gave me the big FU, and as you said topicals suck, atleast for me. Besides a bunch of CS gas I didn’t have any chemical exposure. I really just want to know how to approach the Dr. I’ll have my wife with me so that should help. You never know who your going to get through the VA so I could get a foriegn doc an old doc, or a doc right out of medical school. Either way I dought he will be as educated as some on here.

I don’t want to go through the years of trial and error. First two weeks on androgel felt the best I have felt since I was a teenager. It quit working and so did everything else. Please just tell me how to appoach him.

And I already am on the TRT route, no turning back.

At a minimum your VA docs “should” be trying to find the primary cause of the hypogonadism. A good place to start is an MRI of the pituitary to rule out tumors which screw up the feedback loop between the pituitary and gonads. Did the urologists say anything about a varicocele or “varicose” vein underneath your testicles in addition to the hard calcium lump? I discovered a hard lump in one of my balls 30 years ago and immediately went to a urologist expecting to be told I had testicular cancer. Turns out it was a calcium "lump’ but in addition I had a varicocele leading into that lump in the testicle. That could be one reason for hypogonadism but the pituitary has to be considered as well.

I had an MRI of my head and it was normal. There were no problems Varicose veins. I thought the same thing that I had cancer. But like you it was just a calcium deposit. I had my TT, Bio T, E, and LH tested as well. I will post those today hopefully. Just waiting on a phone call.

When docs cant or wont find the reason sometimes they are lazy, and sometimes your shit just doesn’t work anymore, I think the word they use is idiopathic.
Androgel will make you feel better for a cpl weeks, then back down, they up your dose, you feel better and then down again due to the E2 following more T.
I’d just push for shots, when I made the switch between gel and inject it was night and day, it even made me give up adderall which I never thought I’d be able to do.

It may be useful for you to print this and bring it with you to review with your doc.


I have seen a lot of posts saying that it helped get their doc on board.
Emphasize to the Doc that this is to feel well, not for body building, tell him you don’t even life weights.
Good Luck.

New test results 10/15/2012 TT 189 ng/dl Bio-T 3.8 ng/dl E 13.5 ng/dl on three pumps of androgel 1.62 per day. This was at my peak roughly 4 hours after aplication. What do you guys think?

I think those are stupid results, from a stupid test. Why is it stupid? Read the stickies.

Go to Mexico, or India, or wherever. Walk in to a pharmacia or a pet store. Buy what you want. (Actually, that’s how I do it!) If and when that doesn’t work, we’ll still be here.

I read the stickies and think that is a dick answer… I came here for help. I live in Michigan and I want to do things the right way. I can only do what my Dr. and the VA lets me do.

You clearly aren’t absorbing the androgel. When you get the prescription, there is a leaflet in the box describing the expected results and clinical trials. Take it out of the box and read it, then bring it to the Dr on your next appt along with all your test results pre and post androgel, politely ask to discuss it with him. If your Dr. cares at all he will see that the med is ineffective in your case and “should” offer you another treatment. Hopefully he will offer injections…your job is to insist on injections, do not leave the office until they bring you a shot.

Your care is up to you, you served this country and those Dr.'s are there to serve you.

[quote]nicholasb9393 wrote:
. . . I can only do what my Dr. and the VA lets me do.
[/quote]

Your question is becoming clearer now. I got nuthin’.

I didn’t mean to come off the wrong way. Mt T is low and i’m pissed it’s taking so long to fix. Really though, I am only going to do what the doctor says. I will push for the protocol as everyone calls it, but it’s a 50/50. PKNY - Thanks for the advice and support.

Your inability to absorb Androgel suggests that you could have hypothyroidism, as you would know if you read the advice for new guy’s sticky. Many TRT guys here have thyroid problems.

What did you have for LH/FSH before androgel?

Check body temperatures
Test TSH, fT3, fT4
Evaluate your iodine intake

I don’t have hypothyroidism, almost the opposite (hyperthyroidism). I’ll post those results after I go to the doc on Thursday. I have had my TSH, T3, and T4 tested many times for hyperthyroidism. but am always just at the cutoff point. I don’t know if that affectes it as well.

I am not a big sweater even if I run 2 miles I stay pretty dry, And I have bent neddles with just my skin, Maybe its too thick? I have been told it is by several nurses, I don’t know. But your right I can’t absorb the Androgel. I have read the stickies as I said before. I am shooting for the shots Thursday and will get back on here. Thanks

First off, I want to thank you for your service to our country. I hope the VA does everything they can to help you through this.

I’m interested in seeing your thyroid results. I ask because you’ve suggested that they’re “in range”, which doesn’t really tell us much. The results might fall in the labs expected range of results based on some extraneous criteria, but (as I’ve told my doctors before) “in range” does not equal optimal or healthy.

Additionally, T3 and T4 (bound and unbound) need to be in a certain ratio to each other, and TSH output needs to fall in relation to T3, T4 production. So if fT3 is on the low end of normal and fT4 is on the high end of normal, that could indicate a problem. Thyroid results can get ms-interpreted very easily. Some doctors say a low-normal TSH is a good thing, but others say it could be hypothyroidism. Well… who is right?

You indicated in one of your early posts that your testes ache but without a fever. What sort of pain are you feeling? Is it a dull, persistent constant ache?

In the 9th post above you stated that you already had an MRI. What were they looking for? Did they look at the pituitary for adenomas? Did a neuro-radiologist review the MRI?

You seem to be concerned about approaching/persuading your doctor into a course of action. It’s okay to feel some anxiety about that. It’s also good to be active in your medical health. I have a much easier time telling doctors to follow my lead or they can pound sand - but that’s because my mom was nurse for 25+ years and knows how crooked the medical profession is. I recommend bringing a pen and paper with you to the appointment, as well as a small book that you can use as a clipboard for writing on the paper. Write any questions ahead of time on it.

What I’d say is (and look him straight in the eye), “Doc, I’m not looking to get ripped and I don’t care about body building… BUT I do know that T levels this low in men pose a very serious health risk for a lot of things - diabetes, blood pressure problems, arterial disease, depression, etc. etc… Someone my age SHOULD NOT HAVE LEVELS THIS LOW.”

Get him to agree with you on that point first. Once you’ve got him to accept an obvious fact, you can steer the discussion towards causes and treatment.

Then go on to ask him, “What do you think is causing this? Forget about treatment, talk to me about causes.” He’ll probably list off some.

Then ask him, “Based on the tests that, what can you confidently exclude as a cause?” He’ll spit out a few things that he thinks are not likely.

If you want to try T injections, tell him, “I did feel some benefit to Androgel but only at first and for a short time. The efficiency between the various topical TRTs is absorption, and I’m also concerned about transference (make up some excuse about how you get massages or something). We’ve done a lot of tests so far. I’d like to try a short-term trial with TRT injections… only for a few weeks or a month - just long enough so we can determine how I’ll feel with a clear rise in my total T levels, and so we can measure those levels. How long of a trial time frame would you suggest?”

The last part is key - ask him a question for how long you should be on an injection trial. That forces him to answer in a time-frame as opposed to telling you to switch back to a topical.

I don’t have time to write more. Good luck! You may find that you can cut your SSRI dose too. I cut my Lexapro dose from 20mg to 10, and am considering going down to 5.