T Nation

How to Educate Dr. on HRT?

going to see my uro in a couple days about HRT.

I have already taken the adams test to bring with me, and I also have lab work with my test, cortisol but not estradiol. Any other suggestions that may help get him on board would be greatly appreciated. My test levels are extremely low for my age, and a 70 year old for that matter.

I’m off to read the steroid neewbie thread right now…

thanks again

My guess is your urologist is treating other patients for HRT.

I started with an endocrinologist, now I am seeing a urologist. I wasn’t crazy about my endo, and he was moving away anyway.

Coincidentally, when I had shoulder surgery this summer, I had to be catheterized. The urologist who did that seemed like a good doc – I asked him if he did TRT and of course he did.


As to reading any “steroid newbie” thread that is not for you.

Steroid users are trying to temporarily get to a SUPER-DUPER testosterone level.

You are trying to get back to a normal testosterone level. That is a whole different ballgame. Your best bet is to do a search for “TRT” and “HRT” – that will produce some good threads around here.

There is actually a lot of good info in a thread I started:

http://www.T-Nation.com/tmagnum/readTopic.do?id=1200966

The good info doesn’t come from me! LOL. It is from all the guys who are there to answer my dumbass questions.

I will tell you I had a hard time of it, just getting it under control recently with the help of this urologist.

Most guys do well right from the start. I am sure that will be your case.

Good luck with your doctor visit.

Let us know how it goes. Most doctors I’ve dealt with were very put-off by me knowing what I was talking about. The last thing they want is an informed patient.

happydog,

I have found the same thing. After explaining all of my symptoms (one of the major ones being mood swings especially as of late) and the doctor seeing my lab results, he suggested that if my mood swings continue that I “seek out therapy”.

UNreal, I’m presenting almost ALL symtoms of low test and the best you can come up with is “therapy”.

If the urologist doesn’t work, I’ll be treating myself by the new year.

[quote]train51 wrote:
going to see my uro in a couple days about HRT.

I have already taken the adams test to bring with me, and I also have lab work with my test, cortisol but not estradiol. Any other suggestions that may help get him on board would be greatly appreciated. My test levels are extremely low for my age, and a 70 year old for that matter.

I’m off to read the steroid neewbie thread right now…

thanks again[/quote]

Wow…I suppose it can be done…maybe…

Realize that most doctors regard their patients as idiots/cattle. Most won’t take the time to even glance at any studies you bring. They will look at your numbers and ignorantly prescribe 5 grams of Androgel per day. Most won’t know about HCG except perhaps as a scam weight loss being pulled on women (my GP called HCG for men ‘pseudo-science’, while actually prescibing statins to me!!). They will laugh when you ask for Arimidex.

Try this guy: www.allthingsmale.com

He advocates HCG.

If you can actually convince a Uro/Endo of anything, you should be renamed Johnny Cochran. ;D

Anyone wonder why the science behind injecting T is more or less readily respected, but not HCG or AI? This seems bizarre to me. Are HCG and AI newer, more cutting edge? Are they more controversial?

katzenjammer: hcg+ai is more complicated.

For one thing, hcg use generally leads to more Estrogen production. That’s why an AI is needed, but getting the right does of that AI is tricky. Also, overdoing the hcg can desensitize the leydig cells of the testes.

With each new doctor visit, I am getting closer and closer to Headhunter’s general perception of doctors being greedy, ignorant bastards. My last visit with my “old friend” urologist was so amazingly bad, if I listened to him I would pretty much want to kill myself. He gave me no hope for testicular failure and basically told me aggressive HRT (which he defined as using T to create levels above 400, plus any use of AI or HCG) is destined to ultimately create total HPTA failure resulting in complete impotence.

However, his true colors came out when he bragged that he was the number one penile implant surgeon in Florida now, so he is clearly invested in worst case scenarios.

But I found it intriguing that his BIGGEST objection was to HCG. He practically was jumping up and down out of anger at my request for this, claiming it produces temporary benefit followed by leydig cell failure and worsened ED. It gave me pause, even though I ignored everything else he said. Doc

SUCCESS.

Went to the uro this am that I had seen about a year ago for some infertility issues.

I handed the doc my lab report form a couple of weeks ago and described to her the way I was feeling. She started to talk about androgel and I told her I had been doing alot of reading lately and I would prefer to use the shots over putting lotion on every day. Before she had a chance to say anything I said I would prefer them weekly so I don’t get the peaks and valleys with the hormone levels. She said we would do 100mg/wk. She took a quick look at my lab report and I think she realized right away I needed treatment, whereas my primary doc disregarded the low T level and suggest I seek out therapy if my frustration and anger issues continued.

She agreed to the weekly shots. Mentioned they would take blood to get their own baseline levels and we could start the shots. I expected to have to go to a lab, get the blood drawn, have the results sent then wait a couple weeks before starting therapy…next thing I know the nurse is walking in with my first shot of test!!!

Mentally I feel better already, I’m sure there is no effect from the shot yet (duh), but at least there is someone willing to help and acknowledge the problem.

What is the first thing I will notice as the therapy starts to work? Labido?

[quote]train51 wrote:
SUCCESS.

Went to the uro this am that I had seen about a year ago for some infertility issues.

I handed the doc my lab report form a couple of weeks ago and described to her the way I was feeling. She started to talk about androgel and I told her I had been doing alot of reading lately and I would prefer to use the shots over putting lotion on every day. Before she had a chance to say anything I said I would prefer them weekly so I don’t get the peaks and valleys with the hormone levels. She said we would do 100mg/wk. She took a quick look at my lab report and I think she realized right away I needed treatment, whereas my primary doc disregarded the low T level and suggest I seek out therapy if my frustration and anger issues continued.

She agreed to the weekly shots. Mentioned they would take blood to get their own baseline levels and we could start the shots. I expected to have to go to a lab, get the blood drawn, have the results sent then wait a couple weeks before starting therapy…next thing I know the nurse is walking in with my first shot of test!!!

Mentally I feel better already, I’m sure there is no effect from the shot yet (duh), but at least there is someone willing to help and acknowledge the problem.

What is the first thing I will notice as the therapy starts to work? Labido?[/quote]

You will still need HCG to keep your balls from dying and Arimidex (or Ana) to prevent your body from converting your new Test into Estrogen.

Your doctor sounds like a possible winner. Run off some of Dr. Crisler’s stuff about HCG (www.allthingsmale.com) and show her. Who knows?

my balls are already dead.

infertile and not produceing test, should i still worry about hcg? Last time I was tested LH levels were through the roof, doc said pituitary ws reaction to no test in system.

Also asked them to test est. , as i feel like a crying bitch most of the time

[quote]Dr.PowerClean wrote:
With each new doctor visit, I am getting closer and closer to Headhunter’s general perception of doctors being greedy, ignorant bastards. My last visit with my “old friend” urologist was so amazingly bad, if I listened to him I would pretty much want to kill myself. He gave me no hope for testicular failure and basically told me aggressive HRT (which he defined as using T to create levels above 400, plus any use of AI or HCG) is destined to ultimately create total HPTA failure resulting in complete impotence.

However, his true colors came out when he bragged that he was the number one penile implant surgeon in Florida now, so he is clearly invested in worst case scenarios.

But I found it intriguing that his BIGGEST objection was to HCG. He practically was jumping up and down out of anger at my request for this, claiming it produces temporary benefit followed by leydig cell failure and worsened ED. It gave me pause, even though I ignored everything else he said. Doc [/quote]

Pretty frustrating, eh? They’ll make you crazy. What gets me is when you do like Galileo: you beg the Cardinals to at least look through the telescope but they refuse. “Here Doctor _______, look at these studies from the Journal of Endocrinology and Metabolism.” …doesn’t even look…

Why would it give you pause? Exactly how are your leydig cells going to be functioning when the exogenous testosterone you’re taking shuts your testicles down completely and they atrophy to the size of raisins?

Dosages over 1000 IU a day can cause desensitization but smaller doses have not shown this problem. The 250 IU EOD protocol is well below the danger level.

His objection is bullshit. I’ll let you decide if he’s simply ignorant or if he’s a vampire setting you up for his pet procedure.

[quote]happydog48 wrote:
Dr.PowerClean wrote:…But I found it intriguing that his BIGGEST objection was to HCG. He practically was jumping up and down out of anger at my request for this, claiming it produces temporary benefit followed by leydig cell failure and worsened ED. It gave me pause, even though I ignored everything else he said. Doc

Why would it give you pause? Exactly how are your leydig cells going to be functioning when the exogenous testosterone you’re taking shuts your testicles down completely and they atrophy to the size of raisins?

Dosages over 1000 IU a day can cause desensitization but smaller doses have not shown this problem. The 250 IU EOD protocol is well below the danger level.

His objection is bullshit. I’ll let you decide if he’s simply ignorant or if he’s a vampire setting you up for his pet procedure.[/quote]

Fair comment. My pause comes from a paucity of long term data on HCG use in this way, combined with even our esteemed KSman's posts about the "lifetime" of usefulness HCG has. It will not work as long as testosterone replacement will, as I understand it. And with primary testicular failure, with nuts already shrunken by 80%, if the use of HCG in any way contributes to overall HPTA desensitivy to androgens and hence sooner complete impotence, it would not be worth it to me. I experienced complete impotence the month of estrogen poisoning, refractory to Viagra, great porno, everything. That struck fear in me and reduced me to a babbling vagina. 

I know that uro was an idiot, its just I think we are in pioneering times with long term HCG use. Even though I plan on getting on it, I would like to get to a better comfort level with it. All of us here on T-Nation buying into the current state of the art HRT triad of drugs have no real clue what will become of our erectile function in twenty years. We may simply be deferring the ultimate atrophy of our testicles. I know there is no curent better option, but somebody has to raise the question.                                            Doc 

I agree 100% and the real shame is that we don’t already have those answers and are unlikely to get them in the foreseeable future given the current hysteria about all things testosterone.

We’re always left in the position of trying to decide what to do given the fact that we know our understanding is imperfect.

In my own case, the answers are made fairly easily because I know for a fact the consequences of not doing what I do. In other words, not taking hCG makes my balls hurt and shrink. Taking it stops that from happening. It’s a slam dunk.

We know for a fact that low testosterone has deleterious effects on the body. It might be that testosterone replacement has long term negative effects so it may, after all, be a question of which evil is less. We don’t know.

In the mean time we all have to make our choices and hope for the best. I’ve already made the decision that if it turns out that I’m sacrificing longevity for quality of life then I’m ok with that.