Is My Doctor a Moron?

pnsc114 2011-01-01 00:16:15 UTC #1

I am going to be 27, 161 pounds and currently on "TRT". Back in September, I had finally convinced my doc (a urologist) that I should have my T levels checked. Typical symptoms...inability to gain/maintain muscle, no morning erections, numb mood, social withdrawl, no libido, etc.

The only things he tested were TT, LH and FSH. Forgive me, this is going off of memory, he didn't give me a copy of the results.

TT 291 (187-790)
LH 8 (can't remember the range)
FSH 21 (no range...but it was high)

After that, he sent me for a fertility test. The nurse called me with the results and said I was in "complete testicular failure" based on my T results and fertility test.

The doc wanted me to try Testim. According to him, at the low dose of 50mg/day of gel, it only "supplements" my body's production without shutting it down and should help. I inquired about the shots (having been reading this forum) knowing they were more effective. The nurse told me they were an option, but the doc only wanted me to have me on them for a "short time" without giving me a reason. So not wanting a fight and just wanting relief from this hell, I went with the gel. The nurse told me I would have to come back in three months for a blood test (for TT and to make sure I wasn't over-producing RBCs).

What bothers me...I don't have any kids. I want kids. The nurse implied there is still a slight chance I can have kids...but it would be an invitro type procedure to pull it off. I've been on the gel three months now (without HCG) and I have a meeting with the doc in a week. I am going to be demanding the shots, a blood test in two weeks after starting the shots and HCG therapy to hopefully have children someday.

My only concern is the dull pain in my testicles and the fact that symptoms have not improved. The only change I've noticed is the horrible rash that broke out on my arms from the gel (the doc said to put it on my abdomen after I complained...now it gets sweated off/scrubbed off).

Any recommendations on convincing my doc this is what I need (shots and HCG)? I've thought about trying to order HCG myself...if someone could PM with any info trying that, please do.

My biggest concern in trying to get treatment that works is the doc getting spooked and pulling me off treatment all together.

KSman 2011-01-02 20:18:17 UTC #2

Talk to local compounding pharmacists and ask for a referral for a new doc. There is a sticky on this. Explain what kind of TRT you are seeking and also a doc that uses hCG and Arimidex/anastrozole. You probably do not want a referral to a doc that does not take insurance.

Get your lab reports, you will need them.

If your TT and FT respond well to TRT and FSH does not go to zero, you might have an FSH producing testicular cancer. I only bring this up because your FSH seems so high relative to the LH. Normally testing LH/FSH is not otherwise needed when on TRT.

You cannot augment T with TRT. Read the stickies.

pnsc114 2011-01-10 14:07:01 UTC #3

Just an update: I met with my doctor to go over my 3 month lab work (TT and a CBC). I printed out the sticky on injections. KSman, I want to say, I am very thankful you took the time to post that information.

The doctor, after realizing I am not another ill-informed patient, actually heard me out and read through the sticky. Three months on the gel only boosted my TT to 334 (from 291). I told the doc I wanted start injecting AND wanted a lab test in 2-3 weeks to see where TT and E2 values are sitting. I made sure he knew I was aware that TRT is something something long-term and "supplementing T production" isn't a realistic treament.

The fertility issue was also discussed. Getting it straight from the doc, the analysis showed zero sperm in the sample. He mentioned "direct needle aspiration" can sometimes yield a few viable sperm. I had used this result to push the use of HCG in my treatment. He initially wanted to put me on clomid and "cycle it" to avoid any negative side effects. After almost pleading with him, he reluctantly wrote a script for HCG. He mentioned he doesn't have a single pt on this treatment and those he has tried it with noticed nothing.

The normal protocol for his patients getting injections (scary) is 400-600mgs of only T cypionate every 4-6 weeks. I told him a flat-out no. I told him literature suggests 200mg every two weeks and I told him I will cut the dose into fractions and inject more frequently.

The most suprising thing happened...he wrote a three month script for T cypionate (200mg/mL 10mL vial x3) and told me to dose it how I see fit. I also have a script for hcg (10,000iUs 10mL vial). The only thing I didn't recieve is arimidex.

Illinois requires a script for needles and syringes. He wrote a script for 1 1/2 21g needles and 3cc syringes. Though this was stupid as hell, I was just happy he got me the materials to get on the right path. He forgot the script for the insulin pins for use with the hcg. My pharmacist saw this and shoved two bags of 30g 0.5" 0.3cc insulin pins at me.

My dosing:

(All SC)
250iu HCG EOD
25mgs T EOD

I am counting on the fact that my follow up lab work in 2-3 weeks will show elevated E2 levels (warranting a script for arimidex). For now, everything is going SC. The ache is gone and some issues have begun to reverse themselves (mood and energy).

In the end, a quick question: can I order more insulin pins online without a hassle? The cost of another doctor visit and another back and forth explaining that SC can be as good as IM is something I'd rather not deal with at the moment.

Avaric3 2011-01-10 14:56:16 UTC #4

im jealous that your doc is so open-minded lol

Hardasnails 2011-01-10 17:17:25 UTC #5

Why not find out why your testosterone levels where low. Was it primary or secondary? Have you had your Dr look indept at your adrenals and thyroid to rule them out before commencing on TRT. Many guys on TRT feels good for a while then end up feeling worse several months into TRT. If these people on TRT do not feel right despite proper numbers they are usualy given an antidepressants as a cure instead of further investigation of thyroid or adrenals.

pnsc114 2011-01-10 22:20:16 UTC #6

He really wasn't open-minded. I tried to meet him on his level without being insulting. It was a lot of feeling him out as we were talking. I'm convinced the thing that sold him on it was my insisting on a follow up lab within a few weeks of starting injections. The lab work will not only help me figure out the correct dosing for my body, but it shows that I will do it intelligently and not use the "if some is good, a lot is better" mindset.

I've found that doctors will not take you seriously at my age...it really doesn't help that I'm going to be 27 but look like I am 18. It did help that I could follow him when he tried to deter me using "big" words. Benefits to working as a paramedic lol We aren't trained in endo issues outside of thyroid storm or graves disease. I couldn't have done it without KSman sharing his vast amount of knowledge in this forum.

pnsc114 2011-01-10 22:33:01 UTC #7

Hardasnails: it's primary. Problems with undecended testicles when I was a kid finally came back to bite me. I've had my other values tested and the lab numbers were unremarkable according to two other docs. Nothing to indicate any damage anywhere else.

Everything to indicate it is the testicles not producing. I am still going to find an endo to get everything worked out and documented. Like I said, it was the issue of the "boys" sitting in the body cavity for years that led to their eventual failure. I want to make sure if others have my same history, docs know what to look for, hence the documentation.

Hardasnails 2011-01-10 17:49:05 UTC #8

See this is crucial information validating why it is medically neccessary. Have you tried to stimualare them directly such as clomid? or an HCG stimulation test?. If these have been ruled out then you are prime canidate for TRT. Please make sure you are having thyroid (free t3, free t4 total t4, reverse t3, TPO, TGAB all checked by dr) as well as your estrodial sensitive.
Keep in mind proper lifestyle, nutrition,stress management , positive emotional state are essential for your over all wellness.

PureChance 2011-01-10 23:26:26 UTC #9

Don't expect much from the Endo - Ihave not heard one good success story that I can remember from anyone here seeing an Endo.

You do also need to get your Thyroid and Cortisol checked. If you have problems with one system, chances are that put stress and may have caused problems with your other symptoms.

BTW, good job working with your doctor and standing up for yourself. It is not easy by any means.

It seems like we have been trained as a society to trust in doctors, to sit uncomplaining in waiting rooms for hours on end, to almost blindly follow whatever advice not matter how trivial that they might be gracious enough to share to us poor peons, to not dare to object or offer alternates... rather than realizing that we are the customer, that this is our body, our one and only life, and by golly we are the ones in charge. Not the doctor. The doctor is nothing more then a paid consultant. They work for us. We are the decision makers.

Doctors are not GOD, they don't know everything even though they would like us to treat them like they do, Doctors make mistakes, Doctors are overworked and don't have the time necessary to spend with each patient - but rather than object, most people just seem to roll over and accept whatever scraps they are given.

Hardasnails 2011-01-10 18:44:44 UTC #10

PureChance wrote:
Don't expect much from the Endo - Ihave not heard one good success story that I can remember from anyone here seeing an Endo.

You do also need to get your Thyroid and Cortisol checked. If you have problems with one system, chances are that put stress and may have caused problems with your other symptoms.

BTW, good job working with your doctor and standing up for yourself. It is not easy by any means.

It seems like we have been trained as a society to trust in doctors, to sit uncomplaining in waiting rooms for hours on end, to almost blindly follow whatever advice not matter how trivial that they might be gracious enough to share to us poor peons, to not dare to object or offer alternates... rather than realizing that we are the customer, that this is our body, our one and only life, and by golly we are the ones in charge. Not the doctor. The doctor is nothing more then a paid consultant. They work for us. We are the decision makers.

Doctors are not GOD, they don't know everything even though they would like us to treat them like they do, Doctors make mistakes, Doctors are overworked and don't have the time necessary to spend with each patient - but rather than object, most people just seem to roll over and accept whatever scraps they are given.

If you really want some scary facts. We have had a couple dr's in the past few years that have came. Lets just say its scary to see their blood work. Just to think this was only just a blimp of e dr, surgeons and other medical professionals who are responsible for our well being. When I first started with Dr O, I had him check his levels. Lets just say we practice what we preach. People did not see him in few months notice the immediate difference. More health professionals need to take better care of them selves if they want to take care of their patients. !!

Like purechance said I applaud you for taking control of your health because alot of people just take the dr's world as if its the bible.

KSman 2011-01-10 18:45:51 UTC #11

Do not do labs after only 2-3 weeks. That is too soon for E2 to balance. If you feel great, you do not have any motive to test soon. If you feel great and that starts to slide, you may be feeling elevated E2, then you are motivated to get tested and deal with the lab results.

Your T dose of 87.5 mg is a bit low. You can dose to get higher normal FT levels. You are young, one also needs to look at youthful T levels, not age adjusted.

pnsc114 2011-01-10 20:04:22 UTC #12

I'm lucky with the insurance I have right now, so I will take full advantage of lab work lol. From what I have read, I'm sure E2 will, at some point, start to work against the T. If anything, the test in a few weeks will provide a window into how my dosing is working out. If E2 doesn't cause a problem, great, that's one less drug I have to take.

I'm sure there is room to play with regards to where I am sitting in the lab value range, but I certainly don't want to be at the extreme top of his lab range after I convinced him to work with me on treatment. It'd be nice, but I'm worried he would pull the plug on treatment if anything looks "excessive" to him. I am young and I know youthful levels should be much higher than what he is used to working with. But the fact that he IS used to working with much lower levels is what worries me. I'm spooked that anything TT of 700 or above will raise a red flag in his mind. He only agreed to treat the 291 value because it was giving me such a problem for the past few years.

Am I short-changing myself on T? Probably. But I'm to the point where anything higher is a very welcome improvement.

KSman 2011-01-10 20:46:44 UTC #13

700 would do a lot more for a younger guy than an older guys, receptors and cellular response, better metabolic systems etc.

pnsc114 2011-01-28 20:17:04 UTC #14

Okay, got an update. I went in for the bloodwork that I requested last week just to get a picture of my dosing. I had been getting moody and little sensitive around the right nipple. Dosing has not changed (87.5mg/week in divided doses SC EOD).

I called the nurse and after saying that she didn't know if the doctor liked his pts knowing their values...anger rising at this statement...I convinced her they are my labs and I would like to know.

TT 1663 (241-827)
E2 46 (less than 57)

This blew my mind and now I am freaking out that the doc will pull my treament or force me to pay for an office visit every month so he can personally administer the treatment. The E2 would explain why the good mood disappeared.

Does anyone have an idea as to why a sub-standard TRT dose of 87.5mg/week shoot my TT levels that high? I was just planning on seeing where the E2 levels were sitting and hoping if they were high he would be open to controlling it.

One theory of mine is that the SC injections caused a back up of T in my system due to the slower release time. So instead of clearing it in time for the next injection, I just loaded more into an already "overloaded" depot.

For now, I am going to cut the dose in half and start injecting the T IM. Any and all advice would be welcome...especially if you have an idea of how to explain this to the doc. He was open enough to help me and now the labs look like I just started shooting like kid in a candy store.

Akaji 2011-01-28 20:33:09 UTC #15

Oh god. I would send a strongly worded letter to whoever chairs that department. Patients absolutely have every right to know everything about their care, including (especially!) test results (e.g. lab). Good on you for not backing down.

Some people are T overresponders. I believe there's some information on that in one of the stickies. This might be what you're running in to. Your theory doesn't seem possible to me, but I'm no biologist - someone else here may know more.

KSman 2011-01-28 23:45:45 UTC #16

Good story, but I will refrain from dealing with your questions as that is off topic for this sticky. Add that to your existing post that you use for your case, see ya there.

VTBalla34 2011-01-29 00:20:53 UTC #17

???

Akaji 2011-01-29 01:01:00 UTC #18

I think KSman thought he was in a different thread.

pnsc114 2011-01-29 01:31:37 UTC #19

This is my "case thread"...

pnsc114 2011-01-29 15:45:38 UTC #20

If he pushes to change my dosing to 400-600mg every 4-6 weeks due to this, what could I expect as a result? I know E2 is already high and left unchecked is going to be a larger problem than it already is (right nipple is already sensitive). Is the liquid arimidex as a research chemical still an option or have things changed legally?