T Nation

Lab Results are In. Depressed by my Doc’s Response

I had made a previous post about being frustrated with Kaiser and it’s anti TRT motto. After bouncing from doctor to doctor I finally found a doc that would put in a blood work request to test my testosterone. Well the results are in per below pictures along with my doctors response to my results. He had said before the test that show me the numbers and we can work from there. Apparently it’s not low enough for him to do anything about it. I’m depressed at his response and I’m also furious as well. I feel like I’m not getting any help and I just don’t have extra income that I can go to an anti aging or wellness clinic where they would put me TRT at those numbers.


I’m 32, 5’8”, and ~200lbs. I’ve always been at 200lbs +/- 10lbs through my whole adult life. Even when I was lifting weights and was in decent shape I would always hover around that weight. Whether I eat like shit or mostly clean. Its always been consistent.

I don’t know how to respond to his message. I’m speechless. I can’t think of anything that could convince him to put me on a low dose of TRT. Or whatever the optimal dose would be for me to go from below the range to at least in middle of the range. Any help in replying or trying to convince this doctor is appreciated. I’m honestly tired of going from physician to physician here in SoCal Kaiser. If anyone has Kaiser here in San Diego area that can recommend a doctor that knows what he/she is talking about I’d live to go visit that doctor. I don’t even know if I send my doctor links to some articles and research would help change his mind. I’ve read around that low dosage of testosterone can be a health risk for young men in their 30’s. I just feel disappointed and lost a battle.

Find a new doc man. Where are you?

Fly out to see my doc tier1hw.com

Stop fucking asound with these non trt docs man.

You are dying and need to get help. Same level as me.

Find a TRT DOC. Stick with insurance and keep messing about. Post your location and ask if anyone knows of a good local doc.
Make a new thread with that question.

I’m in San Diego, CA

Dude you have a great option. Click my name and email me. I’ll introduce you to my doc . He’s dr nichols . He has license to practice telemedicine in cali.

He’s one of the top trt docs in the country. You won’t have to worry about these idiots anymore and you’ll get started in the coming Days.

Go to YouTube and type in lifting dermatologist Keith nichols. Watch his videos. He used to be on jay cambells videos as well. Overal great doc.

@dbossa

The problem with going outside of Kaiser is that currently I’m financially bounded. I won’t be able to afford Dr. Nichols or anyone in TN at the Tier1HW. The $25 copay at Kaiser and free labs if I can convince a physician to order for me is affordable. Going outside means everything is out of pocket and that I just can’t do at this moment. Possibly in the future I might be able to as we just bought a house out here don’t have much savings left.

You need to them use defy medical and consult us as you optimize. Or use low t nation . Find a clinic only start cypionate Pregnalone dhea and that’s all. No ai no HCG. If theybsuggest thyroid do it.

Otherwise stay low t until you find money.

I was dying at 185 total and 3.5 free t. I would of sold my bike and tv to pay for service. I suggest you find a way. It’s only going to get worse .

Kaiser is buklshit. They should be tied
And shot for harming men.

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You according to your levels you qualify for TRT scoring under 300 according to endocrine society guidelines, the problem is Kaiser doctors are anti-TRT and are just ignorant and you never really stood a chance. You have yet to receive proper testing and diagnosis to determine why levels are as low as a 90 year old man.

Kaiser doctors cannot even follow guidelines because they are anti-TRT and are blind by personal bias. Your SHBG is 11, levels this low are associated with metabolic syndrome, you’ll never lose the weight because you are at a disadvantage and are probably insulin insensitive.

It doesn’t seem like your doctors even attempted to investigate your low testosterone with proper testing, more likely because they don’t know what tests to order or how to interpret the lab testing.

You clearly have low testosterone and your Kaiser doctors are ignoring very low testosterone and expect a guy who is probably insulin insensitive do to very low SHBG to lose weight. There is a reason why metformin didn’t work, because testosterone is very low and you are unable to drive glucose into muscle tissue without normal testosterone levels.

I have an idea, see if you can get a referral to Dr. Demoss Daniel MD, an endo at Kaiser Harbor City. He is younger and he will listen and seems like a great open minded guy. I know it’s a long drive but it may allow you to get your foot in the door.

Click on highlighted link below.

Here are the guidelines for TRT according to the endocrine society

Recently, other hormones are also being measured as per recommendations. In patients with low testosterone, serum luteinizing hormone should be measured to establish the etiology of testosterone deficiency and may be an important factor in determining if adjunctive tests should be ordered

Serum prolactin levels should be measured in patients with low testosterone levels combined with low or low/normal LH levels to screen for hyperprolactinemia. Persistently elevated prolactin levels can indicate the presence of pituitary tumors, such as prolactinomas.

The ISSAM and the ISSM use the cutoff value of TT 350 ng/dL; they widened the indication of TRT to TT <350 ng/dL in 2008 however in 2015 they suggested that TRT may be reasonably offered to symptomatic patients with TT concentration higher that 345 ng/dL based on clinical judgement.

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Thanks @systemlord for the recommendation of Dr. Demoss. I replied back to my physician asking him to give me a referral to Dr. Demoss in Harbor City since he currently is accepting new patients. I totally don’t mind driving to LA at all to get proper treatment. A tank of gas and LA traffic is totally worth it for me. I wasn’t aware that low T and SHGB would hinder me from loosing weight. I’ve tried eating at a caloric deficit and it’s still hard for me to drop weight. I’m still shocked that my PCP thinks Total T of 210 ng/dL is not alarming to try and start a treatment for someone of my age.

I’m just curious even if somehow I dropped 30lbs to get down to 170lb range I wonder if that would have a significant impact and increase my natural testosterone and SHGB back into good acceptable range. And you are right that 500mg Metformin twice a day isn’t helping much in dropping my blood glucose really. I’m sure it’s helping a tiny bit but just not enough to make a significant or noticeable impact.

Crossing my fingers that I get the referral that I need to go see a proper endocrinologist and see what he thinks of my lab work.

This is not likely, you may see an increase but it will never be enough to see optimal levels. Your low SHBG is more than likely genetic, low thyroid function could be partly to blame. Your thyroid should be investigated considering your symptoms, checking TSH, Free T3 and Reverse T3 at a minimum. TSH >2.5 is indicating a problem.

The normal ranges for TSH are not normal, it is compiled from sick people seeking treatment, this is how the ranges were created and over the years ranges adjusted, healthy individuals have a TSH closer to 1.0 <2.5.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH.

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I mean, let’s be honest mate. Indeed, you’re below the normal/healthy range, but you’re looking for the easy way out… which is TRT. At 5’8 and 200lbs, unless you’re some pro bodybuilder, you’re most likely overweight, borderline obese.

TRT is a lifetime commitment, you’re gonna have to inject your ass for the rest of your life until the day you die, there’s no easy way out of it once you start. Your doc seems really professional and it sounds like he’s only trying to make sure that your problem is indeed real, and not lifestyle related.

What if you lose 40 pounds and your T shoots up? Why become addicted to TRT when you can wait for a few months, try and lose weight and see what happens, if your T is low still, after losing weight and a healthy lifestyle, then consider TRT. Don’t rush to these type of really important decisions without analyzing everything first.

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Tell him You are getting a lawyer and will plaster that letter and blood work all over the internet and mens health forums/groups
Also dont listen to zav25 you probably have the extra weight from being low T. Losing 40lb isnt going to do much for your T. I’m 5’10" and was 220 when starting TRT with double digit t I’m now 210-215 and have lost quite a bit of fat 5 months into TRT and 3 months into going to the gym. I work hard days of heavy construction. I’m not a pro body builder im probably around 20%bf maybe less. Statistically I’m probavly obese but i have a lot of muscle. Guys call me elephant calfs because of how big they are and I don’t even work my legs at the gym besides the elliptical.

I also suggest natural approach first always this is what Im trying to do however if with this low SHBG he is diabetic he will never loose the weight without T.

He needs to try at least clomid or HCG mono.

Hey @systemlord I finally got a chance to make a phone appointment with my primary care and he agreed to give me the referral to Dr. Demoss Daniel MD at Kaiser Harbor City. Going to go see Dr. Demoss on Wednesday morning. I think he should have access to my lab works if not I’ll just print them out and take it with me just incase. Hopefully he is able to listen and actually understand/ comprehend my problems and symptoms rather than just listen and ignoring them like everyone else before.

I was just curious if you knew Dr. Demoss personally and interacted with him before or just knew that he isn’t stuck in Middle Ages with HRT like rest of the Kaiser physicians that I’ve talked to. Going to be a nice long drive up north at 5am Wednesday haha so I can beat all the traffic and don’t want to be late for the 9am appointment.

Thanks for all the help guys, I’ll report back on how it goes Wednesday. I’m going to read up on more stuff so that I can ask the right questions.

Excellent, he is a nice guy and not intimidating, he seems more experienced than any of the other endo’s I have seen. See if you can get him to investigate low SHBG which can be thyroid related, see if you can get a full thyroid panel. Daily injections using 27-29 gauge insulin syringes is recommended if low SHBG is genetic and not related to thyroid.

It might sound a little aggressive, but these small syringes are a piece of cake, you just have to get past the mental part of sticking yourself daily.

Also tell him how metformin didn’t really do much for you, TRT improves insulin within days, but full control can take anywhere from 3-9 months

Thank you very much for all your help and suggestions and the knowledge that you share. I will for sure ask him about my thyroid and see if something is wrong on that end and get that fixed if its out of the norm.

I’m ok with daily injections if it helps me feel better in general and raises my SHBG levels to normal range. When you said 27-29 gauge insulin syringes, i’m assuming you are referring to daily SubQ injections of a low dose like ~20-30 mg/ day depending on if the doctor even puts me on Tect C. I’ve given myself SubQ injections in the past so i’m not worried about that.

Can’t wait for tomorrow. Hopefully it all goes smooth with Dr. Demoss.

The best thing you can do is arm yourself with studies like the ones already provided and take them into your appointment for him, it never hurts.

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

hey @systemlord thanks for recommending Dr. Demoss. Just came back from seeing him this morning. Pretty cool non intimating guy like you had said. We had a long, almost an hour talk about my symptoms and issues and he understood them and tried to see what are the options and actions we can take.

He wanted me to redo the lab works again right after the appointment to dig deeper and said he wasn’t against putting me on TRT if that’s what it takes to get me to feel normal. Apparently my PCP didn’t order detailed labs and didn’t test my Free T and other things… Before prescribing anything he wanted to see where my levels were again and wanted to make sure i don’t have some Pituitary tumors or anything causing me to have Low T and SHBG so we tested that.

Before the labs, we were talking about how i’m having hard time loosing weight even on clean eating caloric deficit, so he was thinking of possibly putting me on Saxenda and mentioned that he can guarantee that medication would drop me like 20-30lbs and put me into 170lb range but he warned me it’s super expensive and it has some not so fun side effects. He did write a script just for the hell of it to see what would be my copay if he decided that i should try that first. Turns out that medication for me is completely out of the question as it’s insanely expensive for just 1 (3ml)pen even with Kaiser insurance hahaha.

Next he wanted to put me on Clomiphene as it was much cheaper than Saxenda since he had some of his patients that were on low T and with that medication they jumped up to ~400 ng/dL range. But if my tests came out low enough he might try and just put me straight on the Test C after the blood work. When i mentioned the 20-25 mg QD dosage he wasn’t really into that. He was open to the idea of putting me on 100-150mg every two weeks. After doing a ton of research on this for past couple of weeks and reading on this forums it seems like that 100-150 mg every 2 weeks is just too low and especially just one IM shot every two weeks. I’m going to try and fight my case to possibly increasing the dosage to maybe 100-150mg every week and even splitting that up into EOD or QD SubQ injections if he agrees to ever put me on TRT.

Attached are the new Lab results that just came in like 2 hours a go and seem to indicate my total and my free t are garbage along as SHBG being crap. the LH, and possibly the Ferritin seem to be within normal range everything else is out of wack. Still waiting on Prolactin results as that will take 2 days. Below are the numbers.

Testosterone, Total: 158 ng/dL Range: 240-871 ng/dL
Testosterone, Free Calculated: 5.3 ng/dL Range: 7.0-36.7 ng/dL
SHBG: 7 nmol/L Range: 11-78 nmol/L
LH: 3.6 mlU/mL Range: <=12.1 mlU/mL
FSH 1.7mlU/mL Range: 1.0-12.0 mlU/mL
TSH 1.74 mclU/mL Range: 0.35-4.00 mclU/mL
T4 Free 0.9ng/dL Range: 0.8-1.5 ng/dL
HGB 13.9 g/dL Range: 14.0-18.0 g/dL
HCT, AUTO 40.0% Range: 42.0-52.0%
Ferritin 270ng/mL Range: 25-336 ng/mL

I’ll try and send him an email or make a phone appointment and just explain that i really don’t want to be on Clomid or Saxenda and somehow explain to him i don’t want the every 2 weeks shot to experience those peeks and valleys. I probably doubt that i would have huge peeks or valleys on a 100mg every 2 weeks but still don’t want to feel worse than i already am. I think the half life of Test C will be my supporting point in moving him a way from the whole every two weeks deal.

Strange Dr. Demoss knows I inject daily and I told him and explained why, I didn’t know he was still prescribing every two week protocols. This protocol will push SHBG to zero, guaranteed! I believe any protocol will with an SHBG of 7.

If you don’t have any SHBG to bind testosterone, TRT will not do anything for you. Dr. Demoss is the best you’re going to get at Kaiser. You need Free T3 testing, if low could help explain low SHBG, Free T3 increases SHBG, it provides energy to every organ in your body.

HCT is on the low end, hemoglobin is very low and not much oxygen is reaching your tissues. Testosterone increases hemoglobin, hematocrit and red blood cells providing oxygen to your tissues.

There is an upside, you’ll at least have a diagnosis you can use anywhere.

Ferritin is great.

Show Dr. Demoss the clinical study below, proof these every two week protocols do not work.

https://www.jstage.jst.go.jp/article/endocrj/53/3/53_3_305/_pdf