T Nation

Low T, High E2 and Kaiser


#1

Hi all,

Been reading the boards for awhile but this is my first post.

I have Kaiser for my medical coverage. Generally really good care but I'm finding out when it comes to questions of some areas of mens health it's far from good.

I'm a 58yo firefighter and gym rat. Been telling my doc I feel like crap just about every afternoon and not getting the muscle gains since I went on a serious lifting schedule about two years ago. He sent a message to an Endo who blew me off assuming I just wanted to "juice". (Not.)

I finally got my doc to test for TT, FT, and E2.

TT=461 (ng/dL) (Range: 250-1100 ng/dL)
FT=60.5 (pg/mL) (Range: 35.0-150.0 pg/mL)
E2=44 (pg/mL) (Range: <56 pg/mL)

Looks to me like andropause and I asked to get referred to a urologist. I got back everything is in range and to have a nice weekend. grrr...

So my two questions are:
1) Has anybody navigated this through Kaiser? If so how'd you do it?
2) Barring the Kaiser route I'm willing to pay for an outside doc. Anybody know one in the Northern California area? (Santa Rosa specifically.)

Thanks

(edited 9/22/09 to include units of measure and ranges)


#2

[quote]FirePig wrote:
Hi all,

Been reading the boards for awhile but this is my first post.

I have Kaiser for my medical coverage. Generally really good care but I’m finding out when it comes to questions of some areas of mens health it’s far from good.

I’m a 58yo firefighter and gym rat. Been telling my doc I feel like crap just about every afternoon and not getting the muscle gains since I went on a serious lifting schedule about two years ago. He sent a message to an Endo who blew me off assuming I just wanted to “juice”. (Not.)

I finally got my doc to test for TT, FT, and E2.

TT=461
FT=60.5
E2=44

Looks to me like andropause and I asked to get referred to a urologist. I got back everything is in range and to have a nice weekend. grrr…

So my two questions are:

  1. Has anybody navigated this through Kaiser? If so how’d you do it?
  2. Barring the Kaiser route I’m willing to pay for an outside doc. Anybody know one in the Northern California area? (Santa Rosa specifically.)

Thanks
[/quote]

DR mariano is very well respected
www.definitivemind.com


#3

I haven’t seen anyone try to get HRT through Kaiser, but we have Kaiser for our medical coverage as well. In general, Kaiser offers standard and accepted treatments that have been around for awhile, with drugs that are listed on their formulary. Not generally the new, exotic, or unfamiliar.

But it all depends on your doctor. The good thing I have found is that you can keep seeing different doctors, until you might find a great one. That’s what I did. I didn’t think the doctor I landed as my PCP was up to treating my chronic and puzzling stuff in the best possible way. I made a same-day appointment with another randomly-chosen doctor in the system that day and hit the jackpot with a great internal medicine specialist who went to Berkeley. He tested my thyroid to see if it was in the optimal range, not just the reference range. I don’t know for sure that he’d prescribe HRT, but if a patient brought in some literature, I think he’d look it over, and there’s a chance. (However, it might be something that Kaiser just doesn’t allow, I don’t know. I think you can appeal that though.)

So see if you can find a good doctor, before spending your own cash. You may want to check the clinician directory to find some promising ones to choose, then call each day to get an appointment in the same-day system. (I think all doctors have to do some same-day duties on certain days.) Or ask for a referral from your current PCP. For example, in my closest hospital I found one female endo; she went to Yale and also has certification in Internal Medicine. Good luck.


#4

FirePig, please list units and range for FT and E2 - edit them into your 1st post.

Your serum E2 is too high. I assume that its range is 0-54. Lower E2 and that alone might make a big difference. You need to review meds, Rx and OTC for potential to increase E2, as well as alcohol. We can do some of that via PM.


#5

Done.

I have maybe one beer a week. Taking statin, Zocor 10mg, for cholesterol. Lots of whey protein and amino-acid supplements.

Thanks KSman. Have read alot of your posts and you seem to know your stuff.


#6

Zocor: You could add CoQ10 to your supplements.
TRT may decrease total cholesterol a lot while maintaining HDL.

Ask this compounding pharmacy:
http://healthfirstpharmacy.net/

For a referral, explain your labs and symptoms, topical vs transdermal, insurance status, and that you seek a doc who does testosterone, hCG and manages E with anastrozole. Beware of “clinics” that provide labs and drugs, very expensive and do not take insurance. They will treat you and your wallet.

Most docs will not treat TT=460. Thus using adex to lower E2 may be your only option to improve QOL.


#7

Saw my Kaiser doc again today. He ran a whole series of blood work and x-ray to test for liver function, kidney function, thyroid function, TB, lymphoma, PSA, cholesterol, and a couple other things. Aside from a few screws loose I’m as healthy as can be. But I still sweat at night, have trouble sleeping and crap out in the afternoon. He doesn’t know what it is but now he wants me to cut out my supplements for three months and then see what happens.

Here’s the short list of my daily intake of supps.

Arginine - 4g
Carnitine - 2g
ALA - 200mg
CLA - 1g
Creatine - 3g
MultiVit- 1
Calcium - 1g
Protein powder - 150g
BCAA - 10g
fish oil - 3g
CoQ10 - 150mg

Does anything in that look out of whack to the more experienced folks in here?

(I am checking out referals to other non-Kaiser local docs anyway but I thought I’d just throw this out for comment.)

Thanks


#8

Trouble sleeping, no energy, and night sweats could be a number of sleep disorders. Maybe see about getting a referral to a sleep specialist and have a sleep study done?


#9

[quote]FirePig wrote:
Saw my Kaiser doc again today. He ran a whole series of blood work and x-ray to test for liver function, kidney function, thyroid function, TB, lymphoma, PSA, cholesterol, and a couple other things. Aside from a few screws loose I’m as healthy as can be. But I still sweat at night, have trouble sleeping and crap out in the afternoon. He doesn’t know what it is but now he wants me to cut out my supplements for three months and then see what happens.

Here’s the short list of my daily intake of supps.

Arginine - 4g
Carnitine - 2g
ALA - 200mg
CLA - 1g
Creatine - 3g
MultiVit- 1
Calcium - 1g
Protein powder - 150g
BCAA - 10g
fish oil - 3g
CoQ10 - 150mg

Does anything in that look out of whack to the more experienced folks in here?

(I am checking out referals to other non-Kaiser local docs anyway but I thought I’d just throw this out for comment.)

Thanks
[/quote]

He’s an idiot. Asking you to cut out supplements without understanding what they do, and coming up with at least a semi-logical reason why they would be negatively effecting you, is what we call the shotgun approach. This will get you nowhere.

E2 is high. If he is not going to take proactive action to lower it, do it on your own.


#10

Visited a new doc today in Santa Rosa. This one, Ron Kennedy MD, specializes in andropause and HRT for men.

http://www.medical-library.net/

Spent a couple of hours with him and he ran another physical and did some blood work right in his office. Pretty trick to look at my blood through a phase contrast microscope. Like going back to college bio class but with some technology. He also ordered up the 24 hour urine sample hormone test.

This stuff costs more than a pretty penny!!! Yeow! (And it’s going to be all out-of-pocket I think.)

Thanks for all your help so far guys. I’ll let you know how it goes.