T Nation

New Here, Need Help with Doctor

I’m 34 and I’ve been worried that I suffer from low t for a long time now. I only have one testicle and I’ve always felt I’m to tired or feel to old for my age. I’m seeing my general doctor next week to ask about a blood test and maybe seeing a specialist(?). She doesn’t seem to be to well informed on this topic but neither am I so I want to know what test I should ask for. Or the way I should go about our appointment. Thanks for any help.

More often that not these general doctors aren’t up to speed on hormones, typically knowledge is poor at best and men are told their levels are normal and the docs are unable to distinguish between an 85 year old men with heart disease and a young 34 year old man who should if healthy have testosterone levels in the upper mid to high normal reference ranges.

As far as finding a specialist, it’s like looking for a needle in haystack. You might have to seek a private specialist outside of you healthcare provider, but beware of these T-mills (Low-T clinics) where your health is a distant forethought and profit is the only driving factor.

The endocrine society recommends TRT to those below 300 ng/dL on two separate tests and as far as protocols recommends 75-100mg weekly, NOT 200mg every 2-3 weeks which is to be avoided at all costs and is probably what your doc may attempt to initiate treatment.

These private docs have a little more discretion than a sick care docs and can prescribe TRT with levels higher if treatment is warranted.

Best thing to do is arm yourself with studies, maybe your doc is open-minded and willing to learn.

Test your doc should order for a Low-T diagnosis:

  • Total T
  • Free T
  • SHBG
  • Estradiol (E2)
  • LH-Luteinizing Hormone
  • FSH-Follicle stimulating hormone
  • Prolactin

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis

Testosterone Therapy and Cardiovascular Risk: Advances and Controversies

Sorry for the dumb question but by specialist you mean urologist or endocrinologist? I’m was going to get a referral from my general doctor or should I find one and schedule directly with them?

My thought was have my doctor run my blood than refer me to a urologist or endocrinologist.

I would like to deal with this face to face if possible and avoid using online doctors. If possible.

For now get ANY Dr to order labs mentioned above

7/8/20
Free test 5.6
Shbg 19.5
Total test 221

First round of tests done should know my second test results this week.

Doctor said another low t result and she’ll refer me to a endocrinologist. I found near me who specializes in:

Looks low to me. Learn as much as you can so you can talk intelligently about doses, frequency, AI’s, etc.

It sucks she’s making you have 2 low tests before even referring you. Clearly, you’re low. Even if you go up a few points and are “normal”, you’re still low and it doesn’t change anything IMO.

The endo might require 2 as well on their own depending on how reasonable they are so it could drag things out a bit at best. Some of them are pretty strict and old school about TRT so I’m not sure what your chances are of getting treatment. It’s worth a shot but I’d have low expectations.

That’s why a lot of us end up at TRT clinics and the like where they’ll actually prescribe what you need. The downside is they don’t take insurance so it costs more.

Right looks very low haha. Lower than I expected really.

Do you think the endocrinologist I found will have the know how to treat me? I thought his area of focus lined up with mine.

If not I’ll probably look into Dr. Rob Kominiarek

I think the standard protocol for a General Practioner doctor to refer a patient to an Endo is 2 blood tests with results below the labcorp ranges (rightly or wrongly). That is what I had to do as they need a medical basis for the Endo referral.

My TRT doc now is an Endo and specializes in the same list you posted above, and I find the ones also that do the transgender stuff tend to be younger and more modernized docs that will be more flexible with your TRT regime and allow you to try different dosages/etc (my endo confirmed this). I was with an old-school TRT doc/endo before who was like 70 years old and he was brutal.

Thanks for the reply and your experience is reassuring. How long did you have to wait after the referral?

If you qualify for treatment, the wait to see the Endo was entirely dependent on the Endo’s schedule. Could be the next day/week if you can find a cancellation, otherwise many Endo’s are booked up for a couple months. If you don’t qualify for treatment (i.e. 2 blood tests that are below the Labcorp ranges), I’m guessing you could hit a TRT clinic instead as they are more flexible on treatment thresholds.

In terms of Endo standard protocol, many Endo’s will also run the standard tests for hypogonadism including pituitary MRI scan and perhaps a bone density scan to see if your low T is causing any bone loss, which could take 1-2 months to get done. They may also give you the option of trying Clomiphene first to see if you have primary or secondary hypogonadism, but I’m not sure it’s worth this second part as Clomiphene sucks for many guys (it did for me), and many eventually go on injections anyways.

If you do decide to do the TRT route (i.e. injecting testosterone), I would suggest at a minimum a doc that lets you self-inject (majority of guys here self-inject), and added bonus is one that prescribes a larger monthly Testosterone dose so you can eventually try different dosages on your own. 200mg/week is I think the max that most can prescribe, and standard starting dose is 100mg/week. There are many opinions on here as to whether to add HCG (for fertility maintenance and maintain testicle size) and/or AI like anastrozole (to control estrogen) upfront with your testosterone injections, but I’m in the camp of starting with the base TRT dose and no other hormone drugs so you aren’t trying to dial in too many things at once. It can take months/years to find a dose that works best for you so prepare to be patient.

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Test date 7/18/20
Free test- 7.6
Shbg- 19
Total test- 291
Seeing a endocrinologist on Tuesday hoping I don’t get the run around. Any input is appreciated. Thanks

That’s low man. Doc will probably start you on 150 mg a week. My numbers were worse than yours and I started at 160 mg. Good luck to you, give it time.

What’s your age? I’m only 34

It’s kind of a crap shoot as to what you get when going to a ‘regular’ doc vs a trt doc. If you get a typical one they’ll, probably at least try to, start you on 200mg every 2 weeks. It can be kinda frustrating. Good luck

Seems like life span of test is a good counter agreement for that type of treatment. Doesn’t it lose affect around a week?