T Nation

New Member, TRT

Hi Guys,
Like so many others, i have been dealing with low T for a number of years, starting in my mid 30’s.
After seeing the Dr. on many occasions with the “usual” complaints, they finally tested and told me my results were “normal”. I simply let it go. A year or two later, i went back, blood work normal, this time i asked about the results. i was 241 on a scale of 231-827 (?) Dr, basically told me i was fine, please pay the receptionist on the way out.

I finally decided that I can’t live the rest of my life feeling like this.
Although I have always been able to “force” myself to do my work, there is nothing left for life.

ZERO energy, interest in anything i previously enjoyed, libido.

Complete exhaustion, weakness, fatigue, weight gain (30 lbs in 2 years)and my mind feels like mush.

I made an appointment with another Dr. My first visit, he seemed uninterested in my evaluation and previous test results.
He took blood and called in a prescription for an anti-depressant.

Phone call from his office, “test results are normal”, make a follow up appt.
First question is, “how are you feeling”, my reply, same as last visit. “How are you doing on the medication I prescribed”?
I haven’t taken it.
“Well I wanted to see how you were adjusting.”
So I explained that I had no intention of taking any medication until the test results came back.
PAUSE. (with an obvious look of discontent)

He tells me that my T was 232.
He takes more blood and tells me that i “MAY” be a candidate for TRT.
So i asked just which part of me “MAY” be a candidate? So, we went into the whole depression thing to which i replied, If you gave me a questionnaire for low T, that would have been the end of it. If you gave me the questionnaire for depression, that would have been just as conclusive. But seeing as my actual test results support my claim???..

Follow up visit, he has a prescription for Androgel 5mg. I then ask about an estrogen blocker and show him the research I have done highlighting the more important information to which he replies he doesn’t like to do two things at once. This I respect because I believe in having a good baseline before making changes but from everything I have read, this should be SOP.
But in the end, no go.
I forgot to ask about E2 (assuming he tested for it) but that will be my next question.

I went to the pharmacy to fill the script, “sorry sir, the insurance company needs a written letter from the Doctor”.
The way I figure it, the insurance company will probably refuse it due to the fact i was 232 not 230. (under the 231 mark)

Now, I am beginning to feel like I’m making a little progress, have the script at least, more hurdles to come but I am also beginning to feel as though I may be setting myself up for a nasty ride dealing with a Dr who is unwilling and in reality unqualified (not saying that in a mean way) to treat this condition.

Tomorrow I see a doctor for a follow up visit regarding a deviated septum and I’m going to ask him if he knows of anyone who specialized in TRT.

Does anyone here know of a good Doctor anywhere near S.E. Pa who is willing to actively work with patients on this issue?

Any advise would be appreciated, all comments welcome.


Use the “location options”

Many of the symptoms of hypogonadism are the same as hypothyroidism. You could do some of your own lab testing and then have the data in hand with first appointments.

Get copies of your lab work and retain.

You can order labs from LEF.org

Have you tried more than one pharmacy? I can’t believe they could refuse a script. At worst you might have to pay for it… Good luck to you, there are many here who are in your boat, so keep us updated…

I picked up copies of my test results today. I didn’t see anything along the lines of estrogen testing.

On the way home, I was passing a Quest Diagnostics so i thought i would stop there, explain about the recent test and ask if they could do the estrogen testing at my expense.

That was an experience.

I thought the woman was going to come across the desk, beat me down, cuff me and call the police.
She told me, with enough volume that EVERYONE in the place could hear and a tone that made me feel like a child molester that

“It is absolutely ILLEGAL for us to do any testing on anyone without a doctors order!”

I asked, really?

And she again began to read me the riot act.
All eyes upon me as i did my walk of shame from the desk to the door :-{
(Holy crap!)

Im still having a difficult time wrapping my mind around the fact that it is somehow illegal for me as a human being to request any test on myself at my expense for my own satisfaction with no diagnosis or treatment requested.

Anyway, still no word from the insurance company about covering the androgel prescription.

Test results:
Testosterone total 252 (241-827 ng/dl)
TSH, 3rd generation 1.69 (0.40-4.50 mIU/L)
B-12/folate serum panel
B-12 1243 (200-1100 pg/mL) (I do take a b-12 sub lingual tab daily)
ALT(?) 68 (9-60 U/L)
FSH 3.8 (1.6-8.0 mIU/mL
LH 2.8 (1.5-9.3mIU/mL
Prolactin 9.5 (2.0-18.0 ng/mL)
PSA 0.3 (<OR = 4.0 ng/mL)

Theres a lot of other test information but i didn’t know if it was pertinent to the TRT topic.

The journey continues.
Any input, comments, questions thus far?


Are the above test results before starting TRT?

ALT and other “liver makers” are not liver specific. ALT and others can also be elevated by muscle injury or soreness from training.

You can get tests [Labcorp] via LEF.org

In some states, a doctor’s order is a legal requirement. LEF has their lab orders signed by a doctor and you are good to go.

From a pragmatic point of view, you do not need E2 levels until your TRT is started. When T levels change, E2 will change. Thus E2 will change with dose and/or changes to absorption rates.

I do all tests via LEF/labcorp and take the results to my doc. I pay for all out of pocked and this is least cost.

My insurance company was billed 1400.00 for the same male pattern hormone test my MD ordered that LEF offers for 269.00. My deductible for the insurance was 150.00. Typical huh.

Yes, the test results are prior to starting treatment.

My thought was it would probably be good to have E2 level from the start but maybe its not done like that. (Im new to all of this)
Does anyone know how long it would take to begin development of “man boobs” if the E begins to rise from the T treatment?

$1400 for the insurance co on a 269.00 test?

Shortly after starting my HRT I fell back into the same symptoms you are having. I thought it could be my E levels but it was discovered that I have sleep apnea too. The weight gain (40 lbs) I had put on over the past few months aggravated the apnea to the point it could be easily diagnosed. I had no idea I had it. Something you might consider as well…

I’m surprised you even got your doctor to test for E2. I finally had to write it on his lab order myself to get a number. I now don’t use him.

Seriously: www.renewman.com

Next week Im actually going in to have a deviated septum straightened out. On the CT scan, my septum looks like a corkscrew and a malaria germ are locked in fight to the death. I actually seem to sleep better now than in the past but hopefully this will help as well.

I have had times years ago where i would wake up gasping for air so i guess i have some level of sleep apnea. One step at a time I guess.
Im wondering if i should hold off on the androgel until after the surgery (which is on the 12th) or if i should get started tomorrow (the 3rd)

Thus far, I haven’t had the doctor test for E2 but i did drop off literature about it hoping to prime him for me next visit.

Got a message today from the Ins. company. It said they are approving the coverage for the Androgel until 2013 (assuming i keep the coverage) I am wondering what happens after 2013, do the just refuse coverage after that or reevaluate the claim?

Anyway, one step closer i suppose :slight_smile:

Hiram - start the agel now, no reason to not to.

Test E2 levels with next lab work. With Quest, you need the ultra high sensitivity test. Test in 2 or 3 weeks.

Your LH and T are both low. That seems to be secondary hypogonadism.

If you are going to sell E2 testing, you have to be selling use of Arimidex to lower E2 to the lower 20s. If you are in “range” and he says you are normal, you may be screwed. Transdermals create more E than injections. At that point many self medicate to manage their TRT induced estrogen imbalance.

How much will Vitamin C and Zinc alone reduce E levels? I know that the book you recommend encourages their use for that purpose, but is it enough to help someone like Hiram until he can bridge over?

My concern about starting the agel now was just because I have no idea what to expect as far as my reaction to it.
Do guys get a noticeable energy increase when starting the gel?

I thought it might be difficult to lay still after the surgery if it makes me “antsy” (for lack of a better word).

According to the (ENT) Dr, day after surgery, flat on your back only get up to use the bathroom, next 2 days, very limited movement, next week nothing strenuous.

The info i left with the Dr included Arimidex so hopefully it will point him in that direction between now and then.
Hopefully, he will address the issue, if not, plan I guess.


If the other suggestions don’t work, try www.renami.com . Dr. Patino is the shit and he actually talks to you and listens when you talk. There isn’t a need to convince him about anything. I have been using him for 2 years now and will continue to do so.

It is not cheap (my insurance sucks balls) but it is worth it to not be so depressed I feel like killing myself on a daily basis. And that is not “figurative” either, it’s literal.

[quote]Icarus wrote:
If the other suggestions don’t work, try www.renami.com . Dr. Patino is the shit and he actually talks to you and listens when you talk. There isn’t a need to convince him about anything. I have been using him for 2 years now and will continue to do so.

It is not cheap (my insurance sucks balls) but it is worth it to not be so depressed I feel like killing myself on a daily basis. And that is not “figurative” either, it’s literal.


Dr Patino is a friend of mine, and a fellow Michigander. Great guy. Walks the walk and talks the talk.

I’m not a patient of his. But I do know he isn’t cheap though.

Well, started on the third, had surgery, no problems.

I had blood work done the beginning of this month. (Jan 09)

After 1 month of Androgel (5 grams), my T level actually dropped from 252 to 233 (241-827). Which I suppose is related to natural production shutting down. (?)

This time he did an E2 and the level was 50. (20-130??)

My Dr. is a GP and he doesn’t feel that he should be treating me further with this so now I need to see an endocrinologist or a urologist.

In my case, which would you guys recommend?

So far, the two leads i have both have offices in Doylestown Pa.

Dr, Al Ruenes (uro)

Dr. Gkonos (Endo) (pronounced gun-us)Works out of Abington but also has an office in Doylestown.

I hate the thought of starting over with another Dr but I also feel lucky that my Doc realizes that he is not equipped to treat me for this.

Any comments, suggestions, anything from you guys?


Have you looked into seeing Dr. Shippen? He is in the SE Pennsylvania area - if he is still practicing. He is one of the most respected HRT doctors in the world and the doc who most doctors follow as far as HRT protocol (including Dr. Crisler I believe). Look him up and see what he can do for you. I’m sure that it will be a matter of time before you dump this doctor and try to find a new one anyway.

If Shippen is no longer in practice (I think there was talk of retirement a while back), Dr. Crisler does consultations with other doctors who are admittedly gunshy about treating patients for HRT.


Some do not absorb transdermal T. You need to inject.

Those with hypothyroidism are classic non absorbers. Your TSH level was good, but that does not preclude low T3/T4. Might be good to do more thyroid labs next go around. Your next doc needs to be have this concern brought to his attention.

Range for E2 is bogus. What units… please double check. Did it state E2-estradiol?

If you take travel out of the equation, would you consider either doctor to be a “better” choice?

Should I be pursuing TRT only or should i be looking at the anti aging treatments as well?

I (like so many others) really need to get myself straightened out. I cant go through the rest of my days feeling like this.

My insurance wont pay for anything outside of their network so the Dr. visits will be out of pocket.

So, my question, is one Dr. (Shippen or Cristler) preferred over the other based on their methods, protocols, demeanor, willingness to work with their patients and so on…

Again, thanks.

I can only comment on reputation. Almost everywhere I read, Dr Cristler tops the list as most knowledable and most successful. I have yet to find anywhere that someone had a complaint.