T Nation

Stay with Current Doctor?

I went for my annual physical in May and told the doctor I had been feeling tired and been having some problems with ED. He said he would check my T levels and Vitamin B12 on my blood tests.

More information:
Height - 5’-8"
Weight - 203 lbs
Hair - no hair loss, hair arms, chest & back
Symptoms - tired all day long especially afternoons, erection problems, moody, carry fat in mid-section only, muscle cramps at nights mainly in calves, joint pains in shoulders and elbows
Exercise - Lift 5 days a week for 30 - 45 minutes a day.
Diet - Average - try to watch simple carbs but not on a low carb diet
Past medical - vasectomy in 2008 - double hernia surgery 2010
Test results:
Total Test - 231 ng/dL range 348-1197
TSH - 5.660 ulU/mL range 0.450-4.500
Vitamin B12 - 391 pg/mL range 211-946
Cholesterol - 185 mg/dL range 100-199
Triglycerides - 70 mg/dL ragne 0-149
PSA - 1.3

Doctor prescribed Androgel 1% 5 grams a day. On the Androgel 1% after a couple of weeks I notice small increase in energy, faster recovery from workouts and a decrease in joint pain. I requested to be changed to the 1.62% after the 1st month, I travel some for work and the 1% packets would fall out of the box and the box was damaged and with it being a controlled substance I didn’t want to risk getting caught without the script another benefit was less gel to use. After week 5-6 noticing the fatigue was back and erections were almost non-exitant.

Blood tests after 2 months on the Androgel:
Total Test - 137 ng/dL
TSH - 5.950 ulU/mL
T4 - 6.7 ug/dL range 4.5-12.0

Talking with the doctor on another matter I had told him the fatigue was back. I also ask about E2 levels to which he replied no need to worry unless you start getting man boobs.
When they called back with the test results they prescribed 200mg of Test Cyp once a month and blood test again in 3 months. I had to ask about the TSH level increasing and if they were going to do anything about that, they prescribed 25 mcg of Synthroid a day.

Should I stay with the current doctor or ask him for a referral to the only endo in the area? My family has been seeing this doctor for years and he has been great but I don’t want this to drag on for years while they experiment. I also don’t want to go to another doctor and get completely pulled off of all meds and have a crash.

“I also ask about E2 levels to which he replied no need to worry unless you start getting man boobs.” Ask him if he’ll pay for the corrective surgery when this happens since most insurance companies won’t surgically fix gyno because it’s “aesthetic” and not a health emergency. If you wait to treat estrogen until you have tits, you’ve waited too long.

“When they called back with the test results they prescribed 200mg of Test Cyp once a month” This is insane! The average guy pumps out about 70mg a week of testosterone. Your doctor is asking you to take 30% less than that. He also wants you to take it once a month so your levels will spike and you’ll feel good for about 8 days and then feel like totally shit as your levels tank over the next three weeks until you’re due for another shot.

He even dosed your Androgel 1% crappily (not sure if that’s a word). 5 grams (4 pumps, right?) is the minimum dose. At this dose you’re shutting down all natural production of testosterone and barely replacing it with anything. This is why your levels kept dropping. Some guys can be on this dose because they absorb gel really well, but most guys don’t absorb too well and need bigger doses to get good T levels. No matter how many pumps though, most would agree that the gel sucks anyway.

Personally, the “boob” comment would be enough for me to want to punch the guy in the face. His recommendations on the dosing of both the injections and the gel are really (I don’t know how to put it a better way) stupid. Even if he was open to new ideas I wouldn’t stay with the guy for his flat-out ignorance of the potential issues with estrogen. Docs like this tend to not test things, and when they do they tend to not want to treat them.

Hate to be the bearer of bad news, but Endo’s might not be any better. Some docs are completely clueless, some are mostly clueless, and rarely you’ll find some who know how to properly work TRT.

I suggest you read the Stickies “TRT: Protocol…” and “Lab Work…” on the front page. This way you’ll know what you are looking for and why, and can either find a doctor who can go with the flow and follow the recommendations there, or a doctor who knows the stuff outlined there and is cool with it. A lot of us find doctors who just let us take the lead on our treatment and they’re really just there to write scripts, labs, and to make sure we aren’t doing anything medically stupid.

Best of luck to you. Keep us posted.

Also, your TSH is really high! You need to get the thyroid labs outlined in the “Lab Work” Sticky. I personally wouldn’t start taking Synthroid until I had a complete thyroid lab done. You need more than just a T4 test and TSH. One more thing I forgot to ask: Did you get LH and FSH tested before you went on testosterone?

That was all the test that were performed. I’m on my third month of replacment and didn’t find this forum until the last 3 weeks of so. I started having testicular atrophy about 5 weeks into treatment. Didn’t know much about it then was going on trust of the doctor. Felt good for a while so thought I was on the right track. Don’t know where to start on finding another doctor other than the endo in this area.

A lot of people with low thyroid (high TSH) bloodwork and symptoms also tend to be poor absorbers of the gels. Your story is very common. Feel good for a few weeks, then levels tanks.

There is a sticky for finding a doctor, using google and finding a compounding pharmacist and asking for doctor reocmmendations that prescribe testosterone injections. Other pharmacies may be helpful as well.

You really need to do a bit more research on the forum here to get a handle on your problems. You are almost certainly hypothyroid and need further testing before beginning thyroid meds.

Also need to get acquainted with proper T dosin protocols.

Note that it is possible if you fix your thyroid, you will not need TRT.

Had an appointment with endo yesterday. Told him what current doctor had prescribed for dosage, he kept saying that’s not enough. He asked who gave me the test cyp injection. I told him I did and when I told him I gave it in my thigh I thought his eyes were going to roll back in his head. He said that it went in the butt. He stated he wanted me to quit taking testotesrone until we could find cause it was low. Said that one reason could be tumor in brain.
He asked if I knew that a stroke was a side effect of TRT and if I felt that bad. Told him that was the reason I was there because I felt that bad.

He told me to stop the synthroid because my 5.996 TSH wasn’t high enough to treat. I asked him what he considered high enough to which he replied 10. He asked again if I thought the risk was worth it. I told him that the ED problem was enough for me. He was walking out the door and asked me if I had considered a penile implant. Told him that was pretty extreme considering the testosterone could cure it.
Overall pretty sucky experience.
They did draw blood to check LH and prolactin at least. He said if my prolactin was over 10 he was going to order a MRI

Doctor seems like a loser to me!

Attitude on thyroid is terrible…

Penile implant vs what I can only imagine in his head is a TRT-induced stroke secondary to polycythemia?! Are you freakin’ kidding me?! That is literally like saying instead of giving you insulin for your type I DM why don’t we just put you on the kidney organ recipient list…that way we don’t have to worry about the inconvenience of sticking needles in you and you know every stick could get infected! Can you say can’t see the forest for the trees…

I have many friends who are physicians…I work in the biomedical field…I can’t believe some of these doctors are this stupid??

[quote]mlroll wrote:
Had an appointment with endo yesterday. Told him what current doctor had prescribed for dosage, he kept saying that’s not enough. He asked who gave me the test cyp injection. I told him I did and when I told him I gave it in my thigh I thought his eyes were going to roll back in his head. He said that it went in the butt. He stated he wanted me to quit taking testotesrone until we could find cause it was low. Said that one reason could be tumor in brain.
He asked if I knew that a stroke was a side effect of TRT and if I felt that bad. Told him that was the reason I was there because I felt that bad.

He told me to stop the synthroid because my 5.996 TSH wasn’t high enough to treat. I asked him what he considered high enough to which he replied 10. He asked again if I thought the risk was worth it. I told him that the ED problem was enough for me. He was walking out the door and asked me if I had considered a penile implant. Told him that was pretty extreme considering the testosterone could cure it.
Overall pretty sucky experience.
They did draw blood to check LH and prolactin at least. He said if my prolactin was over 10 he was going to order a MRI[/quote]

God damn dude! I’m so sorry you had to go through that shit. What a meat-head! You must be a saint, because I think any rational person would have punched the guy!

Time to get a new doctor…one whose head isn’t up his ass.

Got my test results back from trip to endo:
Total Testosterone 234 range 348-1197
TSH 3.67 range 0.450-4.500
FSH 3.50 range 1.5-12.4
LH 3.90 range 1.7-8.6
SGHB 26.0 range 16.5-55.9

Nurse called and said doctor wanted me to quit the synthroid (it reduced my TSH by over 2 points in a month)
Set me up for a MRI on the 10th. She said doctor wanted that done before my next visit first of October. So no test cyp or synthroid for over a month at least. The way she talked he’ll start back with treatments depending on the MRI results. Said he didn’t want to treat until we can find out what the problem is.

[quote]mlroll wrote:

TSH 3.67 range 0.450-4.500

Nurse called and said doctor wanted me to quit the synthroid (it reduced my TSH by over 2 points in a month) [/quote]

I’m confused…that’s what Synthroid is supposed to do to TSH? Mine went from 4.7ish to 1.8ish and the endo said great.

Your endo is a shithead. Your thyroid definitely needs treatment and your test as well. Seeing where your LH and FSH it makes me wonder if you are primary. How long after your injection was the blood test? Read the stickies, especially the one about finding a TRT doc. I called a compounding pharmacy and found a doctor light years ahead of the primary care doc and the urologist I had been seeing.

Endo does not understand thyroid meds? WTF

Read the advice for new guys sticky and note body temperature, iodine, iodized salt, sea salt, TSH issues. Report body temps and other info here.

Got the last of the test the endo wanted to run. Prolactin level was 8.0 which they said was normal.