T Nation

Stupid Things That Docs Do and Say

I gave all symptoms of Low-T to my GP and he wrote me a script for Adderall. This is even after i told him I’m a recovering drug addict of 20 years, he said: “it’s not physiologically addictive.” My ass it’s not, I could pay for my TRT with this script. Bye-Bye doc.

I can’t make this stuff up… The female endo was trying to impress her new female nurse practitioner, who was also in the room.

Female Endo: I bet your testicles have shrank from being on TRT!
Me: Nope, because I use hCG.
Female Endo: looking at me scornfully Well, I bet you’ve developed gynecomastia!
Me: Nope. I use anastrozole and cabergoline.
Female Endo: (frustrated because she can’t stump me) Well, you need to be off all that stuff.

Needless to say, I don’t go to her anymore.

I have many. Some are close to or verbatim to what was said by the doctor or endo, others are similar or same idea.
Such doctors also practiced for years, worst with endos.

Doctor said:
All of my other patients just take T and do fine.
He never ran into any problems with giving T, or anything like I was talking about.
I was the only one who brought up such ideas and concerns.

When my Estradiol was the low forties pg/mL (lab range: < OR = 39 pg/ML)
Doctor said: Estradiol is slightly high but not much.

When my Free Testosterone was 43.1 pg/mL (lab range: 46.0 - 224 pg/mL) from my doctor’s tests.
Recommended to Endo 1 from my doctor for low T.
Endo 1:

  • Said: I’m not testing for testosterone. Blood testing isn’t accurate and you can’t afford the tests.
  • Didn’t see anything wrong with my labs that I came with from my other doctor.
  • Did not take my low T and my symptoms seriously at all.
  • Joked, poked me in my belly button and said: We all get depressed around this age (early 50).

I also noticed at this same time that my nipples were surprisingly larger than usual and sore when I hardly brushed them with my shirt, strange. I am underweight, not overweight, no problem with belly fat.
Endo 1 said: Do your nipples drip?
I said: "No,"
Endo completely ignored it.
(A couple of months later, possibly first time I tested for my estradiol, which was at mid teens pg/mL, so I’m not sure how to explain the nipple problem. This was a month prior to starting TRT.)

Endo 2
I went for low T, and check for all Endo 2 could find out about my whole endocrine heath.
Endo 2 found I have hypercalciuria, which is serious. More on that and so forth in my other posts.
Note: a year prior to seeing Endo 2, I asked for my first Bone Density Test from my PCP for my curiosity. Tests showed I have osteoporosis, which I never knew I had. (Right or wrong, my PCP told me to take Vitamin D, and that was it.)
A year later when I saw Endo 2, I had a Bone Density test which showed my osteoporosis worsening to severe osteoporosis in a year.
Endo 2 said that my osteoporosis is definitely severe, though not as severe as they first though…whatever that means.
I repeatedly told Endo 2 how I also was concerned about my osteoporosis coming from low T, plus worsening as my T worsened.
Endo 2 mostly ignored what I said, my words just went through the air.
Endo 2 was HIGLY perplexed, and many times said:

I CAN’T UNDERSTAND how a man your age has osteoporosis…and why I have osteoporosis.

First tests by Endo 2 (used another testing facility than my PCP) showed:
Free T at 50 (reference range 47 to 244 pcg/mL).
(PSA at 0.7, with no baseline PSA to compare…was written by Endo 2 next to my free T results, though I do to remember her discussing this if she did.)

Endo 2 said of my Free T: Your Free T is low (or sort of low?) but it’s not low.

Endo 2 sent me to her colleague Endo 3 who said:
Low testosterone can cause osteoporosis, but you do not have low testosterone.

ONE MONTH LATER
Endo 2 tests showed my Free T at 29 pcg/mL (same testing place, reference range 47 to 233 pcg/mL)

The most salient part of this is how Endo 2 acted and looked, and her attitude of reluctance, disgust having to say the following to me of my test results:

You have low testosterone. This and you hypercalcuria are causing your osteoporosis.

I wonder what was causing my severe osteoporosis before a month ago, when it wasn’t from low T - ha!

Endo 2 told me later that she could give me a TINY amount of testosterone.
I decided to go to my PCP, who was at least more open with treating my low T, though I wrote in other posts of how it’s not going well…you know what I mean.

I used to live in a 2nd world country in the 90s and even the doctors there were not as stupid as posters in this thread are claiming. I’m pretty sure at least half of the people here are making things up.

Sad, but this is the crap that happens. If these things never occurred, there would not be so many people needing to find forums like this.

Well boys and girls, I think I have a story to end all stories.

Background: I have a history of mental illness.

Meeting with my psych doctor, we decided that it would be best for me to go on lithium, as I have been through many many antidepressants with not much result. However, once he discovered I was using test he insisted I stop using before he would prescribe me lithium. I informed him that I was on TRT doses as I was suffering hypogonadism- which I don’t think he understood.

Then, get this, he asked me if I had been hearing voices since I started BECAUSE STEROIDS CAN CAUSE THAT. This is problematic for two reasons- 1) I have a small history of hearing these things which means he hadn’t bothered reading my case file and 2) he was a doctor that thought testosterone caused people to hear things that aren’t there (audio hallucinations).

Being desperate, I did as he said and stopped taking my test. Needless to say, my mood worsened, my energy dropped and I was in an incredibly dark place. I got my bloods done with my GP (is that what they call it in the states?), who called me in a panic as soon as he got my results. My test was down to 1.2 (I think that’s about 110 in American readings). I had the results sent straight to the psych doctor who then would not prescribe the lithium to me because my bloods weren’t satisfactory. This guy was clearly in way over his head and I am dying to see him again to rip him a new one for the HELL he put me through.

Yes, I am back on test and no I will never stop my treatment at the orders of an absolute fool again.

Lesson learned, I should have realized how stupid he was once he said steroids cause hallucinations.

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Here’s one contribution I can make to this thread:

I do research with one of the world’s top, say top 5, famous urologists (nothing much to do with TRT).

Urologists and other doctors often read “throw-away journals” which briefly summarize actual research published in harder-to-read peer-reviewed journals.

In one issue of the throw-away journal “Urology Times,” an endocrinologist?s musings on TRT were described in an interview format:

After my BS sensor went off, I emailed the doctor the following:

"Hello Dr. Sokol,

As a researcher intimately engaged in the PSA controversy, I appreciate how a “one size fits all” attitude is often folly.

Regarding your Urology Times contribution, “Men too often receive T for “soft” indications,” you write that, as far as what serum testosterone level you consider too low, you “go by <250-300 ng/dL, measured in the morning on repeated testing, with associated signs and symptoms of low T. The Endocrine Society guidelines recommend using the lower limit of normal range for healthy young men”"

Given the wide range of testosterone values found in healthy young men, I was wondering how you determined to apply <250-300 ng/dL as a threshold value for everyone. (The Endocrine Society guidelines for testosterone therapy, “Testosterone Therapy in Men with Androgen Deficiency Syndromes: An Endocrine Society Clinical Practice Guideline”, reference research that doesn’t actually support this threshold).

I appreciate your time. Thank you."

Any good academic physician who cares about what they’re doing would be able to respond to a question like this by citing studies. After a few weeks and a reminding prod, she responded with this email containing a quote from the Practice Guideline:

"Hello,

Below is from the Endo guidelines:
2.3 Older Men with Low Serum Testosterone Concentration

Summary of Evidence-Based…METHOD OF DEVELOPMENT OF …GUIDELINES1.2 Screening for Androge…2.0 Treatment of Androgen…2.2. Testosterone Therapy…2.3 Older Men with Low Se… <<2.4 Patients with Chronic…2.4.2 Glucocorticoid-Trea…CITING ARTICLES

2.3.A RECOMMENDATION

We recommend against a general clinical policy of offering testosterone therapy to all older men with lowtestosterone levels. (REFERENCES)

We suggest that clinicians consider offering testosterone therapy on an individualized basis to older men with consistently low testosterone levels on more than one occasion and clinically significant symptoms of androgen deficiency, after explicit discussion of the uncertainty about the risks and benefits of testosterone therapy. (REFERENCES)

The panelists disagreed on serum testosterone levels below which testosterone therapy should be offered to older men with symptoms. Depending on the severity of clinical manifestations, some panelists favored treating symptomatic older men with a testosterone level below 300 ng/dl (10.4 nmol/liter); others favored a level below 200 ng/dl (6.9 nmol/liter).?

What is interesting is, if you look at the research the Endocrine “Society”'s journal cites in this “Recommendation”, it doesn’t actually support the recommendation - something that I guess was lost on her. In fact, to my knowledge, a study evaluating the T levels of eugonadal males with verified no symptoms has never been done. My guess is it varies by individual, which is what the cited sources actually state or imply.

Glad to see I am not struggling alone with Drs. From the UK - 35 and no issues until I was given a SSRI (after investigating since I found it causes T levels to drop) for sleep issues. Numerous side effects that carried on after I came off the drugs - low energy, weight gain, drastic reduction of libido… My Drs response

“Perhaps we should give you a different SSRI for your “issues””
“I can prescribe you viagra” - But Dr the problem is libido - “yeah it won’t help with that”

Upon doing a private blood test for T and getting a reading of 164 ng/dl
"Well if you ask for a private test looking for problems the lab will find one"

After doing a full blood work

“Your levels are all normal” - new reading 247 ng/dl
"You have male pattern baldness so its not Low T" - been going bald for 5 years problems started in Feb
"You have facial hair" - been growing since Apr trim about once a week/fortnight
"sex once a week is normal" after I told him I was having sex 5/6 times per week prior to SSRI treatment
"I won’t prescribe T treatment because you are heavy" - Low T promotes weight gain and reduction in muscle mass

In the UK we have a “free” central health service but getting treatment is like getting blood out of a stone and its full of Drs who think that “take a painkiller” is good advice when you go with a problem.

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A medical group cannot recommend T for all cases of low T, unless there are symptoms. So they dance around that problem and really cannot address the problems full on. Yes, its all a crock of shit, especially in the common wealth countries and many others with socialized medicine.

Try this one…a coworker was diagnosed with severe low T. His doc feels he will need 150mg/week. So he gives him a 600mg shot once a month!! When his nipples start burning 2 days after his injection he asks the doc to check his estrogen that he may need arimidex. The doc answers, “we can check it but if your estrogen is high I’ll have to lower your testosterone.” Geez! Talking about screwed up on so many fronts!

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Repeating my self…

Doctors need to have a good memory to get through training.

Deductive reasoning and critical thought are not required.

Because of things like this, many docs are technicians as they in no way masters of their field of work.

Went to a doctor for HCG/anazstrazole refill.

Said my body must have ‘adapted to TRT’ and thus I had low testosterone and because of that my testes were shrinking and therefore I should go off TRT.

Then as an argument for why she shouldn’t prescribe me HCG: ‘some patients I give HCG for the HCG diet just stop responding and they don’t lose weight and maybe the same thing is happening to you’.

Oh, also one thing she thought could be a cause for testicle shrinkage could be the gabapentin I take messing with things.

Upon hearing that I had low temps, took iodine, and now feel better, my GP responded, â??Whoa, that might have been a mistake. Maybe youâ??re supposed to run at a lower temperature.â??

When he saw that I had a total Test level of 270 at 3pm on one blood draw and a total Test level of 213 at 9am at a second blood draw: â??You don’t have low testosterone. Maybe youâ??re Mr. Opposite Man, and your test levels are higher in the afternoon and lower in the morning.â??

Recently saw an endocrinologist, because it would be good to see if I have primary or secondary hypo. Man, this guy, Dr. Lyko had so much bullshit spewing out of his mouth…

  1. Testosterone injections are not well tolerated by the body, and result in little to no absorption. Standard of care is to use a gel.
  2. It is not standard to use an aromitization inhibitor during TRT, and if someone on TRT has E2 increases, they should come off TRT completely until the E2 is under control.
  3. Injections should be no less then 2 weeks apart, any more frequent and you don’t produce the peaks and troughs that your body needs.

For bonusies.
My T4 number is fine, mid range, my T3 is below range. He wants to treat the T3 by having me take added T4. Even though labs suggested the T4 isn’t being converted to T3. He claims dosing of T3 is a fad thing that was only appropriate 100 years ago.

I think I found a winner.

My first test was a total T only test. It came back at a mind boggling 146 which is next to nothing… urologist prescribes me the armpit gel… another time walking in, the doc didn’t even bother to see me. Instead the nurse did. I told her I still felt tired all the time… she said I should go get prescribed adderal…

When I learned enough about TRT, and went to my PCP, I told her I needed to get some labs. I mentioned Testosterone, and E2, her response, " Men have Testosterone, woman have Estrogen" I said, men & woman have Test, E, Preg, Prog, DHEA, just at different levels. She stumbled and said, “I’ll give you a referral to an Endo”.
The Endo, was working at a major Boston Hospital Clinic, “test E2?, you don’t have breasts” I moved on quickly.
I found a Uro recently, he said" MD’s and their research isn’t driving medicine any longer, its patients with greater knowledge (from the internet) who know more than most MDs". This Uro reads not just the TRT forum, but said he’s learned more from the Steroid forums.

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That is a great story, but like the others, sort of a sad state of affairs. I hope the new doc is everything that you are wanting.

I’ve been going to a clinic but recently went to an Endo, who also practices as an internist, for an annual physical and to see if I could get on self injection. I forget the context, but he explained to me that test cyp has a three week half life.

I really wanted self injection so I just shut my yap.

I told him I was on 140 mg a week, and he said "they’re giving you a lot of medicine (my total T was 660).

He also told me that he would write it but the pharmacy probably wouldn’t fill it because of the insurance - they did. I got it home and it was 200 mg per cc and he had written the script for 1.5cc E7D, or 300 mg per week.

I really liked the guy, but it shows how there’s no way an MD can know everything about all of the things they practice, and, they have to practice a lot to make money anymore with the insurance companies fee scheduling everything and requiring all the paperwork.

Caveat emptor.

DUMB ass Doctor…
Ok, so I had this doctor, we got into an argument about T injection’s verses T cream which one was safer… he would not prescribe me injections any more touting they are now on the class 1 list (false) and are a danger to kids or wannabe body builders…
Truth is - Creams are much more easily stolen or misused where injection’s need a needle if you’ve never injected yourself you’ll understand why.
Put it this way you steal a bottle of T-injection but no needle good luck although needles are easy to get T-cream is hands down more accessible extremely easy to use and dangerous to the unknowing.

"You’re only 49. There’s no way you could have hormones problems. Just wait till you’re 60 and then we can run labs."
Thanks…you are such a great help doc.