T Nation

Trouble Finding a Doc in KC


#1

Hello all. Many thanks for this highly informative and wildly helpful forum. I've learned a ton and have been lurking for a while. I've read the stickies and was very interested in the how to find a doc sticky as I have been looking for one for some time. Unfortunately my search in the KC suburb area has proven unfruitful in terms of finding someone who is 1) willing to listen, 2) willing to treat and 3) willing to partner with me or maybe I haven't looked hard enough. I have called a couple of the compunders in the area but they were unwilling to speak with me and referred me to some of the "wellness" docs and clinics. I called a couple of these and got a cash pay only option but all of them were only willing to do Bio-identicals or if true TRT they wanted to do a pelletized TRT. Nobody I spoke with is willing to entertain AI or Hcg if needed. As the advice for new guy sticky said doctor = idiot. sigh

I am trying to stay within the confines of my insurance but may be forced to go outside and pay cash only. If anyone has any advice other than keep knocking on doors (which I intend to do) I will gladly accept it. I would also any suggestions on what you may see in the below information about me.

I brought up the discussion in a general physical and talked about: marked lack of libido and desire, lack of spontaneous erections, lack of morning erections, unusual wt gain though on 2200Kcal diet and lifting 4-5x's a week, sleep pattern changes, development of "Man Boobs" not true gyno but troubling enough that I often think of the Sienfeld episode about the "manssiere", slow recovery from exercise, not maintaining mass or strength.

So here are some particulars about me
Age 49
WT 210 (yes I know but it is stubborn)
BF% is unknown but is High for sure
HT 5'7"
waist (at belly button) 41
Hair is normally growing and not thinning

Medical HX (surgeries)
chemotherapy x3
Radiation x3
open fracture reductions
shoulder surgeries x2
knee surgeries x2
Laparotomy to biopsy cancer

Lab values (LabCorp)these values are first draw with a repeat of TT and FT later due to low values
Value Ref Range
PSA .5 0-4 ng/ml
VitD 25HYD 36 30-100
Test,serum 245 348-1197 ng/ml (1st draw)
FT 3.8 608-21.5 pg/ml (1st draw)
FSH 14.6 1.5-12.4 mIu/ml
LH 5.8 1.7-8.6 mIu/ml
T4 7.1 4.5-12.0 ug/dL
TSH 1.86 .45-4.5 uIU/ml

Lipids
TC 199
Trigs 200 HI
HDL 55
VLDL 40
LDL calc 106 clinically non sig hi
TC/HDL ratio 3.8
LDL/HDL ratio 2.0

CMP
Fasting Glucose 95
BUN 27
Creatine, serum 1.17
Sodium 144
Potassium 5.2
Calcium 9.7
Albumin 4.3
Globulin 2.0
Alk Phos 62
AST 22
ALT 30

CBC
WBC 6.5
RBC 5.0
Hemoglobin 15.6 (previously treated for anemia sequelae to radiation)
H-crit 46.1
MCV 92
MCH 31.2
Platelets 274

Other values on demand as they are most liekly not germane but all are WNL.

2nd draw a month later per MD to evaluate the low TT and FT levels (Labcorp)
TT 379 348-1197
FT 9.6 6.8-21.5
LH 5.8 1.7-8.6
FSH 14.5 1.5-22.4
Prolactin 13.1 4-15.2

Doc said I was lo but seemed okay and we would discuss later but he thought I should think about and research testopel. Later has not come about unfortunately and my conversation with him about EOD injectable has met with a not favorable but not completely averse response. While I have a friend on testopel that seems to do fine I am concerned about the primary driver behind using this modality -- $$$$. Also a little concerned it seems like a one and done no worries type solution in the doc's mind. I know I will want my E2 monitored as well as other levels. He was not at all open to AI and Hcg was for women. I was sad because he actually ordered the prolactin and FSH on his own without my prompting. That filled me with hope.

Anyway suggestions and encouragement are welcome as I am becoming frustrated and tired in this pursuit.

Thanks all


#2

You appear to have primary hypogonadism.

TSH is getting high enough to be a concern. Have you been using iodized salt, or are you iodine deficient?
Check your oral body temperature when you first wake up. Should be 97.7+, 97.3 is a problem! Also check that you hit 98.6 mid-afternoon.
Low thyroid function promotes fat gain.

Checking body temperature is important!!!
If low, do more labs as suggested below and read the thyroid basics sticky.

Find 5,000iu vit-D3 tiny oil based caps and take 25,000iu for first 5 days and 5,000 thereafter.

rockcreekwellness is good but strickly out-of-pocked. Depends on what your quality of life is worth and your budget.
They will do injected T [least cost], hCG and anastrozole/Arimidex

Good thyroid labs are:
TSH
fT3
fT4 [not t3, T4]

Your labs should include E2 [estradiol]

Read the advice for new guys sticky.

Prolactin and estrogen promote fat gain and man boobs.

[Lawrence KS]