T Nation

TRT-Brevard County Area


#1

My primary care doc had me on 5 shots of Androgel with no AI for years. I don't think he ever even tested estrogen. When I asked about AI, he told me the awful side effects women have, and I should lose weight if I'm worried about estrogen. He told me the same thing every time I asked. Well, my insurance company decided to review my case and denied my prescription, so I've been without for close to three weeks. I work out 4 to 5 times a week, and I swear I can see myself shrinking every day! I hope that's just in my head.

Seems like a good time to find an endocrinologist or "An enthusiastic GP" to get me on a real treatment plan. Anyone in Brevard County, Fl have any recommendations? I'm 53 years old and obese, determined to get in my best shape before it's too late.

I've only called a couple pharmacists so far, but they "aren't allowed to recommend a physician".


#2

You are going to have to go to a small, independent pharmacy if you want them to bend the rules. You also need to go in, calling on the phone won't get you anything.

If cost is an issue, you may consider SERMs (if secondary) or injecting. Gels tend to be expensive.


#3

I plan to talk to him about SC injections, but I'm hoping insurance will cover it. They denied me because they need more information from my doctor. Five squirts of Androgel seemed like a lot to absorb. I thought an AI would prevent me from converting testosterone to estrogen, which seemed more important due to my belly fat. Would a SERM be better? Am I wrong that SERMs prevent the body from using estrogen, while AI prevents the conversion to estrogen, thereby leaving more T available?
Taking the kids to the park (yay frisbee cardio!), be back shortly.
Thank you for responding!


#4

SERMS block estrogen at the pituitary, stimulating your pituitary to tell your testicles to start producing T. SERMS are only an option if you still have functional testicles, but they are CHEAP. AI is also CHEAP. Gels are probably one of the most expensive options out there, and aren't as good as injecting. etc.

I don't mess with insurance, I just pay out of pocket, my meds for the year are under 200$.


#5

Reading that made me very happy! I was worried insurance wouldn't cover it and I'd be screwed because I couldn't afford it. Now as long as I can get a prescription for it, I'm good! With insurance I'm paying $45/month for the gel alone.
I have a referral for an endo, but they may not even have gotten it from my doctor yet. I asked, and they are booking about a month out, so at best I'm another month from a new prescription, whatever it is. If the insurance eventually approves my Androgel, should I get back on it, or just wait?
My doctor's referral is for a random endocrinologist, so I'm still looking for a recommendation for someone who knows what he's doing. If the pharmacies are open and I can escape the family for a little bit, I'll try to visit some.


#6

It's your call on which way you want to go. If the gel is working for you and you can afford it, then great. If not, there are cheaper options.


#7

So I got the official letter of denial from the insurance company. They won't approve it without the labs from my doctor, who in three weeks hasn't been able to get those to them. I've called them repeatedly and driven there once. It's been a week and they haven't gotten around to sending the referral to the endo, so they still won't see me.
I'm going to start calling other endos tomorrow to see if I can find one that will see me without a referral.


#8

I got these labs off the patient portal. These are the only labs I have except for my last one, which I don't think he tested anything HRT related, just diabetes related. (I have it, apparently.) I don't do the gel the morning of the labwork.

The diabetes labs they mailed me for some reason, I'll get them scanned in and post them if anyone wants to see them.


#9

are those before and after TRT? If so, I'm less than impressed with your numbers on the gel. Consider injecting.


#10

I was on Androgel daily for years before either of those labs. I took my last dose the day before the tests, not the morning of. It probably all converted to estrogen... I was never tested for it, I have a lot of belly fat, and was never given an AI.

I'm definitely interested in injecting, I think 5 pumps is too much. On Androgel's website under dosing information, it only goes up to 4 pumps. Also, I read somewhere on here that gels aren't good if you shower often or sweat a lot. I'm in Florida, by the time I walk to the car in the morning I'm drenched! Just kidding...mostly.


#11

This started as just a request for help finding a doctor, but since it's my first thread, I should probably tell you about myself: I'll answer straight from the "Advice for New Guys" template:

I turned 53 about 11 months ago
5'10"
Not sure of my waist. My pants are 38, but they are worn well below my gut.
weight-260-ish (I hit 280 a few years ago, but working my way down. Been stuck in the 260-265 range for a while though)
Average chest hair, no back hair. Goatee, but the rest grows in too thin for an actual beard. Still have all my hair.
Almost all my fat is around my gut. Twenty years ago I was wearing 30" waist jeans with a flat belly, lean and fairly muscular. Then I got married...
My health? I'm a morbidly obese diabetic with high blood pressure and low T.
Generic Diovan, never hair loss or prostate drugs. Metformin is prescribed but not taken.
I've posted the lab results I have so far. I'll post the new and improved ones as soon as I get some.
Diet is mostly processed and convenience foods. This is getting better and will continue to improve.
I train in the mornings, usually 4-5 times a week, splitting up the body. Far from overtraining, my workouts are short.
testes rarely ache, and then minor and brief. No fever.
Never had a wood problem, ever. Would pop up randomly a couple times a day. I'd say probably above average my whole life. Been off T about four weeks, haven't had an erection in about two weeks. None!

That was pretty awkward to type. You know more about me now than my wife does, I think.


#12

Take your metaformin. It's as close to a miracle drug for diabetes as there is.


#13

Two words: Loose bowels.

One of the side effects of Metformin. My job doesn't always offer the convenience of a bathroom. I've had some issues with my digestive system in the past and I finally found a system that works to keep things more or less normal. Not sure I want to throw "loose bowels" into the mix. I have the pills, they sit menacingly on the counter daring me to take them.
My plan is to lose weight so I don't need them. I'm hoping getting everything else in line makes that easier.
I've always run colder than the 98.6 average, at least as far back as I can remember. I plan to get an oral thermometer today and start taking morning temps. If they're off I'll have something to show my doctor.


#14

I wouldn't mention the temps to the dr, he won't care. If you are low, supplement zinc, and if you are still low get your TSH / T3 tested.

Have you had "loose bowels" from metaformin, or did you just read the warnings? Most medicines will list that on the side effects. Might be worth it to try on the weekend.


#15

He prescribed it when I was "pre-diabetic" many years ago.

There was an incident.

In Metformin's defense, I believe I was on also on anti-biotics at the same time. In fact, my wife swears I never took the Metformin, that it was the antibiotics alone that caused...the incident.

Again, I have a long history of digestive issues. It's my issues that have me concerned.

I didn't get a thermometer today, I got a sick kid from school and came home early instead.


#16

Heh. Yikes. Say no more. :wink:


#17

I have an appointment with an endo, but the earliest I can get in is October 10th, which sucks. On the plus side, he does prescribe injections according to the nurse I spoke to. She put me on the cancellation list, so hopefully I'll get a call sooner than that..

I'm also trying to get in to see a new primary care. He's kind of an anti-aging guy, but a co-worker likes him and he's on our insurance. He seems to be a pellet pusher, but I hope he'll work with me.

Whoever seems more knowledgeable will be my primary HRT doctor.

And as for the aforementioned incident, the only people that know about it are my wife and doctor. And now of course everyone here...
I don't want people thinking something embarrassing happened in a crowd or anything, it wasn't like that.


#18

You don't want pellets.


#19

Post more labs with ranges. Not just sex hormones.

Labs:
TT
FT
E2
CBC
hematocrit
fasting cholesterol
fasting glucose
A1C
DHEA-S
AM cortisol
CRP
homocycteine
PSA
AST/ALT


#20

I have hard copies from my last labs. If my wife won't scan them in tonight I'll figure something else out. (Her scanner hooked up to her computer) I'll use the camera phone if I have to.
It won't have everything you list, but more than he's ever given me before.
I can tell you what I see that matches the above:
A1C was 8.6 with a range of 4.4 - 6.4
Hematocrit:48.9 Range 36.5 - 50.0
Cholesterol (fasting) 170 Range <200 desirable

That's all for now, I'm out of time. Again, I'll try to get the rest posted tonight. There's nothing HRT related on these labs that I can see.