T Nation

What Would You Ask a Doc

If you knew what you knew now about TRT what are some of the things you would ask a doc to make sure they understood your test results and that they knew what they were doing? What would be red flags for you?

(1) Targeting mid range testosterone levels
(2) Dr. says TRT causes prostate cancer
(3) Dr. says TRT causes heart attack and strokes
(4) Injections every two weeks or lower than 100mg weekly dosing
(5) Not checking both Total and Free T or not checking SHBG prior to treatment.
(6) Everything above 300 ng/dL is normal

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Ditto

I started through a urology center guy thing covered by insurance. Dude was nice and personable and even on TRT himself. BUT, he just assumed his experience with TRT would be identical to everyone else’s. Only thing he cared about was total, and a peak total of 600 was perfect, even if I had zero symptom resolution. He was a fan of no AI and weekly injections, so that was good. He did hint around at the possibility that it didn’t matter what he personally thought about how treatments should go, but rather what insurance would allow him to do without any questions or unwanted attention.

Ultimately I left for a private company that didn’t give a damn about numbers (so king as they were absurdly high or dangerous), and was focused on symptom resolution.

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That’s what I was wondering also. Why is it that a doctor would need you totally crippled at 300 total T for them to treat you? I do know that some people may feel okay at that level depending on age and other factors, but why is it we’re bombarded by chemicals that lower testosterone and increase everyday and we still need to be growing tits to get help? I’ve seen some things on “normal,” that are pretty atrocious such as 300 being the threshold for treatment. You would think eventually they would start looking into the reasons for low T among young men, but they don’t even routinely check

Because unless it’s a private clinic they are bound by insurance and what they deem in range.

I’m talking about just that tho the root of it. What has to happen before the threshold is reconsidered?

Like what would you have to do to make insurance companies change the guidelines in which they decide if a treatment is justified or not? That would be a quite expensive and wasteful journey I’d imagine. If you are right on the cusp of the 300 total T line (seems to be what most places in the US need), there are plenty of ways to get that number to dip below 300

I can tell you this 300 cutoff point wasn’t based off any studies, in fact the studies point the symptoms of low-T far earlier. One reason why the threshold is so low, insurance companies collect premiums and pull more money in than they put out, kind of like casinos, a river of money flowing in, little going out.

The insurance companies are responsible for the 200mg every 2 week protocols in the guidelines. In the beginning it was thought the patient would be coming into the doctor’s office and have a nurse administer the injection every 2 weeks, so cost was a factor even though the doctors said this isn’t an optimal way to replace testosterone.

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I tested at 270 a few years ago, and I was left to decline for 2 more years. They simply believed that I was well within range. Clomid was the only thing they gave me, which made feel worse. The range is a blanket. As long as youre within the range you’re fine

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I had a 26y/o in the office with his extremely attractive girlfriend. He explained that he was tired all the time and had zero libido, while his girlfriend glared at me.

He had already been tested by his GP, 255 (250-1100). He reported that the doctor told him he was normal, in the lower part of the range, but within the normal range, and he did not need testosterone.

The girlfriend was pushing him to do something and I’m sure she wanted me to know that it wasn’t her.

See this all the time.

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So did you treat him?

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What do you think?

Yes lol

Bro my dad is 75 and has 500 -600 total … selling guys short on TRT is their new tag line.

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Were you thinking tell him he is fine, send him home, but leave the girl?

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Sorry, I don’t understand. You’re saying 500-600 should be a normal thing for older men right?

Right now it might be, what was normal 60 years ago isn’t normal now, normal is redefined all the time as the human condition is degraded.

In the world War 2 era men had higher testosterone than than men do now, but instead of doctors focusing on what’s normal in the present, what is healthy should be the focus.

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I agree. It’s like it used to be be “hey you’re not doing so well,” to now it is, “you’re still alive. Here’s a bandaid.” The goal post Keeps getting further and further away.

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Probably close. He’s very healthy and that’s his level … free t is 15… it hurts my head seeing guys here trying to keep their levels around 15 .