T Nation

Will Doctors Ever Learn?


How long will it be before doctors, endocrinologists, etc learn how to properly treat patients with low testosterone? Will they learn? And, all those doctors that won't prescribe an AI because it's considered a 'cancer/bodybuilding drug' How's any treatment supposed to be successful without keeping estrogen levels in the normal range? Where is the root of the problem? Are they not teaching this in medical school; or is it the pharmaceutical companies/ insurances?

I'm not a doctor or anything, but I have been researching this for a couple of months..And, my logic tells me that testosterone + an AI(if high estrogen levels are comfirmed) is what should be apart of every TRT protocol- At the very least. That's not including the benefits of HCG.

They're making it way too hard to find proper care. Do you think this will ever change? Sorry, just venting. lol.


As KSMan and others have written about, there is simply no interest (read: profit) to develop official TRT protocols, or seek FDA approval of ancillary drugs for the purposes we use them for, because these drugs are generic. Nobody is going to spend millions of dollars to do the required studies. So at least for the foreseeable future, TRT is more art than science and its effective use will be limited to a fairly small cadre of doctors. Most physicians are simply reluctant to prescribe drugs off-label for an unofficial treatment protocol.

Just as an aside, not everyone on TRT needs an AI (lucky bastards.) It should not automatically be prescribed along with T. Prescribing an AI to someone with good E2 levels would be harmful. If the labs come back after the initial few weeks of treatment showing elevated E2, which they usually do, then an AI is in order.

Also remember that conventional western "health care" is really more like "sick care." Its focus is not to enhance quality of life, prevent disease, or maximize functionality--but rather to treat recognized dysfunction and disease. TRT is more about optimizing the body and lowering the risk of disease than immediate life threats. We come in with a constellation of subjective symptoms, and it sounds like a psych issue to most docs. God only knows how many low-T guys are on SSRI's they don't need, instead of testosterone they do.


Well Repros is sure spending a ton on Androxal. It's been a long up hill battle. At the least, when it comes out, it will possibly be a good replacement for HCG. Not that HCG needs to be replaced but it will make international travel easier since you won't have to worry about something you're dragging around that needs to stay cool. If the drug works as advertised it may be a good stand alone for secondary hypogonadism. Another good use would be to use it as the primary drug and see where yuor T levels end up. After that top off with a little T Cyp to make up the difference.

I know everyone hates antidepressants but you know they can actually be a huge positive in the right combination. Combine zoloft with mirapex and you turn into a wood popping teenager. The reason they get a bad rap is because everyone is on an SSRI alone and they are way out of balance.


Actually, the big reason SSRI's have a bad rap is because they're based on bad science and have been soundly proven to INCREASE risk of suicide, which is kind of the opposite effect we're going for. Brain chemistry is a rather complex and delicate thing and we truly don't know what we're messing with. Even worse is medicating developing brains. We are re-wiring a generation of young brains and setting them up for a lifetime of dysfunction.

A study was done wherein one group was put on an SSRI, and another was given fish oil and asked to spend a few minutes a day in the sun (no shade or sunglasses--your eyes need to receive direct sunlight for this effect). They were equally effective. Depression in my view stems from a physical problem and it's not that hard to treat. Diet, exercise, sunlight, forcing yourself to be social...these things work and don't have nasty side effects.


Some very good posts here!

Doctors need to be good at learning what they are taught. Deductive reasoning is not required. That is the root of the problem. Sort of like the difference between a technician and an engineer. When a technician gets a problem that is out of scope, the outcome can be poor. When a problem gets out of scope, an good engineer gets interested.

Doctors are equipped to provide canned responses to defined problems. So the doctor is really simply looking for defined problems that he can perceive. The problem for the doctor is lack of appropriate pre-defined problems. If your estradiol levels are too high, it does not compute to use a cancer drug because you do not have cancer. In cases like this the reasoning is stuck at the level of a 10 year old.


I agree with all of the above but would just like to add that there is something else going on. Medicine is a business, just like any other, and many of the more successful TRT docs and clinics would just as soon not have every last family practitioner and internist know what really works.

Publicizing your successful protocol may seem like shooting yourself in the foot.

End result: the doctor "on the street" doesn't have a clue. (And they didn't didn't teach this in medical school.)

Additionally, "big pharma" has invested dollars in patches and gels, and they're going to market them heavily to urologists and endocrinologists.

Thus you see very little published about what should be the "gold standard" of care for testosterone deficiency: the triple therapy of SubQ Testosterone, HCG, and an aromatase inhibitor.

Eventually someone will publish a paper and it will become conventional medical wisdom, and all those TRT and Aging Clinics will come out of the woodwork and say, "that's what we've been doing all along!"

(I'll introduce myself in another thread.)


Androxal=modified Clomid. It remains to be seen whether it will offer any real added benefits in contrast with the assuredly higher price. But it's sure to be marketed aggressively, just as patches/gels have been, even though they are more expensive and don't offer any advantage over injections, save convenience for those who aren't willing to inject (and in fact have many downsides.)


Dr. Crisler has already published his TRT protocol online...he also gives seminars every month, and has a pricing option in which you can plug your own family doctor into him for a consult while you are in the office...I think other TRT savvy docs do the same...

There are tons of published studies showing benefits of TRT and what dosing protocols are appropriate...not to brag, but I think many of our members here could make your average family practitioner or even a lot of endos look very foolish while discussing TRT...the information is out there, but many have too big of an EGO to go and seek and implement it...(realize there are potential hurdles to implementing, i.e. overzealous governmental regulatory authorities, but still doesn't stop many willing to push the envelope from implementing)...


Post asking for a link to Dr. Crisler's protocol deleted. I found it under "publications" on his web page.