I have thought about this issue a great deal. Why do MD's hand out Statins and Antidepressants like candy but seem unwilling to treat hypogonadism?
There are many meds that MDs commonly prescribe that are much more toxic to the body than testosterone.
I have narrowed it down to 3 things:
One - lack of education. If your MD thinks that testosterone causes prostate cancer and heart disease he/she is unlikely to prescribe it. If your MD thinks that any blood T result which falls into the normal range means that you don't need treatment, you probably wont get treated.
Two- Fear of the DEA. Steroids & Testosterone are class III controlled substances. Many MDs have been targeted by the DEA (and treated like drug dealers) for giving pain meds (in Pain Treatment Centers) to patients with chronic pain. There is even a newsletter for MDs about this subject and what meds to avoid (if one wishes to avoid the DEAs wrath). It is possible that MDs just don't want to deal with the "risk" involved with prescribing testosterone due to social bias (anti-steroids) and fear of loosing their license.
Three - Fear of Malpractice Suits. One could argue that "you don't really need" testosterone and that the potential risks outweigh the benefits. There is division in the medical community about treating patients with testosterone. Those MDs that do prescribe testosterone are probably in the minority.
Most of the current research on testosterone supplementation has been positive. You could try to educate your MD by showing him/her current research which demonstrates a high benefit/low risk ratio of testosterone treatments.
You could encourage frank and honest discussion with your MD. Ask him/her if they are concerned about the DEA or a malpratice suit. Ask them to provide you with current research which indicates that the risks involved with testosterone supplementation outweigh the benefits.
You also need to cut your MDs some slack. They probably have experienced many patients who are looking for meds that they don't need and subsequently are hyper-sensitive to patients asking for certain medications (like testosterone and pain meds).
I think that it is reasonable to ask your MD about testosterone supplementation and demand that any any decisions he/she makes regarding your treatment should be based on science and not on personal or social bias.
If you have low testosterone (confirmed by bloodwork) and have other indications of primary or secondary hypogonadism, then I feel you have every right to expect and demand treatment. In fact, if you have solid evidence which supports your condition, it's possible that one could file suit if treatment was denied.
I think it would be unreasonable to ask or expect your MD to provide supraphysiological levels of testosterone. I do think it is reasonable to ask for a high enough dose to bring you up into the high-normal range. Most users say they "feel" the best when their T-levels are higher.
If there are any MDs on this board I would love to hear your opinions and feedback about this matter.