T Nation

Your Doctor, Your Deal(ing)...


#1

with an idiot.
Pardon the play on the article Your Doctor, Your Dealer. Yesterday, the 4th doctor I've seen for low test wanted me to cut down my Androgel! I'm in the 300's (very low -- should be about 600 ng/dl) and he wants it in the 200's!
I know that judging a large group by the actions of a few idiots is not logical, but it sure is tempting. I know I can't go to another doctor because if the next said something stupid like this, I'd be tempted to punch him in the face.
Anyway, this thread is to share your experiences with these so-called healers. Give the new guys a chance to see what their up against.


#2

18 year old with ~250 ng / dl. Doctor tells him that its only 50 ng / dl below 'normal' and that its not enough to worry about. This was that fella on Alpha Male, with plenty of fat, and ZMA... Scares the shit outta me to think of his endocrine system on a low fat / high sugar diet, without the supps. Then my mate asks me if his 250 is low or is the doctor correct...


#3

The kid is lucky he had some Alpha Male... otherwise he might as well start shopping for some new panties.


#4

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.


#5

Which is why when I finally get through all this schooling... you guys will be very happy at my practice.

If you're close... nothing is wrong with prophylactic medicine.


#6

This is why everyone here should be against all of the focus of anabolics in sports and the hype on "reality tv". Expect for it to get worse because the general public does dictate what your doctor does. Most docs wouldn't want to be held liable (mind you, you won't be paying out for being sued...they will) should some guy with his Fruit of The Looms in a twist decide to hire a lawyer because of liver values. I am surprised that HRT is still prescribed much at all because of the reaction by the general public.

I'm sorry, but in this case, I can completely understand why those looking for HRT would be running into problems lately. We live in a society that loves to sue yet has very little knowledge. That leads to everyone jumping on the "steroids are evil" bandwagon with your doctor becoming the target should any of the "evil" actually get prescribed. With insurance the way it is and legal "get rich" tactics being thrown like loose handed frisbees, your docs can't take a shit without someone attempting to crawl up his ass.


#7

Excellent posts, everyone! I do try to see things from the physicians point of view, but it sure is tough sometimes. Here's a little background...
Feeling very crappy last summer, I got a very thorough physical. The only thing wrong with me was low T, with borderline thyroid. The normal range for a guy like me is 250-940 ng/dl.
On testing, over the last few months, I get 146, then 224, then 366 (while on the gel). Improvement, enough to keep me from jumping off a bridge (joking), but BLAH ... like drinking warm flat beer on a red hot, working outdoors kind of day. Then these docs, 4 of them mind you, keep giving me this crap about 'Be happy with your level.' or the guy yesterday with the "Its too high." nonsense. AAARRRGGGHHHH!

I guess I have to go to one of those websites in the Steroid section to get any help.


#8

Borderline thyroid? Hypo or Hyper? Hypo can make you feel run down.

What were your free or biological levels of testosterone?

Did you have your Estradiol level checked? Too high or too low can make you feel like crap.

Did you have your liver and kindey functions checked out?

Some people prefer Depo-Test shots (once a week) and tend to feel better and get higher T levels than they did with gel. I think shots are cheaper too.

It does not make sense that your MD would consider 366 to be too high.


#9

Went to Primary Physician months ago. With reluctance, tested my T levels. Total level was low, mid 200s. After two low early morning readings, the doc said, "we can do something for that". "But, first would like to have evaluation from a Urologist". The Urologist then says, "yes it's on the low side of normal, but you seem reasonably healthy and it realy isn't that low to supplement HRT".
Meanwhile, I show many of the symptoms associated with low t-levels. And no real direction to turn for professional guidance.
The problem is, many doctors see someone who may fit the "steriod user" profile (aka. someone who works out regularly), and they are reluctant to go the path.
The stigma exists.


#10

Yep, had all of those checked. I am slightly hypothyroid, again not enough for meds. I'm considering buying some low-dose Cytomel on my own and reluctantly stay with the doctor who gives me 10 g/day of gel. He seemed the best of the bunch and might move me up to shots once/week.
I know they're busy but I'm a high school teacher and I often am more up-to-date than these guys! How hard is it to google the Journal of Clinical Metabolism and Endocrinology?


#11

I must admit that the young lady to our left is helping my T level :slight_smile:


#12

If the doctor you're dealing with is neither a male endocrinologist nor one of the 1-6 (all male) doctors in each state who knows a lot about steroid use in healthy strength athletes, you're probably pissing against the tide. At the first sign of trouble, QUIT DEALING WITH THE SONOFABITCH!!! This world is highly populated with OTHER DOCTORS!
I stress that the doctor you deal with must be a guy. A 40+ year old female doctor is still a 40+ year old female. She may recite the traditional mantra that sex is normal and healthy, but, deep in her middle-aged female heart, she probably thinks that anything over three fucks per month is a lot of sex. The whole idea that more testosterone means more sex--usually true--leaves her saying: "So what?" The notion that sex is so good that more sex must be more gooder is totally foreign to her brain.... If your male endocrinologist is muy busy and wants his (female) partner or nurse-practitioner to handle your case, refuse to deal with her under any and all circumstances. Once she has decided that she wants your "T" prescription reduced, he will ab-so-fucking-lutely never increase it again. I speak from experience.


#13

I agree with every word that Coach Joe just wrote.


#14

All good advice! Thanks Coach Joe and Prof X!
I've decided, for insurance purposes, to try a new guy every 3 months, until I strike 'gold'. I know there is a good HRT doc out there but, like anything worthwhile, just got to keep trying.


#15

Coach Joe;

Where would I go about finding the 1-6 doctors ? The reason I ask is that my total testosterone just came back at 270, which my PCP says is in the normal range of 241 - 890. However, I want to get a second consult with an endo. I just don't know where to look for a good endo. Thanks.

Brian


#16

I know you didn't address this to me but: Endo's are not the doc to go to -- go to a urologist. Found this out yesterday.


#17

Why a urologist and not an endo ?


#18

Endos do not, in general, deal with this area. The guy I went to explained that the prostate and so forth are not endocrine glands. (Boy, did I feel dumb!). He sent me to urologist.

Probably the best thing to do is call urologists and ask if they do male HRT.


#19

Thanks Headhunter


#20

For what it's worth, it may be beneficial to deal with a "life extension" doctor. There is a database at lef.org that you can search by state. Try contacting some of these M.D.'s. I was successful in finding one willing to prescribe HRT.