Here’s a link to my last post: Just Turned 20. Need Help w/ Blood Work
My endocrinologist ordered a testicular ultrasound - my next checkup is tomorrow.
I’ve heard a lot of you mention that Endocrinologists are under-educated on HRT and follow a poor protocol. I’m wondering if you could share your opinions on whether the Endo. will be a waste of time (would it be better to just skip to Defy Medical)? Would there even be a chance of treatment under my endocrinologist? Which option would be least expensive?
Thanks
Not a waste of time. Worth the copays even if they don’t administer trt. They should evaluate you. Hormones is complicated stuff and you need the perspective of an Endocrinologist. Especially at 20. Let them rule out other disorders. Like pituitary tumor, testicular tumor, adrenal fatigue, thyroid diseases, and shit we don’t even know about. Pick the best Endo you can. Yes you may end up seeing another specialist after the Endo, but that’s ok.
Folks on here that say all doctors are dumb except for private hrt clinics are dumb. Private hrt clinic, guess what, they are very inclined to prescribe hrt even maybe without investigating root cause or diseases. And they want you to buy THEIR medicine through them.
Just remember we comment here the best we can on blood labs that give us numbers at a point in time. Hormones can fluctuate hourly. There’s a reason why doctors want to see more that 1 lab with low t numbers. Complex.
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It’s true that most endocrinologist are TRT ignorant, few doctors are know how to do TRT well. The question you have to ask yourself is do you want to play the doctor lottery? I’ve never notice anyone here on T-nation state all doctors are dumb, this is a first I’ve heard of it.
@anon10230041 it’s dumb, not dum.
Negative Studies Shed Light on Poor Management of Men on TRT
Houston, TX — 02/10/2014 — A study recently published that concluded that testosterone replacement therapy (TRT) can increase the risk of heart attacks in men shed lights on what happens when older men are given TRT without managing blood levels of certain well-known factors that can potentially affect their health. Men volunteering for this study, seeking to regain their vitality, were exposed to higher risks due to negligence and lack of compliance by researchers to current medical guidelines.It is well known from 30 years of research that testosterone replacement can increase red blood cell (and hematocrit which is the total red cell volume) and estradiol production, two important factors for men’s health when present in normal levels. Red blood cells carry oxygen and estradiol maintains healthy bones, cognitive function and sex drive. However, due to genetic, age or other factors some men can have excessive production of both while on TRT. Unfortunately, this study failed to manage hematocrit and estradiol. Furthermore, most men were not retested to have their testosterone blood levels optimized after they started TRT, so many of them may have remained with inadequate testosterone blood levels. Low testosterone blood levels have been shown to increase cardiovascular risks.
Additionally, this latest nonrandomized study states that “No data were available on indications for testosterone prescription, race, laboratory findings, occupational, environmental, or lifestyle factors.” To jump to conclusions without knowing some of these factors is purely unethical.
Luckily, not all medical practices in the U.S. are ignoring proper monitoring of men on TRT. Many clinics are managing hematocrit by recommending blood donation or phlebotomies to men with hematocrit over 53 to decrease their red blood cell amounts. They are also recommending treatment with low dose anastrozole, an estrogen blocker, for men with estradiol over 50 pg/mL.
It is alarming that studies of this nature do not follow any of the main four testosterone treatment guidelines in the world. This table shows a summary of monitoring required by these medical groups showing the required frequency for monitoring men on TRT. These guidelines should also be revised to include estradiol testing.
It is imperative that future studies follow at least the minimum requirements from current guidelines. Are these studies liable for not following minimum guidelines and exposing their volunteers to increased risks?. Institutional review boards (IRB’s) who approve these studies need to educate themselves about this problem so that no more studies are allowed that do not properly monitor men on testosterone replacement. Lawsuits from men who claim being exposed to unnecessary risks on TRT are starting spreading around the U.S. which may shed light on how poorly informed physicians and researchers are of the current TRT guidelines.
I love it when people on message boards say that people who are endos (like myself) are ignorant about hormone replacement or anything else. Sure there are poor quality endos. But those low quality endos have assloads of more education in the field than anyone else on this forum. Also, we have to think about lots more than HRT and how underlying disease states relate to hormone replacement as a whole. So before everyone jumps on the specialty clinic bandwagon,why not look into why you suffer from low hormone output to begin with. Na. Fuck that. Let’s just take drugs and then MORE drugs to counteract our other drugs! Oh and yes. I attend seminars every other month and lecture. So please guys, tell me how TRT should be run and how to be an effective endocrinologist.
Also, @systemlord, before you correct @anon10230041 for the use of dum, read through your old posts and look at your grammar. My seven year old has less typos. Get yourself together.
I likely won’t be posting in the TRT forum anymore. There’s way more to learn in pharmacy tbh. For awhile the forums looked promising again but the kool aid drinkers are back in full effect with their AI requirements and all.
For all of you guys I’ve helped - I’m happy to have assisted. My new clinic will be open in Denver in November and we will be taking on international clients. And we treat the whole patient. Not just the symptoms. It’s why we currently work with 14 NHL teams, 13 NFL teams, and both the Canadian and American ODP programs. Cheers guys.
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You know 2 weeks ago I added an AI and I feel fantastic for the first time since I started TRT, I was admitted to the emergency room a week ago with a Total T in the middle ranges and the cause was very high estrogen that had caused a massive spike in blood pressure and almost didn’t make it to the emergency room.
When I got to the ER, the staff noticed me staggering, you seem to want to condemn AI’s and I think it’s shortsighted, there are times when they’re use is warranted and very necessary.
The comment to charlie was do to the charlie’s flame which I didn’t appreciate.
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@systemlord And why is your e2 high? What is your lifestyle like? What’s your BF? What’s your training? What’s your liver health like? Are you over 19% BF? Then you shouldn’t Be on testosterone yet. . Are you assuming superoxide is to blame for your high BP?
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I’m a skinny fat 6 ft, 233 pounds 33 percent body fat, I know that this is my problem and is the reason for high aromatase activity. The anastrozole cured my blood pressure spikes within a day. I don’t plan being on an AI long term, lose the weight and get off it.
I couldn’t get around with a Total T of 120, health problems were mounting.
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hey @physioLojik so are you leaving the forum entirely or just the TRT section…
INTERNATIONAL CLIENTS YOU SAY??? That is an EXTREMELY interesting development to hear, how does international client taking work? Do I (I mean… people) have to book a flight to Denver, because certain individuals could easily do that, hint, nudge, nudge, hint, hint, hint, wink, nudge, wink, nudge, wink, hint, hint, hint, other words related to me hinting.
Good luck with the clinic, you are an amazing doctor (from what I can gather, and because you’ve taken the time to assist people on these forums free of charge which is awesome) so who gives a fuck what a few guys on forums say when your patients are happy. I wish your clinic success and maybe you’ll meet some movie stars, wouldn’t that be rad. If you meet any of the stars from that 70s show or archer ask the 70s show people if they think there will be a reunion and ask the archer people if he’s gonna wake up.
Savage burns sir
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Am done with this forum too. I was in here counteracting those pushing 20 year olds to go on trt and private clinics based on one set of labs. That is not good. They need to see an Endocrinologist to start! Period.
And a doctor will not prescribe thyroid treatment with a TSH of 2 nor should they. Stop pushing guys to get their thyroid stimulating hormone to 1.0 and e2= 22!! That’s absurd.
I question myself if I was put on trt for the wrong reasons. But am staying on it because am 41! Not 21! But I actually had an Endocrinologist who put me on trt. I could always try a restart if I want.
I thank all of you guys who helped me through this you know who you are.
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@anon10230041 @physioLojik Your wealth and breadth of information will be missed. Best of luck and health to both of you.
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All doctors, especially specialists like endocrinologists spent YEARS of their life educating themself so they can help people, years of schools, universities, educations…
So - to hear an expert can never be a waste of time.
I would personally prefer to solve a problem causing low T than ending on TRT for life.
It’s quite easy to go to private clinic and end up on TRT, one night of no sleep and heawy drinking - and I could most likley do it too. Just, being 22 and on TRT wouldn’t be a good idea, especially if I don’t need TRT.
If I had low T - I would probably try all other options before TRT.
It’s way more convenient to have your testicles do the work than rely on lotd of labs, injections, drugs… and if your testes aren’t working properly and can be fixed - then fix the problem.
Private clinics get their money, and they’ll happily perscribe you with high doses of T to keep you happy too.
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Sooo damn true . I have also seen people laughing at 20 year men for there 300_400 level testosterone . There are thousands of ways to get better testosterone not just trt . It’s only for those men who are consistently below 250 or boys who don’t have there testiscles working due to some by birth damage . All Dr says 400 is a normal level if they say it they mean it . They know it’s all the body needs .
Hormones aren’t taught in medical school, it isn’t even glossed over as androgen therapy isn’t seen as profitable enough, if an endo wants to learn about hormones as it pertains to TRT he will need to look elsewhere because medical school doesn’t teach it even now.
There are those select few endocrinologist and urologists who actually have a desire to improve their knowledge in TRT, some even receive additional training, but they are in the minority and this is the problem.
The question was asked if endocrinologist was a waste of time and the short answer depends on whether you consider yourself lucky enough to find an endocrinologist who is skilled in TRT, the odds are against you.
I would advise new members to stay away from those T-Mill or Low T centers, you need to seek out qualified physicians and ask the right questions to vet them. Start with the “TOT Bibble” as it’s packed with studies not yet available to the public.
I know I sound like a broken record, but new members need to realize what they’re getting themselves into and the current state of androgen therapy, it’s not just a problem in the US, but worldwide.
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You are right but don’t get fooled by defy medicals or any other such clinic they are doing great business . Testosterone fluctuate on hourly basis . Its almost half by noon and peak when we are sleeping . So boys in there 20s have no way to be on trt . It’s definitely gonna ruin there basic life style . It’s just pushing our body beyond its natural life cycle .
It’s not about the numbers ramanmania. You can’t just say men in their 20s have no use for TRT. What about their exposure to xenoestrogens? What about TBI? What about hypogonadism? If a man is 24 and hypogonadal for some reason and having a T reading of 400 where he was 1100 the year before he is more than likely going to need some hormonal assistance.
How does the patient feel? What are their symptoms? Being dismissed as fine with a “normal” reading on total T of 300 and not looking at anything else is as bad as blindly prescribing test in my opinion.
Lets not forget the fact that some labs have dropped their normal range from 350-1100 down to 175-775.
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You should be knowing the side effects of these steroids . Clomids and all is fine
Cholesterol, pregnenolone and testosterone are all natural steroids, clomid is a drug, a chemical not natural to the body which is why there are so many horrible side effects. Using clomid on the pituitary gland long term has got to have consequences down the road, it’s a drug and we have no idea what will happen.
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What side effects of increased testosterone are you referring to? Less cardiac events? Increased libido? Decreased depression? Decreased body fat? Increased LBM?
Who told you hormones aren’t taught in medical school? I had a semester about them in third year, and then two years in my endo fellowship based purely on hormones. I have no idea where you get the ideas you toss out man.
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Oh I’ll still be in pharmacy if you need me 
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