Low T, New to TRT

Pharma TRT
141

I might need help finding one, I am in Florida. How easy is it to test for vitamins and minerals? Is this something my primary can order.

Read this…

The first step in diagnosing hypophosphatasia is assessment of the visible signs and symptoms of the condition. If a bone mineralizing disorder is suspected, HPP can be differentiated by checking the level of ALP and the substrates it metabolizes.

My platelet count and MPV suggest Hypophosphatasia AND my Low ALP is an even bigger indicator… Think your onto something. Especially since my ALP is low as expected when diagnosing Hypophosphatasia.

142

You should have said so earlier, Dr. Saya is in Tampa Bay and is a true leader in TRT/anti-aging. Dr. Saya used to be an endocrinologist in sick care and majored in cardiology. He does consultations only as we as full treatment.

I’m certain he can come across situations like yours in the 10,000 plus patients he’s treated on TRT.

143

I will look into it I live very close to Tampa area, and I will keep you updated as I find more information out. Also what is your opinion on people saying my E2 is too low? I think in the presence of 106 pg/ml Free T it is expected. Also I think with my new dosage increase both Free T and E2 will rise to healthier levels.

144

Maybe, maybe not. Moderately severe hypothyroid symptoms…….nice TSH though.

thyroid labs

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145

Curiously, how do you know this and do you know, or wonder, how many of these are currently patients?

146

Looks like I will get more extensive Thyroid labs as well, it doesn’t look like Quest offers this. Any suggestions? I would like to have Free T3, RT3 and Free T4 tested to finally rule out Thyroid.

147

Quest offers them.

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148

A 22 estrogen is not low, it may be on the bottom of the healthy range, but it’s not low. Your estrogen had to have been low pre-TRT when TT was 380. You want estrogen 25-35, but some men can handle estrogen quite a bit higher in the 40-50’s without symptoms.

149

Its crazy how I need so much TT to have higher E2 and Free T. Have you seen this before?

Most with a TT of 700 have a free T of 150 pg/ml on the same reference range. I seem to do poorly with Free T to TT ratio even though SHBG is middle of the road.

Also is this something that will change with time, or is it just the way my body handles Testosterone/estrogen? Can I always expect to require higher TT levels to reach adequate free T?

150

Dr. Saya is one of the best and have read some of his published papers and have told you this before, maybe you forgot. Dr. Saya is most inform doctor I have ever spoken with and has quite the reputation among his patients, he has a ton of followers and I think that speaks for itself, but this has more to do with the fact you hate telemedicine and prefer face to face doctors.

The OP is in FL, perfect because now he can have a face to face if he chooses to do so.

151

Please, if you can, answer my question. Then I will address what you think I forgot.

152

I do not hate telemedicine, in fact, I think it has a place, after the doctor has had a face to face consultation and provided a proper physical examination with the patient. Think about it, you have never met your doctor, but you had a physical exam prior to starting treatment. Your doctor took the word of someone else, someone he does not even know, and made medical decisions based on that faxed exam. An exam which he can not be positive even happened.

My concern is more with breaking the law. It’s pretty clear, I provided it below, but it is public record if you care to look for yourself. A practice doing something this blatantly illegal raises concerns in my mind as to what else are the doing.

But, that’s me. If you, or anyone else, is cool with it, then fine. I’m just saying make informed choices. It’s possible more TRT guys are underground than not and at least with this there is nothing illegal from the patient’s end. Your over the top claims here got me to wonder about this and look into it. This is part of what I found:

Ch. 2019-137 LAWS OF FLORIDA Ch. 2019-137
393.17; part III of chapter 401; chapter 457; chapter 458; chapter 459; chapter 460; chapter 461; chapter 463; chapter 464; chapter 465; chapter 466; chapter 467; part I, part III, part IV, part V, part X, part XIII, or part XIV of chapter 468; chapter 478; chapter 480; part II or part III of chapter 483; chapter 484; chapter 486; chapter 490; or chapter 491; who is licensed under a multi-state health care licensure compact of which Florida is a member state; or who is registered under and complies with subsection (4).
(2) PRACTICE STANDARDS.—
(c) A telehealth provider may not use telehealth to prescribe a controlled substance unless the controlled substance is prescribed for the following:

  1. The treatment of a psychiatric disorder;
  2. Inpatient treatment at a hospital licensed under chapter 395;
  3. The treatment of a patient receiving hospice services as defined in s. 400.601;
    or 4. The treatment of a resident of a nursing home facility as defined in s. 400.021.
153

I don’t give a spit about someone going underground to get his script underground, but the OP is seeking a medical help from a professional more capable than most doctors in sick care.

There are laws that provide exemptions to these law you’re listing.

Lets just say I wouldn’t want you for my nextdoor neighbor when you reach old age, lol.

154

I didn’t think you did, for the record, neither do I. I did that once, not for TRT though. Point was, the telemedicine patient is not breaking the law. Your clinic is.

Could you provide that exemption? I’m curious about this, and why you would even think such an exemption exists.

That would depend on what law you were breaking…………however, if someone was screwing with your property, you would want me as a next door neighbor.

155

It wouldn’t be me breaking the law, I’m law abiding, maybe I’ve seen too many Judge Judy episodes where the old man is bored and turns his attention to being the neighborhood self elected sheriff.

156

No way, I would be the opposite of that. But, if you think I am bored because I participate in this forum and have the temerity to question some of your outrageous, and apparently unsupported, statements, so be it. You say many things here that you do not, or cannot, back up. It’s OK, I wouldn’t expect you to like getting called on it.

157

Almost everyone thinks their doctor is the best. The success of the treatment often depends on that.

No, I did not forget. Those were articles posted on the internet with marketing intent. When I asked you for anything published in a scientific, peer reviewed, referred journal, you provided nothing.

And you know this how? Maybe one of the best you’ve seen, or know. But there are thousands out there that you do not know. They also have “quite the reputation among” their patients. I won’t say “a ton” of followers, because I do not know what that means, but almost all doctors have a lot of followers (patients).

How is it determined one is a “true” leader? It seems any “TRT/anti-aging” doctor is leading their patients.

Huh? So, do you mean a board certified endocrinologist? He did a residency in endocrinology? “Majored” in cardiology? What does that mean? He must have done a residency in cardiology then because medical students do not “major” in anything.

This is not logistically possible. You failed to state where this number comes from, but do some math and figure it out. GPs typically manage 1000-2000 patients, specialists less. Primary care would be less time intensive than TRT/HRT, at least if done right. My guess is that you made this up. Doctors usually do not brag about numbers like this, so I doubt he said that. He could have, I just don’t think so.

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158

Dr. Saya graduated as a class Valedictorian from North Carolina State University with a dual Bachelor’s Degree in Biological Sciences and a Bachelor’s Degree in Economics. He then received a medical degree from the University of North Carolina at Chapel Hill, School of Medicine, and subsequently performed his internship and residency training at the University of South Florida/Morton Plant Mease Family Medicine Residency Program. In addition to his education and training, he is privileged to hold the following certifications, honors, and memberships:

  • American Medical Association (AMA)
  • American Association of Family Practitioners (AAFP)
  • World Anti-Aging Academy of Medicine
  • American Academy of Anti-Aging Medicine Courses/Training (A4M)
  • National Society of Collegiate Scholars
  • Golden Key International Honor Society
  • The Honor Society of Phi Kappa Phi
  • Phi Beta Kappa Honor Society
  • Phi Theta Kappa Honor Society

Honestly, I’m much more inclined to listen to Dr. Saya and trust his advice and vast experience than the “bro science” on here, or some self-proclaimed internet TRT guru. Just say’n @highpull.

As for someone questioning Defy’s choice to offer telemedicine and the legality. Again, I’m confident a man of Dr. Saya’s character and experience did his research and would not jeopardize his practice, patients or license if he wasn’t 100% sure he could do it legally. I’m equally confident, he has a team of legal professionals he consulted before choosing this one sector of his business model. That’s idiotic to imply. You’re attacking a man’s livelihood and character without a shred of evidence. The burden of proof is on you @highpull not @systemlord.

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159

Your points are valid, and well taken.

This is not intended to be about Dr. Saya, certainly not personally, I did look him up on the internet a couple of weeks ago and he appears to be fairly well qualified. I think I would go to him if I did not know anyone who could give me a personal referral. Many here are in that position. I prefer to use doctors that I know, or doctors that take care of people I know. I’d also love to ask him about telemedicine in his state because my experiences are different.

This started when I began TRT years ago and consulted with a doctor in Florida, who is still my doctor. I had to travel to Florida and establish in person and receive a physical exam in the office due to statutory requirements. Years later, in reading posts here, I see this is apparently not something adhered to by others. My doctor (still) insists on in person initial visits and I know this because I have referred others who flew there to start. So, I’m being told different things and I started doing some research and found what I found. I posted the state statute, proof in my mind. I’m just reading the law, I can’t find anything else. Systemlord stated there are exemptions, fine, can I see them too? Please, if you can, tell me where I’m wrong. I also looked at telemedicine laws in multiple states, especially in regards to licensure. I just find this interesting.

I also spoke to a DEA agent about this, I’ve related that previously. I was told they are aware of some skirting the law (according to him, many do this) and watch these practices, moving in when the time (money) is right. He recently busted a TRT clinic and doctor in my area. You can go ahead and buy all of your testosterone off the internet, they really do not care. Buy $100,000 of it, then they’ll think you’re dealing, and that they will care about. Take it for what it’s worth, and it’s not worth much. If you care, or are curious, check it out on your own. If not, don’t. No big deal.

I’ve searched the Florida statutes. I have experience in this. I cannot find the exemptions systemlord reported. He simply makes statements that do not ring true. He is so over the top with his clinic that I still wonder if he is a part owner. It seems strange.

(2) PRACTICE STANDARDS.—
© A telehealth provider may not use telehealth to prescribe a controlled substance unless the controlled substance is prescribed for the following:

  1. The treatment of a psychiatric disorder;
  2. Inpatient treatment at a hospital licensed under chapter 395;
  3. The treatment of a patient receiving hospice services as defined in s. 400.601;
    or 4. The treatment of a resident of a nursing home facility as defined in s. 400.021.

How can anyone interpret this differently?

Last, I think anyone claiming to be an expert is not one. As expert should be smart enough to know they are not an expert.

160

Yikes

Yet he prescribes tk brodcience and has trained his nurses to say “it’s an estrogen symtom if trt isn’t working” or giving an ai to a dozen men who already have extremely low ai.

I don’t care how smart someone is. It doesn’t mean they don’t practice bro science.

Any doctor who gives an ai is following bro science protocol. There is not one study showing an ai is needed. I haven’t found one. Have you?

All the trt studies are without an ai when they show benefit.

Doesn’t mean he’s not smart, but he is more apt to give the patient what he or she wants versus putting his foot down and saying “trust me you don’t need this”