Two Fired Doctors and Some Labs

Pharma / TRT Testosterone Replacement
1

Went to see a Urologist. Had to wait 1 hr 45 mins to see him, prescribes Clomid, no tests, completely discounts my concerns about E2( I had just spent 2 weeks sitting at home with swollen feet ). I mention sore and shrinking Testicles, he checks and says they seem fine to him! He didn’t have an answer when I asked what his point of reference was since he hadn’t seen them before. He finally agrees to test for E2 to “shut me up because I’m barking up the wrong tree” and he’s never seen an E2 issue in men before.
A week later I call for results and get the lab tech who says the results were normal.

Me “Normal? What was the result?”
LT “55”
M “55! Really?!? what’s the range?”
LT “<56, everything is fine, no red flags.”
Me " So at 55 I’m okay, but at 57 I have a problem?"
LT “At 57 the Dr. would want to monitor it more closely.”
M “Great!” FIRED!!!

On to the next Dr. who “Specializes in HRT” but doesn’t really use AI’s or HCG except for diets.

-About me
45
5’7" stocky, no big growth spurts but lots of body hair, usually add muscle pretty easily but have never been able to completely lose the spare tire, even at my leanest
usually 175 to 185 lbs, in the past 2 yrs crept up to 205 after getting REALLY ill on Nexium, which apparently caused me to be Vit D deficient and hypogonadal.
Been taking 4000 iu vit D, 3 Men’s over 45 multi’s and 3000mg fish oil daily and doing the T Cyp progression from 1/m to E2W to currently MWF(3/40mg) 120 mg but no HCG or AI because I can’t find a Dr with a clue.

Labs taken 8:00 am Thursday 8/19 morning/fasting
They were supposed to test for Vit D also but didn’t.
Glucose 100mg/dl 65-100
Bun 14mg/dl 8-25
creatine 1.1mg/dl .8-1.4
eGFR non african am. 72ml/min/1.73 >60
calculated bun/creat 13 6-28
sodium 138meq/l 133-146
potassium 3.9meq/l 3.5-5.3
chloride 101meq/l 97-110
CO2 28meq/l 18-30
calcium 8.9mg/dl 8.5-10.5
protien total 6.7g/dl 6.0-8.4
albumin 4.1g/dl 2.9-5.0
calculated globulin 2.6g/dl 2.0-3.8
calculated A/G ratio 1.6 0.9-2.5
bilirubin total 0.5mg/dl 0.1-1.3
alkaline phospatase 62
Cholesterol 239mg/dl <200 was 165 a few months ago when I was doing monthly T shots???
triglycerides 303mg/dl <150 was also fine at last check
hdl 41mg/dl >39
calculated ldl 137mg/dl <100
risk ratio ldl/hdl 3.35 ratio <3.55
( I swear all cholesterol #'s were good at last check about 6 mos ago ??? Maybe from excess E2 aromitization?)
LH <0.1 miu/ml 1.0-9.0 *of course
FSH 0.3 miu/ml 1.5-14.0 * "
Magnesium 2.3mg/dl 1.3-2.3
Prolactin 8.0ng/ml 3.0-30.0
T4 thyroxine 6.1ug/dl 4.4-12.4
cortisol am specimen 16ug/dl 7-25
CBC
WBC 8.3k/ul 4.0-11.0
RBC 5.24m/ul 4.10-5.70
hemoglobin 15.9g/dl 13.0-17.0
hematocrit 46.1 % 37.0-49.0
MCV 88.0 fl 80-100
MCH 30.3pg 27.0-34.0
MCHC 34.5g/dl 11.0-15.0
RDW 13.6 % 11.0-15.0
neutrophils 56 % 40-74
lymphocytes 29 % 19-48
monocytes 12 % 4-13
eosinophils 2 % 0-7
basophils 1 % 0-2
platelet count 296k/ul 130-400
estradiol 33pg/ml <56
DHEA sulfate 96 ug/dl 82-455
insulin 11 uiu/ml 6-27
PSA total 0.9 ng/ml <4.0
Free T3 3.5pg/ml 2.3-4.2
TSH 2.4uiu/ml 0.3-5.1
testosterone 799ng/dl 241-827
SHBG 9 nmol/l 13-71
calc free test 28.6 ng/dl 6.0-27.0
dihydrotestosterone 324.0 pg/ml 106.0-719.0
somatomedin-c 296 ng/ml range by age 41-55 yrs 87-267

This guy wants to prescribe his “specially compounded” T Cyp 150mg/week and 50 mg DHEA but wants to hold off on HCG or any AI. Then he starts pushing HGH really aggressively saying even though I was at 296 and the goal is 300 (platelets I guess), I’ll feel SOOOO much better with $400/month in HGH.
Hmmmmmm, let me think about that one. He sends in the script and I leave. Several hours later his nurse calls to tell me my script is ready, but I need to give her my CC info because I pay there but p/u at the pharmacy, and did the Dr discuss price w/me. Sure he did I say, $150 for 10ml Tcyp (seems a little high, but whatever) and $50.00 for 1 mos. DHEA. She laughs, silly Dr. Tcyp is $270.00 for 10 ML!!! WOW!!! I’m gonna have to consider that and call you back…
So I call the compounding pharmacist and ask if the Tcyp is any different that what I’ve been getting at Walgreens for $108.00. Nope, exactly the same stuff. Hmmm…what about different doses, what would that cost for 150mg/ml 10ml bottle?
$90.00. Really?
Wow, $180.00 for calling in a script.
When I call the Dr back to tell him to get bent, the ofc mgr acts so surprised and will be sure to tell the Dr because he needs to know what’s going on…YEAH RIGHT…FOAD!

Is my experience typical here?
Are there really that many unscrupulous/uneducated Drs out there?
Might be worth a drive from Austin to DFW…

2

At least you are able to catch their red flags! I went to my general doctor complaining from loss of libido. She tests me for Testosterone and it came back reading low. She calls me up saying I could prescribe you Androgel so you could pick it up at my pharmacy. Really? Without at least doing some more blood work or referral to an Endocrinologist to rule out anything else? I am looking for an up-to-date TRT doctor currently. Anybody know of people in the Chicago-area?

Good Luck to you!

3

That’s what I got to start.
First T test came back at 202, so he had me come back in the morning for a retest.
It came back at 252ish with a range of 250 to 1000 age 18 to 85. Dr say it’s in range and normal. I took one look at it and said normal for an 85 yr old maybe, but I’m only 45. He agreed to monthly shots.

I did the usual feel good for a few days and 3 1/2 weeks of crap until I found an Endo’s paper saying shots E2W was better. He agreed to do that , but that’s all he’d let me teach him. As soon as he agreed to let me do shots at home I started doing E2D, then changed to EOD with better results, but still need more help.

4

What is “LT”?

Look close at iodine and thyroid issues.

Zoom into your region with Google Earth and in the “Fly To” box search for compounding pharmacies. Explore their web sites and find those that talk about male HRT and referrals, etc. Phone and explain your situation and ask for referrals to docs who do T+hCG+AI.

You can read the ‘find a trt doc’ sticky too.

5

LT = lab tech.

What am I looking for as far as iodine and thyroid issues?

The compounding pharmacy is where I got the name of Dr HGH & $270 TCyp.

The search continues.

6

If you are not using iodized salt you are probably iodine deficient. TSH=2.4 means that you should be paying attention to thyroid levels. TSH is only part of the story. Check waking body temp when you first wake up before you get out of bed. If near or below 97F, there is a problem. Normal waking temp should be near 97.8

I think that in that part of the world, medical extortion may be quite common.

7

Thanks KSman,
I’ll go buy some iodized salt today and start checking my temps.

That was my first experience with an overtly greedy Dr. Makes me wonder what kind of GP heis, not that I’ll ever find out.

8

Should I be concerned about SHBG and DHEA-s being lowas well?

What, if anything can/should I be doing about them?

9

When asking for referrals, ask for docs who deliver scripts.

10

fastersteve…I’m in Austin also. When you find someone that your comfortable with please let me know. I’m also looking for another doc. Mine in P-ville doesn’t even have the nerve to call me back to go over anything.

edit…got a phone call from a doc in Austin that mentioned the protocol on here before I mentioned it. Maybe or maybe not a good thing, but can give you the name and number if you want.

11

Fastersteve…sent you an email. I have an appt. 9/9 with Dr. He’s the first one listed on the email.
They sound like a good one. Compounding Pharm is onsite

12

Great.
Keep us updated.
Looks like I need to find and Endo. I’ve been monitoring my temp when I first wake up.
It’s been pretty steady 96.5/96.6, but today was 95.9. I’m guessing that’s not a good trend.

13

Update

The more I read, the more I’m coming to the conclusion I’m suffering from Adrenal fatigue. Between two surgeries 2 yrs in a row, and chronic stress at work, I haven’t consistently slept or felt well since 2006.

Looking at my last labs in this thread

Sodium 138meq/l 133-146
Potassium 3.9meq/l 3.5-5.3
Cortisol AM 16ug/dl 7-25 *Shouldn’t this be higher in the AM?
DHEAs 96ug/dl 82-455
TSH 2.4 uiu/ml 0.3-5.1

I have not been tested for Aldosterone yet.

Also, bp is higher when seated, and lowers after standing for a few mins.
I did the dark room/flashlight pupil test last night, and my pupils definitely flutter instead of staying constricted.

My waking temps range between 95.7 - 96.7, but not any higher since I’ve been monitoring them. I’ll start checking every 3 hrs. today. I’ve been taking Kelp supplements for 1 month with no change to this.

I’m debating whether to arrange a consult between Dr. Crisler and my Dr., or just fly to Michigan for a face visit.
Or is there someone more versed in Adrenal fatique?

I appreciate any thoughts, advice, suggestions from all you dudes more versed than I.

14

looks and sounds like a thyroid problem - cortisol does not look that terrible (<15 is an issue)

get more thyroid tests per the blood test sticky.

15

So, <15 is an issue, but at 16 I’m fine?

Phrases like that make me nervous. Also, that was Cortisol at 8:00 in the morning. I gather from what I’ve been reading that it should be at the higher end of the spread.

How about DHEA serum of 96?

From STTM How Adrenals Can Wreak Havoc - Stop The Thyroid Madness

I already fail 3 of the 4 test for adrenal fatigue, and just started taking daytime temps today.

16

How long were you on the nexium? Low stomach acid can really put a hamper on digestion… sounds like your spleen was not functioning from the start. As long as that is the case I suspect the adrenals will be taxed from cleaning up undigested rotting food covered in fermenting toxic bacteria and your nuts will have little nutrition to build hormones. Again, I am not the guy to tell you a magic pill will solve your problem - so tar and feather me if this sounds too real for you.

17

About 1 yr on Nexium.

Actually, first reasonable post I’ve seen from you:-)

18

I was reading an interesting thread on another forum about the evils of Nexium and that how acid reflex can actually be caused by TOO LOW stomach acid (kind of like cjackson’s post) - and that people have found relief by actually increasing stomach acid (with Betaine HCL) - which also helps fully digest food, increases absorption, and helps heal instinal issues.

Ideal Cortisol is 15-20 at 8am… yes normally the higher the better
<15 = possible problem
<10 = problem

the gold standard I think is the four time daily saliva test to measure what your Cortisol does during the whole day. I am trying to get one myself.

DHEA-S = DHEA Sulfate which is different from a DHEA, serum test. DHEA serum is constantly fluctuating through out the day, and a single reading on DHEA serum is not that useful. DHEA-Sulfate fluctuates less and provides a more stable reading.

DHEA of 96 = not that useful
DHEA-S of 96 = a fairly low reading that warrants additional tests for Pregnenolone and Cholesterol - or possible 25-50mg DHEA supplements

19

Yeah, Nexium is some nasty stuff. We (wife and I) actually spent several days thinking my time here was short, I was so weak and sick. No more stomach issues since I started eating yogurt w/probiotics.

Yesterday the highest my temp got was 98.0 at 7:00 pm.

My PCP already says I know more about the subject than he does. Hopefully he’ll be agreeable to doing a phone consult w/ Dr. C.

I’ll find out today.

Has anybody made a full recovery from adrenal fatique? I read on AllThingsMale that expecting full recovery of T production was unlikely, that a 10% increase was all that could be expected.

20

stopthethyroidmadness has some stories of people who have been able to get off of Cortisol replacement once their system was rebalanced… but others have had to stay on cortisol for life.

here is one article about low stomach acid

http://www.charlespoliquin.com/ArticlesMultimedia/Articles/Article.aspx?ID=27