What questions to ask to a new TRT physician

Thread starter #1
I will be meeting with an FNP to discuss HRT. He was referred to me by a local 66-year old bodybuilder who gets his testosterone cypionate from him. I don't know what else the FNP knows about HRT, but I'll find out.

I will also be meeting with a female FNP at a women's health clinic, since they treat both men and women there. Being a newbie to all of this, I don't really know what questions to ask. I thought there was a Sticky here with a list of questions to ask a physician, but I can't seem to locate it. Any help? Thank you.
 
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#2
I doubt this women's clinic will be the solution to your problems, these clinics are typically staffed by doctors who don't really have a clue what their doing, often they have these cookie cutter protocols designed for everyone. SHBG is the most important test you could ever run, it will tell us how well you hold onto your testosterone and help to design a protocol for you.

If they don't at least run the tests below to determine why your testosterone is low, leave and don't look back! A good doctor will at least investigate why your testosterone is low before starting TRT. Do they monitor estrogen using the LC/MS/MS method? Do they provide arimidex to control excess estrogen production that is sometimes needed? Do they prescribe HCG for testicular atrophy?

You mention no symptoms of any kind, if you aren't symptomatic then you should strongly consider what you are about to do, shut down your natural testosterone production. If you thinking of going on testosterone to only build muscle, then we won't be able to advise you further. We don't do that sort of thing here, we are here because of debilitating symptoms of low testosterone and require TRT for therapeutic purposes.

If you are symptomatic then would do lots of research before beginning down this road and to navigate through a world of doctors who could end up making things worse for you. The truth is most doctors fail at male hormones.


Total Testosterone
Free Testosterone
SHBG
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel
 
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#3
This is an excerpt from Jay Campbell's book:

1) How long have you been managing patients on TOT, and how much of your total practice do those patients represent? 2) Do you have a preferred form of therapy (injections, gels, etc.)? 3) How do you determine your dosing schedule for a new patient (Testosterone, AIs, etc.)? 4) What is your opinion on the usage of AIs? 5) What blood labs are you going to draw before initiating TOT? When do you draw labs again, once TOT starts? 6) How many times will you want to draw labs per year? 7) What is your preferred therapy for maintaining fertility (hCG, hMG, Clomid, etc.)? 8) Will you use these medications with or without concomitant TOT (i.e. at the same time as TOT)? Explain the dosage strategy to me. 9) How long does it typically take until I start seeing results, or feeling different? 10) Will you allow me to administer my own TOT injections, upon scripting injectable testosterone?

His bokk is great and a good resource when when you have questions.
 

DragonBits

Active Member
#5
Are these questions in Jay Campbell's book?

What I would ask any new doctor in the beginning for the interview.


  1. What total serum concentration of testosterone will confirm your diagnosis of hypogonadism?
  2. If my total serum testosterone is near the lower limit of normal do you consider free testosterone and what level of free testosterone would you use to initial TRT?

I am not sure if that was the best way to ask, and I am not sure I would get an answer.

Does anyone know a better way to ask those questions?
 
Thread starter #6
Thanks, everyone. I'm 60, and definitely have symptoms of low T. I've just discovered a urology group who claim to administer hrt, so, there's another possibility. I'm thinking I'll skip the women's clinic, and see what the male FNP knows, as well as the urologists. If neither pan out, I'll go with Defy. This is really beginning to stress me out!
 
#7
Thanks, everyone. I'm 60, and definitely have symptoms of low T. I've just discovered a urology group who claim to administer hrt, so, there's another possibility. I'm thinking I'll skip the women's clinic, and see what the male FNP knows, as well as the urologists. If neither pan out, I'll go with Defy. This is really beginning to stress me out!
I know it's frustrating, but be patient. You're approaching this in a systematic manner, and that's going to work to your advantage in the long run. The most important decision a man makes when he is considering hormone replacement is his choice of doctor. All the best.
 
Thread starter #8
Okay, I was able to email the FNP today a question that Nelson mentions in the Sticky on how to speak to a physician the first time. Here is the question followed by the FNP's reply. His remarks are largely over my head, so I'd appreciate any comments. Is he totally off base? Is he worth meeting with? Thanks.

Question: Do you use HCG and estradiol/hematocrit management?

Response:
I test and manage estradiol and hematocrit during TRT. Testosterone increases IGF which can also increase erythropoietin which can increase your blood count causingsecondary polycythemia. Also TRT can increase estradiol levels. The combo can put individuals at increased risk for blood clots and stroke. HCG is very expensive and not on most insurance formularies. It also requires a prior authorization. I don’t typicallyrx it. Clomiphene is a less expensive way to get FSH increase to act upon your Leydig cells to produce more natural testosterone. Basically does the same thing. HCG benefit to cost ratio is poor.
 
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