New Member - Looking for TRT Docs in Ontario, Canada

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AR

New Member
Hello everyone,
Found this site a couple of weeks ago and have been checking out the posts and trying to educate myself on where I should start and if TRT is the way to go for me. Some great information and been great learning from everyone with their case histories.

I am 43, a father of a 3 yr old and with another one on the way. Married for last 6 years. Run my own business part time and work part time as a supply teacher. Have been feeling pretty tired the last 3 years. My son really didn't sleep much the first year of his life so thought the fatigue was just the lack of sleep and still trying to run a business. Downsized the business and now son is sleeping well so get 6-8hrs of sleep each night yet still found myself really tired all the time, low motivation to do things, libido has been low last 3-4years. Did have a right hip replacement in Nov. of 2015

I hit the weights 3-4 times per week, do cardio 2-3 times per week and 70-80% of the time each a good nutrient dense diet with fairly high protein/fat. Despite, this have not seen as much improvement in fat levels going down or weight moving much. Recently cut off coffee as found was too dependent for an energy pick me up.

I am 5, 8", weigh 188 this morning and bodyfat roughly 23%. Have always struggled in putting on muscle mass and when try to lose fat, tend to lose muscle/strength as well despite trying to keep the weights
up.

Supplements I currently take:
D3-10,000 IU 3-4 times per week (was taking 50, 000 IU since D levels were low on last blood work. Has improved energy levels.)
Thorne B Complex (1 a day)
Meriva HP from Thorne (Curcumin) (1 a day)
Omega 3 Liquid Fish Oil (1 tsp a day)
1 Thorne Multi

Growing up, I played lots of soccer. Some concussions through this along with a soccer ball or two to the testicles. Never had them checked for damage but remember one incident was sore for a good week or two in my mid 20's. Also, trained and competed in kickboxing for a period of 15 years, with the competitive side being over about 5 years. Many blows to the head from sparring/competing, with serious concussions causing me to quit in 2005.

In early June, went to my family doctor and asked to have my testosterone checked along with a few other markers as hadn't had any blood work in a couple of years. This was done via Life Labs.

Asked to get referred out to see an Endo. Saw here about 3 weeks ago and bascially dismissed me saying I am in range and didn't think testosterone would help me despite all my symptoms and past history.

I am willing to go over the border and get more specific blood work through Discounted labs and will post here once I do so. Hope someone can provide a doctor or two I can get a referral to. I am in Southwestern Ontario.

Hematology
#5639
WBC 4.8 4.0 - 11.0 x E9/L
RBC 4.84 4.50 - 6.00 x E12/L
Hemoglobin 140 135 - 175 g/L
Hematocrit 0.42 0.400 - 0.500 L/L
MCV 86 80 - 100 fL
MCH 28.9 27.5 - 33.0 pg
MCHC 337 305 - 360 g/L
Platelets 204 150 - 400 x E9/L
RDW 13.5 11.5 - 14.5 %
Differential
Neutrophils 2.7 2.0 - 7.5 x E9/L
Lymphocytes 1.6 1.0 - 3.5 x E9/L
Monocytes 0.4 0.2 - 1.0 x E9/L
Eosinophils 0.1 0.0 - 0.5 x E9/L
Basophils 0.0 0.0 - 0.2 x E9/L
Biochemical Investigation of Anemias
#5687
Ferritin HI 291 22-275 ug/L
General Chemistry
Glucose Fasting 5.4 3.6 - 6.0 mmol/L
Hemoglobin A1C/Total Hemoglobin 5.3 <6.0 %


Creatinine 94 67-117 umol/L
Glomerular Filtration Rate (eGFR) 85


An eGFR from 60-89 ml/min/1.73 m2 is consistent
with mildly decreased kidney function. However,
in the absence of other evidence of kidney
disease, eGFR values in this range do not fulfill
the KDIGO criteria for chronic kidney disease.
Interpret results in concert with ACR measurement.
For patients of African descent, the reported
eGFR must be multiplied by 1.15.
Effective May 4 2015, eGFR is calculated using
the CKD-EPI 2009 equation.
KDIGO 2012 guidelines highlight the importance of
eGFR and urine albumin creatinine ratio (ACR) in
screening, diagnosis and management of CKD.
Results for eGFR should be interpreted in concert
with ACR.
Urate 418 230-480 umol/L
Alanine Aminotransferase 28 <50 U/L
Lipids
Hours After Meal 13 Hours
Triglyceride 1.11 mmol/L
Cholesterol 5.50 mmol/L
HDL Cholesterol 1.63 mmol/L
Non HDL Cholesterol 3.87 mmol/L
Non HDL-Cholesterol is not affected by the
fasting status of the patient.
LDL Cholesterol 3.37 mmol/L
Consider the non HDL-C value as an alternate
lipid target if monitoring treatment in
intermediate or high risk patients.
Cholesterol/HDL Cholesterol 3.4
Lipid Target Values Lipid Target Values should be based on patient
10 year CVD risk assessment.
! High or Intermediate CVD risk
-----------!-----------------------------------
Primary ! LDL-C < or = 2.0 mmol/L OR
Tx target ! > or = 50% decrease in LDL-C


Thyroid Function
Thyroid Stimulating Hormone [TSH] 1.04 0.32-4.00 mIU/L


Tumour Markers
Prostate Specific Antigen 0.70 <4.0 ug/L
Methodology: Abbott Architect immunoassay.
Results should not be interpreted in isolation as
absolute evidence of the presence or absence of
malignant disease.
Changes in serial results may be misleading
unless all Total PSA results are from the same
laboratory method.


Reproductive and Gonadal
Testosterone 11.3 8.4 - 28.8 nmol/L
Total Testosterone levels may not reflect the
biologically-active testosterone when SHBG levels
are abnormal.


Bone Markers
25-Hydroxyvitamin D 84 75 - 250 nmol/L
Season, race and dietary intake affect 25-Hydroxy
Vitamin D levels. Highest levels are found in
the summer months and lowest levels during the
winter.
 
Defy Medical TRT clinic doctor

AR

New Member
Thanks CoastWatcher. Much appreciated. I will get my GP to get a referral to Dr. Greenspan.

A doctor friend of mine recommended Dr. Adam Millar. Have you heard good things about him?
 

CoastWatcher

Moderator
Thanks CoastWatcher. Much appreciated. I will get my GP to get a referral to Dr. Greenspan.

A doctor friend of mine recommended Dr. Adam Millar. Have you heard good things about him?
He has a solid reputation, very knowledgeable. I have heard that he is highly selective in who he sees. I have one friend who had his family doctor submit the referral and was told he didn't qualify for TRT - on the basis of his lab work alone! He may be a wiz...but that struck me as absurd.
 

madman

Super Moderator
Hello everyone,
Found this site a couple of weeks ago and have been checking out the posts and trying to educate myself on where I should start and if TRT is the way to go for me. Some great information and been great learning from everyone with their case histories.

I am 43, a father of a 3 yr old and with another one on the way. Married for last 6 years. Run my own business part time and work part time as a supply teacher. Have been feeling pretty tired the last 3 years. My son really didn't sleep much the first year of his life so thought the fatigue was just the lack of sleep and still trying to run a business. Downsized the business and now son is sleeping well so get 6-8hrs of sleep each night yet still found myself really tired all the time, low motivation to do things, libido has been low last 3-4years. Did have a right hip replacement in Nov. of 2015

I hit the weights 3-4 times per week, do cardio 2-3 times per week and 70-80% of the time each a good nutrient dense diet with fairly high protein/fat. Despite, this have not seen as much improvement in fat levels going down or weight moving much. Recently cut off coffee as found was too dependent for an energy pick me up.

I am 5, 8", weigh 188 this morning and bodyfat roughly 23%. Have always struggled in putting on muscle mass and when try to lose fat, tend to lose muscle/strength as well despite trying to keep the weights
up.

Supplements I currently take:
D3-10,000 IU 3-4 times per week (was taking 50, 000 IU since D levels were low on last blood work. Has improved energy levels.)
Thorne B Complex (1 a day)
Meriva HP from Thorne (Curcumin) (1 a day)
Omega 3 Liquid Fish Oil (1 tsp a day)
1 Thorne Multi

Growing up, I played lots of soccer. Some concussions through this along with a soccer ball or two to the testicles. Never had them checked for damage but remember one incident was sore for a good week or two in my mid 20's. Also, trained and competed in kickboxing for a period of 15 years, with the competitive side being over about 5 years. Many blows to the head from sparring/competing, with serious concussions causing me to quit in 2005.

In early June, went to my family doctor and asked to have my testosterone checked along with a few other markers as hadn't had any blood work in a couple of years. This was done via Life Labs.

Asked to get referred out to see an Endo. Saw here about 3 weeks ago and bascially dismissed me saying I am in range and didn't think testosterone would help me despite all my symptoms and past history.

I am willing to go over the border and get more specific blood work through Discounted labs and will post here once I do so. Hope someone can provide a doctor or two I can get a referral to. I am in Southwestern Ontario.

Hematology
#5639
WBC 4.8 4.0 - 11.0 x E9/L
RBC 4.84 4.50 - 6.00 x E12/L
Hemoglobin 140 135 - 175 g/L
Hematocrit 0.42 0.400 - 0.500 L/L
MCV 86 80 - 100 fL
MCH 28.9 27.5 - 33.0 pg
MCHC 337 305 - 360 g/L
Platelets 204 150 - 400 x E9/L
RDW 13.5 11.5 - 14.5 %
Differential
Neutrophils 2.7 2.0 - 7.5 x E9/L
Lymphocytes 1.6 1.0 - 3.5 x E9/L
Monocytes 0.4 0.2 - 1.0 x E9/L
Eosinophils 0.1 0.0 - 0.5 x E9/L
Basophils 0.0 0.0 - 0.2 x E9/L
Biochemical Investigation of Anemias
#5687
Ferritin HI 291 22-275 ug/L
General Chemistry
Glucose Fasting 5.4 3.6 - 6.0 mmol/L
Hemoglobin A1C/Total Hemoglobin 5.3 <6.0 %


Creatinine 94 67-117 umol/L
Glomerular Filtration Rate (eGFR) 85


An eGFR from 60-89 ml/min/1.73 m2 is consistent
with mildly decreased kidney function. However,
in the absence of other evidence of kidney
disease, eGFR values in this range do not fulfill
the KDIGO criteria for chronic kidney disease.
Interpret results in concert with ACR measurement.
For patients of African descent, the reported
eGFR must be multiplied by 1.15.
Effective May 4 2015, eGFR is calculated using
the CKD-EPI 2009 equation.
KDIGO 2012 guidelines highlight the importance of
eGFR and urine albumin creatinine ratio (ACR) in
screening, diagnosis and management of CKD.
Results for eGFR should be interpreted in concert
with ACR.
Urate 418 230-480 umol/L
Alanine Aminotransferase 28 <50 U/L
Lipids
Hours After Meal 13 Hours
Triglyceride 1.11 mmol/L
Cholesterol 5.50 mmol/L
HDL Cholesterol 1.63 mmol/L
Non HDL Cholesterol 3.87 mmol/L
Non HDL-Cholesterol is not affected by the
fasting status of the patient.
LDL Cholesterol 3.37 mmol/L
Consider the non HDL-C value as an alternate
lipid target if monitoring treatment in
intermediate or high risk patients.
Cholesterol/HDL Cholesterol 3.4
Lipid Target Values Lipid Target Values should be based on patient
10 year CVD risk assessment.
! High or Intermediate CVD risk
-----------!-----------------------------------
Primary ! LDL-C < or = 2.0 mmol/L OR
Tx target ! > or = 50% decrease in LDL-C


Thyroid Function
Thyroid Stimulating Hormone [TSH] 1.04 0.32-4.00 mIU/L


Tumour Markers
Prostate Specific Antigen 0.70 <4.0 ug/L
Methodology: Abbott Architect immunoassay.
Results should not be interpreted in isolation as
absolute evidence of the presence or absence of
malignant disease.
Changes in serial results may be misleading
unless all Total PSA results are from the same
laboratory method.


Reproductive and Gonadal
Testosterone 11.3 8.4 - 28.8 nmol/L
Total Testosterone levels may not reflect the
biologically-active testosterone when SHBG levels
are abnormal.


Bone Markers
25-Hydroxyvitamin D 84 75 - 250 nmol/L
Season, race and dietary intake affect 25-Hydroxy
Vitamin D levels. Highest levels are found in
the summer months and lowest levels during the
winter.

Welcome AR! Would be nice to know your free t/shbg/DHT/estradiol numbers also but unfortunately, most GPS just test for total, and regarding estradiol as Coast has stated in many posts to members that in Canada they only use the standard assay and not the sensitive assay that is done in the US which is more accurate than the standard. Your total t numbers are very similar to mine as I tested at 11.3 nmol/L range 8.4-28.8 and also at 11.7 nmol/L both done at Lifelabs and my Free T was 225 pmol/L range 196-630 pmol/L. My GP tried to tell me I was still in range even though I stressed to him my symptoms mainly loss of libido/low energy/irritable, angry, depressed/poor recovery from workouts but he insisted I was ok whereas I knew my levels were low normal and effecting my overall health/wellbeing. Luckily my gp was retiring and the lady whom took over his practice had also looked over my labs and felt I was still ok but I explained to her the symptoms I was still experiencing and had asked her for a referral to a well-known urologist as not only does he treat patients for sexual related issues but is known for combining trt with pde-5 inhibitors (if needed) in patients that do not respond well to pde-5s alone as many of the negative responders usually suffer from low testosterone. She faxed my lab work to his office and within 2 months I had my appointment with him. It was surreal to say the least as I sat across from him in my chair and he said I see you have come to see me regarding your testosterone levels and you have been suffering from lack of libido and low energy among other things and as I was somewhat nervous trying to explain my situation and the symptoms I was experiencing for so long ( like in my mind I was trying to convince him thinking he would not treat me LOL) he said your total t is low for your age and your free t is also rather low we can start you right away on a 6 month trial of testosterone and he said your options are patches/gels or creams/injections and right away I said I would prefer injections and he said would you prefer to do your injections at home as I have my patients do sub-q once weekly so I will set you up with an injection clinic. He basically said he does not treat the numbers but the patients symptoms and prefers to have most of his patients in the high 20 nmol/L range but everyone is different where they feel best. I was in total shock that someone finally understood how I was feeling and did not hesitate to treat me. I started my trt at the end of December 2016 and it was rough in the beginning for the first 6 weeks as your testosterone levels take time to stabilize and after 8 weeks I needed a dosage increase and slight protocol change to improve my symptoms. I am now 7 months in and feel amazing! Wish I would have looked into finding treatment years ago. Unless your numbers fall under 8 nmol/L most doctors will not treat you especially in Canada as it is difficult to get treatment. Your levels as mine fall in what most doctors in the know regarding trt refer to as the GREY ZONE 8-12 nmol/L (LOW/NORMAL)which usually merit a 6 month trial if the patient is experiencing low t symptoms. My doctor is old school in some of his ways but is very knowledgeable and experienced regarding testosterone treatment. I would strongly suggest you ask your GP for a referral to him as you would like a second opinion. He will definitely treat you with those numbers and especially that you are suffering from low t symptoms. He is recognized as one of the leading figures in Canada regarding his field of work and was most likely one of the first to pioneer sub-q trt injection use in patients!
http://www.stacommunications.com/journals/diagnosis/2005/February/PDF/075.pdf
http://www.canjurol.com/html/free-articles/V19I5S1F-04-DrGreenspan.pdf
Urologist took questions
https://www.thespec.com/living-story/2129385-there-are-many-ways-to-beat-ed/
 

AR

New Member
That is odd. I will aim to get a referral to Greenspan then. Do doctors mind if you bring lab work in from the US as I was planning on heading over to Michigan to go the needed blood work while I wait for my referral?

Thanks again!
 

CoastWatcher

Moderator
That is odd. I will aim to get a referral to Greenspan then. Do doctors mind if you bring lab work in from the US as I was planning on heading over to Michigan to go the needed blood work while I wait for my referral?

Thanks again!

I do all my hormonal testing in the US. It's the only way to get the sensitive estradiol.
 

AR

New Member
Thanks for the welcome Madman. I have been reading your past posts and have learned a lot. Thanks for sharing your experience and what to potentially expect with Greenspan. Hope I can get a second opinion and a referral from my GP.

Yeah, never really occurred to me that my testosterone would be so low at my age but the more read the more I figured it might be the reason for my symptoms especially with all the concussions I have had in the past. I told all this to the endo plus that my levels were that of an 80yr old really and she just stuck to the numbers and said I was in range. Quite disappointing actually!

You guys are actually really giving me hope that I can feel much better and have a full life with my boys and not just turn into a frail old man. I have to try and keep up :)

Thanks again for your input. Hope to post my numbers soon as hope to head over to the states soon to get all the needed blood work done.
 

CoastWatcher

Moderator
Thanks for the welcome Madman. I have been reading your past posts and have learned a lot. Thanks for sharing your experience and what to potentially expect with Greenspan. Hope I can get a second opinion and a referral from my GP.

Yeah, never really occurred to me that my testosterone would be so low at my age but the more read the more I figured it might be the reason for my symptoms especially with all the concussions I have had in the past. I told all this to the endo plus that my levels were that of an 80yr old really and she just stuck to the numbers and said I was in range. Quite disappointing actually!

You guys are actually really giving me hope that I can feel much better and have a full life with my boys and not just turn into a frail old man. I have to try and keep up :)

Thanks again for your input. Hope to post my numbers soon as hope to head over to the states soon to get all the needed blood work done.


You have every reason to on to be hopeful in this regard. Almost all of us felt dismal, and we experienced the medical run-around as we learned how little doctors actually know about male androgens. It's more difficult, for many reasons, to get the care we need here in Canada, but it can be done.
 

AR

New Member
Hi Madman,
Finally got my referral to Dr. Greenspan and see him next Wednesday. Curious if you can tell me a bit more about his approach and what sort of treatment he has given you and how your numbers have turned around? Any input would be greatly appreciated.
Thanks,
AR
 

madman

Super Moderator
Hi Madman,
Finally got my referral to Dr. Greenspan and see him next Wednesday. Curious if you can tell me a bit more about his approach and what sort of treatment he has given you and how your numbers have turned around? Any input would be greatly appreciated.
Thanks,
AR

That's awesome good for you glad to hear! When you go for your appointment he should have a copy of your lab work faxed from your gp and if not than you will need to bring your most recent lab work. Explain to him exactly what symptoms you are experiencing and a brief history of when you felt changes occurring. Be honest. My main symptoms were loss of libido/low energy and also depression/irritable/angry(negative mood)/loss of muscle/ weakness and definitely poor recovery from workouts but I did not mention that as most do not really care about your workout recovery. The low libido/energy are two of the main symptoms of low t mind you not everyones libido vanishes as it may just diminish mine was basically null and void it scared the sh** out of me! He will explain to you that even though he prefers to have his patients testosterone levels in the high 20s nmol/L he does not just treat numbers but the patient and their symptoms is what matters. He will be very upfront and to the point as he does not waste time. When he looks at your numbers especially that you are experiencing low t symptoms he will more than likely tell you there are options such as hcg or clomid but will tell you that he will start you on a 6 month trial of testosterone if that is the route you choose and tell you the different methods of treatments such as patches/gels/injections. If you decide you want to pursue therapy I would just tell him you prefer injections as you have children and do not want to use the transdermals let alone I and many think injections are far more effective and easier to reach the higher end of test levels with i.m. For patients using injections, he will prescribe sub-q and I think most will start on 100mg/week he will book you for an injection clinic at the hospital to show you the procedure and do your first shot as he likes to teach his patients how to do their own injections at home which is great I think. He will give you a requisition for blood work to be done 6 weeks later and than at 8 weeks you will see him and he will ask how you are feeling overall and what if any type of symptom improvements you are experiencing and than go over your lab work and depending on how you feel and your testosterone levels(lab range) may leave you at that dose or increase your dose slightly if there is only little improvement and your numbers are still somewhat low. Overall symptom improvement is what is critical not just your numbers. Most need to have their test levels above 500ng/dL to experience improvement but even then that is only mid/normal and doctors in the know usually try to achieve a high normal 700-900ng/dL which is optimal for many. Mind you some do very well in the mid/normal range 500-600ng/dL whereas many do better in the high/normal range 800-1000 ng/dL but as I said overall symptom improvement and feeling well is what really matters. Originally I started at 100mg/week sub-q and for the first few weeks you are still producing endogenous test/combined with your exogenous test and you experience a short honeymoon period as your blood levels are in flux. You will hit some rough spots in the beginning as after a few weeks your hpta is shut down and it takes at least 6 weeks for your blood levels to stabilize. I noticed in the first few weeks I felt really good but at week 3 it started to get rough as I would feel good for the first 2-3 days after my injection than felt as if I was crashing.............mood/energy/libido ups and downs and as the weeks went on instinctively felt as if my levels were too low so had my bloods done at 6 weeks and my total came back at a dismal 16.8 nmol/L (480 ng/dL) and I did not feel well. At my follow up I knew my numbers ahead of time as I have my own account at LifeLabs and Dynacare. I told him how I felt overall and that there were some minor improvements but felt as if I was crashing 3-4 days after my injection and overall I did not feel great, with slight improvements in libido/energy/mood. He increased my dose and I was retested 6 weeks later my numbers had improved greatly as well as my symptoms strong libido/tons of energy and a stellar mood let alone stronger in the gym and much-improved recovery but that was the least of my concerns and even at 12 weeks in I felt great but it has been even better the longer I have been on as over time things seem to improve more and more. I am 9 months in now and feel the best I have felt in years! PM me after your appointment and I will give you advice! Wish you the best of luck and am confident he will treat you. Keep in touch with everyone as there are many experienced members on this forum with valuable information and will be more than happy to guide you on your journey as there is so much to learn and share, take care!
 

AR

New Member
Hi madman,
Wow. Thanks so much for sharing all the great info. Makes me feel more prepared going in. My biggest issues is libido as it is pretty much non existent. Energy has been up and down but find I get wiped out from my workouts even if I just push a little harder. Hard to make progress when I feel I have to do everything perfect when it comes to eating and training.

I am really doing this for my boys. Being an older father I don't want them to remember me as the someone who couldn't do anything with them or keep up. I want to have lots of vitality and be physically active with them. A big plus as well it will help a great deal with my marriage as having very low libido does not make for a very loving relationship.

Again, thanks again for sharing and will let you know how it goes.

Take Care,
AR
 

madman

Super Moderator
Just make sure you mention that physical activity fatigues you and do not emphasize workouts/recovery, stick to your main symptoms as most doctors are not concerned with whether you have poor recovery from intense weight training sessions or are concerned that you have a hard time gaining muscle in the gym.
 
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