New Here and Concerned About Doctor

Hi everyone. My name is Daniel, I just turned 30, am in southern Mississippi, and I am working on a Masters degree. I mention that I'm in school because, with my insurance, pretty much the only visits they fully cover at at my university clinic. They're great people and they try, but they're not experts... and neither am I. I went in to the clinic on a whim to get tested, because I'd been really fatigued, have been trying to lose weight and couldn't, etc, etc, etc. It turns out that my levels are low (lab results following) and my doctor wanted to start me on TRT immediately. She ordered some testing done (lab results following) and started me on testosterone cypionate 200 MG/ML Injectable Solution and she has me down for getting 2 ml (400 MG) every 4 weeks.

I'm mainly concerned that, because she isn't specialized, I won't get the level of care that I need. I don't really have an option to go anywhere else, so I need to learn what I can so that I can teach her. Also, importantly, if she is wrong, then I would like to know before something happens to me.

I really do appreciate any help that y'all are able to give, even if it's just saying that everything is fine.

Lab results (As listed on my lab results page):

Testosterone, Serum: 211 Range: (348-1197)
WBC: 8.1 Range: (4.1-10.9)
RBC: 5.1 Range: (4.2-6.3)
HGB: 15.2 Range: (12-18)
HCT: 43.6 Range: (37-51)
MCV: 85.6 Range: (80-97)
MCH: 29.9 Range: (26-32)
MCHC: 34.9 Range: (31-36)
MPV:7.2 Range: (0-99.8)
PLT: 272 Range: (140-440)
RDW: 13.1 Range: (11.5-14.5)
LYM: 2.3 Range: (0/6-4.1)
MID: 0.6 Range: (0-1.8)
GRAN: 5.3 Range: (2-7.8)
LYM%: 28.1 Range: (10-58.5)
MID: 7.7 Range: (0.1-24)
GRAN%: 64.2 Range: (37-92)

You're going to get a lot of responses here but:

1. You need weekly injections not every four weeks at the drug has about a 6 day half life. You need to explain this to your Doctor right away as every 4 week is all wrong.

2. You need more labs to see if your low serum levels are due to other medical conditions. There are a host of metabolic and endocrine pathologies that can cause low testosterone serum levels.

You need to learn here on our forum and site on the proper protocols for testosterone replacement and get your Doctor trained.

I can only support what Gene wrote. There is no way an injection every four weeks is going to do anything but make you feel miserable. A good starting dose is 50mg every 3.5 days. There is a wealth of information you can track down via the search function here on the Forum. You will simply have to be your own advocate - but it can be done. All the best!

You are on a guaranteed-to-fail protocol from a doctor that has no idea about modern TRT. Do 50 mg every 3.5 days as CoastWatcher suggested above.

Daniel, How many shots have you had? If just a few there is another course of action to consider especially because you are 30.

If you've only briefly been on TRT you might consider stopping, waiting a few weeks until your natural T returns to baseline, then getting the proper baseline labs which are listed in the intro sticky here.

Ordinarily the steps taken prior to TRT involve looking at everything that might be depressing endogenous T: stress, exercise level, environmental toxins, diet, lack of quality sleep, sleep apnea, ect and determining if your hypogonadism is primary or secondary.

Lifestyle changes and/or alternate therapies may or may not work. Considering the lifelong commitment TRT requires they are certainly worth the effort.

If the hypogonadism is diagnosed as hypogonadic or "secondary" your doc may wish to try a jump start such as hCG or Clomid before resorting to TRT .

It's worthwhile noting that for every month on TRT or other steroid use the time required to re-set the HP axis(s) to get back to baseline is usually an equal number of months to which the body was exposed to exogenous steroids. A few individual find they are unable to re-start endogenous T production at all. The likelihood of that increases with each month on exogenous hormone use.

Therefore, a decision to try alternate modalities is best made sooner than later. It should not be assumed that TRT is your fastest route to vigor. If your doc decides you are a candidate for hCG or Clomid those might well get you feeling better faster.

On the issue of what your student insurance covers check to see if a referral from Student Health might pay for a specialist. You might also contact the financial aid office to see if any grant money is available.

Hey everyone, sorry for just now responding. I spent almost my entire weekend doing research and all of y'all are definitely correct. I printed out a couple of different research journals (mainly from endocrinologists) about clinical guidelines for TRT for my doctor to look over. They had the half life, recommended 1x a week shots (although the every 3.5 days sounds more reasonable), those sorts of things.

I went by the clinic today to talk with my doctor and it went horrible. I brought up my concerns, mainly about the fact of the shots being once every 4 weeks and the fact that she didn't do any tests for other issues. The doctor flat out refused to look at any of the research, listen to the half-life of the drug, nothing. She went on to tell me that I "read too much online" and when it came to the recommend 1x a week shot that "I would never do that." Needless to say, after all of that, I then asked for a referral to an endocrinologist, which she initially refused to give me.

Needless to say, I've been extremely unhappy today.

I'm sorry you ran into a wall. Many, perhaps most, of us here have had issues getting plugged into the right care. If you're lucky, you may find a sympathetic endocrinologist. Can you swing a consultation out of your own pocket?

CoastWatcher said:

I'm sorry you ran into a wall. Many, perhaps most, of us here have had issues getting plugged into the right care. If you're lucky, you may find a sympathetic endocrinologist. Can you swing a consultation out of your own pocket?

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CoastWatcher,

I finally did get her to refer me to an endocrinologist, which will only be a $20 copay. (Then 80% of lab work is covered.) I refuse to go see that particular doctor in the clinic ever again. Also, I don't think that she quite knows how testosterone works, because she wanted me to get a free testosterone test today "to get another baseline" ....after she gave me a short last week!

DJC105 said:

CoastWatcher,

I finally did get her to refer me to an endocrinologist, which will only be a $20 copay. (Then 80% of lab work is covered.) I refuse to go see that particular doctor in the clinic ever again. Also, I don't think that she quite knows how testosterone works, because she wanted me to get a free testosterone test today "to get another baseline" ....after she gave me a short last week!

Click to expand...

Run from that particular doctor. Be prepared that you may have to engage in a good bit of "explaining" to the endocrinologist you're going to see. It is a real challenge.

Don't bother with the Endo referral - They have a horrible track record on the forum.

The sad reality is that for proper TRT care, 95% of us have to go out of pocket. Look at it as investment in your health, not as an expense.

ERO said:

Don't bother with the Endo referral - They have a horrible track record on the forum.

The sad reality is that for proper TRT care, 95% of us have to go out of pocket. Look at it as investment in your health, not as an expense.

Click to expand...

I'm hoping that maybe they'll be at least better than the doctor at the clinic. I can't afford much of anything out of pocket right now. Graduate Research Assistants at my school get paid $700/mo and between that and class work I'm usually putting in 70-80 hours a week. Not much time to make any other money to pay for stuff.

Im going to assume theres some typo and you mean 200mg every two weeks, that's STILL the archaic way Dr's administer Test that have zero clue what they're doing. At any rate, on that, you'll feel amazing for about 5 days then you'll be a pile of dog crap for the other 9 leading up to your next injection. It's a wild roller coaster ride. Guaranteed to F up your estrogen, too.

My advice, don't start there. If you can't afford any other option, you'll have to cope with it. Your Dr sounds like someone that could be educated, though.

If you can get the Endo to let you self-inject then you can go ahead and inject every 3.5 days instead of the horrible protocol you are on now. It's worth a try.

DJC105 said:

I went by the clinic today to talk with my doctor and it went horrible. I brought up my concerns, mainly about the fact of the shots being once every 4 weeks and the fact that she didn't do any tests for other issues. The doctor flat out refused to look at any of the research, listen to the half-life of the drug, nothing. She went on to tell me that I "read too much online" and when it came to the recommend 1x a week shot that "I would never do that." Needless to say, after all of that, I then asked for a referral to an endocrinologist, which she initially refused to give me.

Needless to say, I've been extremely unhappy today.

Click to expand...

I don't know how else to say this, so I'm just going to say it. Your doctor is a frigging idiot. Her ego is writing checks that her TRT knowledge deficient brain can't cash. She is completely clueless about TRT, and will do you more harm than good.

If there is any way you could swing a consult with Defy Medical, it would be worth every penny spent. I have my doubts about your Endo being much better than your primary care doctor.

Agree with what Jackie has stated, along with others!! Unfortunately, sometimes a doctorate degree can tend to transform a few select individuals into demigods; giving them a distorted perception that their knowledge on all subjects is by far superior than any mortal undergrad could ever comprehend.

I had an endo at one point try to convince me that I was reckless and in danger of cardiac arrest with test serum over 700ng/dl. He also said it was illegal for any patient in the US to administer their own injections!! His rationale was that this is why it is called a scheduled "controlled" substance; meaning that it had to be completely controlled for treatment from a medical professional!!

When anyone knocks you because you are learning Online, you can be assured that person doesn't give a rat's a$$ about your welfare!! Turn about, run like hell and never look back!! LOL, my GP (also a female) started encouraging me to go to medical school. She admits, HRT isn't her strong suit, but she pays close attention to the details of my HRT program outside of her care, and we have productive conversations about it.

Even on subjects that she might not agree with me on, she will (by means of intelligence) challenge me to articulate the subject deeper, so that I'm not just parroting certain talking points that sound good. Things like half-life, and minimizing E2 spikes are things that she could grasp when it's presented somewhat scientifically.

Anyhow, my point is that there needs to be some type of partnership with your physician(s), with a level of mutual respect, it has to go both ways. I know with my GP, I better sharpen the pencil and put my "A" game on, because she's incredibly smart, and only giving her bits and pieces, without being able to backup my objective will only lead to gaps.