Doctor Told me to Stop TRT to Get Baseline Tests

[River Rat]

Hi All - Doctor asked that I go off testosterone injection for 2 months to obtain baseline tests that my previous Doctor did not order. I was only on T injections for 1 month. Question is whether or not I have to be off for 2 months to obtain accurate baseline tests or can I get accurate results sooner. I feel terrible and felt better when on TRT.

 

[blackebob]

What the hell does a baseline test do for you at this point? That is like being told to hit your self in the head with a hammer so he can gauge how bad your migraine was before you came in to see him. Your already on TRT, and now you feel like crap. If this is a new Dr. you should have asked him the point of this stupid experiment, and what it would change to your treatment. It is where your T level is at when on the medicine, that is the important number.

Whats hard about this, is that as an uninformed patient you are at the mercy of ignorant Dr.s. I would have fallen for the same thing 2 years ago. Today, I would have gotten a little pissed, and left.

 

[HealthMan]

Hi All - Doctor asked that I go off testosterone injection for 2 months to obtain baseline tests that my previous Doctor did not order. I was only on T injections for 1 month. Question is whether or not I have to be off for 2 months to obtain accurate baseline tests or can I get accurate results sooner. I feel terrible and felt better when on TRT.

WHat testosterone ester are you using? It depends on that and how fast you metabolize testosterone (most related to SHBG levels). If you are using testosterone cypionate and you have low SHBG 1-2 weeks is more than enough to get a low number but that wont give you a baseline since your natural testosterone production will still be shut down. Given you are only on testosterone injections for 1 month your body might resume its own production in a couple of months. But to get your true baseline you indeed would have to wait 2 months +. To get a low number as little as 2 weeks might be enough

 

[HealthMan]

What the hell does a baseline test do for you at this point? That is like being told to hit your self in the head with a hammer so he can gauge how bad your migraine was before you came in to see him. Your already on TRT, and now you feel like crap. If this is a new Dr. you should have asked him the point of this stupid experiment, and what it would change to your treatment. It is where your T level is at when on the medicine, that is the important number.

Whats hard about this, is that as an uninformed patient you are at the mercy of ignorant Dr.s. I would have fallen for the same thing 2 years ago. Today, I would have gotten a little pissed, and left.

He might not have low testosterone. Previous doctor didn’t check levels so who knows where his natural levels are? So this is a valid experiment. His symptoms might not be related to low-T etc etc

 

[FeelingLost]

My guess will be the new doctor needs this info to get insurance to pay.
Most if not all major medical insurance companies want two blood tests at least a month apart before they will pay for TRT.

 

[River Rat]

My previous Dr did check my total testosterone which was 228. However he did not check FSH or LH to see if I had primary or secondary hypogonadism.

 

[River Rat]

WHat testosterone ester are you using? It depends on that and how fast you metabolize testosterone (most related to SHBG levels). If you are using testosterone cypionate and you have low SHBG 1-2 weeks is more than enough to get a low number but that wont give you a baseline since your natural testosterone production will still be shut down. Given you are only on testosterone injections for 1 month your body might resume its own production in a couple of months. But to get your true baseline you indeed would have to wait 2 months +. To get a low number as little as 2 weeks might be enough

Thanks for the response . i was taking 100 mg of cypionate per week.

 

[HealthMan]

Thanks for the response . i was taking 100 mg of cypionate per week.

Do you know your SHBG? If you only want to get a low read then a couple of weeks should be more than enough if your SHBG is not high

 

[blackebob]

He might not have low testosterone. Previous doctor didn't check levels so who knows where his natural levels are? So this is a valid experiment. His symptoms might not be related to low-T etc etc

My bad.

My previous Dr did check my total testosterone which was 228. However he did not check FSH or LH to see if I had primary or secondary hypogonadism.

Why did you switch DRs

 

[Nelson Vergel]

I am so tired of hearing guys going through this. Making guys crash for their doctor's satisfaction to have information in the chart to protect them against potential legal issues that are unfounded. All he has to do is to say that you are a patient that transferred from another clinic and that pre-TRT baseline info is not available and that he is not going to induce hypogonadism because of quality of life impairment. Having said that, some insurance companies may be making doctors do this. But if you are paying cash (no insurance), he is a moron.

 

[River Rat]

Why did you switch DRs[/QUOTE]

I had been feeling terrible for 16 months with fatigue, brain fog etc. I had seen multiple doctors but never had Testosterone tested. My neurologist tested T and it was 228 so my primary care physician referred me to an endocrinologist which took 3 months to get an appointment. On my own, I found a Urologist who saw me within a month and prescribed 200 mg cypionate every 14 days. He did not run FSH, LH, SHBG or estrogen.

After a month being on TRT, I was finally able to see the endocrinologist who said that additional testing should be done to determine if I am primary or secondary. She did not mention testing estrogen or SHBG. I have been off T for a month and feel terrible.

 

[River Rat]

I am so tired of hearing guys going through this. Making guys crash for their doctor's satisfaction to have information in the chart to protect them against potential legal issues that are unfounded. All he has to do is to say that you are a patient that transferred from another clinic and that pre-TRT baseline info is not available and that he is not going to induce hypogonadism because of quality of life impairment. Having said that, some insurance companies may be making doctors do this. But if you are paying cash (no insurance), he is a moron.

Thanks for the response Nelson. To this point, my insurance company has been paying for Testosterone injections without an issue. Seeing that I had only been on it for a month, maybe the insurance company would take time to realize it. My first Testosterone Test was 227 and my second was 401. I am not sure if the 401 would prohibit me from TRT but the 227 test is certainly low. Also, I am having and have had all of the symptoms of low T for 16 months.

 

[River Rat]

Do you know your SHBG? If you only want to get a low read then a couple of weeks should be more than enough if your SHBG is not high

No, my SHBG was never tested. I will have tested in a few more weeks once I have been off TRT for a few months. I will be started over.

 

[River Rat]

Per my doctors instructions, I got off TRT for 7 weeks and had my testosterone tested again. My testosterone came in at 218 and my LH and FSH are normal. I believe this confirms my Urologists diagnosis of Primary Hypogonadism. Been a rough 7 weeks but I suppose it in now confirmed. Now I have to decide if I want to continue with my Urologist who prescribed TRT in the first place but did not order sufficient test or if I should go with my Endocrinologist. She said she will only prescribe gel and I would prefer injection. Any thoughts.

 

[1Draw]

Per my doctors instructions, I got off TRT for 7 weeks and had my testosterone tested again. My testosterone came in at 218 and my LH and FSH are normal. I believe this confirms my Urologists diagnosis of Primary Hypogonadism. Been a rough 7 weeks but I suppose it in now confirmed. Now I have to decide if I want to continue with my Urologist who prescribed TRT in the first place but did not order sufficient test or if I should go with my Endocrinologist. She said she will only prescribe gel and I would prefer injection. Any thoughts.

View attachment 4932

River Rat your symptoms may not be ALL testosterone related. Have you ever had a full thyroid panel done? Here is some good information how the symptoms are very much related and alike:

https://www.restartmed.com/thyroid-symptoms-men/

IMHO, you aren't going to get the necessary treatment and advice from an Endo or Urologist on proper testosterone/thyroid treatment. I waited 3 months to see an Endo years ago and he told me nothing wrong, I'll give you a prescription for Cialis.

If you can afford it, Primebody and Defy Medical are both sponsors of this site and know what they are doing. They do telemedicine so, you don't have to go see them. Yes it takes some time to get the proper blood test and start treatment but, it is no where close to 3 months. Ongoing treatment cost me about $600 year. They will issue scripts for blood test that your insurance will cover.

Its a decision you will have to make for yourself. Very few members here are getting the proper treatment with Endo's and Urologists.

 

[River Rat]

River Rat your symptoms may not be ALL testosterone related. Have you ever had a full thyroid panel done? Here is some good information how the symptoms are very much related and alike:

https://www.restartmed.com/thyroid-symptoms-men/

IMHO, you aren't going to get the necessary treatment and advice from an Endo or Urologist on proper testosterone/thyroid treatment. I waited 3 months to see an Endo years ago and he told me nothing wrong, I'll give you a prescription for Cialis.

If you can afford it, Primebody and Defy Medical are both sponsors of this site and know what they are doing. They do telemedicine so, you don't have to go see them. Yes it takes some time to get the proper blood test and start treatment but, it is no where close to 3 months. Ongoing treatment cost me about $600 year. They will issue scripts for blood test that your insurance will cover.

Its a decision you will have to make for yourself. Very few members here are getting the proper treatment with Endo's and Urologists.

I have had thyroid checked and results are fine. My Doctor just called and said that even though my Total Testosterone is 218 that I do not have hypogonadism as my free testosterone is fine.

 

[Systemlord]

I don't know your age, but 218 is that of a 100+ year old man. The only way free T can be inranges is if you have super low SHBG. Free T measured directly is inaccurate do to the very short half life of free T, free T is released in short micro pusles throughout the day and an hour later it could be low. The reason why your doctor offer only gel is she knows full well she is ill equipped to balance your testosterone and estrogen and provide aromatase inhibitors to control excess estrogen because she's inexperienced like most doctors.

It's far easier for to do two pumps a day of gel then deal with the headache of balancing your hormones on injectables, less skill is required for those already seriously lacking experience. Insurance doctors aren't permitted to prescribe aromatase inhibitors as it's not considered standard of care. My first endo pushed gels on me even though I wanted injections, it didn't take long to learn he had never done TRT before and it was new to him as he doesn't normal do TRT.

Thyroid is fine? Are we taking the word of the very same doctors who are failing to order proper labs for TRT? Fine equals in ranges, these ranges are already far too wide and have lots of people in ranges with symptoms. Forgive me if I seem skeptical.

 

[Systemlord]

All - Attached find the labs that I have had done over the past few months. I have had two Testosterone readings under 230 but the Doc says I do not have Hypogonadism because my Bioavailable Testosterone is normal. I do not meet with her until next week but wanted to get your opinion. I am 48 years old and have felt terrible for almost 2 years. Typical symptoms of Low T, but have had a great deal of brain fog and always tired.

I have already seen a Urologist who prescribed TRT Injections but my PCP wanted me to see an endocrinologist who took me off TRT to run baseline tests.

What are your thoughts, my Testosterone is 218; should I be on T injections. I am thinking I must have low SHBG and I am concerned if I take T that my estrogen will get to high..

These doctors don't even know what tests to order to properly evaluate you, so their entire diagnoses is based on a lack of proper testing. This doctor is no better than the first one. SHBG is the gold standard for sex hormone evaluation and there is NO WAY anyone could diagnose you without it, they also failed to test estrogen. You're well below the ranges of what's considered low testosterone, it's clear these doctors are against TRT andor are incompetent in regards to diagnosing low testosterone.

This doctors entire diagnosis is based solely on directly measured free testosterone which is a problem, free T has a short half life and changes throughout the day so an hour later it can be low. This is why most knowledgeable doctors measure Total T and SHBG to get more accurate free T numbers.

I seriously doubt you will find a doctor in your insurance network who are any better than the last two, you need to go private. Even if they gave you TRT they wouldn't know the first thing how to design a protocol for you, you need to pay out of pocket for proper care. I've had three endos and none of them know what their doing.