Going to my Endo tomorrow. Borderline T. Advice?

[Quantium]

Hi!

I'm going to my endocrinologist tomorrow. I've taken several blood tests showing low TT (240-320 ng/dl) and free. As well as low E2 and low LH.

My TT and free T are both on the edge of their reference range. Sometimes slightly below, sometimes slightly above.

I've taken en mri showing that my pituitary seems normal. I've done all the lifestyle changes I can, and live optimally for proper testosterone production. I'm 29. I have ~80% of the symptoms of low T, and it bothers me a lot, and have been for years.

My fear is that the endo will be conservative, and say that I don't need TRT.

I have probably done more than 100 hours of study on the topic, and have a fairly strong base of knowledge at this point.

That said, is there anything you guys can think of that would convince the endo to try TRT? Should I bring studies? Should I talk in a specific way? etc. etc.

I'd just like some advice on how to approach the situation!

In advance, thanks!

 

[Mountain Man]

Consider rescheduling for a later date, cut back on sleep for a few days and give bloods at a later time of day. Seriously though, you may get a hard time because of your age. You may be able to raise it slightly, enough to impress a doctor who is not knowledgeable, but not enough to feel better. Look around for a men's health clinic that does this stuff if you want to use insurance. They want to treat you with TRT whereas average endos don't. If you can't find one that is good and takes insurance, go with Defy, which a lot of guys here do. I use insurance and it's dirt cheap to get a good result. I was very persistent with my PCP, but I was 62 years old and politely wouldn't take no for an answer. I was “in range” but argued that I was working out regularly, was fit for my age, but was struggling with brain fog, low energy, and sarcopenia. The only truth there was sarcopenia.

Be assertive, stress how you feel on a bad day, and politely don't take no for an answer.

 

[Vince]

What's healthy levels for a man at your age. I would find some doctor that will help if they don't.

 

[Quantium]

Consider rescheduling for a later date, cut back on sleep for a few days and give bloods at a later time of day. Seriously though, you may get a hard time because of your age. You may be able to raise it slightly, enough to impress a doctor who is not knowledgeable, but not enough to feel better. Look around for a men’s health clinic that does this stuff if you want to use insurance. They want to treat you with TRT whereas average endos don’t. If you can’t find one that is good and takes insurance, go with Defy, which a lot of guys here do. I use insurance and it’s dirt cheap to get a good result. I was very persistent with my PCP, but I was 62 years old and politely wouldn’t take no for an answer. I was “in range” but argued that I was working out regularly, was fit for my age, but was struggling with brain fog, low energy, and sarcopenia. The only truth there was sarcopenia.

Be assertive, stress how you feel on a bad day, and politely don’t take no for an answer.

Thanks. I'm in Norway, and thankfully the healthcare is covered by the government. Glad it worked out for you!

What's healthy levels for a man at your age. I would find some doctor that will help if they don't.

Yeah, the plan is to try this, then if that doesn't work go to my PCP who is open minded and great.. if that doesn't work either, I have to go to a private clinic..

I totally understand the need for systems and reference ranges, but it definitely sucks knowing you need treatment, but having your life in someone else's hands...

 

[madman]

Thanks. I'm in Norway, and thankfully the healthcare is covered by the government. Glad it worked out for you!



Yeah, the plan is to try this, then if that doesn't work go to my PCP who is open minded and great.. if that doesn't work either, I have to go to a private clinic..

I totally understand the need for systems and reference ranges, but it definitely sucks knowing you need treatment, but having your life in someone else's hands...

Under most of the testosterone defieciency guidelines (USA,Canada,Britain,Europe,Australia) if a male has total testosterone levels in the low/normal end of the reference range ( 8-12 nmol/L ) along with a low free testosterone and is also experiencing low t symptoms than they would qualify for a 6 month trial of testosterone replacement.

Let alone any knowledgeable doctor who understands trt if a males testosterone levels were in what one would call the grey zone 8-12 nmol/L along with signs of low t symptoms than the doctor would treat the patient.



Many men can start to experience low t symptoms at <15 nmol/L

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648196/figure/F1/?report=objectonly

 

[Quantium]

Under most of the testosterone defieciency guidelines (USA,Canada,Britain,Europe,Australia) if a male has total testosterone levels in the low/normal end of the reference range ( 8-12 nmol/L ) along with a low free testosterone and is also experiencing low t symptoms than they would qualify for a 6 month trial of testosterone replacement.

Let alone any knowledgeable doctor who understands trt if a males testosterone levels were in what one would call the grey zone 8-12 nmol/L along with signs of low t symptoms than the doctor would treat the patient.



Many men can start to experience low t symptoms at <15 nmol/L

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648196/figure/F1/?report=objectonly

Thanks. Yes, I actually already know this, but it's nice to see someone else say it as well! Interesting article/study by the way.. I'll give it a good read.

 

[ratbag]

Endo's are usually the worst MD's to see for TRT. The evidence in your case is your pituitary MRI... he is looking for a problem and 9.9 out of 10 times the pituitary looks fine after an MRI. Yet many people including myself have very low hormone levels and the pit is responsible for that. Most TRT experts couldn't care less what your pit looks like because they know that it isn't relevant in determining your condition. Unless your endo is an experienced TRT MD it's unlikely he'll help you... and if he does his protocol might not be any good. Remember 85% of men who start TRT drop it in less than a year because it did nothing for them. Our site sponsor Defy can work with your MD to set up a good TRT protocol (this is highly recommended) should your MD be willing to work with a TRT expert. This would be your best case scenario. Perhaps you can approach this idea with him. At least you'll know the protocol will work if Defy is involved.

 

[OMI100]

My MANTRA...
Take what you need.
You might download DR. Johns paper "TRT: Recipe for Success" and the PowerPoint and give to your ENDO (IF you don't think it will piss him off).

A GREAT paper written by a DR. for DRs.
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First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man’s Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
********************************
One other forum that has great info that might be useful to you is:
http://www.peaktestosterone.com/
GREAT article onE2 – A MUST READ
http://www.peaktestosterone.com/Hdr_Estrogen.aspx
********************************
Dr Saya's Videos on Testosterone Therapy and Side EffectManagement
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
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Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The CompleteHypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
andthe TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
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ALSO look at the videos that are posted on this site. A LOT of great info totake in....
******************************
Now you will have a great reference library and knowledge base to go forward on!

 

[Quantium]

Thanks for all the answers.

The appointment did not go well.. He was very conservative. Completely disregarded all my symptomps and said they were not related to my testosterone levels and that I basically just had to live with it. He also used a range of 6.7-24 nmol, which is laughable. I'm at 8.4 and 9.4 (coupled with a normal/high shbg).

He also said that because my testicles were pretty normal and i had hair down there, there wasn't any clinical indicators for low testosterone.

Extremely disappointed.. I'm going to appeal to my PCP July 9th.

 

[Kristian]

What is new with you? Any luck with your doctor? TRT is not easy in Norway - I am here too and it is a real challenge...