How do/did you choose an "expert" TRT doctor?

[JimBob]

By "expert", I am referring to the docs on the Roundtable as well as others like Saya, Morganthaler, Rouzier...
It seems like a bit of a crapshoot, really. There are several treatment issues, like the management of hematocrit, and estradiol, etc, on which some of these docs are opposed. They are all reading the same literature, yet, there is this divergence. How does the average schmuck like me make the right choice, when these "experts" seem to depart on the treatment/management of various things?

 

[captain]

You can take the safe route and see an endocrinologist or take more risk with a hand full of doctors that think they know more than all the other endocrinologist. Do they really know more or did one of them silver tongued devils say something you like to get your money? After they get your money and your no better off than you was you may ask yourself what are you doing? I find the hand full of doctors monitor your labs better than the endocrinologist do and will let you have meds the endocrinologist will not. You have to decide what you think you need and pick who can help you with it.

 

[Systemlord]

I can only speak from my own experience, Dr. Saya is exceptional at balancing hormones and I doubt anyone would disagree.

I think some of the roundtable doctors are really good at what they do, they may have a different way they go about doing it. When Dr. Rob Kominiarek and Dr. Crisler speak, I listen closely. The new guy from Irvine, CA has my attention as well. He's only 28 little bitty miles away but too expensive for me.

Defy Medical is cost effective and my last consult was 35-45 minutes that I would never get with my previous endo as he gets nervous after about 10 minutes like he's got other things he needs to do.

 

[Mountain Man]

I lucked out. I used to live and work in Massachusetts, and Abraham Morgantaler’s clinic was 3 miles from work. I live in New Hampshire now and four times a year I drive down to Boston for bloodwork and appointments. Visits are covered by insurance and testosterone cypionate is cheap. Consider myself very fortunate.

 

[JimBob]

I lucked out. I used to live and work in Massachusetts, and Abraham Morgantaler’s clinic was 3 miles from work. I live in New Hampshire now and four times a year I drive down to Boston for bloodwork and appointments. Visits are covered by insurance and testosterone cypionate is cheap. Consider myself very fortunate.

Does Morganthaler keep your estradiol within a set range? Is he opposed to using AIs?

 

[JimBob]

I can only speak from my own experience, Dr. Saya is exceptional at balancing hormones and I doubt anyone would disagree.

I think some of the roundtable doctors are really good at what they do, they may have a different way they go about doing it. When Dr. Rob Kominiarek and Dr. Crisler speak, I listen closely. The new guy from Irvine, CA has my attention as well. He's only 28 little bitty miles away but too expensive for me.

Defy Medical is cost effective and my last consult was 35-45 minutes that I would never get with my previous endo as he gets nervous after about 10 minutes like he's got other things he needs to do.

It's not so much a difference in methodology as it is that some of these doctors diverge in principle. One doc keeps estradiol within a certain range, regardless of symptoms; another doc doesn't even check it without symptoms. One doc says AIs can be taken on just a temporary basis; another says no...

 

[Mountain Man]

Does Morganthaler keep your estradiol within a set range? Is he opposed to using AIs?

His big thing is that he only treats the symptoms. His clinic does not go crazy over what the numbers are, rather they go by how you were feeling. An AI is not given automatically. I’m sure if one was warranted, they would do so. They tend to be conservative, which works well for me.

 

[JimBob]

It's strange to me that no one seems concerned that two supposed "experts" can be completely opposed on some possibly critical issue, and then you're supposed to determine which one is correct before choosing him to be your own trt doc. I'm not talking about minor differences in style, but serious issues whereby the two physicians cannot both be correct since they hold opposite positions. I think it matters.

 

[DragonBits]

It's strange to me that no one seems concerned that two supposed "experts" can be completely opposed on some possibly critical issue, and then you're supposed to determine which one is correct before choosing him to be your own trt doc. I'm not talking about minor differences in style, but serious issues whereby the two physicians cannot both be correct since they hold opposite positions. I think it matters.

It's certainly shows the lack of well designed research into long term TRT use.

But what can you do about it when experts disagree?

I see a lot of doctors disagree about many things. thyroid levels, RT3, high levels of supplements of Vit D, iodine, etc. IMO when you start pushing the upper or lower boundaries of normal ranges then you are taking chances and most of the time it isn't a good idea. A lot of times it's harmless, sometimes it helps.

But for most men, I don't see the value in an expert TRT doctor. It's not like I or most men are all that complicated of a situation. I would do my own research more to prevent a doctor from screwing me up or ignoring low levels of T that fell into the lower range of normal. I don't think it takes any sort of expert to do that.

Now if you have complications, tumors, cancer, pituitary adenomas, weird abnormal blood tests, then you do need an expert.

 

[BenM]

But for most men, I don't see the value in an expert TRT doctor. It's not like I or most men are all that complicated of a situation. I would do my own research more to prevent a doctor from screwing me up or ignoring low levels of T that fell into the lower range of normal. I don't think it takes any sort of expert to do that.

I kinda agree with you IF you have a doctor that's willing to be guided by you. Some doctors have very strong ideas, won't try anything new and won't prescribe things unless it's their idea! Others (like the endo I'm using) has strong ideas but is willing to listen to mine as well and try things based on my feedback even if they're against his advice. Which is kinda working OK, in the sense that he wanted to put me on cream (and I said no) but on the other hand, I would probably prefer to be dealing with someone who is actually on the same page as me.....

 

[Systemlord]

It's strange to me that no one seems concerned that two supposed "experts" can be completely opposed on some possibly critical issue, and then you're supposed to determine which one is correct before choosing him to be your own trt doc. I'm not talking about minor differences in style, but serious issues whereby the two physicians cannot both be correct since they hold opposite positions. I think it matters.

All doctors have their own style, GP's, endocrinologists and urologists.

Choose a doctor and if it doesn't work out for you, find another one.

 

[DragonBits]

I kinda agree with you IF you have a doctor that's willing to be guided by you. Some doctors have very strong ideas, won't try anything new and won't prescribe things unless it's their idea! Others (like the endo I'm using) has strong ideas but is willing to listen to mine as well and try things based on my feedback even if they're against his advice. Which is kinda working OK, in the sense that he wanted to put me on cream (and I said no) but on the other hand, I would probably prefer to be dealing with someone who is actually on the same page as me.....

When I look for doctors, there is a tenancy for google to direct me to large hospital groups to search, or for sure insurance companies direct you to doctors within their networks.

These large enterprise systems and big-name hospitals have a huge control over health care providers and control is concentrated in fewer hands. Their doctors don't want to prescribe outside of government / hospital guidelines despite their personal opinion might be different.

So often the decisions of an individual doctor in one of these groups is dictated by group policy.

The "experts" are usually sole entrepreneurs or a part of a clinic specializing in antiaging medicine. So IMO this is a big reason they have more latitude in prescribing.

All this makes it difficult to find doctors that aren't part of a big group and don't have an internet famous name. If I were looking, I would look outside of doctors being recommended by hospitals / insurance groups.

But I spent 5 years on TRT without any doctor, so you can do it on your own, it's trickier to order but it can be done and you do need to do some research. I don't particularly like that route as it isn't very stable. Like ordering natural desiccated thyroid over the internet without a script, people do it all the time.

I think telemedicience is fundamentally changing this dynamic making it easier to find doctors you can work with.

BTW, just chatting about the subject and not recommending any particular route to take.