Is this FNP worth pursuing with a follow-up appt?

[Roguejim]

In my search for a physician with HRT experience, I found an FNP who answered an HRT question of mine via email. Based on his reply to my question, is he worth a follow-up appt? Some of what he says is over my head, so I'm hoping someone in the community here can help me out.

My question to his assistant: "

Does Jason use HCG and estradiol/hematocrit management?​

The FNP's (Jason) reply: "

I test and manage estradiol and hematocrit during TRT. Testosterone increases IGF which can also increase erythropoietin which can increase your blood count causingsecondary polycythemia. Also TRT can increase estradiol levels. The combo can put individuals at increased risk for blood clots and stroke. HCG is very expensive and not on most insurance formularies. It also requires a prior authorization. I don’t typicallyrx it. Clomiphene is a less expensive way to get FSH increase to act upon your Leydig cells to produce more natural testosterone. Basically does the same thing. HCG benefit to cost ratio is poor.​

"

 

[Vince Carter]

I wont disagree for my own personal experience that HCG benefit ratio is pretty low as far as I'm concerned. Expensive? From some of the compounders its 6000iu for about $40 so he's wrong there.
I also would disagree with using Clomiphene WITH Testosterone....thats normally a one or the other kind of thing and not in combination. Plus if you're primary Hypo (problem being the testes) there's going to be little testosterone production any way so there's little point in even saying that the way he did.
I would like a more complete answer to how he manages Estrogen...with an AI? and what AI does he prescribe?

 

[Systemlord]

In my search for a physician with HRT experience, I found an FNP who answered an HRT question of mine via email. Based on his reply to my question, is he worth a follow-up appt? Some of what he says is over my head, so I'm hoping someone in the community here can help me out.

My question to his assistant: "

Does Jason use HCG and estradiol/hematocrit management?​

The FNP's (Jason) reply: "

I test and manage estradiol and hematocrit during TRT. Testosterone increases IGF which can also increase erythropoietin which can increase your blood count causingsecondary polycythemia. Also TRT can increase estradiol levels. The combo can put individuals at increased risk for blood clots and stroke. HCG is very expensive and not on most insurance formularies. It also requires a prior authorization. I don't typicallyrx it. Clomiphene is a less expensive way to get FSH increase to act upon your Leydig cells to produce more natural testosterone. Basically does the same thing. HCG benefit to cost ratio is poor.​

"

Things were really looking good up until the highlighted statements. Strike two is the HCG comment, everyone is different. If I were you I would look elsewhere for TRT. An experienced physician would find problems with these statements.

 

[Roguejim]

Thanks. I guess the search continues.

 

[Roguejim]

Things were really looking good up until the highlighted statements. Strike two is the HCG comment, everyone is different. If I were you I would look elsewhere for TRT. An experienced physician would find problems with these statements.

Can you direct me to a study, or data that would disprove, or dispute Jason's remark about test/estradiol increasing chances of blood clotting and strokes? I might still see the guy since it won't cost me anything for the first visit.

 

[Vitamin_C]

HCG isn't that expensive at all, I either go through Empower or I get it compounded locally. If I go through Empower its like $120 for a 3 month supply, if I go locally I get it for $60 for a 2 month supply. I also switched to doing 100 IU/day and its the way to go in my opinion.

 

[Vince]

No Prescription HCG​

https://www.excelmale.com/forum/showthread.php?4074-No-Prescription-HCG

 

[CoastWatcher]

Can you direct me to a study, or data that would disprove, or dispute Jason's remark about test/estradiol increasing chances of blood clotting and strokes? I might still see the guy since it won't cost me anything for the first visit.

Can you amplify your question? TRT can, very frequently does, raise hematocrit/hemoglobin. One responds by monitoring the CBC and, when necessary, donating blood or having your provider write an order for a therapeutic phlebotomy. For many guys on a testosterone protocol, it's the cost of a ticket to the game.
https://www.excelmale.com/forum/sho...t)-Caused-by-Testosterone-Replacement-Therapy

 

[Roguejim]

Well, I saw the FNP since it was a freebie for the first "meet and greet". I kind of laughed to myself when I met him since he is clearly a former body builder, as was confirmed to me by his receptionist. He's still huge. He also mentioned his own present use of testosterone. He said that he primarily prescribes injection or creams. He spoke ill of the other clinics around town that use pellets. Women with testosterone in the 1,900 range due to the pellets, have seen him. When I told him I was a member here, he quickly pulled the site up on his computer. "It's big", he said. He also said he doesn't test for SHBG. I think he said something to the effect that it is most commonly a problem with very obese males. I could be wrong on that. Anyway, I don't like doctors who state flatly that they don't test for this or that. It's the reason I'm dumping my former doctor who wouldn't test my hormone levels. I know Defy is still an option, but I'd prefer to be able to use my insurance, as well as not being totally comfortable with telemedicine.

 

[Systemlord]

No SHBG, this dude is clueless and sounds like a hobby for him, something on the side. He doesn't sound like he cares at all for his patients.