Low Testosterone and Erectile Dysfunction in Young Men. Good doctor in New York?

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Bentiger07

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Low Testosterone and Erectile Dysfunction in Young Men. Good doctor near NY or telemedicine?

Hello ExcelMale,
I appreciate help and will certainly do the same. I found you by reading much online on ED, low libido, and testosterone. I'm 30. I've heard 20s are the best yrs and it's been my worst. It's tough to be in a relationship with these issues. On the bright side, these issues gave me more understanding to help others struggling, especially youngins' who tend to get more resistance from docs and are left feeling there's nothing else to do. I was that guy. I tried to stay positive for yrs because I hoped more diet, sleep, and exercise would work, but I was already in decent shape. I'm uncertain if my ED and low libido is being caused by low T alone, but I have no idea what's causing my low T anyways! I want to explore the cause at my age to rule out serious issues. Due to clomid raising levels, I believe I have secondary hypogonadism. I've read most common causes are related to the pituitary or hypothalamus, but it can also be due to chronic kidney failure, cirrhosis, chronic lung disease, glucocorticoids, and more.

Without researching specialists, I saw 2 local urologists. In 2013, Dr. Gary Goldberg prescribed 5-10mg of cialis. It helped erections somewhat but did nothing for libido. He saw my T levels were around 250 and prescribed dhea. I can't remember but I THINK I took it for a few months & it raised my T by about 100. What I do remember is it did nothing for libido/erections & I had more hair loss. I was then prescribed clomid. After about a month, it made my T jump from about 350 to 800, and elevated my estradiol to 65 pg/mL. I still felt no change. I would have tried clomid longer than a month, but my concern was that the doc didn't think estradiol was high when I read it was. I didn't want it to raise more. A month on clomid didn't help ED/libido anyways. I read it sometimes makes it worse compared to other forms of HRT.

Around mid 2016, Dr. Bruce Gilbert did a bone density and penile doppler scan. Bone results came back normal. As for the penile doppler, he stated I have a primary arterial issue that is contributing to ED. I can't remember for sure but I THINK he also said the arterial issue was indirectly leading to a venous leakage. He said while rare, people are usually born with the arterial issue I had or it's caused by injury which I don't remember having. He felt Trimix was the best solution. It did nothing for my libido, helped somewhat with erections, but it felt a bit painful. He also didn't feel my T of 190 ng/mL was low enough to be a possible cause for ED. That's when I decided researching my issues isn't enough. I have to research knowledgeable docs on my issue too. I'm unsure but I felt both docs didn't have much experience in treating my issues in a younger man, or they didn't realize how tough it is to be in a relationship with this problem.

I don't do drugs. I rarely get morning wood. My erections get worse if I stand, which I've read low T & venous leakage may be the cause of. My appetite isn't strong. I used to have eczema but I haven't had it for 1-2yrs now. I live in Bellerose, New York City. Do you guys have any recommendation for which doctor I should see specializing in low T, ED, and libido in the NY, CT, or NJ? I'm open to telemedicine if better. Since I'm taking health more seriously now, I'm willing to travel for a knowledgeable specialist if I must. Can anyone recommend Dr. Michael A. Werner?

About Me: South Asian, Male, 30yrs, 5'11", 190lbs, average-somewhat muscular

Results in April2016 (included only what is out of normal range, and what is normal but has relation to Low T/ED):
Free Testosterone: 6.0 pg/mL LOW (Reference 9.3-26.5)
Total Testosterone: 189.8 ng/dL LOW (Reference 348.0-1197.0)
Estradiol: <5 LOW? (Reference 26-61 pg/mL)
Prolactin: 3.2 ng/mL LOW (Reference 4.0-15.2)
Follicle Stimulating Hormone: 4.2 IU/L (Reference 1.5-12.4)
Luteinizing Hormone: 5.9 IU/L (Reference 1.7-8.6)
Vitamin D 18.5 ng/mL LOW (Reference 30-100). Working on it. Getting more sun since Feb2016. 10am-3pm spring-fall are ideal times to get some D.

Results in March2016:
Estradiol: 8 pg/mL LOW (Reference 26-61 pg/mL)
Prolactin: 6.1 ng/mL (Reference 4.0-15.2)
Cholesterol: 218 mg/dL HIGH (Reference 10-199). Working on it. Dropping weight from 190 to 175.
LDL Cholesterol: 137 mg/dL HIGH (Reference <=129)
Total Cholesterol/HDL Ratio: 4.0 (Reference: 3.4-9.6)
Glucose: 115 mg/dL HIGH (Reference 70-99)
HGB A1C: 5.7% HIGH (Reference 4.0-5.6%, High risk prediabetic 5.7-6.4%)
TSH: 2.46 uIU/mL (Reference: 0.27-4.20)
 
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Defy Medical TRT clinic doctor
Welcome to Excellmale.

You certainly have some challenges, including finding a good doctor. On the latter question, I have heard nothing about Dr. Werner. Many members here rely on Defy Medical, Drs. Saya and Crisler, for their care (I am not a patient, but have respect for their practice model). Quite simply, it works. You can also consider Prime Body.

In regard to your labs, you had the incorrect estradiol test run. Men should only measure E2 levels with the "sensitive" test (LC, MS/MS). Something to keep in mind as you continue on this journey. You had a very limited thyroid evaluation - in addition to the TSH your doctor should have checked t3, t4, rt3, and thyroid antibodies.

What treatment, if any, was proposed for the arterial issue?
 
Thank you CoastWatcher. I never knew that about estradiol. Yes, I feel my prior doctors were not experienced enough in understanding why a young patient would have low T/ED. I just picked any doctor local at that time. I'll look more into the docs you mentioned as well as Prime Body. Those docs aren't local to me. Given I'm not the typical patient over 40 with these issues, is it wise to be treated remotely? I assume it's better to try to find a good local doctor I can visit in an actual office, then be treated remotely by phone. No need for a referral/agreement from my PCP to see them? I'm willing to fly out to them once or twice a yr if better, but it'll have to be mostly phone calls.
 
Thank you CoastWatcher. I never knew that about estradiol. Yes, I feel my prior doctors were not experienced enough in understanding why a young patient would have low T/ED. I just picked any doctor local at that time. I'll look more into the docs you mentioned as well as Prime Body. Those docs aren't local to me. Given I'm not the typical patient over 40 with these issues, is it wise to be treated remotely? I assume it's better to try to find a good local doctor I can visit in an actual office, then be treated remotely by phone. No need for a referral/agreement from my PCP to see them? I'm willing to fly out to them once or twice a yr if better, but it'll have to be mostly phone calls.


Your age age makes no difference. Dr. Saya and Dr. Crisler are two of the most experienced androgen-oriented doctors in the United States - they have seen it all. You can certainly fly to Florida if you like, but you won't be required to, www.defymedical.com.

What treatment did your urologist propose for the arterial issue identified?
 
Contributors to ED you have two of them I see, you're about to be diabetic according to your A1C and then you've got something got on with a suboptimal Thyroid of 2.46, both with Low T are contributors to ED.
 
Coastwatcher, I'll look more into them and will keep you posted. I promised to give myself a week to research good doctors. So far, everything I've read on defymedical has been good.

After the penile doppler scan, the doctor said it was a primary arterial issue contributing to ED. He felt Trimix was the best solution, and didn't think my T was low enough to effect ED. I've learned otherwise. Trimix helped somewhat for erections, but did nothing for libido. He did order a bone density scan recently which shows me he's not completely ignoring the low T.
 
Coastwatcher, I'll look more into them and will keep you posted. I promised to give myself a week to research good doctors. So far, everything I've read on defymedical has been good.

After the penile doppler scan, the doctor said it was a primary arterial issue contributing to ED. He felt Trimix was the best solution, and didn't think my T was low enough to effect ED. I've learned otherwise. Trimix helped somewhat for erections, but did nothing for libido. He did order a bone density scan recently which shows me he's not completely ignoring the low T.

My bone density scan indicated osteopenia - but I had been hypogonadal much longer than you have been. Low estradiol is a health challenge just as high estradiol can be, somethig to also keep in mind. Though you are young, was a psa run? It is a baseline test that needs to be performed.
 
Bentiger07 - I can tell these issues are causing you great distress (as they should), after reading your post here and on peaktestosterone.

Many folks don't realize how simple, yet efficient, convenient, AND thorough working remotely can be. It extends the reach (and availability) of experts to those that otherwise may not have access.

This is what we do and we have LITERALLY treated hundreds (if not thousands) of patients in a very similar situation/demographic to you.

Fly down if you wish (if you don't find adequate care locally)...there are worst places for a mini-vacation than the Tampa/St Pete/Clearwater area! However, if you feel open to it, also consider the ease, convenience, and functionality of remote telemedicine treatment...I don't think you will be disappointed or let down.
 
Hi Bentinger, Looks like Dr. Saya sees a challenge he'd like to take on. Accept his rare invitation without hesitation.

You mentioned treating the low serum D with sun therapy. The Vitamin D Council recommends 7,000 IU/day of cholcalciferol to achieve a target of 60. You could try that and retest in 90 days. 20,000 IU / day of soy-free high grade D3 is what it took for a year to slowly raise mine and I'm still not there. That's atypical. You'll want to determine your own individual response.

Free T
My lab reports 35.0 - 155.0 pg/mL as their standard range. You say your lab states 9-26 pg/ml as their reference range?
 
@Dr Justin Saya, MD Wow, great to see doctors posting! While I'm reading great things about DefyMedical, PrimeBody, LowTestosterone, and a few local doctors I've researched... DefyMedical is my first choice at this point simply because I know who the doctors are already, the specialization, the amount of happy reviews, plus the icing on the cake with you actually responding here. I suppose finding a good doctor in office isn't that beneficial then. I'm giving myself some time to research my issue, but expect an appointment from me soon. I'll probably call tomorrow. My name is Shahed.

@Re-Ride Thanks for the advice on Vitamin D. I researched D awhile ago, and actually just responded to a recent thread in this section titled "Sunshine !". Also, I've double checked the reference range I see on the lab report for free T. 9-26 pg/ml is what I see. (Performed At: BN LabCorp Burlington, Medical Director: Dwayne A. Breining, MD)
 
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Hey Guys,
Update: I went with DefyMedical to treat my issues. They had me do some labwork. Total T was low at 300 ng/DL. I spoke to the doctor over the phone and felt comfortable with his knowledge and experience. I was put on 25mg of clomid every day & anastrozole twice a week for 35 days. After 30 days, I was to get labwork done. My total/free T and estradiol was rechecked. Total T was 1015, free T was a little high, and estradiol in range. Problem is there was nothing to be excited about. While clomid worked on paper, I felt no change in anything. The medical rep I spoke with was surprised that my T levels were changed so much yet I didn't feel change. The rep also mentioned the person who made my lab order made a mistake as my LH and SHBG wasn't included in the results. Due to their error, he asked me to pay to get blood drawn again for that asap since I'm been off clomid for the past few days now. Since I understand mistakes happen and the expense was small, I didn't feel like making a big deal about it, since I ultimately care about getting better. Being off clomid for a few days, hopefully the results are still useful for the doctor. I suppose if clomid didn't help, TRT and/or HCG may be the next step.

Waiting for my next appointment is where I'm at now. The other issue was my next appointment wasn't for a couple weeks and I was all out of clomid/anastrozole. I didn't know if it was safe to continue taking clomid/anastrozole given my results, taper, or stop. I couldn't really get any clear answer when I called DefyMedical on this. I googled the question a bit and it sounds like most of the content I read say to taper off, but some people just stopped cold turkey with or without problems. I figured since the medication didn't help symptom-wise and I feel the same so far stopping, I'll just stop while waiting for my next appointment. I guess I need to speak to the doctor to get a clear answer.
 
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Hey Guys,
Update: I went with DefyMedical to treat my issues. They had me do some labwork. Total T was low at 300 ng/DL. I spoke to the doctor over the phone and felt comfortable with his knowledge and experience. I was put on 25mg of clomid every day & anastrozole twice a week for 35 days. After 30 days, I was to get labwork done. My total/free T and estradiol was rechecked. Total T was 1015, free T was a little high, and estradiol in range. Problem is there was nothing to be excited about. While clomid worked on paper, I felt no change in anything. The medical rep I spoke with was surprised that my T levels were changed so much yet I didn't feel change. The rep also mentioned the person who made my lab order made a mistake as my LH and SHBG wasn't included in the results. Due to their error, he asked me to pay to get blood drawn again for that asap since I'm been off clomid for the past few days now. Since I understand mistakes happen and the expense was small, I didn't feel like making a big deal about it, since I ultimately care about getting better. Being off clomid for a few days, hopefully the results are still useful for the doctor. I suppose if clomid didn't help, TRT and/or HCG may be the next step.

Waiting for my next appointment is where I'm at now. The other issue was my next appointment wasn't for a couple weeks and I was all out of clomid/anastrozole. I didn't know if it was safe to continue taking clomid/anastrozole given my results, taper, or stop. I couldn't really get any clear answer from DefyMedical on this. I googled the question a bit and it sounds like most people say to taper off, but some just stop cold turkey with or without problems. I figured since the medication didn't help symptom-wise and I feel the same so far stopping, I'll just stop while waiting for my next appointment. I guess I need to speak to the doctor to get a clear answer.

Bentiger - without the LH and SHBG level it is tough to say conclusively. I will say that changes in symptoms with Clomid take time...more time than with TRT. I will also say that based on your reported results, it appears your endogenous system (HPTA) is quite healthy and CAPABLE based on your testosterone response to stimulation.

I would typically begin a slow titration (but depending on LH/SHBG). Until your consult I would titrate down to 12.5mg daily (1/4 of 50mg tab). Everything else status quo. Tell staff you discussed with Dr Saya for refill purposes. You can copy this response to them in email to include in your chart.
 
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