My doc refuses TRT, says my T is normal, I don't think it is

[NeedMoreTee]

I've had 2 T tests in the past 3 months and from my research I believe this is not normal right? I've been feeling progressively worse for about a decade now. I didn't really put 2 and 2 together until the last couple months. I'm 37 years old, extremely overweight (i've tried desperately and cannot lose weight), I have every single low T symptom and I have repeatedly told her I haven't felt right in years, I'm getting worse, and that something is wrong. She won't listen and just wants to put me on antidepressants.

I was going to post graphs but my post count is too low so these are my numbers, first is March 29th, second is July 6th:

Free T: 63, 52 pg/nL
T: 371, 324 ng/dL
LH: 8.2, 9.6 IU/L
FSH: 8.3 7.0 IU/L

Free T and T is at the absolute ragged edge at the bottom of the "normal" range. My LH is off the charts and above the normal range, is that not my body screaming that it needs more T? I used to have a very, very strong sex drive (10 years ago). I used to be naturally muscular and trim. Now, I have almost no interest whatsoever, my wife feels awful because I just don't care about sex. I have absolutely no drive or motivation any longer, indecision is so bad I can barely do the simplest thing without my mind rolling in unsure circles. I used to be freakishly strong, now when doing yardwork I feel like melting jello. I'm an emotional trainwreck that is cut to the core by the slightest negativity. I didn't used to be like this!

This is the message my doctor gave me in my test results:

"[FONT=&quot]Good Afternoon Scott, [/FONT]
[FONT=&quot]Your testosterone was within normal range. With it being in normal range I am not comfortable replacing it, if you would like to talk to someone about still replacing it I would recommend you to make an appointment with urology or endocrinology and they can discuss it with you further."

[/FONT]I'm still researching and reading, trying to arm myself with knowledge. If I'm going to schedule an appointment with a urologist or endocrinologist I want to go in there knowing whether I should stand up and fight saying that I really think I need TRT or if my case probably doesn't warranty therapy.

If not that should I instead go to a T clinic? I don't have much money and I believe the best price I can find is $200 a month but if these normal doctors are going to just keep wasting my time then maybe I should just do that?

I need help guys, what would you do? Are my numbers "normal"?

 

[user_joe]

You probably realize this, but your body is barely making enough T to be functional in spite of very strong signaling. Probably won't respond to clomid. I'd follow the docs advice to see a specialist, but research to find one that specializes in TRT.
All else fails go to the clinic, but seek the root cause of this first, and know enough to direct your treatment. Plenty of clinic are not just real knowledge. Many are careless.

If you truly can't lose weight with a solid caloric deficit you likely have thyroid issues as well. I'd have it looked into anyway. It's not uncommon.

 

[NeedMoreTee]

Okay, seek the root cause. I was so angry about her telling me my levels are normal I forgot a few key things with what might be going on. My left testicle has been funny for years, it kind of hangs up high or is inside my abdomen for periods of time. Sometimes when I feel it with my fingers, it seems smaller than usual, other times normal. It doesn't ever really seem to hang all the way down, like its on a short leash. My semen production seems to be very low as well.

Would you recommend a urologist or endocrinologist at this point? I'm assuming now that I think about it I really need someone to take a look and figure out what is going on down there. I've been hesitant having my current doc take a look as she has shown a pattern of incompetence and at this point I'm done with her.

My thyroid has been normal, it was 1.5 - 1.6. When I try to lose weight I just have no energy or spirit to exercise, work out like I used to. I try to restrict calories but it seems like it takes everything I have just to lose a pound a week and then I eventually fall off the wagon. I know weight loss is extremely difficult but this is just insane, I used to be able to control myself in my 20's and change my body how I wanted, but now I just can't do it.

 

[Vince]

For weight loss, I go low-carb. Personal, it takes away the hunger that eating carbs causes and low-carbs it becoming very mainstream.
What happens to the carbs?
https://www.excelmale.com/forum/showthread.php?4276-What-happens-to-the-carbs

 

[Hoosier52]

Thank her for her time and go to Defy Medical.

 

[CoastWatcher]

Your doctor's response is far too typical. It doesn't surprise any of us, in fact, most of us have had experiences very similar to your own. Frankly, while you may get lucky and find a doctor in your area who understands androgen protocols, the odds are against you. I'd also be very wary of paying a flat fee every month for the "privilege" of obtaining care from a testosterone clinic.

I urge you to call Defy Medical and Prime Body. Both are site sponsors, I am a patient of neither, I live in Canada, but I have great respect for their abilities. Yes, it will cost you some money, but probably not as much as you fear. If you contact them they will detail their pricing models and explain their approach to patient care, no evasion. They treat many of our members - just spend some time using the search function here using Defy amd Prime Body to get a sense of things.

 

[NeedMoreTee]

Oh cool I had no idea you could do all this over the internet now. I thought it had to be a local clinic. I'll search around and see what the process is, hopefully I can send over and use the lab work I've already done.

It really sucks when your doctor is afraid of a treatment, when I'm at the end of my rope and the possible negative consequences of TRT are relatively small compared to trying to get a functioning body back... I feel like my life has been ruined by this, if this is what is causing my problems. I've spent years with different doctors in those offices treating these symptoms, depression, can't concentrate, no motivation, etc. Nothing they ever prescribed worked. I kept insisting with them something was abnormal about all this but they just ignored me and wrote another prescription for some different medication that never helped. I had to demand Testosterone tests because I was researching low libido and realized I had every single symptom of low T.

 

[Will Brink]

Your testosterone was within normal range. With it being in normal range I am not comfortable replacing it, if you would like to talk to someone about still replacing it I would recommend you to make an appointment with urology or endocrinology and they can discuss it with you further."

She's passing the buck as your expense. But as she obviously has minimal knowledge of the topic, wouldn't have done well by you anyway is my guess.

 

[CoastWatcher]

Oh cool I had no idea you could do all this over the internet now. I thought it had to be a local clinic. I'll search around and see what the process is, hopefully I can send over and use the lab work I've already done.

It really sucks when your doctor is afraid of a treatment, when I'm at the end of my rope and the possible negative consequences of TRT are relatively small compared to trying to get a functioning body back... I feel like my life has been ruined by this, if this is what is causing my problems. I've spent years with different doctors in those offices treating these symptoms, depression, can't concentrate, no motivation, etc. Nothing they ever prescribed worked. I kept insisting with them something was abnormal about all this but they just ignored me and wrote another prescription for some different medication that never helped. I had to demand Testosterone tests because I was researching low libido and realized I had every single symptom of low T.

The amount of time spent on male hormones, and treatment of deficiencies, in medical school and residency is limited. My own doctor told me she only became aware of that after she was in practice and realized how none of her hypogonadal patients ever seemed to get better. She now practices with a high degree of skill in this area, but she had to spend time and effort coming to grips with the material.

You can find quality care. You aren't doomed to suffer like this.

 

[a_crossfitter]

Oh cool I had no idea you could do all this over the internet now. I thought it had to be a local clinic. I'll search around and see what the process is, hopefully I can send over and use the lab work I've already done.

It really sucks when your doctor is afraid of a treatment, when I'm at the end of my rope and the possible negative consequences of TRT are relatively small compared to trying to get a functioning body back... I feel like my life has been ruined by this, if this is what is causing my problems. I've spent years with different doctors in those offices treating these symptoms, depression, can't concentrate, no motivation, etc. Nothing they ever prescribed worked. I kept insisting with them something was abnormal about all this but they just ignored me and wrote another prescription for some different medication that never helped. I had to demand Testosterone tests because I was researching low libido and realized I had every single symptom of low T.

You are going to get your T one way or another; however, what are you going to do after you get it? Will you stay overweight and call it a day or will you drop your weight?

 

[NeedMoreTee]

Thanks for all the info guys. It's really helpful to get a wide perspective from various viewpoints.

I saw a urologist yesterday and it went much better. She was a nurse practitioner working under a guy that specializes in hypogonadism. She explained everything well and did an exam. So apparently if anyone doesn't know this, if you have a rectractile testicle that hangs out up in your abdomen somewhat it gets overheated. That causes it to shrink, to make less T, make less sperm, etc.

She ordered some additional tests, bioavailable T, free and total, or something or other. Also an estradiol test to check on the ratio. I'm also going to have a scrotal ultrasound to see if I have varicole veins causing trouble or anything else weird.

I asked her if 324 was normal and she said some guys will feel great at 300 and others need 700 to be alright, and that they will get me treated and feeling better after they get all the tests and information. I felt really good after hearing that.

I really hope once I start treatment it will help get me jump started back into cardio, weight lifting, eating better. I have tried it so many times in the past 10 years and only had very limited success followed by massive failure. I was pretty good at it in my 20's but not in my 30's. If this can help push me over the edge and get me back into gear, it will have saved my life.

 

[Vettester Chris]

Keep us posted with the updated labs, and as mentioned, there's several great specialists like Dr. Saya at Defy, who can help.

 

[NeedMoreTee]

Got some more tests done.

Another total test: 317ng
SHBG: 37nmol
T Free: 54pg
Testos Free: 1.7%
Estradiol by TMS: 23.1pg

They also did an ultrasound to check for varicole and didn't find anything, all good I suppose.

So they gave me a call and said because I'm "low normal" they won't do TRT so I'm back at square one. I'll be calling up Defy or that other suggested one and going from there. I really don't understand what their problem is when I tell them repeatedly I don't feel right and the symptoms of low T are quite blatant. Surely the symptoms can be caused by other things and I'm sure low T is only part of my problem, but geez, help a guy out if he asks for it, right? Oh well, moving on.

EDIT: Forgot the estradiol results

 

[OMI100]

While I am not as knowledgeable as some on this forum (A bunch of GREAT guys willing to help ALL) I have some good basic references that have helped me better understand a lot of the discussions and to better understand my situation.
So here goes my suggestions on reference material YOU NEED TO GET:
1. Get a copy of Nelsons book if you have not already done so!!!!!!!.
2. "My thyroid has been normal, it was 1.5 - 1.6." That does not mean that you do not have thyroid issues. TSH does not tell you the whole story. Go to TIREDTHYROID.COM and spend some time learning about thyroid issues and the basic test panels you need to get so you will have a clearer picture of whether or not you might have thyroid issues or something else going on. My personnel view is that this site is the best site anywhere, with clear fact based information, and it is not coming from someone wearing a tin foil hat.
3. Get the book she has written. Her book is even more detailed and deeper in this subject. The book is written for us non DRs. The depth and coverage of the subject would match ANY Doctorial Theses on ANY subject. Every thing is discussed, and any points made are footnoted with reference cited at the end of each chapter. The chapter references can be anywhere from one to over seven pages. References are published medical papers, research papers, papers from NIH...... NOT from folks wearing tin foil hats.
4. Get a copy of "The Secret Life of Fat: The Science Behind the Body's Least Understood Organ and What It Means for You". An easy read and hard to put down. Some AMAZING things you would never know about FAT and some of the latest studies. Did you know you can CATCH being FAT!!!!! Not very common BUT it can happen. Apparently so and the research and studies that back this up are covered in the book.
I think the above would make a good basic starter reference collection for you.