Question about low Testosterone and what should I do next

[R1982]

Hi,
I'm 31 years long and due to level symptoms of low Testosterone I asked my doctor for the needed tests and got the following results:
Testosterone 10.76 nmol/L
Free Testosterone 38.26 pmol/L
Prolactin 194.5 mIU/L
Estradiol 127.6 pmol/L

Although it's clear that my tests are not good, my endocrinology is trying to convince me that although the results are a little bit low they are fine and normal and all I need to do is to exercise more and loose weight (my BMI is 27) , and according to him this should fix my testosterone level naturally.
He refuse at this stage to recommend a medical treatment.

What do you advise me to do ?

 

[HarryCat]

Can you post the reference ranges for your lab results?

 

[R1982]

My results with the range of the lab next to each result:

Testosterone 10.76 nmol/L [Range: 8.4 to 28.7]
Free Testosterone 38.26 pmol/L [Range: 31 to 142]
Prolactin 194.5 mIU/L [Range: 45 to 375]
Estradiol 127.6 pmol/L [Range: 0 to 146.1]

 

[Nelson Vergel]

How do you feel? It is not all about the numbers. Your testosterone would be considered low in the United States.

 

[R1982]

I have all the symptoms of hypogonadism:
Sapped libido , always gain weight and have huge difficulty of loosing weight,Lack of energy - I'm tired most of the time ,Difficulty to consecrate and worse of all : I suffer from gynecomastia, which my endocrinologist diagnosed as pseudogynecomastia.

In the United States my test results (plus symptoms) would justify testosterone treatment even though I'm relatively young (31) ?
My doctor claim that if I will exercise more and loose weight then the testosterone will come back naturally.
I doubt that - my extra weight is not that extreme to explain my low testosterone level.
I don't understand why endocrinologist are so afraid of testosterone treatment and they do anything to convince their patient that he does not need it.

 

[HarryCat]

My doctor claim that if I will exercise more and loose weight then the testosterone will come back naturally.
I doubt that - my extra weight is not that extreme to explain my low testosterone level.
I don't understand why endocrinologist are so afraid of testosterone treatment and they do anything to convince their patient that he does not need it.

Probably because he feels signing up for a lifetime of TRT at 31 years should not be done casually, and rightly so.

I'm not saying you shouldn't do it, but make sure to do your homework. Read through the stickies on this site, or even better buy Nelson's book.

Right now I'm reading another excellent book called "The Low T Book" by Dr. John Crisler and Dr. Rob Kominiarek, and they talk about what can be done in terms of diet and exercise before committing to TRT. Might be worth reading and then going to your Dr. with what you learn.

Good luck.

 

[DHM]

Clomid stim test by chance?

 

[R1982]

Is HCG(tumor market) giving the same indication?
It came up normal < 1.0 mIU/mL.

 

[Nelson Vergel]

Testing for HCG in males is useless unless a tumor is suspect. It has nothing to do with testosterone work up.

 

[R1982]

I did the hcg test only because my endo asked me to do it as results of my blood test results. I did not ask for it...
He also asked me to do ultrasound of my chest (due to my gynocomastia) and also ultrasound of my testicle - he claims it's because of the relatively high e2 and not because of the T which he claim is normal.
It's strange that from the one hand he claims that my tests results are fine and all I need to do is to exercise more and loose few pounds - and from the other hand he sends me to do so many extra tests, which I guess should be done due to bad results...

 

[Nelson Vergel]

It seems to me that you need a new doctor.

 

[R1982]

Is it true that most endocrinologists tend to disapprove testosterone replacement treatments and they tend to disagree to recommend this treatment unless the testosterone is very low ?
When I say very low, I mean significantly bellow the lowest border of the range which the lab is using.
And what I also heard is that most urologists tend to agree to recommend TRT even for corner cases of low testosterone such as mine ?

Can you share your experience about the consultations with the type of Doctor which you visited for the TRT ?
Was it endocrinologists or urologists ?

 

[Nelson Vergel]

Many endocrinologists are very conservative and not well trained on testosterone replacement therapy unless they are younger ones who got TRT training in medical school. Most are great when dealing with diabetes, thyroid, and sometimes adrenals.

My TRT doc is my primary care physician who is a family doctor and has learned a lot about hormones in his 20 years of experience. You do not need an urologist or endocrinologist as sole sources of testosterone replacement.

In the United States, most doctor who take insurance treat men with low T if their total T level falls under 350 ng/dL (12 nmol/L) and who have symptoms of low T (lack of sex drive, low mood, erectile issues, fatigue, etc). Doctors who do not take insurance may treat men with total T under 450 ng/dL after ensuring that natural ways to increase testosterone failed.

To determine if the doctor you are about to see is knowledgeable, ask some basic questions to determine their level of knowledge and comfort about testosterone. Some may feel insulted to be asked questions like these, but if they are it's probably not going to be a good match for you (of course, be nice and diplomatic when asking questions!)

Questions to ask a doctor/clinic administrator about testosterone treatment:

How many men does he/she treat for hypogonadism?

Does he/she offer HCG therapy, in addition to testosterone for testicular atrophy? (Many doctors do not know how to use HCG.)

Does he/she use Arimidex (generic: anastrozole) to keep estrogen down in case of gynecomastia (enlarged breasts) or other high estradiol related issues?

Do they provide other therapies that can complement testosterone replacement?

Does he/she allow patients to self-inject at home?

Does he/she work with any compounding pharmacies to access cheaper and customized hormonal products? (Some doctors worry compounding pharmacies have poor quality control)

How many times do you have to go see him or her?

Do they share blood work results with you?

What is the set-up lab/doctor fee and approximate drug costs per month?


Prepare yourself before the first visit. It will set the tone of your patient-doctor relationship.


I invite anyone who hates to read but wants to watch a video before they call a potential doctor so that they know what to ask to take some minutes to watch this:

https://www.excelmale.com/?s=16-...cement-Therapy

Before your first visit, do your homework so that your doctor will know you are educated. Educated patients get better care. Read these posts:

https://www.excelmale.com/forum/threads/164...s-on-ExcelMale

I hope this answered your question.

 

[R1982]

Hi,
Nelson - Thanks for all the information.
In the country in which I live, Family doctors usually asks for recommendation from endocrinologist before prescribing TRT and actually anything special.
Today I went to a meeting with Urologist. This urologist is known to be pro TRT.
However, in our meeting he said that due to my young age (31) , he thinks that it will be wrong to treat my borderline testosterone level with TRT.

BUT - he did prescribe me a medication called IKACLOMIN.
He told me first to do sperm test and bone density test and after faxing him the results to start taking half a pill once in two days.
He said that taking IKACLOMIN will help my body to self increase the testosterone - (of course I should also loosing weight and also increasing my muscle mass).

Have someone here ever heard about this medication and it's potential to increase testosterone?
Can it really work or could it be that this doctor hopes that the Placebo effect of taking this pill (together with diet and exercise) will help me feel better (which may help the T as well)?

The consultation meeting was very expensive and it could be that this doctor got the (correct) impression that I will want to consult with him in the future only if he will recommend sometime (and not clichés about loosing weight - I'm not that fat!).
Therefore, before coming back to my family doctor I would like to hear the readers opinion about this new suggest approach.

 

[R1982]

I just found out that the medication which was recommended to me is a generic name of Clomid (or the opposite..).
And it's indeed mentioned as a medication which may help for cases of low T.
I will read all the related posts about this medication.
If you have specific inputs to provide to me about it's Pros and Cons - please so.

 

[HarryCat]

Ikalomin is called clomiphene in the US. See here for info:

Is Clomid (Clomiphene) Effective to Increase Testosterone, Fertility and Sperm Volume?

 

[R1982]

It sounds like an interesting way to handle low testosterone which is very different then TRT.
By the way, although my family doctor told me that I should have an endocrinologist recommendation in order for him to give me prescriptions for TRT - he hinted that if I will insist enough then he will be able to give me prescriptions for TRT for several months (2 - 3) to see how it will effect my sex drive, weight, mood and gynecomastia.
Now I need to come back to him with the Urologists recommendation for several months of Ikalomin (and ask for sperm test and bone destiny test).
I wonder what he will have to say

I would like to hear other people opinion about if you think that trying Ikalomin/clomiphene for several months is the right direction ....

 

[DHM]

If you're secondary Hypo, your test numbers will go up with Clomid. It's a SERM and should not shutdown your HPTA.

the pill is has a cis/trans configuration component where one half is an estrogen agonist.

could you share your dosing schedule?

 

[R1982]

He recommended the dose of 25 mg (half a pill) once in two days for several months.
If this option is that good and risk free then why isn't it more known and advocated as a way to increase testosterone ?
i was trying to come to the meeting with that doctor well prepared and yet he surprised me with an option I haven't heard of.

 

[R1982]

What do you think about this doze?
Is it too low? Can such a low dose achieve anything?