Went to Urologist Today - Your Thoughts Please

[johnt]

A couple of weeks ago, I went to my Primary Doctor for physical. I complained of following symptoms:

Fatigue, Irritability, Moments of Sadness, Anxiety, etc. I asked about having T checked. After some push back the doc agreed to run only Total T, which came back at 266. The docs assistant called to give me results and said I am within normal range. I am 46 years old.

I went ahead and made an appointment with a Urologist (I have a PPO so no referral needed). Funny thing is the day before my appointment my Primary Doc calls (two weeks after my original results) to say that after further review she thinks my T is too low but would like to re-run blood work including Free T and if comes back low to discuss treatment options. I declined her request since I had a Urologist appointment.

Today, I went to Urologist and met with the Nurse Practitioner. He said Total T is low and my symptoms also are consistent with Low-T. However, he wants to run the following blood tests first:

Free and Total T, FSH, LH, Prolactin, and Estradiol.

They could not draw blood at the office because they said I needed to fast. I didn't think you needed to fast for this blood work. Is fasting the norm for hormone levels?

I asked what they would typically recommend for treatment assuming low T is confirmed. He mentioned giving me a pill, I think Clomid (used a different name) to try to get my testes to put out more Testosterone. This would be first step to see if I respond well. He said for someone my age sometimes that is all that is needed. If that does not work then Gel or Injections of T along with HCG to avoid testicle shrinkage.

What are your thoughts so far on the direction of the Urologist?

 

[Vince Carter]

Sounds reasonable and theyre working with you...time will tell if its productive or not.

 

[PAUL-E]

Sounds ok, also check PSA before TRT to get a baseline.

 

[Steve Williams]

Your Urologist is way ahead of your Primary in terms of TRT.

 

[johnt]

Sounds ok, also check PSA before TRT to get a baseline.

My Primary did PSA (per my request), it's 0.4.

 

[MG123]

I would probably add SHBG. Fasting is not necessary for any of the tests mentioned, but this NP seems to be pretty reasonable in regards to everything else, so I would give him a chance. Usually when someone starts off with "Saw the endo/urologist today..." something crazy follows. I was rather happily surprised that you had a good experience.

 

[johnt]

I would probably add SHBG. Fasting is not necessary for any of the tests mentioned, but this NP seems to be pretty reasonable in regards to everything else, so I would give him a chance.

He seemed reasonable and knowledgeable during our conversation but when he mentioned I needed to fast that threw me off to think does he really know what he is talking about. I even noted my surprise to him advising that I did not fast because I read on several sites that fasting was not required for these tests. He politely responded that I would need to fast and ideally take blood draw before 11:00 AM.

 

[MG123]

Getting the labs drawn earlier is a good thing as endogenous testosterone goes down as the day goes by. I wouldn't let the fasting thing throw you off, especially since it is insignificant. I would hear him out, come back, and let us know the Clomid protocol that he decides puts you on. His basic thoughts on the matter seem good, though.

 

[MG123]

As a contrast, years ago, I was referred to a urologist for low T; one test was even below 200. He had me take my shirt off to examine me, saw that I had chest hair, and said that I was fine.

 

[James]

As a generalization, I've found urologists more up-to-date on the benefits of TRT when compared to endos and GP's. If LH and FSH are low, clomid may be worth a go. I strongly agree with the post suggesting you include SHBG in the testing. I wonder if there are a few other things they will test and therefore want you fasting. It's possible they heard 'testosterone should always be tested in the morning, when it's at its highest' and assume that must mean fasting is necessary.

 

[Vince Carter]

AS far as fasting or not, I prefer to fast on all my tests, I think it's advisable and there's plenty of conflicting yes or no's on google if you look.

 

[James]

AS far as fasting or not, I prefer to fast on all my tests, I think it's advisable and there's plenty of conflicting yes or no's on google if you look.

I do too. Even if I'm testing only TT and FT.

 

[johnt]

As a contrast, years ago, I was referred to a urologist for low T; one test was even below 200. He had me take my shirt off to examine me, saw that I had chest hair, and said that I was fine.

Wow, that is crazy!

 

[johnt]

As a generalization, I've found urologists more up-to-date on the benefits of TRT when compared to endos and GP's. If LH and FSH are low, clomid may be worth a go. I strongly agree with the post suggesting you include SHBG in the testing. I wonder if there are a few other things they will test and therefore want you fasting. It's possible they heard 'testosterone should always be tested in the morning, when it's at its highest' and assume that must mean fasting is necessary.

Looking at script and it lists no other tests.

 

[CoastWatcher]

Which estradiol test did he order? LC, MS/MS (sensitive)?

 

[johnt]

Which estradiol test did he order? LC, MS/MS (sensitive)?

It just says Estradiol.

 

[Smokin Joe]

Fasting is a must.
If you don't fast it can affect your results.
https://www.endocrine.org/news-room...10/testosteronedecreasesafteringestionofsugar

 

[Vince Carter]

As a contrast, years ago, I was referred to a urologist for low T; one test was even below 200. He had me take my shirt off to examine me, saw that I had chest hair, and said that I was fine.

That's the dumbest thing I heard reported from a Endo or Uro on this site....!!!!

 

[bruin]

Sounds to me like you have a guy with a great sense and understanding of HRT. I specifically fast, not sure why, maybe because as far back as I can remember, one fasted before a draw. May have something to do with additional test being ordered. Anyway, check up on the special assay for Estrogen, something tells me this urologist is up on it. Just go with it.

 

[Ramrod]

As far as Fasting. Depending on how long. Won't that lower T levels more. My guess is he wants to see your low point, but then he has you before 11am. So I'm not sure there.

Are you needing insurance to cover it?

That's the dumbest thing I heard reported from a Endo or Uro on this site....!!!!

Mine blamed my Marriage and suggested to look at porn to raise T level, No joke. After I meet with dumb doc I was lost for 4yrs before looking back into TRT.