question from a user
Is there anything you recommend to have tested to rule out other bad actors besides hypogonadism? Or how about tests that could conclude it? I was offered TRT for the first time, but this is through a local clinic. I tested at 42.2 total t. They said they'd do additional tests just to find out what but they said it was so low, I'd need treatment regardless of what other tests indicate. It was really odd to be offered treatment for the first consultation after I'd been fighting with my PCM about it for years. My endo refused treatment even though I was 170 Total, 8 hormone binding, and 42 free. They keep telling me to "eat right and exercise". My thyroid is in check, sleep apnea is treated, and sleep is pretty damn good considering my t levels. I just don't know what to do. It's been so long with low T that I'm starting to fear the correlations of other severe side effects of low T - mainly the heart issues. 35 M, 25% BF, 240 LBS, 105 lbs of muscle - according to my Garmin scale :) so there's that. I exercise 4-5 times a week. High Protein diet. A full panel was just done and everything was within normal markers besides triglycerides - which I assume circle back to the prolonged low T. Any advice, information, resources, links is very much appreciated.
AlphaMD's Answer
First let me say that I am sorry for your experience, we hate when we hear about men being treated like that.
Let's start by breaking this down into two sections: Why you were treated that way & why it feels misaligned with your next TRT experience, and your main question.
First, why were you treated like that?
Being a PCP or general practitioner is just that, very general. They are not specialists when it comes to hormones. This means based on their education of TRT, which is not much as a base, unless they sought more out themselves they aren't going off of much. What they do know is what insurance covers and what it doesn't. The arbitrary values of "what is normal" were mostly create by insurance companies as a way to avoid paying for TRT, as insurance companies make the most money when they don't pay for care. Often times PCPs rely on the values or insurance company standards to shorthand say "look, I'm not going to get paid for this & it's not going to be covered, so I'm going to run a ton of low level tests that are covered to try and build a case, then drag you along with Clomid after that to raise your levels a very small % because that is potentially covered." It's not their fault, but they're not experts.
When it comes to endos (and all providers) it comes down to their personal views in TRT. They're really smart when it comes to hormones and how everything interacts, but if they don't value knowing a lot about TRT or caring about men, you're going to have a bad experience. We've had a *veteran* get *laughed at* by his female endo and called a drug seeker for having low T & seeking treatment. That's not okay, but it still happens.
When you met with a TRT clinic, they're there to be specialists, and the logic checks out. Even if you can pinpoint the cause, if the cause isn't some issue that can reasonably be fixed, it doesn't matter in the end as you're going to need to be on TRT. They're treating you the way the first providers should have. It's very easy to see if your Sx are hypogonadism related if you elevate your T levels and the Sx improve, especially if you're as low as you are.
So your main question: There are ways to rule things out and zero in on the issue, and that's 100% what your endo should be there for. It's fine to fire your endo and find a new one if this one refuses to do the work. As to if you need treatment? Based on your Sx & your current values, you would be someone we would put on treatment and watch your improvement. It sounds like you're doing everything right on your end & you had the wrong providers.
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