A lot of that has to do with comfort levels. Generally speaking, primary care is not as comfortable doing TRT or even evaluating the labs because they don't see it and practice it as frequently. We focus on this therefore we are more Comfortable evaluating lab values and symptoms for diagnosis. Prescriptions also can pose a huge burden as there is very specific and expensive additional licenses that are required in order to prescribe medications like these. Unless it's used frequently most primary care will not pay for the additional licenses in order to prescribe these types of medications. Follow up can be time consuming, and it most primary care you only get your 15 minutes. We can devote much more time to that and have much lengthy conversations and talk about why we do certain things.

There are some downsides with not being comfortable. They can prescribe, what we call sub therapeutic, which isn't providing much noted effect. That can be frustrating for the patient. Also going over too high can pose some threats to other health conditions. Therefore we need to evaluate and monitor closely which can all again fall back into comfort and frequency.