The Intelligent & Relentless Pursuit of Muscle™
T Replacement
 
Finding a TRT Doc
1 2 Next Last
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

Do not discuss your own issues in this sticky. Create your own post.

The biggest problem for guys with hormone problems is finding a doctor who knows what he is doing. Most doctors are ignorant and unwilling and many who are willing are dangerous and stupid. Do not think that a specialist like an endocrinologist or a urologist is going to be able to help you. As a rule, these specialists are some of the worst offenders. An enthusiastic GP is your best bet.

Factors:
-do you have insurance for docs and labs?
-do you have prescription drug coverage?
-does a doctor take your insurance?
-does your insurance cover compounded drugs?
-do you have any strong preference for injections vs transdermals?
-what country are you in? Any English speaking ex British colonies other than the USA are a problem


How to get a referral:

Talk to your doc first, if he is not willing or able, he may know who is. If he sends you to a endo or uro, he may simply be getting you out of his face.

-Google Earth: http://earth.google.com/...load-earth.html
--zoom into your region
--enter "compounding pharmacy" in the "fly to" box
--explore links to web sites, look for patient info concerning male hormones and referrals, start phoning and ask to talk to a pharmacist and explain your needs [factors above] and explain what you are looking for, health insurance issues, and preferences for injected vs transdermal and your needs for Anastrozole and hCG
--compounding pharmacies know regional doctors, the pharmacy need not be close to you.

-Local Pharmacies:
-- start phoning
-- local pharmacies will know local doctors
-- see above

-Anti Aging clinics:
--They can be good and bad. Many will do the labs and mail all of the drugs and syringes to you. The prices can be very extreme.

If you are paying out of pocket, injections are cost effective. Compounded T creams can be affordable. T gels are $250 - $300 per month, depends on dose. Do not consider pellets or patches.

Study: http://tnation.tmuscle.com/...e_your_hormones

And write down your history symptoms. Print two copies, one for you and one for your doc. Doc can mark that up and retain and spend less time taking notes and asking random questions. This puts your concerns up front and provides talking points.

age
height
weight
waist
describe body and facial hair
did to grow fast or slow and steady as a teen
testes ache or hurt? ever?
mood
depression
libido
get cold easily? a change?
dry skin, brittle nails?
use iodized salt?
eat much sea food?
exposure to chemicals?
ever used hair loss drugs?
Rx and OTC drugs

Related:
http://tnation.tmuscle.com/...27&pageNo=0

And just when you thought things could not get any worse: http://tnation.T-Nation.com/...nd_say?pageNo=0

  Post New Thread | Reply | Quote | Report
 

PureChance
Level

Join date: Oct 2009
Posts: 1547

who controls the stickies, and how many IM's will it take to said person to get this post stickied at the top?

I would also suggest having a sticky (or adding to this one) for all recommended blood tests along with arguments for people to use with their doctor on why they need certain non-standard blood tests (i.e. - RT3, Vitamin D, etc.)

Other Recommendations:

Print out all previous blood tests you have ever taken. I compiled my test results into a spreadsheet to keep track of them + it helps the doctor who can look at four consolidated pages rather than wasting your and their time sorting through 50 pages of blood test results.

Other things to track and report(possibly):
avg daily body temp + avg waking body temp
general energy levels
difficulty gaining muscle / recent muscle loss
weight gain (difficulty losing weight)
general diet
concentration/focus/drive
confidence level/anxiety level
general health + number of recent antibiotic treatments
chest size/gyno?/chest sensitivity
trouble urinating or awareness of prostate
morning erections/ability to maintain erections
current supplement/vitamin regimine
past medication/supplement history
normal sleep patterns

Many people have learned through experience that most Endocrinologists and other 'specialists' are very narrow minded and do not look at the big picture. They will normally prescribe a single treatment option and will mostly only go based on the blood test results rather then your symptoms. They can be extremely by-the-book mainstream vitamin/supplements-are-worthless etc. There are exceptions of course, but read through this forum to see how many have had less than positive results by going to an Endocrinologist.

Once you do find a doctor:

Ask what blood tests they plan to run. Make sure you understand what they are testing for and why. Speak up and recommend the blood tests you read about here (or elsewhere). Print off reasons why you want certain tests in case the doctor pushes back. YOU ARE THE CUSTOMER. THE DOCTOR IS THERE TO PROVIDE YOU WITH SERVICE. YOU ARE IN CONTROL IN THIS INTERACTION. If the doctor won't listen to you or work with you, go find one who will.

GET the actual test results from the doctor's office. DO NOT accept "oh, your test results came back fine or within range". You are a paying customer. Make them fax you the results or get a new doctor, or ask for the results to be transferred, then get them from your new doctor.

Never just accept that "your results are normal." Most doctors don't know what normal is. Get your own results and do your own research. Always insist on seeing your actual results. Get a copy for your records (in case you are like most people here who have to go from doctor to doctor until they can find one who will work with them.)

Doctors surprisingly know very little. You know your body better then they do. Insist on getting ALL of your symptoms treated.

DO NOT believe the ranges the lab report shows. DO NOT believe that you are fine just because you are "in range". Do your own research.

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

Did you see this?
http://tnation.tmuscle.com/...d_blood_testing

  Post New Thread | Reply | Quote | Report
 

PureChance
Level

Join date: Oct 2009
Posts: 1547

No, I missed that one. Great information, but this post and the blood test post both say they are "sticky" posts in the body of the post, but neither of them are "stickied" to the top of the forum.

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

They will get there... not my control.

  Post New Thread | Reply | Quote | Report
 

Headhunter
Level 4

Join date: Oct 2002
Posts: 15060

One issue not addressed in the thread is distance to a particular doctor. Not many people will drive from suburban Cleveland, for ex, to Cincinnati on any sort of regular basis. It would be the same amount of trouble to just fly to one of the clinics in Florida.

In short, if the doc you find is more than 30 or 40 miles away, very few will ever do this.

  Post New Thread | Reply | Quote | Report
 

VTBalla34
Level 5

Join date: Mar 2009
Posts: 7536

Headhunter wrote:
One issue not addressed in the thread is distance to a particular doctor. Not many people will drive from suburban Cleveland, for ex, to Cincinnati on any sort of regular basis. It would be the same amount of trouble to just fly to one of the clinics in Florida.

In short, if the doc you find is more than 30 or 40 miles away, very few will ever do this.


I've found a doc who is willing to work with me remotely via phone and email consults throughout the year, as long as I meet him in his office once per year. A few hour drive once per year is very manageable.

  Post New Thread | Reply | Quote | Report
 

Chushin
Level 100

Join date: Feb 2005
Posts: 7435

VTBalla34 wrote:
Headhunter wrote:
One issue not addressed in the thread is distance to a particular doctor. Not many people will drive from suburban Cleveland, for ex, to Cincinnati on any sort of regular basis. It would be the same amount of trouble to just fly to one of the clinics in Florida.

In short, if the doc you find is more than 30 or 40 miles away, very few will ever do this.


I've found a doc who is willing to work with me remotely via phone and email consults throughout the year, as long as I meet him in his office once per year. A few hour drive once per year is very manageable.


Yeah, I'm doing the same. except he's in the US and I'm in Japan!

  Post New Thread | Reply | Quote | Report
 

PDJD
Level 2

Join date: Dec 2009
Posts: 181

after you talk to the pharmacist and get a couple of names of local docs, don't be bashful about telling him/her that you want a blood test, why, and what you hope to accomplish. explain that you are not interested in HRT to hit home runs or with the Tour de France....but only that you want to feel better/beat the symptoms of low T which caused you to see the doc in the first place. Explain that if the test results show normal, you won't press him for drugs that you don't need. Save the explanation of "normal" results for latter.

No doc will refuse to do tests....they LOVE to do tests. once the results are back (and you are low T), tell him/her that you want to try HRT for a few months to see if it helps. Again, explain that you are open to stopping if it doesn't help.

Once you get that first script (the hardest part i think), you are on your way. Then it is just a matter of educating the doc a little as you go along. You need to become your own expert. As things come up,,for example adding an AI, explain it to the doc, back it up with labs, and you won't get a fight.

This worked for me. My doc was a young kid working in a huge clinic....he had no idea what I was talking about and fought me the entire way. He was certain i wanted to hit home runs, power lift, win the Tour, whatever.

Once I got started, and got a little smarter, I fired him, found a sharp Chinese lady doc who helped me,,,then I moved and just took all my bottles and vials to a new doc, told him what I was doing and why. he didn't know a thing about it....thanks to KSman, and a couple of others, and my own research, I was able to educate the doc a little. Now he just looks at me, and says,,,"well, you seem to be doing fine." and signs for my refills.

my last labs showed my FT low. So I told him, I wanted to increase my T a little, by how much, and why. the only thing he said was "say that again so I can write it down on the chart."

So, ask around at the gym or at your work, and at the compounding pharm for a doc that is somewhat open minded. Then be brave!! It might even be best to try your primary care doc you have now....so he/she knows you somewhat, and that you are not there simply to get "roids".

Good luck.

  Post New Thread | Reply | Quote | Report
 

bluecollarjock
Level 2

Join date: Oct 2002
Posts: 609

A few Los Angeles area doctors offices to consider:

1) Holtorf Medical Group, Torrance, expensive but you will get HRT if you need it for sure
2) Dr. Shiva Lalezar, Brentwood, she uses creams but you can ask for injection but it might be in office only
3) Dr. Robert Krochmal, Woodland Hills, amazing doctor with diet, nutrition, "Dr. House" like issues for odd things traditional doctors dont bother figuring out and give you tons of meds for. He uses supplements instead of meds and is a really cool dude. Also if you need it will get HRT.

Ive been to all three, all three had no problems putting me on HRT with my low labs. So they are all expensive Im sure, probably dont take insurance, but will get you started if you are in LA and need a doctor. All are big on supplements too, if you dont want or need them just tell them, no pressure. At Holtorf if you can ask for the script, their prices at the compounding pharmacy they have are out of control high...I didnt know better when I started...Dr. Krochmal will give you the scripts for your pharmacy if you need them and let you self inject at home. Also is very open minded and detail oriented if you have other health issues going on. If you want to do nutritional IVs Dr Lalezards office is great for that, and I think Holtorf does it too.


If this was the wrong place to post this please notify me and I will remove KSman

  Post New Thread | Reply | Quote | Report
 

FracturedSapper
Level

Join date: Feb 2011
Posts: 7

How do I find this Dr. Robert Krochmal of Woodland Hills? I tried to look him up online but cannot find him...

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

Might be here:
http://www.google.com/...l%22+california

  Post New Thread | Reply | Quote | Report
 

randman
Level 100

Join date: Mar 2003
Posts: 3175

I easily found a place that will do the whole 9 yards from setting up the blood work, to working with a local doctor who will write prescriptions and then getting them filled and shipped from a compounding pharmacy. This was easy. The problem is that they don't work with insurance companies and that goes, for it seems like, all of them.

What's difficult is finding a local GP who will do all the same things AND bill my insurance so I don't have to pay for all of this out-of-pocket. I checked with my insurance and they do cover TRT-related costs but it seems near impossible to find a GP who will do all of this and work with insurance to get all the IDC codes right so they can be properly billed and I am left with a much smaller co-pay.

Has anyone on this site been able to achieve a) getting on HRT and b) getting insurance to pay for it through a TRT-friendly doc?

It's frustrating how much in the dark ages we are with regards to HRT as a society. Rant over.

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

You have accurately summarized what most guys experience. Docs who specialize in TRT can be driven out of the insurance pool by the insurance companies. My doc was getting threats of malpractice investigations by the state med board. Some docs in that board were also part of the BCBS board. After he dropped out of BCBS, all of the threats from the state med board stopped. Insurance companies do not want to pay for optimizing quality of life and do not consider low T a disease or illness. From their perspective, they will carry the costs until one goes onto medicare or dies; and there is no cure to limit the expenditures.

The climate created by docs and pharmacies pushing T and HGH illegally has created a witch hunt situation. I started a 'doctors live in fear thread' a long time ago. I just requested that it be moved to this forum.

  Post New Thread | Reply | Quote | Report
 

randman
Level 100

Join date: Mar 2003
Posts: 3175

Thanks for the post KSman. I'd love to see that thread. It's a very frustrating environment. I get the impression if I was a chick, however, and had low hormones; I could find tons of doctors to treat me and have my insurance cover it. Hypocrisy I tell you, hypocrisy!

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

http://tnation.T-Nation.com/..._live_in_fear_1

Women get abused, very few options for them and most of those are harmful. At least they can get 2% OTC progesterone cream in the USA. But as a group, women are clueless about these things, too technical and complicated at best. Things are very much more complex for women too.

Oral Birth Control creates a lot of problems, some deadly.

  Post New Thread | Reply | Quote | Report
 

randman
Level 100

Join date: Mar 2003
Posts: 3175

Well this blows up my perception then. I see lots of HRT doctors for women that are actually advertising on the web that are GPs. I've read a lot of women going to HRT GPs to get hormone replacement. I wasn't aware that there are still a lot of "issues".

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

Progestins are not cardio-protective like progesterone, creates endothelial dysfunction, risks of arterial disease, clots, leading to strokes, heart attacks and thrombosis; as stated with OBC package inserts. This has been known for 50 years.

Most female HRT uses progestins. Some docs are bio-identical aware.

All women have progesterone levels that drop with age just like DHEA. Leads to PMS, long painful bloody periods, estrogen dominance, over stimulation of breast tissue and endrometrium [leads to fibroids] which can progress to cancers. Progesterone can prevent most of that. There are cases where docs want to perform hysterectomies when progesterone can resolve the problems [they do not know]. Some docs prescribe high progestin OBC for cases for an enlarged uterus, increasing a probability of a cardio vascular event.

As a women's progesterone levels drop, she becomes estrogen dominant -dangerous.

I think that a lot of CV disease in women can be avoided by progesterone replacement and that many of the breast and uterine cancers are avoidable. Everyone also asks why breast cancer increased in the last 50 years. OBC is probably part of the puzzle.

I worked with a women who was faced with surgery. With progesterone, she was able to normalize the size of her uterus and expelled the fibroid bodies, as confirmed with ultrasonic imaging. She was a really fast learner who soon did not need any more help from me after I got her started. [She found me here. I have written about this here before.]

Another women was also able to normalize her uterus which was at a 10 week pregnancy size. Docs made her sick with high progestin OBC, I switched her to OTC progesterone, which resolved that and other problems.

Progestins have high oral availability. Progesterone does not. You can't make OBC pills with progesterone. And transdermal is not reliable enough for birth control. The only HRT solutions are transdermal creams and vaginal suppositories.

I think that a women could do well by applying 2% OTC progesterone with her OBC or progestin based HRT [which is very cheap]. But she would have to understand why, and that is a significant barrier.

OBC has estrogen first pass liver effects, increasing SHBG and lowering FT. Sort of fits the loss of libido that some women experience. OBC is HPOA repressive, reducing progesterone created in the ovaries, increasing the effects of the progestin. With post menopausal HRT, there isn't any progesterone to replace, increasing the cardiovascular risks of the then unopposed HRT estrogens.

HRT based in hormones extracted from PREgnant MARes piss [premarin] contains xeno estrogens.

Many GP's dropped female HRT practice when the premarin and progestin products were seen to be increasing heart attacks [woman's health initiative]. Many women dropped HRT from that news or by doc's directive.

  Post New Thread | Reply | Quote | Report
 

randman
Level 100

Join date: Mar 2003
Posts: 3175

This was extremely informative. Thanks for this. So basically a woman with dropping progesterone levels is best served by applying OTC progesterone cream is what I'm concluding from your post. Going to an HRT doctor can end up being dangerous if she is put on progestin-based HRT.

  Post New Thread | Reply | Quote | Report
 

KSman
Level 1

Join date: Aug 2006
Posts: 8009

That was my intent. Now you can read:
http://www.amazon.com/...e/dp/0743406664

  Post New Thread | Reply | Quote | Report
 

VTBalla34
Level 5

Join date: Mar 2009
Posts: 7536

I found this website today listing Functional Medicine Doctors around the world:

http://www.functionalmedicined...

FMD's usually take a holistic approach to treatment, so for those of you who have been spinning your wheels for a while trying to find a good doc, it may serve you to find an FMD who is concerned with your whole body and not just disease management. They also tend to look for optimal lab ranges in bloodwork and not just "normal"

  Post New Thread | Reply | Quote | Report
 

PureChance
Level

Join date: Oct 2009
Posts: 1547

that functionalmedicine sounded pretty amazing.... till I found out that only Chiropractors are signed up as providers at least in Texas... and while I believe in Chiropractic treatments, I'm not sure about their depth of knowledge into hormone issues (plus can they even authorize blood work through insurance companies?, etc.)

  Post New Thread | Reply | Quote | Report
 

jlucky
Level

Join date: Nov 2011
Posts: 8

PureChance,

I have a chiropractic degree and can offer you some insight here. I am keeping a low profile as I am trying to educate myself on HRT while practicing and living in a less favorable country to deal with these issues.

THere are many a chiropractor who are quite knowledgeable about these issues depending on specialization. However, in most situations they have no access to prescribe any controlled pharmaceuticals. THey can refer for most any diagnostic test including labs, but again any treatment options would be limited to over the counter type solutions, which is as you know very limited.

By dealing with my own issues and trying to find an open MD here, I hope to create an opportunity here, we will see.

  Post New Thread | Reply | Quote | Report
 

PureChance
Level

Join date: Oct 2009
Posts: 1547

Hi Damici,

This is a reference thread for everyone. and asking for specific referrals for NYC doc really belong in it's own thread. Can you please edit/delete your post here and create a new thread for your questions?

Much appreciated.

  Post New Thread | Reply | Quote | Report
 

MDAutry
Level 1

Join date: Feb 2009
Posts: 11

Hey All,
I have now been to both an Endocrincologist and Urologist. Neither of the two had a clue about TRT. I have been receiving treatment from a nurse practitioner and so far she has been the best. Good luck to everyone finding a doctor...

  Post New Thread | Reply | Quote | Report
1 2 Next Last