Doc wants to discontinue TRT

Discussion in 'Men's Health Forum' started by xray9, Nov 3, 2008.

  1. xray9

    xray9 Junior Member

    I started TRT three months ago with androgel 5g per day. This was initiated by my primary care physician at my request after treating me for ED and depression for one year. Two labs approximately six months apart showed total test in low 300's.

    Since I began TRT I have felt much better: Increased energy, libido, strength, endurance and improved mood. I had an appointment with the doctor last week for the first followup and bloodwork since beginning TRT. She noticed my improved mood and positive health benefits. I told her how well I was doing on the Androgel but explained that I felt it had lost some of it's effectiveness, that I suspected that my HPGA was suppressed due to the exogenous administration of test. After some persuasion she agree to increase my dose to 7.5. She was reluctant to do this saying she didn't want to shut down my testes. I told her I suspected they were no longer producing test already. We discussed bloodwork and she said that I could pick up a copy of the test results Monday and if there were any issues a nurse would be contacting me.

    So I drop by the doctor's office at lunch today to pick up a copy of the labwork. Total Test is 445 which is right about what I expected. An improvement over 325 but likely lower than what it was when I first started TRT and my body was still producing T. That's why I requested an increase in dosage. LH and FSH results were below detectable levels, <.1 and <.3 mIU/mL respectively, also not unexpected. My HPGA is suppressed due to exogenous administration of T. My only concern is the prolactin result = 22.7H ng/mL. The adult male range is 2.1 -17.7. I have no nipple soreness or swelling but I still might want to address this issue with medication. Still no biggie. All other labs values: lipids, kidney and liver function, CBC, PSA were fine.

    But for whatever reason, the doctor wrote a note on the last page and I quote verbatim "Stop testosterone replacement recheck labs in six weeks". I had already left the office by the time I read that. I went back and asked to speak to the doctor but she doesn't work Mondays. So I said I would come back tomorrow. But in the meantime I am thinking WTF? Why would she want me to stop TRT and so casually? No mention of tapering off, hcg anything. I felt like crap with T at 300, It will be far lower for several weeks if I get off Androgel and I really will feel like crap then. What is she thinking? I get the impression that she did not believe my HPGA would be totally suppressed.

    Is complete suppression of the HPGA to be expected on TRT?

    How long would it take it to return to normal? My LH and FSH values were in normal range before TRT.

    What are the long term effects of gonadatrophin suppression? Is there a point of no return after which they may never function? How serious is this? Three months of low dose Androgel is nothing compared to some of the supraphysiological cycles some bodybuilders use.

    I asked my doc to test for estradiol but she didn't,saying it wasn't recommended. Should I be tested for E2? What else?

    She also suggested that maybe I should she a endocrinologist since TRT isn't her specialty. Should I?

    What arguments can I use to convince her to keep me on TRT? BTW I have a script for four months now.

    Should I just get off the Androgel and go back to living with 300 T? Yay, I've got the testosterone level of an 80 year old man but it's in the "NORMAL" range!

    Sorry for the rambling and long windedness. I'm just kind of freaking out at the prospect of being taken off TRT after having experienced all the benefits. I know that some doctors are very hesitant to prescribe it in the first place, especially if T is not below 300. I fear that may be an endocrinologist's position. What should I do? I guess I need to make an appt to go see my PCP but I'd like to be well prepared when I do.
  2. Swolll

    Swolll Junior Member

    Try and find a Dr that specializes in trt in your area, which as I am finding out is easier said than done. Luckily my Dr will give me a huge dose of injectable test but but won't do the labs I request and won't prescribe any ai or hcg.

    I can't believe she wants you to stop and I know you definetely don't want to stop either. I don't know if any argument will help it seems like most Drs aren't going to listen to anything you have to say. I brought my Dr all the research he should have been doing and he ignored it.

    Just look for a Dr that has a clue yours doesn't obviously. Also I think you would see much greater benefits from a higher test level about twice where you are now 800-900 range I feel great!

    Good luck!
  3. JanSz

    JanSz Junior Member

    As long as you have injectable T you are set.

    AI & HCG you can get from advertisers on this board.
    Blood tests you can buy from couple places.

    Script fot T is important if you are traveling or have unanouced tests at work (like I had).

  4. pmgamer18

    pmgamer18 Member

    You can't go on TRT and then stop your going to crash big dam time your testis are shut down your brain is not sending LH and FSH to them and before going on TRT they were not doing all that much unless your testis don't work. If your LH and FSH levels were low with your base levels you need to do an MRI on your pituitary to rule out a tumor. I say this because your prolactin levels are way up there this can be do to a tumor unless you had sex and then in less then an hour did the labs.

    There is no sense doing LG and FISH on TROT and your levels are still way to low you need to go up to 10 g's and if this does not get your levels up into the upper 1/3 of your labs range then you need to switch to shots. Also you need to keep an eye on your Estrada and keep this down at about 20 pg/ml.

    As your Dr. is she will work with Dr. John over the phone he is the best male hormone Dr. out there. He will work with your Dr. over the phone to test and treat you. Go to his site at All Things Male - Center for Men's Health and read TROT: A Recipe for success and his CHG update show this to your Dr. she is not up on TROT. If not then fly or drive to MI. and see him he only needs to see you once then he can test and treat you by Email.
  5. xray9

    xray9 Junior Member

    Just had a follow-up appt. with Doc. Took in Dr. John Crisler's "Thoughts on TRT" and "Follow-up hcg" papers. I explained to my physician that I felt very well, reiterated that IMO the depressed LH and FSH were to be expected, and pleaded with her not to take me off TRT because I felt like crap with Total T at 325 and I would really feel like crap with it at zero and that it would be jerking around my HPGA unnecessarily.

    She was receptive to my arguments and explained that it was her concern that I might have something else going on like a pituitary tumor since my prolactin is elevated. I had thought that she had tested me for LH and FSH prior to TRT. She had not. Therefore, we don't know if my hypogonadism is primary or secondary. That is why she wanted me to stop TRT. Take the tests and go from there.

    I wish I had taken in Dr. Crisler's recommendations for tests prior to initiating TRT. But since we didn't and I don't care to stop and resume TRT I was able to work with her to come up with a plan of action that doesn't require discontinuance of TRT.

    I am now on 7.5 g (6 pumps) of androgel. I go back in three weeks for the follow-up blood tests suggested by Dr. John. Also will undergo MRI to check for brain tumor (which I seriously doubt I have since I feel good and there are no other symptoms). And I am going to see a urologist January 13th to check out my atrophied left testicle. It was small before I began TRT and I suspect may me the reason behind my low T levels.

    Thanks for your previous feedback and thanks to Dr. John for his insights and guidance.

    Does any one know if one testicle can compensate completely for a non functioning testicle to provide an adequate amount of testosterone?

    Any thoughts on the use of Dostinex (cabergoline) to lower prolactin? My doctor seems opposed to it.
    Last edited: Nov 16, 2008
  6. jgnoonan

    jgnoonan Junior Member

    I urge you to make sure that when the MRI is done that it is done with the contrast. I know I am responding late to this post but without the contract, the MRI will not pick up Pituitary andenomas. You high levels of prolactin indicate you may have a prolactin producing andemoma. These are almost always benign and other than giving you meds to surpress the prolactin, there is not much else they do. THIS MAY BE CAUSING YOUR LOW T!
  7. cumkwakka

    cumkwakka Junior Member

    one testis can do so.. its like a redundant feature.. if you lose one kidney the other still makes up for the other at full capacity
  8. Where are you located at?