Labs don't match up

[Glaim]

Hey guys, I had posted a few days ago that my testosterone assays routinely came back pretty low. My endo wanted to run one more assay before starting me on HRT. Prior to the bloodwork, he gave me an injection of corticotropin, and sure enough my testosterone came back in the 400's. Now he wants to deny me HRT as he claims my levels are 'normal'.

Now, according to what i've dug up, corticotropin directly stimulates the adrenals to begin testosterone synthesis. Is he just being shady? Purposely doing this? Or is he really just that stupid? Does anyone have any insight on corticotropin that I might be missing? I want to be sure that this bloodwork really was altered through his administering that before I begin looking at other avenues.

 

[pmgamer18]

I have yet to find a Endo that was anygood at low T. Go to the sticky above on finding a new Dr.
Phil

 

[Glaim]

I've been contacting Dr. Rothenburg of the California Healthspan Institute. He was reccomended by SWALE and others...so far they haven't responded yet.

It just seems unethical to directly alter my bloodwork in order to say I'm perfectly fine.

 

[BigRagu]

that sounds a bit shady to me......... i would either get another blood test and confront him about what he did.......... but i would def be looking for a new doctor.......... in teh future if some1 injects u with something make sure u know what it is and why he is doing it............... i wouldn't any1 even a doctor stick me with an unknown substance.........

 

[Glaim]

I guess I just figured that a doctor is there to help you, not screw you over.

 

[dj75]

isn't that a good thing that your test went up?

 

[pmgamer18]

It could mean he needs more testing to see why if his levels are to low. Never go on TRT unless you know why you have low T or you have done every test there is.
Phil

 

[dj75]

It could mean he needs more testing to see why if his levels are to low. Never go on TRT unless you know why you have low T or you have done every test there is.
Phil

Phil, is corticotropin TRT or a one shot deal that raises test levels? Is it a temperary raise?

 

[pmgamer18]

It has to do with Thyroid here is a link.
http://www.emedicine.com/emerg/topic277.htm
Phil

 

[Glaim]

It could mean he needs more testing to see why if his levels are to low. Never go on TRT unless you know why you have low T or you have done every test there is.
Phil

But by no means would that mean I don't need HRT, but rather the cause needs to be established, correct? He left a message on my machine saying I'm perfectly normal and that he does not reccomend TRT at this time.

 

[pmgamer18]

Ok what testing did he do please post them with the ranges. If you not having Thyroid problems why in the hell would he give you that shot. And if in the past your T levels have been low this Dr. is a use less to you find a new one. Call and ask a lot of questions like how many men does the Dr. treat for low T and does he test to find out why one is low, does he check for high E2 Estreadiol and does he use arimidex to get it down if high. You will know if you got a good one. He does not have to be an Endo any Dr. that knows is good.
Phil

 

[Glaim]

Yes, I do not care for him at all. I'm only nineteen and in college, so going outside of health insurance isn't going to be particularly easy for me financially. I'm doing the best with what I have.

I've asked him most of that before. He does not see a need to measure E2, and he does not like the use of arimidex or HCG as he feels it's just another drug entering the body that is unneccessary. I have no thyroid issues, but he said that because a portion of the body's testosterone comes from the adrenals (a small portion if i'm not mistaken), he wanted to test them to see if I responded. Hence the corticotropin. I don't have copies of the labs he has done, but I do have some copies other doctors have run. I was never able to get all the necessary assays, however.

Testosterone, total 148 ng/dl (range 241-827)
FSH, serum 5.7miu/ml (range 0.4-8.7)
TSH, Serum 3.43uiu/ml (range .70-6.40)
Prolactin 6.53ng/ml (range 2.10-17.70)

They then reran the total testosterone assay and it came back at

Testosterone, total 52 ng/dl (range 241-827)

Then they kept rerunning the SAME tests...and similar results kept coming back, but unfortunately I don't have copies.

Ok what testing did he do please post them with the ranges. If you not having Thyroid problems why in the hell would he give you that shot. And if in the past your T levels have been low this Dr. is a use less to you find a new one. Call and ask a lot of questions like how many men does the Dr. treat for low T and does he test to find out why one is low, does he check for high E2 Estreadiol and does he use arimidex to get it down if high. You will know if you got a good one. He does not have to be an Endo any Dr. that knows is good.
Phil

 

[earthdog]

This kind of stuff really pisses me off. What, does he think you're stupid, just because you're only 19?? Based on the labs you posted above, to my non-doctoral eye, the testicles aren't working. So what does he do? He does some adrenal hocus-pocus to artificially and temporarily raise testosterone, and then pronounces you "normal." Unless there is some medical reason for what he did that I'm not aware of (help us here, Swale), then this sounds like malpractice to me. But what do I know, I'm only an earthdog.

By the way, it is your legal right to have copies of all your medical records, including your labs. If nothing else, you should get hard copies from this guy, and LET HIM KNOW that you think he pulled a fast one on you so he can avoid treating your illness, and you're going to have another physician review your ALL your labs AND the hocus-pocus act that he TRIED to pull on you, before you seek legal counsel. I'm sure your phone book is full of savage lawyers (sorry if there are any lawyers reading this) who would love to devour this guy and not leave a scrap of meat on his bones. But that's just my anger talking; you do what you think is best, but at least get copies of your labs, as they will come in very handy in the future.

 

[Mmartin]

Glaim - I am 19 as well, and I have to wonder how my treatment may have differed if I was 5 or 10 years older. You're not alone, heh.

I digress; earthdog gave you the best advice. You have the right to access your medical records, and you have the right to find a new doctor who wont treat you like an imbecile.

 

[Glaim]

He's supposed to call me today. So what should I do...be calm, cool, collected and voice my concerns in a civilized manner...or rip him a new one for being a shady son of a bitch?

 

[pmgamer18]

He's supposed to call me today. So what should I do...be calm, cool, collected and voice my concerns in a civilized manner...or rip him a new one for being a shady son of a bitch?

Never burn your bridges behind you you may need to go back across. I am giving you a link to the AACE Guildelines print them out and read and high light the areas that talk about starting treatment and pick the treatment you want be it gels or shots. And high light the part on getting shots every 7 - 10 days. So he does not try to start you off wrong. Be business like but firm when you tell him according to the Bible of Endo's you should be on TRT. The more you learn about this the better you can negotiate with your Dr. Don't show him anything from a nether Dr. that will just piss him off. Try to make him think it is his idea to put you on T.
http://www.aace.com/clin/guidelines/hypogonadism.pdf
Phil

 

[cpeil2]

He's supposed to call me today. So what should I do...be calm, cool, collected and voice my concerns in a civilized manner...or rip him a new one for being a shady son of a bitch?

Corticotropin is a hormone that stimulates production of cortisol. So the endo told you that he gave it to you to raise your testosterone?

 

[mranak]

Never burn your bridges behind you you may need to go back across. I am giving you a link to the AACE Guildelines print them out and read and high light the areas that talk about starting treatment and pick the treatment you want be it gels or shots. And high light the part on getting shots every 7 - 10 days. So he does not try to start you off wrong. Be business like but firm when you tell him according to the Bible of Endo's you should be on TRT. The more you learn about this the better you can negotiate with your Dr. Don't show him anything from a nether Dr. that will just piss him off. Try to make him think it is his idea to put you on T.
http://www.aace.com/clin/guidelines/hypogonadism.pdf
Phil

IIRC, it also says something right after that like 'giving injections every two weeks is a good compromise.' I wish it didn't say that. I tried to track down one of the author's of the guidelines, who appears to have worked at a school in South Caroline, but I wasn't able to get any contact information for him. If we, as an HRT community, could influence these guidelines, then I think that would be a very powerful thing in getting more patients appropriate TRT treatment.

 

[Glaim]

Corticotropin is a hormone that stimulates production of cortisol. So the endo told you that he gave it to you to raise your testosterone?

He told me it was to stimulate the adrenals, which are responsible for a portion of testosterone production. After spending some time on pubmed looking up corticotropin, it appears that it increases testosterone synthesis.
Basically, corticotropin releasing hormone works to increase ACTH which then increases androgen synthesis.

He also asked me to wait in his office for 30 minutes before getting my blood drawn as to avoid a "potential allergic reaction". I didn't know it was common to be allergic to your own hormones...I've never heard of anyone going into anaphylactic shock from a testosterone injection.

 

[pmgamer18]

He's supposed to call me today. So what should I do...be calm, cool, collected and voice my concerns in a civilized manner...or rip him a new one for being a shady son of a bitch?

Did the Dr. ever call you back if so what did he say.
Phil