Join 3,561 readers in helping fund MetaFilter (Hide)


Seeking a knowledgable TRT doc in Central Texas
May 2, 2011 2:08 PM   Subscribe

Do you have a recommendation for a doctor in Central Texas who is knowledgable about male hormone issues, understands that just because a level is in the "normal" range doesn't make it normal, and is willing to try alternatives before heading straight into hormone replacement?

I have a friend in the Austin area who has been dealing with the effects of low testosterone for at least two years. He's a 38 year old male. In 2009, a mid afternoon test showed his level at 272, with a normal range of 262-1593. An early morning test a couple of days later was 464. Prolactin was 8.9 (normal range for the lab is 2.5-17.0). The doctor declared him normal after the 464 test, gave him some Cialis, and sent him on his way.

Two years later, the problems (chiefly ED) persist. My friend went to a urologist who supposedly specialized in male hormone problems after seeing this chart that said yeah, his numbers are normal - for an 84 year old. For a few weeks prior to his urologist appointment, he had been taking a multivitamin, vitamins B and D, Zinc, and Magnesium daily, as well as getting regular exercise. This time his afternoon number was 430. At his appointment, the urologist said he wanted his number to be 450. The doctor does not recommend any treatment, but did pass out Levitra. My friend is convinced the doctors have a vested interest not to treat the problem because they're in league with the ED pill companies.

Research indicates that these are not good numbers for a 38 year old male who is showing signs of having low testosterone. And it also seems that moving straight into testosterone replacement means that he would be making a life-long commitment; that doing so shuts down the body's own production. But there seem to be other treatment options, such as using Clomid, which are not very well-known. In fact, calling around to different men's clinics, aging centers, and other places here in Austin have returned the telephone equivalent of blank stares when Clomid is mentioned.

So at last, the question (TL;DR): Do you know of a doctor in Austin who 1) deals with low testosterone; 2) would treat someone with a level that's not below the "normal" range; 3) is knowledgable about alternative treatment options; and 4) is willing to search for the cause of the problem (i.e. is this a pituitary thing?) rather than simply treat the symptom?

If this doctor doesn't exist in the Austin area, does he or she exist somewhere in Texas?

Throwaway email if needed: littleTtobigT@gmail.com
posted by anonymous to Health & Fitness (6 answers total) 3 users marked this as a favorite
 
I'd advise your friend to look for an in-insurance-network endocrinologist rather than a urologist. While there might be some cross-competencies there, it seems like going at the actual problem might be more effective.
posted by mikeh at 2:14 PM on May 2, 2011


I second the Endo....
What is his E2 score? High Estrogen will kill libido faster than low T can in some cases.
If you get it tested, request a "sensitive E2" test as normal E2 tests are useless for men.
Good Luck,
SG
posted by StUdIoGeEk at 4:04 PM on May 2, 2011


And it also seems that moving straight into testosterone replacement means that he would be making a life-long commitment; that doing so shuts down the body's own production.

Not exactly. Natural production shuts down while you're using supplementation, but if you stop, natural production starts again in a couple of days.

It isn't life-threatening to stop suddenly, but you'll go through a couple of days of hell because your blood testosterone level will bottom out. I can tell you from personal experience that it feels really awful. So it's better to taper the supplementation down over the course of a week or so. But natural production will kick back in pretty rapidly -- up to the level that natural production would otherwise have been, which might be too low for health and happiness.

It is not a life-long commitment in the sense you're thinking of.
posted by Chocolate Pickle at 6:24 PM on May 2, 2011


I don't know a doctor in Texas, but I do know that studies have shown a diet at least 30% fat is optimal for hormone production. Saturated and monounsaturated should comprise the vast bulk of fat intake, polyunsaturated can actually decrease production in excess. Also, high blood sugar is bad for test production. Alcohol is very bad for test production. Get more sleep, you should be getting morning erections regularly. If lifestyle changes don't work, consider exemestane or anastrozole over clomid. Memail me for more info.
posted by blargerz at 8:26 PM on May 2, 2011


>Not exactly. Natural production shuts down while you're using supplementation, but if you stop, natural production starts again in a couple of days.<>
THIS IS NOT TRUE!
Natural production does not always return!
posted by StUdIoGeEk at 6:56 AM on May 3, 2011


If you really want an expert opinion on this subject, I should see a reproductive endocrinologist, preferably at an academic center. Is UT Southwestern too far? If not, you might check into Dr. Gruntmanis there. He is a published expert on male andropause and testosterone replacement therapy.

But I have to caution you, what I'm reading reads a lot less like "I want an expert opinion," and a lot more like "I want a doc who will defer to my google-based expertise on this subject and give me testosterone." Do realize that regardless of the cause of the problem (unless it is psychological or a side-effect of another drug, which it quite honestly often is with ED), there are generally no cures for organic causes of erectile dysfunction. The only possible exception I can think of are cases related to mass lesions in the brain and elsewhere that might benefit definitely from surgical removal. In that sense, whether someone benefits symptomatically from treatment with hormone replacement or a PDE-5 inhibitor should not be looked at any differently. Both are drugs, both have risks and benefits, and both may not lead to a lasting benefit after discontinuation.

Natural production shuts down while you're using supplementation, but if you stop, natural production starts again in a couple of days.

And incidentally, this is most definitely not the case for many patients who have been on prolonged testosterone supplementation. It can be incredibly difficult and unpleasant for some patients to try to wean off testosterone, sometimes taking months for withdrawal to resolve. This may partly explain why some physicians would suggest an "ED pill" instead for borderline cases, depending on the primary symptoms and testosterone levels.

I am not your doctor, I am most certainly not a reproductive endocrinologist, and this is not specific medical advice.
posted by drpynchon at 10:23 AM on May 3, 2011


« Older What would a prospective emplo...   |  Should I take money out of a t... Newer »
This thread is closed to new comments.