Doctor won't take low T possibility seriously.
August 26, 2012 8:28 AM Subscribe
How do I get a doctor to take my concerns about low testosterone seriously?
Over the past 10 years I’ve experienced two episodes of major depression, as well as a more generalized low libido, sleep problems and energy level. Recently it has gotten worse, and over the past two months I’ve been barely functional – in a fog, not able to concentrate on anything, spaced out to the point that it’s seriously worrying me and beginning to be noticed by others who know me. I have taken antidepressants in the past and they did seem to help somewhat, but side effects made me stop taking them. I talked to my doctor – he did thyroid and metabolic panels, all of which came back normal.
I’ve continued to feel pretty bad, so I went back and asked him specifically about low testosterone levels. He said that low testosterone has been highly marketed recently but is actually rare and I’m probably just depressed again. He put me on another round of Prozac.
I decided to pay for my own labwork to check testosterone. Results came back low or just barely in the normal range depending on which reference is used – total testosterone 262ng/dL, free 8.9 pg/ml. FSH and LH are on the lowish end of the normal range. From what I understand the normal reference ranges are an amalgam of all guys, not broken out by age. As I’m in my mid-30s it seems that I should not be so low on a scale that includes data from men in their 60s and beyond.
I’m not a juicer or looking to become the next Barry Bonds. . .I just want to feel normal and have energy and libido levels typical for a man my age. I have no problem taking antidepressants, but if they mask the symptoms of a larger problem I want to address that problem. I’m especially concerned because I’ve been reading research that indicates that low testosterone levels are indicated in a host of degenerative problems such as heart disease, type 2 diabetes and Alzheimer’s.
Should I be concerned? If so, how can I convince my doctor to take it seriously?
Over the past 10 years I’ve experienced two episodes of major depression, as well as a more generalized low libido, sleep problems and energy level. Recently it has gotten worse, and over the past two months I’ve been barely functional – in a fog, not able to concentrate on anything, spaced out to the point that it’s seriously worrying me and beginning to be noticed by others who know me. I have taken antidepressants in the past and they did seem to help somewhat, but side effects made me stop taking them. I talked to my doctor – he did thyroid and metabolic panels, all of which came back normal.
I’ve continued to feel pretty bad, so I went back and asked him specifically about low testosterone levels. He said that low testosterone has been highly marketed recently but is actually rare and I’m probably just depressed again. He put me on another round of Prozac.
I decided to pay for my own labwork to check testosterone. Results came back low or just barely in the normal range depending on which reference is used – total testosterone 262ng/dL, free 8.9 pg/ml. FSH and LH are on the lowish end of the normal range. From what I understand the normal reference ranges are an amalgam of all guys, not broken out by age. As I’m in my mid-30s it seems that I should not be so low on a scale that includes data from men in their 60s and beyond.
I’m not a juicer or looking to become the next Barry Bonds. . .I just want to feel normal and have energy and libido levels typical for a man my age. I have no problem taking antidepressants, but if they mask the symptoms of a larger problem I want to address that problem. I’m especially concerned because I’ve been reading research that indicates that low testosterone levels are indicated in a host of degenerative problems such as heart disease, type 2 diabetes and Alzheimer’s.
Should I be concerned? If so, how can I convince my doctor to take it seriously?
Low testosterone is highly marketed and those ads slyly prey upon the myth that every man is normally a high-energy, active stud. The truth is very different. I would also explore where all that research you've been reading originates from.
The fact is, as we age, our testosterone levels do decrease. But not so much as to cause the issues you are having. Get a second opinion. But, also think about seeing a counselor and getting on the proper antidepressant, as depression absolutely causes all of the symptoms you describe.
posted by Thorzdad at 8:42 AM on August 26, 2012 [2 favorites]
The fact is, as we age, our testosterone levels do decrease. But not so much as to cause the issues you are having. Get a second opinion. But, also think about seeing a counselor and getting on the proper antidepressant, as depression absolutely causes all of the symptoms you describe.
posted by Thorzdad at 8:42 AM on August 26, 2012 [2 favorites]
2nd opinion, 3rd opinion. Your doctor is not taking your health concerns seriously. MeFi's Own Matt Haughey has a benign brain tumor related to testosterone.
For depression that does not respond well to anti-depressants prescribed by a GP/internist, see a psychiatrist for medication review. But check on the testosterone 1st.
posted by theora55 at 8:58 AM on August 26, 2012
For depression that does not respond well to anti-depressants prescribed by a GP/internist, see a psychiatrist for medication review. But check on the testosterone 1st.
posted by theora55 at 8:58 AM on August 26, 2012
See an endocrinologist who specializes in reproductive endocrinology. Also note that unless your blood draw was taken at the specific time of day applicable to the reference range (usually this means an early morning draw), the levels may be inaccurate and underestimate peak levels. Being borderline low means nothing if your blood was drawn at the wrong time as testosterone levels vary throughout the day.
Also, my personal take is that though testosterone replacement has its place, your doctor is fair in suggesting that you may be being played here. People are making lots of money off this sort of stuff, and your average person probably wouldn't have the foggiest idea about this if a wide network of charlatans weren't marketing testosterone directly to consumers as the cure for what ails them. This is not to say that testosterone replacement won't help in some cases (though the literature isn't convincing), but good luck to you if it doesn't and you hope to get off the stuff. Noone really knows how to titrate the dose, so in practice what I see often happen is a patient gets started on a dose, fails to have a symptomatic response, and the dose gets escalated to a point that serum levels run high (with or without any symptomatic benefit). Once you're on it for a long enough while, your endogenous testosterone production is suppressed, and you're then committed to a potentially long and unpleasant weaning/withdrawal if you ever intend to get off the stuff. Return of prior testosterone output can take *MONTHS* in some men.
posted by drpynchon at 9:05 AM on August 26, 2012 [5 favorites]
Also, my personal take is that though testosterone replacement has its place, your doctor is fair in suggesting that you may be being played here. People are making lots of money off this sort of stuff, and your average person probably wouldn't have the foggiest idea about this if a wide network of charlatans weren't marketing testosterone directly to consumers as the cure for what ails them. This is not to say that testosterone replacement won't help in some cases (though the literature isn't convincing), but good luck to you if it doesn't and you hope to get off the stuff. Noone really knows how to titrate the dose, so in practice what I see often happen is a patient gets started on a dose, fails to have a symptomatic response, and the dose gets escalated to a point that serum levels run high (with or without any symptomatic benefit). Once you're on it for a long enough while, your endogenous testosterone production is suppressed, and you're then committed to a potentially long and unpleasant weaning/withdrawal if you ever intend to get off the stuff. Return of prior testosterone output can take *MONTHS* in some men.
posted by drpynchon at 9:05 AM on August 26, 2012 [5 favorites]
Be open to the idea that your problems are not caused by low testosterone. Sleep problems go hand in hand with fatigue and spaciness. Insist upon a sleep test; you may have sleep apnea (yes, even if you are thin and young) in which case a CPAP or dental device will give you back your energy and mental sharpness - and your libido. Sleep apnea linked to decreased libido in men.
Now if your doctor is actually blowing your concerns off or shrugging and saying "I don't really know what to do" or "Live with the fact that you're a low energy person" then please get a second opinion. You should not have to put up with symptoms like you describe; they are not normal. But don't automatically assume that testosterone supplements are the cure for what ails you.
posted by Rosie M. Banks at 9:12 AM on August 26, 2012 [1 favorite]
Now if your doctor is actually blowing your concerns off or shrugging and saying "I don't really know what to do" or "Live with the fact that you're a low energy person" then please get a second opinion. You should not have to put up with symptoms like you describe; they are not normal. But don't automatically assume that testosterone supplements are the cure for what ails you.
posted by Rosie M. Banks at 9:12 AM on August 26, 2012 [1 favorite]
This is the type of situation that a second opinion is made for—when your doctor doesn't seem to be taking your concern seriously, either because he's not or because he's not explaining the situation to you well enough.
But in turn, you really need to be open to the possibility that a physician with years of medical training may be right and your suspicions may be wrong—and testosterone may not be the real issue.
posted by J. Wilson at 9:39 AM on August 26, 2012 [3 favorites]
But in turn, you really need to be open to the possibility that a physician with years of medical training may be right and your suspicions may be wrong—and testosterone may not be the real issue.
posted by J. Wilson at 9:39 AM on August 26, 2012 [3 favorites]
Most doctors I have known have little respect for the self-diagnosis of any patient with no M.D. Even if you know with 99.9999% certainty the diagnosis they need to come up with to treat you eu-practically it seems to be part of the patient's proper role to be really coy about it.
(Eupractice ought to be a real word dagnabbit.)
posted by bukvich at 9:54 AM on August 26, 2012
(Eupractice ought to be a real word dagnabbit.)
posted by bukvich at 9:54 AM on August 26, 2012
You will not be at peace about this until you get a second opinion. I had a doctor who, I thought, would not take me seriously and I not only got a second opinion, but I told my doctor that I did it (in my case, my doctor turned out to be correct).
posted by brownrd at 10:18 AM on August 26, 2012
posted by brownrd at 10:18 AM on August 26, 2012
I agree with drpynchon, but also wanted to comment that even though you paid for these tests to be done out of pocket, you can still ask your own doctor to interpret them for you - as an ER doc I do not know how to interpret those levels, but I do know that there are many many lab tests that we run where a 'borderline low' - or even a result that is actually lower than the bottom end of the reference range - really is pretty meaningless from a management perspective.
posted by treehorn+bunny at 8:15 PM on August 26, 2012
posted by treehorn+bunny at 8:15 PM on August 26, 2012
This thread is closed to new comments.
Nobody can give you a definitive answer over the internet, and the internet is positively larded with shitty medical advice provided by ignorant and/or financially predatory people.
If so, how can I convince my doctor to take it seriously?
This is probably an opportune time to seek a second opinion from another physician; if nothing else comes of it, you may find that the other physician takes the time to explain the issues to you at greater length and in a more satisfactory way.
posted by Inspector.Gadget at 8:34 AM on August 26, 2012 [2 favorites]