How to navigate a convo with my (new) endocrinologist about hypogonadism

September 12, 2018 3:53 PM

I've had (diagnosed) hypogonadism for several years now. I first was treated with a testosterone gel which was ineffective, and then later with injections at 200mg of the cypionate ester every two weeks. You are not my doctor. How do I talk to one about this therapy not really working for me?

My libido and energy have been exceptionally low for quite some time. Testosterone has helped a bit, but as I approach 40, I'm thinking ahead to a life of living like this and I don't really want to. I moved to NY recently, and New York also seems to stigmatize TRT; it's hard to get pharmacists who have a clue and every time I ask for needles despite it being written on the prescription it's like pulling teeth. I'm about to make my first visit to an endocrinologist to discuss this (all other work has gone through primary care doctors). What tests should I ask for? How frequently should I follow up to get resolution? If what I'm doing lately hasn't helped, am I just out of luck? What are the "right" levels of hormones for a morbidly obese 250lb+ male? Are endocrinologists going to think i'm crazy when I ask about Clomid and HCG as alternatives or augmented therapy?

I'm in the Hudson Valley if anyone has recommendations.

posted by arimathea to Health & Fitness (4 answers total)

Best answer: I don't produce my own testosterone because I'm trans, so a lot of your specific questions are out of my experience. I will say that I've had a very frustrating time finding a competent doctor in NYC. I'll send you a me-mail, though, in case coming into the city is an option for you. I've always used gel, but my understanding is that getting pharmacies to give you the right needles is often a pain in the butt. I'm not sure if you can get needles shipped to NY, but I do know people sometimes find it easier/cheaper to get their injection supplies online.

The standard "debugging" questions for trans folks on T likely apply to you as well:

• are you getting your levels checked? (the "normal" range is pretty huge and some people find their body works better towards the top or the bottom of the range)
• are you getting blood drawn in the trough (i.e. the day before your shot)? see if you can do labs two consecutive weeks (if it's not cost prohibitive) to see what the middle of the cycle vs the end looks like
• does how you're feeling track with your shot cycle? It's become common for trans folks on T to inject every 7 days (whereas ever 10 or 14 used to be more common) because it helps people avoid feeling crappy in the trough

I've been on T for a number of years and do labs every 6 months. Some doctors will happily stretch that out to once a year. But in the beginning, it was a lot more frequent--I think I did labs at four weeks, twelve weeks and six months and every six months after that.
posted by hoyland at 6:55 PM on September 12, 2018 [2 favorites]

Another trans man piping in.
See if you can switch your injections to every week. The half life of testosterone cypionate is about 10 days so at 2 weeks you'll be feeling peaks and troughs. This was the first change I made after starting T.

You can get test for free testosterone and total testosterone. My doctor hasn't done this yet but this is one of the ways doctors test for androgen insensitivity.
posted by martinX's bellbottoms at 5:16 AM on September 13, 2018

Yet another trans*man chiming in.

You may want to look for an endo that has experience with trans*people/is trans*friendly. While the circumstances aren't the came, they are similar. A good endo, may be initially surprised at your better researched information, history, and questions, but likely more out of surprise than shock. A good, trans*friendly endo will also have a better understanding of the various forms and how they work with various body types, what blood tests you should be getting regularly, and better understand how to adjust your dosages as needed.

Best of luck!
posted by RhysPenbras at 1:03 PM on September 19, 2018

Response by poster: For what it's worth, just reporting back. I did in fact go see an endocrinologist today who took me off testosterone completely and put me on Clomid instead. Thank you all for the advice, I'll see how things go, but the conversation was refreshingly open and honest.
posted by arimathea at 4:13 PM on September 20, 2018