Got Testosterone?

[usmcvet]

Which estradiol test are you using? Males should be using the ultra sensitive test.

I don't know. I will call now and ask.

[usmcvet]

Originally his endocrinologist . New PCP who does write his TRT script is unfamiliar with using a-dex, so on Friday we will get a new scrip from his new endo. His old endo moved out of state. ��

Sent from my SM-T230NU using Tapatalk

I went to an Endo and she would not even talk about it. It was frustrating.

[usmcvet]

I met with a local Urologist yesterday. It was promising because he seemed open to suggestions. He said he wanted to pull me off the T and start me on HCG to try to restart my natural production of T. I am nervous about that. Is it possible to re boot straying on T and adding HCG? I'll go check out excel male later tonight but I have not had much in the way of response to any of my questions over there. I heard an add on the radio today for the North East Mens Clinic. http://northeastmensclinic.com/ I made an appointment. Anyone familiar with them? Looks like I may be canceling that appointment: http://www.startribune.com/midnight-...nic/261394601/ Bummer. I'm going to call Defy Back. =)

[BadDogPSD]

Looks like I'm member of the low-T club now... total T was 252. Primary care doesn't think it's low as the labs normal range was 175-750. Working on getting a referral to endocrinologist.
Have most of the symptoms and haven't felt 'right's in a few years.

[WillBrink]

I met with a local Urologist yesterday. It was promising because he seemed open to suggestions. He said he wanted to pull me off the T and start me on HCG to try to restart my natural production of T. I am nervous about that. Is it possible to re boot straying on T and adding HCG?

Reboot no, keep the nads working yes. Can't reboot the HPTA with HCG alone regardless.

I'll go check out excel male later tonight but I have not had much in the way of response to any of my questions over there.

I saw responses to your thread. Just need to fill in the Qs asked etc and you'll find mods, etc give excellent advice

I heard an add on the radio today for the North East Mens Clinic. http://northeastmensclinic.com/ I made an appointment. Anyone familiar with them? Looks like I may be canceling that appointment: http://www.startribune.com/midnight-...nic/261394601/ Bummer. I'm going to call Defy Back. =)

Don't know anything about them but most seem happy with Defy. They take insurance?

[WillBrink]

Looks like I'm member of the low-T club now... total T was 252. Primary care doesn't think it's low as the labs normal range was 175-750. Working on getting a referral to endocrinologist.
Have most of the symptoms and haven't felt 'right's in a few years.

You'll save yourself years of hassle and all manner of problems if you take the time to read through this thread.

[BadDogPSD]

You'll save yourself years of hassle and all manner of problems if you take the time to read through this thread.

Thanks Will, I've read some, plan to read through it all!

[WillBrink]

For those in the VA system dealing with the TRT/HRT issue. This study found there's a wide range of prescribing practices in the VA. Something to consider perhaps when/if searching for docs in the VA for assistance with that issue. Not surprisingly, younger docs far more likely to prescribe TRT than older docs, likely due to being much more current with the data on TRT/HRT:

Testosterone prescribing in VA varies by provider's age, experience, specialty and region

Providers in the Veterans Health Administration (VA) system vary in their testosterone prescribing practices, according to a study published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism. This is the first study to examine provider and site predictors of testosterone prescribing in the VA.

There has been a large increase in testosterone prescribing in the United States over the past decade, and prescriptions increased substantially between 2009 and 2012. Some testosterone prescriptions have been made without appropriate baseline evaluation prompting the U.S. Food and Drug Administration to review labeling for testosterone products. However, the clinical context within which testosterone prescriptions occur is not well understood, and better understanding that context could help guide interventions to improve the appropriateness of testosterone prescribing

"Our study clearly shows that there is variation in both receipt of testosterone as well as guideline-concordant prescribing of testosterone in the VA," said study author, Guneet K. Jasuja, Ph.D., of Edith Nourse Rogers Memorial Veterans Hospital (Bedford VA Medical Center) in Bedford, Mass., and Boston University School of Public Health in Boston, Mass. "Provider's age, number of years in practice and geographic area are all associated with variations in testosterone prescribing practices."

In this study, researchers examined provider and site characteristics associated with an index dispensing of testosterone among patients receiving outpatient medications in the national VA system from October 1, 2007 to September 30, 2012. The study included 132,764 male patients who had at least one outpatient testosterone prescription and 550,151 male patients who did not receive testosterone, but did receive another medication.

Researchers found that providers ranging in age from 31 to 60 years, with less experience in the VA, and credentialed as medical doctors in endocrinology and urology were more likely to prescribe testosterone, compared to older providers, providers of longer VA tenure, and primary care providers. While they were more likely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing, compared to primary care providers.

Sites located in the Northeast were more likely to appropriately check two low testosterone levels as well as two low morning testosterone levels. Patients who received care at VA's smaller community-based clinics (known as community-based outpatient clinics or CBOCs) were more likely to receive testosterone and less likely to have received appropriate testing in comparison with patients receiving care at the parent VA medical facility.

"Our findings highlight the opportunity to intervene at the provider and local level to improve testosterone prescribing practices," Jasuja said. "The VA and other healthcare systems can use these insights to promote targeted efforts that can help decrease inappropriate prescribing of testosterone, while ensuring that those patients who can benefit the most can still receive it."

https://www.sciencedaily.com/release...0718142942.htm

Source study:

Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System. The Journal of Clinical Endocrinology & Metabolism, 2017; DOI:

[WillBrink]

Good thread bump:

Study: Long-term testosterone therapy improves urinary, sexual function and quality of life

(Boston) - A new study shows a significant improvement in both sexual and urinary function as well as quality of life for hypogonadal men who undergo long-term testosterone replacement therapy.

These findings appear in the Journal of Urology.

Testosterone is a steroid hormone involved in the regulation of sexual function, urinary health and metabolism as well as a number of other critical functions. For most men, testosterone concentration declines slowly with age and may not cause immediate major symptoms. However, some men may experience a host of signs and sumptoms constituting a clinical condition called Testosterone Deficiency (TD), or male hypogonadism, which is attributed to insufficient levels of testosterone. As a result, they experience symptoms as varied as erectile dysfunction, low energy, fatique, depressed mood and an increased risk of diabetes.

Cont:

https://www.eurekalert.org/pub_relea...-slt081517.php

Study:

http://www.jurology.com/article/S002...145-5/fulltext

[WillBrink]

A new report appeared in the Asian Journal of Urology, "Testosterone Treatment and Cardiovascular Events in Prescription Database Studies," September 2017, concluded "T treatment was not associated with increased risks for thrombosis, MI, stroke, composite CV events, or mortality."

The paper reviewed retrospective/observational studies using prescription databases to the examine the association of testosterone treatment with the above-referenced morbidities. A literature search yielded eligible studies that were either retrospective cohort or case-control studies analyzing prescription or insurance claim databases. Fourteen studies were examined.

Summary of Results by Specific Outcomes

MI (Myocardial Infarction):

Several large MI-focused studies "found no increased risk for MI with T treatment. The largest of these was a well-designed study that included approximately 65,000 T-treated men an reported a 24% decreased risk for MI with T treatment."

Stroke

In three studies of stroke, "T treatment was not associated with an increased risk of stroke." The same study referenced in the MI results section (above) reported a 36% decreased risk for stroke with T treatment.


Composite CV Outcomes

Three studies reported conflicting results on the association of T treatment and composite CV outcomes. However, at least one of those studies was poorly designed.

Thrombosis

Four studies indicated that treatment with testosterone was not associated with an elevated risk for thrombosis. One study indicated an increased risk of such an event.

Mortality

No study found an overall increased mortality risk for men being treated with testosterone. The decreased mortality risk (all-cause mortality) ranged from 22%-66%.

Conclusion

The studies examined over 215,000 men being treated with testosterone. Most, by a substantial majority, showed that such treatment was not associated with cardiovascular disease/mortality. However, the author points out that - given the nature and limitations of retrospective, observational data - discussion and debate will likely continue until a large, prospective randomized, double-blind, placebo-controlled study is undertaken.

The abstract for this article is linked below. For a short time the full-text will also be available.

http://www.ajandrology.com/preprinta...=212903;type=0