Low T and Missed Reps

[Sebastian Ohanian]

I unfortunately watched that excellent podcast after I had asked my doctor. But I guess that just means I don’t get a referral from the doc for insurance purposes.

Some clinics will write you a paper script, and you can get it at the regular pharmacy and get your insurance to pay. If insurance doesn't pay, go to goodrx.com, and you can get coupons that make it a few bucks more than insurance.

You can also open an HSA account and pay for the stuff pre-tax. If you do some leg work you can get it pretty cheap.

[Smyth]

Not usually, in my experience, unless you specifically ask, and it wouldn't matter if he did. The "normal range" of total testosterone is all they pay attention to. GP's absolutely suck at having any clue about testosterone replacement, generally speaking.

You are exactly correct. GP: “you’re 640 - a stud. Your over 300 so all is perfect.” When I asked, “but what if for me specifically 640 isn’t great? Isn’t that a possibility?” GP: “your over 300, so there’s nothing to do. Your good.”

[Steven Kalin]

I have a California license if that is helpful to you. A level of 639 does not mean you would not benefit from treatment. Most important is the free testosterone level not the total.

Dr Nichols, could I ask, is there any situation in which you would prescribe AI for a client going on TRT? I’ve been on for 2 weeks now, and my doc has me on 1ml of test a week, 25 mg of Exemestane a week, 15 mg of DHEA daily. I’m Canadian, or I would have come to you. His explanation was that my estrogen levels were already elevated.

[Mark Rippetoe]

Dr Nichols, could I ask, is there any situation in which you would prescribe AI

Artificial Insemination?
Artificial Intelligence?
Aromatase Inhibitor?
Adobe Illustrator?
American Indian?
Anti-Inflammatory?

All posters: Don't just assume we understand your acronyms.

[Steven Kalin]

I have a California license if that is helpful to you. A level of 639 does not mean you would not benefit from treatment. Most important is the free testosterone level not the total.

Artificial Insemination?
Artificial Intelligence?
Aromatase Inhibitor?
Adobe Illustrator?
American Indian?
Anti-Inflammatory?

All posters: Don't just assume we understand your acronyms.

Sorry, Aromatase inhibitors.

[J. Keith Nichols MD]

Dr Nichols, could I ask, is there any situation in which you would prescribe AI for a client going on TRT? I’ve been on for 2 weeks now, and my doc has me on 1ml of test a week, 25 mg of Exemestane a week, 15 mg of DHEA daily. I’m Canadian, or I would have come to you. His explanation was that my estrogen levels were already elevated.

Gynecomastia is genetic. If you don’t have the genetic predisposition you won’t get it no matter how much testosterone you take. It is actually very rare although men fear it. I have had 2 cases in 15 years. Now, If a man develops symptoms of gynecomastia when he initiates testosterone therapy we would use a short term aromatase inhibitor until the patient could have the curative surgery which is removal of the glandular tissue. Both patients had surgery and are living happily ever after with great testosterone levels and no aromatase inhibitor.

[ChessGuy]

I have a California license if that is helpful to you. A level of 639 does not mean you would not benefit from treatment. Most important is the free testosterone level not the total.

Well, my free testosterone lab test just came back at 49. Way below avg even for a 70 yo guy. Going to have to make an appointment with an endocrinologist soon.

[Mark Rippetoe]

Well, my free testosterone lab test just came back at 49. Way below avg even for a 70 yo guy. Going to have to make an appointment with an endocrinologist soon.

Endocrinologists treat diabetes. Don't waste your time with that.

[Steven Kalin]

Gynecomastia is genetic. If you don’t have the genetic predisposition you won’t get it no matter how much testosterone you take. It is actually very rare although men fear it. I have had 2 cases in 15 years. Now, If a man develops symptoms of gynecomastia when he initiates testosterone therapy we would use a short term aromatase inhibitor until the patient could have the curative surgery which is removal of the glandular tissue. Both patients had surgery and are living happily ever after with great testosterone levels and no aromatase inhibitor.

This was pre TRT, and I’ve kinda always had gynacomastia, even when I was a boy. Even when I was a stud athlete. Used to bother me quite a bit, but don’t really care these days, except as it pertains to this. It kind of is less embarrassing as you get the right kind of bigger.

[J. Keith Nichols MD]

This was pre TRT, and I’ve kinda always had gynacomastia, even when I was a boy. Even when I was a stud athlete. Used to bother me quite a bit, but don’t really care these days, except as it pertains to this. It kind of is less embarrassing as you get the right kind of bigger.

Just make sure we don't confuse true gynecomastia which is glandular enlargement with pseudogynecomastia which is an increase in body fat. Testosterone therapy will actually decrease and improve pseudo gynecomastia without the use of an aromatase inhibitor.