Low T? [Testosterone]

[Koolbreeze]

Very interesting discussion, guys. I was diagnosed with low T fourteen years ago at age 32. It all started as a result of my wife not being able to get pregnant. The cause ended up being me having a low sperm count. I started out with a urologist who ultimately referred me to an endocrinologist. The endo treated my low T with HGH injections initially, hoping to boost my sperm count. It helped a little but not much. Once my wife was able to get pregnant via Intracytoplasmic sperm injection, he recommended we switch to a gel to treat the low T. I did that for a few months, but ultimately got a 2nd opinion from a different endocrinologist who recommended against treating the low T since I had no symptoms other than a low sperm count. I think my levels were in the mid-200s, but I need to locate those lab reports.

At the time, my insurance also wouldn't cover the cost of treatment (not sure about now). A few years ago I had my PCP recheck the levels and he also wanted me to begin testosterone replacement therapy using a gel. But I declined due to the insurance issue and the fact I wasn't having any symptoms.

Being recently diagnosed with mild sleep apnea makes me wander if there is a connection to the low T. At the time I was first diagnosed, sleep apnea diagnoses weren't near as prevalent as they are now in my area and I was never checked until recently. But I've also been overweight the entire time, so that too may be related.

At any rate, I'm second guessing my decision to not treat the low T now and intend to get the levels checked again soon and to research it more. But how does a person go about identifying a good doctor to treat it? My PCP is certainly willing, but I'm wandering if I may be better off with a specialist in the field.

[Sleeprider]

Koolbreeze, your question is very good. The problem with specialists is they are often financially vested in getting you into treatment, and having recurring exams, prescriptions and testing. The tests can be relatively simple and easy to interpret. What gets complicated is if it is a priority to maintain fertility, and balance the complex interacting hormones other than testosterone. There are not many doctors that do that. My care is with my primary care physician who is an internal medicine specialist. Having been through the urologist and endocrinologist, I just decided they had little to offer in a recurring prescription of T-cypionate and stable exogenous hormone levels. So the answer in part is dependent on your objectives. Be aware that Testosterone is a highly controlled Class III drug defined as drugs with a moderate to low potential for physical and psychological dependence. That usually means recurring 6-month exams or physician encounters, and some follow-up testing. In most cases this is like apnea, where the therapeutic need is considered lifetime.

If you go with an endocrinologist, be sure (s)he is engaged in male hormone replacement and not just diabetes. If you go with a urologist, beware the Cystoscopy, which these guys think everyone should have and is the main reason I don't use a urologist for this care.

[Koolbreeze]

Sleeprider, thank you very much for the information. I'm beyond the point in my life where I'm concerned about fertility. I hope anyway, as I can barely keep up with my grandson. I didn't think about the possible conflicts involved with a specialist. Whatever happened to doctors having their patient's best interest at heart instead of that of the drug & insurance companies. I do trust my primary doctor and respect his opinion, although I don't always agree, such as was the case when he recommended testosterone replacement a few years ago.

It's hard to know what to do when doctors disagree but since I didn't have any symptoms, I elected to not treat it. One of the main reasons for that was the life long dependency it may create. I still don't really have any symptoms that I can clearly put my finger one and say low T is why. I don't have the energy I once had, but I'm tired all of the time either. I also see from what little reading I've done some still don't recommend treatment absence symptoms. I do intend to have it checked again but where I go from there I'm not sure.

[Sleeprider]

I would say if you don't have the usual symptoms of fatigue, brain-fog, "stamina" and a few other choice problems, then why worry? I certainly wouldn't have pursued this for nothing. OTOH if you're wondering if V***** or C***** is a substitute, or other related issues are something you work around, then HRT might be worth considering. It certainly should be based on your perceived needs and impact to your life (if any).

[Koolbreeze]

It hasn't impacted my quality of life at all that I'm aware of. That was the main reason one 1 of the endocrinologists that I saw recommended against it. Still I worry about the long term effects of low T on my body. But to be honest, I seem to have become somewhat of a hypochondriac over the last year or so according to my wife.

At any rate, thank you for the information and discussion.

[MoApnea]

Still I worry about the long term effects of low T on my body. 

I don't think there are any long term effects if you are asymptomatic.  I think being on TRT comes with way more baggage.