Is it time to find a new HRT doctor?

[punxweb]

I have been through a few doctors. My most recent doctor has been decent to me but I am losing my patience with him. I have been seeing him for a little over a year now. We have determined that I have adrenal, thyroid and testosterone issues. He has been somewhat receptive on treatments but I am having issues with him not getting things done soon enough. He refuses to treat my adrenals with anything more than dessicated adrenal tissue. My cortisol levels are still low in the morning and I am dragging ass all morning. My thyroid test values are still out of whack. I am getting T3 and a compounded T3 & T4 pill like Armour but my TSH regularly fluctuates between 4 and 10. T3 & T4 values are good, RT3 is high. My testosterone value has never been above 600 but that was for only a month. He has given me test cream that I needed in very high doses but my body did not absorb it well. I fluctuate monthly from 250 to 600. He recently gave me Adrogel but the dose he requested insurance would not cover and now my levels have been at 300. I have requested T shots and HCG but he was not comfortable with this. He spoke with a specialist and he agreed HCG would be good but wanted me to take 5000iu per week but only after some other therapy. He did not want me on shots because the specialist believed I could get off HRT and get back to normal because my LH and FSH are not gone even though I have been on HRT for a year now. I am 28 and sick and tired of feeling good one month and like **** the next. I know this HRT journey is a rough one, but am I being too impatient? Is it time to find another doctor or should I stick with this guy? I am in the Tampa Bay FL area and I would hope there is some decent docs in the area. If anyone has any suggestions, they would be much appreciated.

 

[EasyEJL]

Find another doctor. I'm less sure on the adrenals + thyroid issues, but know of a doctor you can at least consult with on the testosterone portion. In some ways he's right though. At your age, and likely not having had kids yet I can see why he'd want to have you try other things (although I see no real reason why androgel or test cream would be less suppressive than injections)

 

[punxweb]

Easy, I think he is right about me possible getting back to normal. I am not sure which is primary or secondary but I had old blood work that showed I had low LH and FSH before I started HRT. I am pretty confident that a low dose HCG monotherapy would work well but the doc is scared of it because he does not know much about it. I have been lucky enough that this doc accepted my insurance up until November, but there would be no way I would still be seeing this guy if I would have to pay the total out of pocket. I will be paying the total out of pocket from this month on so that was half the reason I was questioning his process and my patience. If you wouldnt mind sending me a PM on the doc, I would appreciate it. By the way, I am in Bradenton.

 

[EasyEJL]

Realistically if you think low dose HCG (or possibly Clomid) monotherapy may work then its probably worthwhile to pursue that yourself as it will be a lot cheaper. My doctor doesn't take insurance either so it gets quite expensive quite fast. But HCG or Clomid solo is pretty inexpensive, and realistically you could just get a blood panel at 3 months in to see where it is going.

 

[punxweb]

The blood work for me is simple. I have a doc friend that allows me to get whatever test I need and insurance covers 100%. The HCG seams to be hard to find locally and I do not know of a reliable source on the net.

 

[Philec48]

Have your serum zinc checked. Low zinc can lower testosterone, it can also raise reverseT3. May be good to check selenium level, too. The body needs zinc and selenium to convert T4 to T3, otherwise, it makes mostly RT3.

And get a good vitamin D3 supplement if you don't get much sun time.

 

[punxweb]

I take 3 ZMA every night. I am also a florida boy so I get more than enough sun. I know you are inteligent on the subject phil, any other suggestions?

 

[Philec48]

For your testosterone, ask your doc about getting a script for compounded T. It's much cheaper than the A-Gel. You may absorb better with PLO-based gel than with the alcohol-based.

Your TSH numbers are just too high. Maybe your doc will adjust the dosage of your Armor. Are you taking it on an empty stomach, and then no food for at least 30 minutes after?

 

[The Matrix]

I take 3 ZMA every night. I am also a florida boy so I get more than enough sun. I know you are inteligent on the subject phil, any other suggestions?

Bull crap about living in florida and getting proper sun.
I have numerous patients from florida that were tan as all can be and were SEVERELY VITAMIN D deficeint <30 ng/dl. Taking ZMA does automatically mean you are absorbing it. Most likely your thyroid is out of balance and needs to be properly investigated by good Dr.

 

[punxweb]

Phil, I was using a PLO based cream before but the specialist that my doc consulted with suggested that I switch to Androgel. I am not overly impressed with it. Per your and the Matrix suggestion, I will get my zinc and selenium checked. Is there also a test for vitamin D? What is a good dosage schedule for a vitamin D supplement and what would this aid in as far as test and thyroid issues?

 

[punxweb]

Phil, I typically take my thyroid meds an hour after I eat. Is that ok?

 

[Gutterpump]

One suggestion about your reverse T3 being high.... if this is the case, you should probably not be on armour or it will continue to cause problems. You should possibly try to lower it by taking T3 only, for a while...and then introduce it again once you've tested it to have lowered. I'm doing this right now myself.

 

[punxweb]

Not a bad suggestion gutter, I have asked my doc to do this but he is hesitant.

 

[Philec48]

One hour after you eat, there is still enough food in your stomach that may keep your Armor from fully being absorbed.

The test to measure D3 is "Vitamin D, 25-Hydroxy". You can order it at privatemdlabs.com for $59.99.

I take NSI brand D3 ordered from vitacost. Each is 2000iu. I used to take 3 each day, but now take 2. You need to eat some type of fat along with it to aid in absorption.
I take 5gm fish oil at the same time.

 

[Gutterpump]

punx, you can break the armour / nature thyroid / compounded thyroid into two (or take the cap apart) and take it sublingually. Then you won't have to worry about meals so much. I hate timing things myself, so this is what I do, even with my hydrocortisone.

One of the only things I don't take sublingually is isocort. I take this with bioperine right now since I am out of hydrocortisone.

 

[punxweb]

Thanks for the suggestions, gutter and phil. What would having low vitamin D levels effect?

 

[punxweb]

I will try the sublingual thing gutter. I hate having to time this stuff also.

 

[The Matrix]

I will try the sublingual thing gutter. I hate having to time this stuff also.

In clincal response many patients thyroid have kicked back into high gear by simple applying vitamin D protocol (goal is 60-80 ng/dl)

 

[punxweb]

Thanks for the input Matrix.

 

[punxweb]

Went to the hrt doc yesterday. He has always been reluctant about using HCG and also treating my adrenals. Yesterday he gave me a script for 5000IU twice per week and also 5mg HC every morning for my low morning cortisol issue. Hope fully I will respond well to the HCG. I think the dose he suggested was a little high. I asked if I could start off at 1000IU twice per week and he said that was fine. Any suggestions as far as dosing? I am surely secondary, so I think I will respond well.

 

[EasyEJL]

even 1000 is high for long term use

 

[Philec48]

HCG at more than 500iu in one shot risks raising estradiol.

 

[ProfBush]

Have you read Dr. Crisler's HCG protocol?
In it, he says he has very seldom seen a patient who required more than 350 IU per day.

 

[punxweb]

I need to raise my estradiol. Last blood test I was at 12 without any AI. I have no idea why it is so low. I have read that on allthingsmale. I have to jump through some hoops so I can get my insurance to pay for it. Does anyone know what it typically cost from the pharmacy?

 

[punxweb]

I am going to start taking some DHEA. I read that that can help raise estradiol. My levels have always been low.

 

[EasyEJL]

i pay roughly $1/100 iu

 

[punxweb]

I have received quotes for between $150-$115 per 10,000 IU's. That is pretty steep! Found out insurance will not cover it. Is there a way to get your insurance to cover HCG?

 

[Philec48]

Reconstituting 10,000iu is wasteful, as it only lasts about a month in the frig. See if you can buy 5000iu at a time.

 

[punxweb]

Every place I called only had 10,000IU vials available. I am going to make some more calls tomorrow.

 

[The Matrix]

Reconstituting 10,000iu is wasteful, as it only lasts about a month in the frig. See if you can buy 5000iu at a time.

break open the lid
Cut it with a clean razor blade and make 2 5,000 ius out of 10,000 ius
i have alot of clients doing this and not having any issues plus are saving alot of money.

If you are unsatified with your DR please Pm me and i be glad to give you a good reference..
One that will look at your from a holistic view and also focus on adrenals, thyroid, and other issues along with testosterone, and e2.

 

[punxweb]

That is a great suggestion Matrix. I was wondering why you could not just make two 5000IU vials.

I think, for the moment, I am going to stick with the Dr that I have. He finally came around and started treating my adrenals with HC and my low test with HCG. If I come to a sticking point with him, I will be sure to shoot you a PM for a suggestion Matrix.

 

[DT5]

if you need a doc, no matter where you live, PM me (if your over 30 years old)