When we undertake any treatment related to our health, our primary concern is always finding the best treatment available. For the man who suffers from low testosterone, this desire is no different. Unfortunately, as many men can attest, finding a physician who will treat low testosterone appropriately can often feel like an impossible task. Increasingly, doctors all over the world are becoming more comfortable and more educated on the topic. However, there are still many physicians who view the treatment of low testosterone as unnecessary. In their view, testosterone levels decline as we age; it’s natural, and we should deal with it. Interestingly enough, doctors do not look at other aspects of health in this manner, but testosterone has for years held an odd place in medical culture for numerous reasons we will not delve into today. Right now, we simply want to know how to go about this process, finding the right testosterone replacement therapy (TRT) doctor to meet our needs.
Hormone Clinic Finder Directories
When googling "TRT doctor near me", you usually see many clinics listed in ads. But how do you choose the best clinic for you? Surprisingly, there are no reliable doctor directories in the field of testosterone and hormone treatments not only in the United States but internationally. Fortunately, a new directory is making it now possible for men and women around the world to find a hormone clinic near them. Just visit the site and click on “Search”. If there are clinics in your area, you will receive emails from them giving you information about their services. You can customize your search by health issue and TRT and related products that are of interest to you.
Main Questions to Ask a TRT Doctor
Once you have found a physician who treats low testosterone through TRT therapy, you’ll find this is merely the first step. The far more important, and sometimes a bit more difficult step is finding a physician that prescribes TRT properly. As the old saying goes, there are many ways to skin a cat, and that’s true with TRT. However, there are also ways to skin the proverbial cat that can be ineffective, problematic, and in some cases, what we might even call disastrous.
First, educate yourself as much as you can by reading a testosterone book like "Testosterone: A Man's Guide" and reviewing posts on the leading TRT forum ExcelMale.com. That knowledge will make you an educated patient that can more easily advocate for himself when asking questions to a potential TRT doctor or clinic.
Once you’ve found a doctor that will treat TRT, there are several questions you need to ask the physician before moving forward. There is a chance your new physician isn’t going to want to answer some of these questions. Some doctors feel like you’re questioning their wisdom and knowledge and, more or less, want you to sit down, stay quiet, and take what they give you question free. Understand, while your physician does deserve a measure of respect, as all human beings do, he/she also works for you. You’re the one paying the bill. If the physician in question is not willing to answer a few basic questions and discuss things back and forth, you already know it’s time to find someone else.
If your TRT doctor is willing to discuss things before moving forward, here is a good starting point list of questions you’ll want to ask him or her:
1. How long have they been treating patients with low testosterone, and how many are they currently treating?
The answer to these two questions isn’t necessarily a deal-breaker if they haven’t been doing this for long or haven’t treated too many. What’s most important is that they understand the proper treatment. However, this question may be an early indicator if the numbers are low. Regardless, let’s keep moving forward with our questions.
2. What type of TRT treatment options do you prescribe, injectable, creams, or other options?
As any experienced doctor, or patient for that matter, will tell you, self-administered injectable testosterone may be the best and most cost-effective way to treat low testosterone. But for men who are not comfortable with injections, testosterone gels/creams may be an option. Other TRT products are pellets, nasal gel, oral, long acting injections, and others.
3. Do they accept insurance or cash pay only?
If they accept insurance, great, go ahead and take advantage of this if it’s coupled with proper treatment. However, if you find, in your case, you can only receive top of the line treatment on a cash pay basis, you will probably need to veer in that direction should your budget allow it.
4. Do they prescribe HCG along with testosterone, or have it available as an option for treating testicular atrophy or helping to preserve fertility?
Many men enjoy the added benefits HCG can bring with their overall TRT. Younger patients, in particular, enjoy knowing their ability to conceive will remain greater than without HCG. Unfortunately, many physicians, even those more versed in the basics of testosterone than the average doctor, do not understand the benefits of HCG plus TRT treatment. This could be a red flag, and a new doctor may be in order.
5. Do they prescribe other products like aromatase inhibitors (AI’s) when needed to help control testosterone-to-estradiol, or ED medications?
When on testosterone replacement therapy, it’s not enough to simply optimize our testosterone levels; there is an entire balance of hormonal levels that must be achieved, and one of the primary hormones to consider, other than testosterone, is estradiol. High estradiol levels may lead to undesirable side effects. Gynecomastia, water retention, erectile issues, and a host of others may occur. Make no mistake, contrary to much of what you may have read online in forums, most men will not need an AI in the long term, but the ability to have one prescribed if and when needed is essential.
6. Blood testing: how often is your doctor going to run lab tests? What are they going to check on the lab report?
- Beyond the initial test, labs should be run every 6-8 weeks until your levels are stable and in a good range, which may take 3-6 months. A “good range” should be associated with not merely the numbers on paper but how you feel.
- Make sure to ask your physician if they’ll be checking both total and free testosterone on your lab work. Total testosterone alone is not enough.
- Make sure you ask your doctor if they will check estradiol levels by ordering the sensitive estradiol test, not the standard estrogen lab report. It is important to mention that the sensitive estradiol test is not available in some countries. The regular estradiol test usually overestimates estradiol by 20% or more due to interferences with inflammation markers. There is still a lot of debate on the need to manage or treat high estradiol in men on TRT
- Your doctor should also monitoring hematocrit and red blood cell count. Your doctor should be able to call in an order for a therapeutic phlebotomy at the local blood center for you to donate blood.
- Some physicians like to also check thyroid function since low thyroid (hypothyroidism) can have some of the same symptoms as low testosterone, so bring this up!
- Keep in mind; if your doctor is open and understanding, they will allow you to order your own labs, which will allow you to ensure you’re getting the exact lab tests you need through avenues such as DiscountedLabs.com
7. Do they offer prescriptions for therapeutic phlebotomy for high hematocrit?
It’s possible that your blood may become a little too thick with TRT, but it is not an alarming issue if it’s one we correct, and correction is quite simple by going to a blood center and donating blood. If your physician is ordering the correct labs, as discussed above, you will be able to keep an eye on this potential issue and eradicate it easily through phlebotomy if needed. Be aware of the risks of frequent blood donations since they can decrease iron and ferritin causing extreme fatigue. Never donate more frequently than every 2.5 months.
8. Do they offer other treatment options, such as erectile dysfunction medications, high blood pressure meds, or other wellness options?
You may or may not need these things, time will tell, but it’s always best if such items are on the table if and when needed.
5. One of our most important questions we will need to ask our doctor: do they allow self-injecting at home?
If the testosterone injection protocol is correct, which will be part of our next question, there is nothing more irritating than going to the doctor every single week, if not multiple times per week. There is no reason your doctor should not allow you to inject yourself at home. If they will not, find a new physician.
6. Injection protocols: Ask your doctor if prescribing testosterone cypionate or testosterone enanthate, the two most common forms of testosterone prescribed, what their typical injection protocols look like?
If your doctor prescribes injections once every two weeks or more infrequently, ask him or her if you can inject very week or twice per week instead. Some men feel TRT’s effects wearing off by day 12-14 when using every two week injection frequency. Also, if they do not allow you to inject under the skin (subcutaneously) with an insulin syringe instead of older methods of injection, ask him or her why. New data shows that subcutaneous injections are as effective and deep intramuscular ones, and they are less painful.
7. Does your TRT doctor work with compounding pharmacies or allow you to work with the pharmacy of your choice?
If your insurance pays for your TRT, then make sure you shop around for the pharmacy that provides the lowest copay if possible. If you are self-pay (cash basis), compounding pharmacies have lower prices for injectable and transdermal (gel or creams) testosterone products.
A good physician will write your prescription for generic, which will allow you to go to a compound pharmacy and receive the same testosterone you would from a big box brand at a fraction of the price. A good physician probably already has a relationship with a compounding pharmacy, making this all the easier. As an added bonus, you’ll often find the customer service at a compounding pharmacy to be superior to what you’re used to at your local pharmacy.
8. Ask your doctor how many times they will require you to come to the office. If it’s more than twice a year, this doctor probably isn’t for you.
It’s also important that you know beforehand that the doctor will allow you to see your lab results and that they will be transparent in their discussion with you. If this isn’t the case, go somewhere else.
9. The final question you’ll need to ask is an important one as each individual’s situation is different: what’s all this going to cost me? How much will the doctor's visit cost, including any follow-up visits? How much will blood work cost, including follow up labs? Finally, how much can I expect to pay monthly for medications, and are there any other fees I need to be aware that may exist?
As you can tell now, preparing yourself for your first TRT doctor visit is important to ensure that you made the right choice and to clearly define expectations and cost.
Visit ExcelMale.com for educational information about TRT treatment options and other men’s health options.