Patients with ‘low T’ complain they often can’t get prescriptions from their own doctors
That research shows that when the symptoms patients complain about — be it fatigue, low libido, or mood disorders — are caused by low testosterone, replacement therapy through gels, pellets, or more often, injections is typically successful in alleviating their symptoms. And with medical guidance and monitoring, side effects, which include testicular shrinkage, reduced sperm production, and breast tissue enlargement, can be controlled.
“We tend to talk about the lengths that men go to as if this is worthy of ridicule, that men would undergo procedures or take elixirs or whatever it is, all seeking to preserve their youth,” said Abraham Morgentaler, a urologist who has been studying testosterone deficiency since the 1970s, and is currently a Blavatnik faculty fellow in health and longevity at Harvard Medical School.
Men who are feeling fatigued, depressed, and generally unwell may find that mainstream medical practices often don’t as much as acknowledge their symptoms as worthy of investigation, let alone engage with the hypothesis low testosterone may be at play. Major physician groups also give conflicting guidance on when testosterone levels are low and therapy is warranted. And so, men look elsewhere.
Morgentaler said “the online comments that the doctors don’t know anything about [testosterone] are accurate, and I can’t tell you how often in my career I’ve had patients come see me who’ve gone from doctor to doctor and [they] have been told that testosterone deficiency and testosterone therapy represent fringe medicine … Many of those patients are deficient in testosterone and respond very nicely to treatment.”
Several patients who eventually started testosterone therapy told STAT they felt that their doctors weren’t familiar with testosterone replacement, or were unwilling to support them and monitor their results. “My primary care doctors — I had two because I moved — both said the same thing: ‘You don’t really need to test that, you’re fine’,” said Dan B., 43, who had complained about feeling lethargic and in a low mood. (Like many of the men interviewed for this article, he asked STAT not to use his full name to protect his privacy.)
Plus in the U.S., “there is incredible availability of testosterone products,” he said, noting there are 17 on his hospital’s list. “So the utilization of testosterone therapy in America is far greater than in other places in the world, including continental Europe.”
Most general practitioners are disappointing. If you find a good one keep them around. Personally I’ll just take care of myself unless it is an emergency. I imagine in the future overall health clinics that take blood tests and other tests and prescribe a range of longevity and healthspan medicines will be the norm.
None of my doctors have any idea of the revolution occurring in personal medicine. Traditional doctors are no longer the gatekeepers they once were. Thanks to India, I can have my own virtual pharmacy. Thanks to peptides, I can treat conditions that may be beyond the reach of conventional medicine. And thanks to AI and sites like this, I can acquire enough knowledge to be my own concierge physician.
I think it needs to be unpacked. As many as 70% primary care doctors in US are employed and must practice institutional medicine prescribed their employer. This means they must follow the protocols and not be over utilizers. And, if they dont their managers would tell them that they are over utilizing resources. Then, of course insurance companies come into play. They would want to deny pretty much anything if they could.
The reality is that pcp or even some endocrinologist have no idea how to treat hormone issues. The situation is even starkee for women. Most doctors probably still think hrt will give women cancer. That “shady” clinics are solving real problems that people have are more a reflection on mainstream care today than anything else.
I think the big problem is whether the “dubious online clinics” are actually doing it right.
Many of these clinics take the approach of their only options being TRT vs. no TRT.
It is critically important to assess root causes and assess LH/FSH/Prolactin and make sure any testosterone level is drawn before 10am and only pay attention to the free testosterone to guide treatment decisions.
The problem with jumping to Testosterone, is that it causes irreversible testicular atrophy over time, and whatever testosterone you could make when you initiated therapy will gradually be eroded. So it then becomes a lifelong therapy, which might have been unnecessary.
Now if a patient’s LH/FSH are already high … and free T is low, we probably really have an issue of testicular failure. Otherwise, it is much better in my opinion to do things to effectively bump up the LH and see what testosterone production one is capable of. Instead of atrophy, you’ll have more active testes. If you happen to stop down the line, you’ve lost nothing.
Quite importantly, items like stress, lack of fitness, obesity, metabolic syndrome, diabetes all play in to one’s brain not generating adequate LH/FSH … and often times, with good advice, once these issues are solved, there is no need for any therapy - things are fine off of the drugs. However, head down the quick path of TRT and you’re now on lifelong therapy.
There is absolutely a place for direct testosterone supplementation, but, in my experience, only a small % of men end up needing this, and I have good success with other approaches.