As some of you have seen from my previous posts, back in September my T levels were at 275 with a free T of 111 (I am 27 years old). I was told at that time to consider trying androgel which I refused to try due to not knowing anything about it. My symptoms of fatigue, low interest in sex and ed continued thru the winter months. I went back to urologist (saw his physician's assistant) in March and my T level had dropped to 230. At this point, I decided to try androgel. I have been on androgel (5g) for approx. the past 7 weeks. Weeks 1-3, my fatigue vanished and my energy levels shot thru the roof to where they used to be. Then in weeks 3-5, my sexual interest and desire came back to almost normal. I had spontaneous erections in morning, throughout the day and the strength of my erections were back very close to normal. After week 5 I had blood work done in preperation for my doctor's visit today. My levels were as follows: T level 426, WBC 10.1, RBC 5.32, Hemoglobin 15.4, Hematocrit 44.7, MCV 84, MCH 28.9, MCHC 34.4 However, over the past 2-2 1/2 weeks these effects have begun to wane and I am virtually back to where I was before...low interest in sex, low strength of erection, etc. I expected this as Hayfarmer warned me the natural production of my body's T could be cut off by the artificially inserted T (androgel) into my body. To make a long story short, I had scheduled an appt. with the urologist today and he was so busy, he pawned me off onto the PA again. The PA had no explanation for why the androgel was not working. I explained to him what you had said Hayfarmer and he did not think it could be the case. He did say that I had primary hypogonadism but could not explain it well to me. In summary, he referred my to an endo and tried to rush me out the door. I am about at my wits end with all of this. I would like to see another urologist before going to an endo. If you guys could please answer a couple of questions it would be helpful....


1) What do you folks make of what I have described above and in previous posts..I am not panicking...I still feel like this will be resolved, but frustration is setting in.
2) Does anyone know of any good urologists in the Charlotte, Raleigh, NC areas..I had considered looking for a doctor at Duke University Medical?
3) Hayfarmer, I am not against flying to Penn to see Dr. Shippen as a last measure. What is the name of his practice? Do you think he would see new patients?
4) I played soccer in high school/college. Has anyone ever heard of any pituitary/thyroid issues relative to constant heading of a soccer ball over the years.

Sorry for the long post...Just very concerned...I had a great sex life w/ women up until last summer when these symptoms started to occur. I still have decent sex but in many cases I have to use viagra before hand.

Any help would be greatly appreciated. Thank you.

Couple of comments. yes it does sound like your hpta is shut down due to external t, happens to most people. Any doctor that practices TRT should be aware of this, i feel there just arnt any excuses for doctors having such little knowledge of trt and prescribing it. My advice is to get out of there. As far as Shippen he is very knowledgeable but he dosnt always take new patients. I see Dr Crisler who is another expert in the field, he is in Michigan. Yes its possiable to mess with the pit gland from head injury, i dont know how hard you were getting hit in the head though.

I think Joe got it all right. You can sustain pituitary damage from a blow to the head. However it does not seem like a soccer ball should be enough....but maybe the repitition of it is? The fact is many men have pituitary issues for no known reason so if that is where your problem is you may never know if it was from the soccer or not.

I am so annoyed with doctors who do not know what they are doing and yet treat you anyway. They should either brush up or refer you to someone who knows. Just no excuse for what the PA told you. I would not bother with another urologist to be honest. In general they do not know how to treat this although there are certainly exceptions.

Dr. Shippen does take new patients last I heard but they will only schedule so many at a time and he only takes one a week on Wednesday mornings. His full name is Dr. Eugene Shippen and he is in Shillington PA. If they say he is not taking new patients try back in a few weeks. You can ask is it possible he will be again if you try back in a few weeks. Also, there was one poster here who seemed very happy with a Dr. James Biddle in Asheville, NC. I have no idea where that is in NC but from what he said the doctor sounded pretty good to me. If you search the forum for James Biddle I bet you can find his post.

Don't give up. You just need a doctor that knows what they are doing.

As you will probably learn and are learning now, finding a good doctor is the hardest part about having low T. I decided to skip all the bs and fly to michigan to see an expert. While there are some good endos out there, most of the time you will find them ignorant on current treatment protocols. A lot of them are still stuck in old school mind frame and are waaay behind the times. Not to get off on a tangent but i will be sending a letter the american association of endocronologists about how poorly misinformed the majority of endos i have dealt with are and how treatment of hypogonadism by endos needs to be handled better.It just isnt acceptable with the current knowledge we have for treatment to be so misshandled.Bottom line is low t is a very treatable illness, but has to be correctly handled.

Thank you for the responses gentlemen....A couple more quick questions....

1) Joe132 you said that it does sound like my hpta is shut down due to external T. Can you translate in easier terms for me? What does this mean? Are we talking something pituitary here?

2) Hayfarmer, Joe132, if I can find a good urologist, is it your opinion that I should see them first or is it your opinion that I need to go ahead take the next step and see an endo?


Thank you.

1. Your hypothalmus senses if testosterone levels in the body are high or low. This is how it tells to signal for more. Now if your supplying extra testosterone into the body it will sense this and stop sending signals to produce more. Now while on its own you may not be producing much, for whatever reason, you are completly dependent on the gel now. Example, without gel you had a t level of around 275. So gel maybe got t levels up to 500-600 area. Your feeling better, levels are where they should be. Then hpta stops sending signal, levels drop by 275ish and your back to where you started. Any trt practioncer should know this and should plan on a) possibly up doseage and b) using hcg which will keep whatever natural production you have going


2. Endos should know more about this then uros, for whatever reason its not usally the case. If i were you id call around to uro/endo offices and ask if they practice trt, if they test for more than just total t including estrogen, bio-t,shbg,albumin,dht, and ask if they use hcg in their protocol. May take a while depending on where you live. Also, be aware that you probably wont find a reason for why your t levels are low. Science just hasnt figured out yet what causes hpta to stop working. You can try restart protocols, which im doing now, before jumping on trt for life. You probably will have a hard time finding a doc for a restart protocol, thats why i flew out to michigan. For some guys though its just easier to jump on trt. Also be aware that not using hcg will cause testicular atrophy and possiable infertility. Something must doctors somehow manage to forgot to mention.

This question is to member Ishwardas...

You mentioned that you have seen Dr. James Biddle in Asheville. I live fairly close by and could easily make this trip...

1) How pleased have you been with him in diagnosing and treating your problem?

2) Does he have experience with T replacement?

3) How has your experience been overall with him thus far?

Thank you.

In the event Ishwardas does not reply I would look at it this way. His doctor is lightyears ahead of yours......he prescribes HCG before going to TRT. I'm assuming he would let you take both at the same time if desired. So I would either give him a try if he is close by, or travel to Shippen or Crisler who definitely know their stuff. Maybe you could even get Biddle to work with Crisler by phone. Crisler does that but your doctor has to be willing also.

Yeah, if hes using hcg before trt then he probably knows his stuff. I dont understand why more doctors dont do this first. If your secondary, then using hcg alone might be enough to get you up there.

I agree with you. But, from what I have read many men need both. Dr. Crisler does not think HCG alone works that great but Dr. Shippen does. Anyway except for lost time I think HCG alone is worth a try. If it does not get you there than add some T to the mix.

Yeah i know dr crisler likes to use both. Ive read where he feels that hcg just dosnt produce the same overall effects without added testosterone. I personaly think the combo sounds the best, t levels are up and testicles are still being stimulated. I actutaly just read about hcg called Ovidrel, its already premixed and lasts up to 6 months. Sounds much more convienent.

Hayfarmer,

Am I correct to assume from your previous posts that Shippen does not like to prescribe HCG?

No Shippen will prescribe hcg, i think most good trt docs will. Its becoming more accepted in trt, just should be more widely used.

Sorry for all the questions...I will end my interrogation after these 3...To Hayfarmer and Joe:

1) I know both of you are biased, but based off of my age and symptoms described, who would you recommend to me between Shippen and Crisler?
2) Does one specialize in a certain area of TRT versus the other?
3) I have heard that Crisler is very thorough and will spend a good amount of 1 on 1 time with the patient during the consultation. Is your experience with Shippen similar, Hayfarmer?

By the way, I called Dr. Biddle in Asheville and the first chance he had to see me was in mid-August...I cannot wait this long if at all possible. I am starting to think more and more that I need to go ahead and quit wasting time with the other docs and see a top-notch doctor.

Ask as many questions as you need, i had a lot when this first started happening to me. I would suggest Crisler due to the fact that Shippen is in the end of his career. I dont know how much longer he will be practicing medicine. I think Crisler will still be around for quite a while on the other hand. Both are top notch doctors that are great with trt and trying to find the root cause. I havnt started trt yet, Dr Crisler is trying to see if we can get my system going again. I think thats a great standpoint, seeing as im 23 and want to avoid a lifetime of drugs if I can. You will be hard pressed to find other doctors willing to try a restart if your interested in that. I think the best choice if you have the money is to see one of them.

Shippen does use HCG....don't know why I would have given any other impression and if I did I apologize to Dr. Shppen.

Which is better for you? Well thats a tough one. Joe is right in that Dr. Shippen is probably going to retire in not too long. And, Dr. Crisler is also an excellent Dr. I do know of some cases that Dr. Shippen has solved that were extremely tough to figure out. Now, I don't know if Dr. Crisler would have done the same or not....but I was quite amazed at how Dr Shippen handled at least one of these cases.

So, I can not really say but either way you go with these two, I'm sure you will be pleased.

In another thread, hayfarmer wrote “If your doctor is willing to work with Dr. John that is the way to go. It is a win for everyone. Not only will you get excellent treatment but your doctor may learn a lot so he can treat other patients.

I believe that to have been truly wise advise.

IMHO… we should help those who may “travel in our footsteps” by spreading the word.

Educate those doctors who are willing to listen. I’m fortunate to have a prmry who is willing to listen and learn…

I only know that because I told him I was going to see a specialist out of state. I asked him if he would be willing to hear what the specialist had to say and possibly work with him as I peruse treatment for my hypogonadisim.

Therefore, my advice is, stop messing around and go see the expert. Ask your primary to be involved. Then, have the expert send copies of all your records back to your primary care physician. Discuses your treatment with your primary, you will probably want your primary to do the follow up blood tests and monitoring any-way (cuts your out of state trips down to about one a year).

Once your primary sees and understands what is going on with you… next time he comes across another case, he will be better informed.

Thanks again to all you who have helped me… makes me want to help others.

one

Joe, Hayfarmer,

While I know this will sound naive....Does it not bother either of you that Crisler is just a DO and not an MD as well?

Also, I have read different things about Crisler but can you tell me what your personal experience with Crisler has been thus far?

Thank you.

Hrt81,

At first, mentally I struggled with that as well… I’m sure someone her will tell you being an endo is just a few courses above an MD and a being a DO actually takes the same amount of time… ect. ect. I will let someone who understands the credentials field the medical degree question.

However, ultimately, what I concluded is that Dr. Crisler has built his entire practice on being an expert in administering hormones and hormone related products to men. That’s a very narrow and specific practice. Research on this site and outside of this site will show you he is well respected in his specific area of expertise by many who are qualified (based on there education) above him.

If a person were still tiring to identify the particular source or problem they have then he may not be the best for that process… (not to say he isn’t good with diagnosis, just that I didn’t research his diagnostic abilities, he may well be one of the best for diagnosis as well)

If you have been accurately diagnosed, (as accurately as you believe is possible) yet your current doctors don’t understand the administration of testosterone well enough to get you better… you wont find anybody with more knowledge and experience who is currently taking new patients.

Seems to me your diagnosis is clear, if you want the best treatment… have no fear of Dr. Crisler

BTW- I spoke with Linda at his office just this morning, they have openings available as soon as Thursday May 22.

I am not one of Dr Crisler's patients but it would not bother me that he is a D.O. I also have an orthopedic doctor that is a D.O. and I have the highest respect for him. From what I have read about Dr. Crisler and from his patients testimony I believe he knows what he is doing when it comes to treating male hormones.......at least he knows way more than the average doctor in this area.

DO is the same amount of time to become an MD, DO is just a different aproach. I prefer DO to be honest, i feel they are more holistic and are more aware of the patients needs.

I did some quick research and compiled this list…

Applicants to both DO and MD colleges typically have a four-year undergraduate degree with an emphasis on science courses.

Both DOs and MDs complete four years of basic medical education.
After medical school, both DOs and MDs can choose to practice in a specialty area of medicine—such as psychiatry, surgery, obstetrics, or sports medicine—after completing a residency program (typically two to six years of additional training).

Both DOs and MDs must pass comparable state licensing examinations.
DOs and MDs both practice in fully accredited and licensed hospitals and medical centers.

Both are medical doctors; MD is specifically Doctor of Medicine and DO is Doctor of Osteopathic Medicine.

DOs can perform surgery, child delivery, treat patients, and prescribe medications in hospitals and clinic settings.

DOs look at the "total person." Osteopathic physicians focus on preventive care. Instead of just treating specific symptoms or illnesses, they look at the whole body.

DOs receive extra training in the musculoskeletal system, which is comprised of the nerves, muscles, and bones. This training gives DOs a better understanding of how an injury or illness in one part of the body can affect another part of the body; therefore, DOs have a therapeutic and diagnostic advantage.

DOs use what is called osteopathic manipulative treatment (OMT). OMT is a technique in which the DOs use their hands to diagnose injury and illness, giving special attention to the joints, bones, muscles, and nerves. Manipulations improve circulation, which in turn, creates a normal nerve and blood supply, enabling the body to heal itself.

I think DO is a better form of medicine.