Author Topic: 27 yr old with possible low T symtpoms, advice needed in getting evaluated  (Read 626 times)

nick

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Hi Charly,

I see you are in Wales. It's no surprise that the relevant info hasn't penetrated that far yet, but its good your doctor is prepared to refer.

I'd say the Andrology clinic in London is a good bet to get the help you need. Not sure if you could be referred to Prof Geoff Hackett, who is closer in West Birmingham, but either would take your issues seriously even on 12.7.

Prof Hackett is at Good Hope Hospital Treatment Centre
Good Hope Hospital, Rectory Road , Sutton Coldfield, West Midlands, B75 7RR

As to your questions:

The UK guidelines state LH and FSH need to be taken in addition to Serum Testosterone and no lab should refuse to do those tests as they define Primary from Secondary Hypogonadism. Others like Free T SHBG and Oestradiol are not essential to the initial diagnosis so would not normally be ordered from a GP's office.

ignoring symptoms is not good doctoring in my view, but in fairness the adherence to numbers dictated by the NHS is nothing new.  Education about the facts has not been circulated with sufficient emphasis on how it changes the historic attitudes and approach towards hormones in mens health. Hence my opening comment.

Lets hope he gets the guidelines quick and reads them.

Borderline has two thresholds now. One between 8 and 9 which is borderline clinically low, the other 12 - 13 which is borderline upper treatment threshold.

The target for therapy is a modest 15 nmol/l which is alright for some, like me for whom the halcyon days of youth and middle age are long gone.

The difference between going private and NHS in situations like this is time. Getting an appointment with either NHS options will take time, although it can be shortened by a phone call to the relevant office begging for an early appointment or saying you could take a cancellation.

It's not something anyone can advise on really because you need to weigh up the pros and cons yourself and how it affects you.

If your GP would be prepared to accept the word of doc Savage and prescribe thereafter, it is clearly an option to consider.

If you are prepared to wait it out to get the help on the NHS whilst educating your GP so others can benefit down the road, that is your choice.

I hope it helps,

Cheers,

Nick
You have all the info from Matt and myself so the choice is yours.







charlysays

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Thanks Nick, much appreciated. Got some points now that I can really stand against.
It seems ridiculous that most other people going through this don't seem to have any trouble getting a testosterone panel done. Tuesday I will check that he has the guidelines by calling reception then arrange a phone call with him some days later.

Thanks again

charlysays

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So here's a link to a scan of all the bloods which were done in February.

TSH looks a little bit high but is well within the wide normal range? FT4 seems ok.

https://s18.postimg.org/yqbdwfzzt/results.jpg

With regards the other tests suggested way back by Olly and Craig suggested I''m still working on it. My doctor surgery is two doctors down at the moment and I've been seeing a locum GP who comes in once a week or something so it can take 3 weeks to get an appointment, even a phone call! Hopefully he'll have read my letter and the guidelines I supplied by my next phone call with him.

On another tack I decided to go and see Dr Savage after talking on the phone with him (he phoned me back personally the next day after I made an enquiry). He says he can most likely do the missing tests inclusive of the consultation fee and should clomid be an option it would cost circa 10 a month. This has got to be worth a trial seeing as I've got a whiplash claim coming through (so some funds for such frivolities as my wellbeing lol) and I can see him on Saturday may 20th or earlier if I go for a week day. I have a friend in Manchester which isn't far from Doncaster I can stay with.

If it looks like I might need TRT then I'd have to think carefully re fertility etc and at the very least try to get the GP to prescribe on dr savages recommendation as the costs would be far higher.

Olly13

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So here's a link to a scan of all the bloods which were done in February.

TSH looks a little bit high but is well within the wide normal range? FT4 seems ok.

https://s18.postimg.org/yqbdwfzzt/results.jpg

With regards the other tests suggested way back by Olly and Craig suggested I''m still working on it. My doctor surgery is two doctors down at the moment and I've been seeing a locum GP who comes in once a week or something so it can take 3 weeks to get an appointment, even a phone call! Hopefully he'll have read my letter and the guidelines I supplied by my next phone call with him.

On another tack I decided to go and see Dr Savage after talking on the phone with him (he phoned me back personally the next day after I made an enquiry). He says he can most likely do the missing tests inclusive of the consultation fee and should clomid be an option it would cost circa 10 a month. This has got to be worth a trial seeing as I've got a whiplash claim coming through (so some funds for such frivolities as my wellbeing lol) and I can see him on Saturday may 20th or earlier if I go for a week day. I have a friend in Manchester which isn't far from Doncaster I can stay with.

If it looks like I might need TRT then I'd have to think carefully re fertility etc and at the very least try to get the GP to prescribe on dr savages recommendation as the costs would be far higher.

Yeah I think you've got the right idea to be honest, seeing Dr Savage would insure your in the right hands, he's usually one to try clomid as a therapy, if not then yes he can usually write to your gp which is what he did in my case, so that's saves on money.

You tsh is about the same as mine, it's not too high, however from what I understand  under 2 is more optimal, so keep an eye on it, given your fT4 is good then that's OK, you could get fT3 checked at some point to be really sure, as that matters a little more than fT4, since fT4 converts into fT3 which is the bio available one.

Your concerns over not being able to get hormonal tests done are common sadly, I've had issues at the start, as when a Dr thinks your fine then they don't like wasting time or money doing anymore, normally just being assertive and explaining why you want it doing will help, even if it's just to humor you.

Olly.

Olly13

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Just looked again, what's your vitamin D levels like?

Judging by your low normal calcium, it's possibly not optimal.

Might be worth looking at.

Olly

charlysays

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Yeah I think you've got the right idea to be honest, seeing Dr Savage would insure your in the right hands, he's usually one to try clomid as a therapy, if not then yes he can usually write to your gp which is what he did in my case, so that's saves on money.

You tsh is about the same as mine, it's not too high, however from what I understand  under 2 is more optimal, so keep an eye on it, given your fT4 is good then that's OK, you could get fT3 checked at some point to be really sure, as that matters a little more than fT4, since fT4 converts into fT3 which is the bio available one.

Your concerns over not being able to get hormonal tests done are common sadly, I've had issues at the start, as when a Dr thinks your fine then they don't like wasting time or money doing anymore, normally just being assertive and explaining why you want it doing will help, even if it's just to humor you.

Olly.

Cool :) yeah since I've seen that my levels are borderline according to the guidelines rather than just low-normal (like 14) I'm more keen to move as quickly as possible on this. I'm just sick of the uphill battle to keep my head above water mentally and physically, the much reduced libido and lack of interest just play on all of this and set up vicous circles which I do my best to disrupt with meditation and exercise.

I'll see what the doc says if he ever gets round to reading my letter asking for the extra tests and the guidelines. Good to hear my thyroid looks OK at face value.

Doc Savage said he usually sends a sort of CV noting the papers he's written and usually GPs are then interested.
So all your medication is on NHS prescription/ free now?

I'll keep at it over the tests including the vitamin D. Well spotted with the low normal calcium, cheers!



charlysays

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So I went to see Dr savage. Very nice bloke and took my concerns seriously.
He looked over my blood tests, had me fill out a questionnaire,  physical exam etc and said that as per the guidelines I should undergo further testing and trial some treatment.

He wasn't concerned much about the prolactin but will be checking it again.
He's prescribed me clomid 25mg ED and has written to my GP with his CV, diagnosis and requirements for monitoring.
I'll try and get some clomid early next week,  he said to pay not much more than 20 a box,  a box lasting two months,  so I'll shop around a bit.


He said it works about 75% of the time and that young men like me with no obvious pathology can sometimes taper off it after 6 months to a year or so and maintain most of the improvement. Will update when he's sent me the latest blood results 😊

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