Finding the Right Doc

 

Without a doubt, the most difficult part of the whole testosterone therapy process is finding the right doctor. This is the part where I see guys get bogged down and discouraged as they struggle to find someone experienced who’s within driving distance and takes their insurance and actually knows what he’s doing. All I can tell you, guys, is that you have to kiss a lot of frogs before you find your prince. You may have to switch doctors at least a couple of times before you find someone good.

My own husband went through 6 or 7 doctors before he found someone who knew what he was doing. If I recall correctly, 1 GP, several urologists and endocrinologists, 1 holistic doctor, and 1 guy who specialized in hormone therapy, but wasn’t experienced enough. We wasted a lot of time and money along the way.

There’s a really broad spectrum out there between the drive-thru testosterone therapy clinics, where you barely have to slow down to get your testosterone injection as you walk in the door and the holistic doctors who don’t want to prescribe testosterone therapy, but instead recommend snake oil and yoga chants. 30,000 om om om‘s later, your testosterone levels are still in the toilet.

So, how do you find someone good? 

The first thing you have to understand is that most doctors get zero training regarding hormones while they’re in medical school. That’s right. Zilch. Zippo. Nada. Bupkas.  In his book, “I’m Still Sexy So What’s Up with Him?”, Dr. Sloan Teeple mentions how surprised he was when he was diagnosed with low testosterone .

“Most surprising of all, perhaps, I had no clue about any of this — and if anyone should have had a clue, it was me. After all, I had studied hard for many long years to become a urologist, a glorified plumber. If any medical doctor should know about testosterone problems, it’s a urology resident. But like nearly all of my colleagues, I had received almost no training in diagnosing or treating low testosterone and the life-altering problems that such a condition can provoke.”  pg. 3

 

If a urologist, who is trained to study the male reproductive organs, gets so little training in testosterone therapy, how much training do you suppose the average GP receives? You’d think you’d have better luck with an endocrinologist. After all, endocrinology is the study of the endocrine glands, the glands that secrete hormones. However, my experience is that many endocrinologists focus primarily on thyroid and diabetes. In my own personal experience, as well as that of my clients, I haven’t seen many endocrinologists with the deep understanding of hormone therapy necessary to safely administer it.

Who does this leave you with, then?

Your best chance of finding a doctor who really knows the ins and outs of testosterone therapy is to find someone certified through the A4M (American Academy of Anti-Aging Medicine). You can google ‘anti aging doctor’ plus <your zip code> to find a doctor in your area. Then it’s a matter of looking at their website to see what they offer. If you’re not comfortable doing this, you can also set up a One Hour Call with me and I can walk you through the process.

Many hormone replacement specialists don’t accept private insurance. You pay out of pocket and file the bill with your insurance company on your own. They do it this way because typically they spend a lot of time with you, usually between 45 minutes to an hour, and don’t want to be constrained to a shorter amount of time by insurance company dictates. You might be concerned that it will be insanely expensive, but that’s not necessarily the case. Depending on your area of the country, an initial visit may run between $200-300, with follow-up visits typically being slightly less. While that’s not cheap, you won’t have to sell your first-born.

As long as your insurance company will cover your lab work, and most of them do, then testosterone therapy can be surprisingly affordable.

Many of the full service clinics are moving to a concierge system, where you pay a flat fee which covers a year’s worth of care, including lab work and follow-up visits. That’s a good model for some people, and allows you to budget for your T therapy at the beginning of the year, knowing what the overall cost is going to be.

What really determines whether your doctor is first-rate is whether he looks for known risk factors and contra-indicators for testosterone therapy as I discussed in this post. Testosterone therapy is not a one-size-fits-all situation and there’s a whole battery of tests he needs to run to determine risk factors for your specific situation. I’ll talk about that in the next post.

T Therapy … The Good, the Bad and the Ugly

I get asked all the time … “Is Testosterone therapy safe?”

To which I answer …. “Yes …………… But Not Always ………… And Not if Your Doctor Doesn’t Know What He’s Doing.

Not much of an answer, I know. The truth is that for the vast majority of guys, testosterone therapy is not only safe, but can actually improve health. For guys who have low testosterone levels, testosterone therapy can have tremendous benefits. Guys undergoing testosterone therapy can see improvements in muscle mass, bone density, heart health, libido, sexual function, mood, energy and motivation.

Some men are actually able to discontinue their anti-depressants (under their doctor’s care) once they start testosterone therapy. They improve their motivation, memory and cognitive function so much that their careers get a giant boost and they earn substantially more money.

They lose the depression and irritability that has impacted their interactions with their wife, family and friends, and their relationships improve and deepen.

Some guys regain the sexual vitality they thought was gone forever. Their marriage and sex life improve beyond recognition.

That’s The Good.

There is, however, a tiny minority of men for whom testosterone therapy can be not only dangerous, but in very rare instances, fatal.

So let’s talk about The Bad and The Ugly.

Prostate or breast cancer

While starting testosterone therapy won’t cause prostate or breast cancer, in men whose testosterone levels have been medically lowered as part of their treatment for pre-existing prostate/breast cancer, changing their testosterone levels can cause already occurring cancer cells to re-grow. So, if you are currently being treated for prostate or breast cancer, testosterone therapy is probably not a good option for you. Good article on the subject here.

However, men with low testosterone levels are actually at higher risk for prostate cancer, so keeping your testosterone levels optimal can lower your risk for prostate cancer.

A doctor who knows what he’s doing will administer both a DRE (Digital Rectal Exam) and PSA (Prostate Specific Antigen) test to rule out any pre-existing prostate cancer prior to starting testosterone therapy. Incidentally, these are both good tests to do periodically even if you’re not starting testosterone therapy.

Heart Problems

This is another of those paradoxes where guys who have low testosterone levels are at higher risk for heart disease, BUT if you already have pre-existing heart disease, then testosterone therapy can be a problem, especially if not administered correctly.

testosterone therapy tends to raise not only your testosterone levels, but also your estrogen levels and your red blood cells. Both of these can be issues for heart health. A good HRT specialist will monitor both your estrogen levels and your red blood cell counts to make sure they stay within optimal limits. If your estrogen increases too much, an experienced doctor will prescribe a med (aromatase inhibitor) to lower the estrogen and will likely suggest that you donate blood to keep your red blood cell count within optimal levels. Article here.

Blood Clots and Strokes

For most men, testosterone therapy is safe, but if you are in the estimated 1-2% of men taking testosterone therapy who has an inherited blood clotting disorder, T therapy could actually cause a disabling or even fatal stroke. Fortunately, there are simple blood tests to rule this out, available with your other blood work at your regular lab and routinely covered by health insurance. BUT, you have to have a doctor who knows enough to request it. It’s really important to do these tests because many people with clotting disorders have no idea that they have one. There’s some good background on the topic here.

 So there you have it … The Good, The Bad and The Ugly. 

Like any other medical treatment, T therapy has risks and benefits. The biggest take-away I hope you get from this blog post is that the single, most important, absolutely vital, Number 1 part of getting testosterone therapy is finding a doctor who has specific training in administering testosterone therapy. Don’t assume that your GP, urologist, endocrinologist or holistic doctor knows what he’s doing. Many of them don’t.

Next up …. how to find a doctor who’s experienced in safely and effectively administering testosterone therapy.

And just because this is a cool video and so you’ll have this song stuck in your head the rest of the day as I do ……….

‘Normal’ Doesn’t Mean Optimal

“My GP said my testosterone levels are normal and so he doesn’t recommend T therapy.”

I wish I had a dime for every time I’ve heard a guy say this. I would … have a lot of dimes.

What is normal when it comes to T levels? The reference range most labs use is 348-1197 ng/dL. What your doctor doesn’t tell you, and very likely doesn’t understand himself, is that those so-called ‘normal’ levels don’t take into account age or health. So, your level may be normal … for an 80 year old man with heart problems.

Yeah, that makes a lot of sense, doesn’t it?

What it means is that a lot of guys go home from their GP’s office feeling like they must be hypochondriacs. ‘My GP says my testosterone level is fine, but I still feel like crap. It must be all in my head.”

This makes me crazy. While having the best of intentions, a GP who doesn’t know anything about hormones can actually dissuade a guy from seeking out the help he needs, thus making the situation worse. If a doctor hasn’t been trained in hormones, he has no business saying anything other than, “Let me give you a referral to someone who knows what they’re doing.”

My own husband went through this with several doctors. They wasted a couple of years of our lives with their ‘not knowing’. Our marriage was on the rocks because of my husband’s medical issue and no one could be bothered to say, “Hey, I’m not sure what’s going on with you, but let’s find you someone who can help.”

How many guys are suffering needlessly due to this nonsense?

Here’s what you need to know.

‘Normal’ doesn’t mean optimal. And most likely your GP is clueless about what’s going on with your hormone levels. Here’s a chart that breaks T levels down for you by age.

Avg Age Tot. Test.
30 617
40 668
50 606
60 562
70 524
80 471
93 376

If your T level is 378, congratulations. You’re normal ………… for a 93 year old man.

And if you’re in that low T fog, you know that 378 doesn’t feel so good.

What you need to remember is that ‘normal’ and ‘optimal’ are not the same thing. And if your doctor tells you that you’re normal, you’re just getting older, there’s nothing to be done, then you need to walk away. Would you stick with an eye doctor who told you not to worry about the fact that you’re having a hard time reading small print, that it’s normal to not be able to see well enough to read as you get older, it happens to all of us?

     “I’m sorry, Mr. Smith. Your eyesight is getting worse because you’re getting older. Just go out and buy yourself a magnifying glass so you can keep reading. Or better yet, I’ve got these stretches that will make your arms longer so you can hold the book out further.”

Of course not. That’s ridiculous.

Just as it’s normal to lose your reading vision as you get older, it’s also normal for your T levels to decrease with age. What’s not normal is to pretend that it’s not a problem, to refrain from correcting it if possible. Both conditions are treatable and need to be addressed in order to retain your quality of life.

So, your GP just told you your T levels are ‘normal’ and won’t treat you because it’s ‘not safe’. Now what?

The next post will discuss why finding an experienced hormone replacement specialist is so important …… 

You Don’t Even Know What You Don’t Know

“We are what we repeatedly do; excellence, then, is not an act but a habit.”

It took me about 3 minutes to realize that I had no idea what I didn’t know.

When I first walked in the doors to the MMA gym, I thought I would be pretty good at it. Seriously. I’ve always been in decent shape and have done various work-outs through the years. I thought I would struggle for a few minutes, but then find my pace and get through the work-out fairly well. That’s actually a little embarrassing to write, now. :-(

And then within about 3 minutes, reality set in and I was all, “Holy crap. This is totally beyond my skill level. How are these people doing this?”

Hell-lo Conscious Incompetence.

My work-out coach, Brian, was the first one to introduce me to the 4 Stages of Competence.

Unconscious Incompetence –> Conscious Incompetence –> Conscious Competence –> Unconscious Competence

Until you try to do something, you have no idea how difficult it is or how unskilled you are. Think about how easy golf looks …. just get that little ball into that little hole, right? …. easy. Until you try it. Congratulations, you just went from Unconscious Incompetence to Conscious Incompetence in one tiny step. It only takes about 3 minutes to get from Stage 1 to Stage 2.

However, it can take weeks, months, or even years to complete the next step; going from Conscious Incompetence to Conscious Competence. I’ve been doing this new work-out for slightly more than 3 months now, and I am still very consciously incompetent.

When a guy first starts coaching with me, trying to improve his marriage and increase attraction, he typically starts with a certain level of Unconscious Incompetence. He knows that his wife isn’t attracted to him, but he has no idea why. As his coach, it’s my job to help him figure out what the blockages are to attraction and how to fix them. However, it’s his job to do the practice that actually helps him get better at the behaviors that attract his wife. The longer he practices, the better he gets.

Typically, what I see in coaching is that slightly more than half-way through, the guy gets tired and discouraged. Even though he’s made tremendous gains fairly quickly in the first half of coaching, he has started to realize how very difficult it is to change behaviors and achieve competence. “This is really haaaaaard,” is a common statement at this point. Yes. Yes, it is. It is very hard to change the behaviors of a lifetime and it takes a lot of practice. Moving from Conscious Incompetence to Conscious Competence can be a frustrating process. This is the point where a huge part of the coaching involves encouragement and support in addition to training and correction.

“This doesn’t come naturally to me,” is something else I hear frequently. No. No, it doesn’t. It doesn’t come naturally to you, but if you practice long enough, it does become second nature to you. You move from Conscious Competence to Unconscious Competence. This is the sweet spot where you no longer have to think about displaying leadership, you just do it.

It’s kind of like tying your shoes. Do you remember how hard it was when you first learned? The strings seemed awkward in your fingers and you were constantly needing advice on which string goes on top of which. But eventually, you learned to do it without even thinking about it. You haven’t consciously thought about how to tie your shoes in decades. Your fingers move without conscious volition.

Unconscious Competence. 

“What should we have for dinner,” your wife will ask, and without even thinking about it, you will tell her, “Let’s grill chicken. That sounds good.”

Unconscious Competence

 

Just Get Back Up

I’ve talked a lot about holding frame and its importance in increasing attraction here and here.

What about when you lose frame? What then? How much damage have you done?

The truth is you’re going to stumble sometimes. The new leadership behaviors you’re practicing aren’t natural to you, yet, and there are times when you’re just going to lose it. You’re going to share your owies with your wife, you’re going to yell at your kids once in a while, you’re going to look foolish in some way. It’s unavoidable in the same way that making mistakes when you learn a new sport is unavoidable.

It’s okay to stumble; the really important part is getting back up. That’s where the magic takes place. When you mess up, but are able to own it and move on, it’s actually a display of high value. A guy who can do this is extremely attractive to women. Bonus points if you can laugh at yourself in the process.

So what does this look like in real life? 

Against your wife’s objections, you’re trying a new bedtime routine to get the kids to bed quicker. It’s been going well and you’ve been feeling pretty smug about it, but tonight your son decides to test your limits. It’s been a tough day at work, it’s been six nights since you’ve had sex, you want to get your wife in the mood, and you have no patience for this crap tonight.

You try to follow your new procedure, but by the fifth time the kid gets out of bed, you grab him by the shoulders and yell at him to get to bed before he gets hurt.

Okay, not a shining moment. You walk back downstairs where your wife’s eyes are burning holes through you. The silence is deafening.

Now what?

Well, now you’ve got a couple of choices.

Option 1  A really common choice I see my coaching clients make is to ignore the whole thing. Just pretend it didn’t happen. Don’t mention it to your wife and hope she won’t bring it up. Except you know that’s not going to work. Even if your wife doesn’t bring it up herself, you both know it happened. She’s waiting to see how you’re going to handle it. This is the moment of truth.

Option 2  You try to excuse your way out of it by whining to your wife about what a lousy day you’ve had. You’re just so frustrated with work, and why can’t she do a better job at disciplining the kids and if you got more damned sex, you wouldn’t be so grumpy to begin with. Ouch. You just took a -1 and turned it into a -10.

Option 3  Just own it. Quietly and simply admit what happened. “Man, I really lost it in there. I feel frustrated and I need to go cool off.” Then get out. I don’t care where. Just leave. If you stay and talk about it, you’re just going to lose it and make things worse. Go for a walk. Go work out. Go hammer some nails. Go punch inanimate objects. Get the stress out of your system.

When you go back home, apologize sincerely to your wife. One time, no more. The next day, apologize once to your son. That’s it. Now put it behind you and move forward. Don’t over-compensate, don’t lose frame. Get back on that horse. If your wife brings it up again, let her know that you’re not going to apologize again, you’re simply going to do better.

By doing this, you turn a -1 into a +10. You can actually increase attraction by making mistakes and then owning them. Everyone messes up. It takes a strong man to own his mistakes and correct them.

It’s what divides the men from the boys.

Maid Day

Ever since my husband started T therapy, he’s … different.

For example, in his low T days, he never would have noticed this postcard we got in the mail ….

Maid Day

 

 

Now, however ….

“I didn’t know you could order one of these,” he said, drooling over the blonde. 

Hmmm ……..

Doing the Dishes is Not Going to Get You Sex

It’s just …. not.

Forum post from a new guy …

She is a stay at home mom, and very attentive and affectionate mother.  We live a typical “middle-class” lifestyle.  Not lavish, but we have what we need to get by, take an occasional vacation, and do fun things here and there … I make a good living and work full-time, handle all the money/bills, my and the kids laundry, most of the dishes, all actual cleaning of the house, all yard work, all home improvement projects/repairs, and cook about 1-3 dinners a week.   On the weekends she sleeps in while I handle the kids, with the exception now being the baby, whom she nurses, and sometimes will need to get up around 5-6 to feed (and sometimes go back to sleep). … What I’m getting at is that I take care of my share of the duties (at least).  Not complaining here, just want to convey that she is not expected to take care of too much. 

I see so many guys with SAHM wives with this mindset. They believe that if they are ‘nice’ enough and take enough off their wife’s plate, they will eventually get more sex.

It doesn’t work.

What most guys find is that the less they expect of their wife, the less sex they get. This is crazy, right? Completely counter-intuitive. Wimminz be crazy.

What you have to understand is that the behaviors that drive female attraction are completely separate from the actions that keep the home and family maintained. Taking care of the kids is great for making your wife feel all warm and fuzzy with you, but it’s not going to give her the butterflies and tingles that lead to great sex.

In fact, if she’s a SAHM and you are treating her like a princess by having no expectations of her, she may actually be feeling a little contemptuous of you for not setting appropriate boundaries. She views it as you being too weak to to set limits in the relationship.

So, here’s a tool you can use.

Draw up a list of all the things you do during the week, including your paid job and all the traditional male chores you do, and then look at all the things she does. Calculate how much free time each of you has. The higher the discrepancy, the less sex you are going to get. (Hint: If she has 4 hours every day to surf the net, and you have 20 minutes by the end of the night after you’ve put the kids to bed, it’s a problem.)

If this is the case, you need to redistribute the work load, giving her more of her share to do. She probably won’t like it at first, but don’t be afraid to make her angry. It’s better for her to be angry than for her to be contemptuous.

And tonight? Don’t make dinner while she sits on the sofa and plays on her phone. Get her off that sofa and get her butt moving.

Let me know how it goes. ;-)

Protect Your Package from Your Cell Phone

The cell phone is the most quickly adopted consumer technology in the history of the world, with over 90% of the US adult population using one, according to the Pew Research Center. There are roughly 6 billion cell phone subscribers in the world.

With rising cell phone use, there have been increasing reports and studies done that cell phones are hurting our health, particularly men’s sexual health. But how valid are these claims?

I’ve been fairly unconvinced over the last few years that cell phone usage is hurting men’s sexual health. Some studies have shown that cell phone radiation seemed to cause damage to rats’ testosterone levels, some have shown connections between cell phone use and lowered sperm levels in men, but the studies I’ve read have been limited and I haven’t seen a clear connection that cell phones are causing damage to men.

However, one study has given me pause. In this study, the researchers divided men into two groups, those who were experiencing ED and those who weren’t. There were no significant differences in the two groups in terms of age, weight, height, and total testosterone.

They found that the men who carried their switched on cell phones longer had significantly more problems with ED. Note that it wasn’t the amount of time they used  their phones — both groups spent about the same amount of time talking on the phone — just the amount of time they carried  it when it was on. The guys with ED carried their switched on phones roughly 4 hours per day versus slightly less than 2 hours per day for the guys who had no performance problems.

The major problem with the study is that it is so small; only 10 guys in each group. The study also doesn’t show causation, only correlation. The study isn’t able to explain why  carrying a switched on cell phone might cause ED.

So, how important is the study? I don’t know.

What I do know is that I am talking to younger and younger guys who are having ED problems. Guys who shouldn’t be struggling with it. There are obviously a lot of factors at play; general health, decreasing T levels, porn use, etc. I am looking forward to seeing larger studies done that will either confirm or refute these results.

In the meantime, what we are telling our 4 boys is that they need to keep their cell phones away from their testes. After all, if the future of our world includes a dearth of guys capable of performing with a woman, thus threatening the future of civilization, think of the advantage they will have. They will be quite in demand. ;-)

Don’t Listen to What She Says

…when she says that it’s really a guy’s personality that attracts her. That she likes a more slender frame on a guy. That she’s not attracted to guys with muscles, that it’s superficial and shallow to spend time at the gym.

Really. Don’t listen to her. 

It’s not that she means to lie. She really believes what she’s saying. But most girls know doodle squat about what attracts them.

And it ain’t the way you load the dishwasher.

It’s not your fathering skills, it’s not your super-sensitive listening skills, it’s not the fact that you put the toilet seat down or the fact that you sit in an office cubicle 9 hours a day.

Chicks dig muscles. The amount of muscle varies from woman to woman. Not every woman is attracted to an Arnold Schwarzenegger amount of muscle, but putting on muscle is going to mean more attraction from your wife (and other women, but that’s a whole different ballgame).

When guys start coaching, they’re surprised that that’s one of the first areas of focus. Having more muscle boosts a guy’s confidence, it makes him look better in his clothes, it increases his T levels and  it makes him feel more manly.

Muscles matter.

Ignore what she says and get to the gym. That is all.

Low T? What a Scam!!

“I wonder if I really have low T. How do I know whether I’m just a bit off lately or maybe just sleep-deprived? This whole low T thing sounds like a crock; just an excuse made up by weak guys who don’t want to exert any effort or doctors and drug companies who want to make money from treating them.”

This is the initial reaction I hear from a lot of guys who are struggling with low T.  Does this sound familiar? Do you wonder whether low T could really be your problem or if it’s all just a load of bs?

Here’s a checklist that should help.

      • Do you have a lack of energy?
      • Are you tired all the time, no matter how much sleep you get?
      • Do you fall asleep after dinner or while you’re putting the kids to bed?
      • Do you find yourself exhausted at the end of the day, or sometimes even in the middle of the day?
      • Do you enjoy life less than you used to, the things you used to find fun are now more trouble than they’re worth?
      • Do you feel grumpy, stressed, moody or irritable a lot?
      • Are you finding it difficult to concentrate on routine or mundane tasks?
      • Do you have fewer morning erections than you used to?
      • Do you lose your erection during sex more often than you used to?
      • Have you noticed that your sex drive is not as strong as it used to be or that you don’t get as much enjoyment out of sex?

If you have several of these symptoms, it’s possible that low T is the culprit. You’re not lazy, you’re not weak, you’re not a wimp. You have a recognizable, diagnosable condition that is fortunately treatable.

“Okay, a lot of these symptoms apply to me, but how do I know for sure that it’s low T that’s causing them. Couldn’t it be other things?”

There are a lot of things that can cause some of the above problems, but if you’re experiencing several of these symptoms, low T is one of the top contenders. It’s easy enough to rule low T in or out by a simple blood test. It’s not complicated, you don’t have to fast, it’s just a simple in and out to your lab and within a week or two, you’ll have your answer.

Next Post: How do I get the lab work done to check for low T?