Two ways to look at it in my opinion. If you're not worried about it and you're confident that the levels are what they are because of your self medicating, don't go to the endocrinologist. If you have an inkling that the levels are NOT a result of your manipulation AND may be caused by an internal physiological problem, then you better get yourself checked out. And I'd be an open book as well if you are seen by the endocrinologist. Put everything on the table (as far as what you're taking) so he can accurately diagnose you. As has been discussed earlier, I don't think you should feel obligated to explain your number one reason for taking the herbs but the Doctor needs to know that you ARE taking them. I was in the Doctors office last week and asked her questions about getting tested for testosterone and Klinefelter's syndrome. It was very uncomfortable and I was afraid she was going to ask why I was so interested in those things but instead, she was completely professional and answered my questions without putting me on the witness stand. I understand my questions could have been asked by anyone (unlike your situation) but I think we're always afraid that discussions are going to go places that make us uncomfortable. That doesn't always happen.

If you're not worried about it and you're confident that the levels are what they are because of your self medicating, don't go to the endocrinologist. If you have an inkling that the levels are NOT a result of your manipulation AND may be caused by an internal physiological problem, then you better get yourself checked out.

That's just it. I'm fairly confident that the levels existed before I started on PM. It's unlikely that the weak herbs I was taking before (fenugreek, saw palmetto, and red clover) have anything to do with them either.

I guess what I really am striving to know is if the low free-T, which is "discordant" with my total-T, is even anything I should be concerned about. Everything still "works" (I know from actual use). I don't know if I'm still fertile but I honestly don't care (I have 4 kids and my wife has had her tubes tied anyway).

I could go to the endo anyway, just to be sure, but I'm not confident that he (or she) would be in any position to advise me one way or another. From what I can tell this is a very unique condition and I'm doubtful that I would be anything more than a curiosity. I certainly don't want to become someone's pet project and undergo endless testing!

I looked up the endo my Dr recommended and am not impressed (lots of bad patient reviews). It also seems that most endos deal primarily with diabetes and only handle the sex hormones as an aside. I'm having trouble locating a doctor in the Denver area that I would feel comfortable discussing some of these issues with as well.

If anyone has any insight on the potential danger of the virtually non-existent free-T alongside normal total-T, I would greatly appreciate the info. My searches have come up empty!

Misty

I'm fairly confident that the levels existed before I started on PM. It's unlikely that the weak herbs I was taking before (fenugreek, saw palmetto, and red clover) have anything to do with them either.

I guess what I really am striving to know is if the low free-T, which is "discordant" with my total-T, is even anything I should be concerned about. Everything still "works" (I know from actual use). I don't know if I'm still fertile but I honestly don't care (I have 4 kids and my wife has had her tubes tied anyway).

I could go to the endo anyway, just to be sure, but I'm not confident that he (or she) would be in any position to advise me one way or another. From what I can tell this is a very unique condition and I'm doubtful that I would be anything more than a curiosity. I certainly don't want to become someone's pet project and undergo endless testing!

I looked up the endo my Dr recommended and am not impressed (lots of bad patient reviews). It also seems that most endos deal primarily with diabetes and only handle the sex hormones as an aside. I'm having trouble locating a doctor in the Denver area that I would feel comfortable discussing some of these issues with as well.

If anyone has any insight on the potential danger of the virtually non-existent free-T alongside normal total-T, I would greatly appreciate the info. My searches have come up empty!

Misty

Without knowing your sex hormone binding globulin (SHBG), it is hard to explain your low free T unless it is laboratory error, which it could be.

Low T can result in a myriad of health problems in males, including diabetes, osteoporosis, heart disease, depression, muscle wasting and weakness, and I forget the rest of the list. You might check out http://www.lef.org (The Life Extension Foundation) for information on low T and other things. I will admit, I've read articles in their monthly magazine, but can never find them on the website when I want to print them and show them to my doctor so it might be hard to find anything. By rights, with a free T reading as low as yours, you should have ED and no libido (other symptoms of low T), but you say everything works so maybe the lab screwed up and slipped a decimal place. Nine makes more sense than 0.9, but I'm not a doctor.

Without knowing your sex hormone binding globulin (SHBG), it is hard to explain your low free T unless it is laboratory error, which it could be.

Low T can result in a myriad of health problems in males, including diabetes, osteoporosis, heart disease, depression, muscle wasting and weakness, and I forget the rest of the list. You might check out http://www.lef.org (The Life Extension Foundation) for information on low T and other things. I will admit, I've read articles in their monthly magazine, but can never find them on the website when I want to print them and show them to my doctor so it might be hard to find anything. By rights, with a free T reading as low as yours, you should have ED and no libido (other symptoms of low T), but you say everything works so maybe the lab screwed up and slipped a decimal place. Nine makes more sense than 0.9, but I'm not a doctor.

Thanks for the reply, MonikaT. Unfortunately we're sure the test isn't an error -- we suspected as much so we repeated the test, one month apart, by a completely different lab. The results were almost identical.

I also agree that I have (virtually) none of the symptoms of low T. That's probably because my total T is in the normal range. In fact, when I'm not taking PM, my libido is actually out-of-control. I did read an article that discussed the difference between "free-T" and "bioavailable-T" (by the Mayo Clinic, I believe) that could explain my lack of symptoms. The thing that is most odd is the discordance between the numbers -- the normal total-T with the extremely low free-T.

Misty

Without knowing your sex hormone binding globulin (SHBG), it is hard to explain your low free T unless it is laboratory error, which it could be.

Low T can result in a myriad of health problems in males, including diabetes, osteoporosis, heart disease, depression, muscle wasting and weakness, and I forget the rest of the list. You might check out http://www.lef.org (The Life Extension Foundation) for information on low T and other things. I will admit, I've read articles in their monthly magazine, but can never find them on the website when I want to print them and show them to my doctor so it might be hard to find anything. By rights, with a free T reading as low as yours, you should have ED and no libido (other symptoms of low T), but you say everything works so maybe the lab screwed up and slipped a decimal place. Nine makes more sense than 0.9, but I'm not a doctor.

Thanks for the reply, MonikaT. Unfortunately we're sure the test isn't an error -- we suspected as much so we repeated the test, one month apart, by a completely different lab. The results were almost identical.

I also agree that I have (virtually) none of the symptoms of low T. That's probably because my total T is in the normal range. In fact, when I'm not taking PM, my libido is actually out-of-control. I did read an article that discussed the difference between "free-T" and "bioavailable-T" (by the Mayo Clinic, I believe) that could explain my lack of symptoms. The thing that is most odd is the discordance between the numbers -- the normal total-T with the extremely low free-T.

Misty

Misty, you're welcome. It just occurred to me the other issue could be aromatization, but without knowing estradiol levels, it is hard to tell. If I understand LH levels, and again, not a doctor, elevated LH can point toward testicular failure, as in they are working harder than they should have to and might wear themselves out over time.

Good luck however you decide. It may not hurt to go to an endocrinologist. While they may treat a lot of diabetics, I think that's largely a function of the crappy Western diet creating an overwhelming number of them. For example, Doritos are engineered so people eat an endless supply while never getting satiated. They've figured out how to engineer good-tasting foods that hit all the right notes on our taste buds, taste better than healthy foods, have little or no nutritional value, are high in calories, cause a huge glycemic load (most grains do), and never satisfy our hunger. This is more or less true of anything that doesn't come from the produce or meat departments, but the unhealthy stuff is cheaper on the front end. It gets us on the back end in the form of medical expenses.

Certainly, endocrinologists also treat hypogonadism, thyroid disorders, and various other issues of the endocrine system so don't give up on the idea of seeing an endocrinologist if you think you might need one. Ask for a different referral if you don't like what you hear about the one your doctor chose. On the other hand, if the complaints are about things like bedside manner, I can handle a lousy bedside manner as long as the doctor is competent. If the doctor doesn't seem competent, based on ratings, I'd definitely want a different referral.

Misty,

Is it safe to assume there is an insurance issue requiring you to go through your doctor to see an endo, rather than forging forward and going to one of your own choice?

If not, and you're steadfastly determined to get to the bottom of you test discrepancy, I can't imagine there are not a number of qualified endos in your area. Denver has for a long time had a quite large transsexual community. I can't begin to believe they have all arrived at the correct meds to take, and the proper dosages of those meds, all on their own. That would be defying astronomical odds! Therefore, there has to be someone with a good deal of experience with hormones, and their application in individual cases, who should be able to interpret your results. Probably more than one "someone".

Trinidad, CO, may still be the sex-change capitol of North America, just another example of the availabilty of assistance. If you explore the transsexual/transgender websites, (reputable ones) you should be able to get info on some of them through resource links. With those sources, you can e-mail them as to the possibility of them being of assistance. Then, perhaps you can suggest one for your doctor to refer you to, or, depending on how bad you want to know, end run your doc and go directly to them. As a last resort, you could always visit one of the more popular TS/TV clubs in Denver, and get your directions straight from the "source". Luck, Patti

Misty,

Is it safe to assume there is an insurance issue requiring you to go through your doctor to see an endo, rather than forging forward and going to one of your own choice?

If not, and you're steadfastly determined to get to the bottom of you test discrepancy, I can't imagine there are not a number of qualified endos in your area. Denver has for a long time had a quite large transsexual community. I can't begin to believe they have all arrived at the correct meds to take, and the proper dosages of those meds, all on their own. That would be defying astronomical odds! Therefore, there has to be someone with a good deal of experience with hormones, and their application in individual cases, who should be able to interpret your results. Probably more than one "someone".

Trinidad, CO, may still be the sex-change capitol of North America, just another example of the availabilty of assistance. If you explore the transsexual/transgender websites, (reputable ones) you should be able to get info on some of them through resource links. With those sources, you can e-mail them as to the possibility of them being of assistance. Then, perhaps you can suggest one for your doctor to refer you to, or, depending on how bad you want to know, end run your doc and go directly to them. As a last resort, you could always visit one of the more popular TS/TV clubs in Denver, and get your directions straight from the "source". Luck, Patti

Thanks, Patti. I have been searching online for endos that at least purport to work with gender dysphoria (haven't found any as of yet) but perhaps I'm searching for the wrong thing. I have found LOTS of psychiatrists and psychologists who work in the field.

Denver is no small place so I'm sure they exist. Maybe they are intentionally mum about the practice and work via referral from the above psychiatric practitioners. And I'm not sure that I want someone whose focus may be to assume that I am looking to transition.

As far as the insurance, I'm not completely sure. My doctor talked as if he hasn't actually referred me (said something to the effect "let me know if you need a referral"). The name he gave me to call is the one I looked up. My insurance is quite good but generally does require referrals for specialists.

I'm still wrestling with this. I wish I knew if I should even be concerned.

Misty

Thanks, Patti. I have been searching online for endos that at least purport to work with gender dysphoria (haven't found any as of yet) but perhaps I'm searching for the wrong thing. I have found LOTS of psychiatrists and psychologists who work in the field.

Denver is no small place so I'm sure they exist. Maybe they are intentionally mum about the practice and work via referral from the above psychiatric practitioners. And I'm not sure that I want someone whose focus may be to assume that I am looking to transition.

As far as the insurance, I'm not completely sure. My doctor talked as if he hasn't actually referred me (said something to the effect "let me know if you need a referral"). The name he gave me to call is the one I looked up. My insurance is quite good but generally does require referrals for specialists.

I'm still wrestling with this. I wish I knew if I should even be concerned.

Misty

Misty,

I don't live in Colorado, searched "transgender therapists in Denver, CO" one result was this service.

The Gender Identity Center of Colorado for transgender therapists in Denver: http://www.gicofcolo.org/resources/metrodenver/therapists.aspx

Hope this helps.

Janet

Misty,

I don't live in Colorado, searched "transgender therapists in Denver, CO" one result was this service.

The Gender Identity Center of Colorado for transgender therapists in Denver: http://www.gicofcolo.org/resources/metrodenver/therapists.aspx

Hope this helps.

Janet

I believe Mindy is looking for a good endo, not a therapist.

I can relate, as finding a LGBT friendly therapist was easier than I thought it'd be living in a small town in the southern US, but an endo is proving much more difficult to find.

One could lose nothing by contacting them and ask for a referral. therapists don't work in a vacuum. They should be tied into a network with endos. When you reach one, it's up to you to be specific about what service you do or don't want them to perform. Chances are, since your doctor doesn't sound too excited by it all, you could give him a name as referral, and he may not even check it out much.