Endo woes.

[TransAm]

I've sort of posted about this in the past but I've finally come to a point where I believe a change in doctors is necessary.
The clinic I'm currently going to is disorganized, iffy and generally uncomfortable at best. You never know if you're going to get stuck with an extremely inexperienced nurse (this last one took twenty two minutes to draw my blood after my *** was in the chair), rude front desk employees or just zero communication from any of the staff.

My endo is a very nice lady. She's polite, engaging and she doesn't try to rush you through appointments. That said, I think she and I are just on very different planets when it comes to our concept of what my levels should look like.
I'm a very binary (somewhat older at 30) man. The hairier, beardier, meatier, and musclier I can be, the better.
I started transitioning just a hair over two years ago at 28 and have been playing the catch up game to my like-aged peers ever since. All of my pre-T levels were in a very healthy range and all of my post-T levels (even at my high dose) were optimal apart from my hemoglobin/hematocrit. At my highest dose (where I felt the best mentally, emotionally and physically), my hemoglobin was at 17.1 and my hematocrit sat at 51.5 after 10 months. My T levels during this time were between 800-900 which, to me, was ideal.
She freaked out at these levels which inadvertently caused me to worry and immediately recommended I cut my dose in half. The halved dose wasn't as drastic as I was concerned it would be but, after several months, the hematocrit and hemoglobin levels hadn't really budged. My T levels, however, had dropped to the 700's--not 'optimal', I guess, but no big deal--but I still felt all right at the dose.
Here's where it started to get really, really ridiculous and hazy. She told me at the time that, since I'd been on T for almost two years, it was "perfectly fine to shoot for T levels in the 200-300 range" with a very small T dose. She made it seem like my blood levels were life-threatening at first and actually made the recommendation that I may have to stop taking testosterone altogether. I let her know that absolutely wasn't an option and she backpedaled a little bit to disclose that I could 'hypothetically get blood draws every three months' to keep my RBC issues at bay.
I more than agreed to that. She told me that I should cut my dose again in the meantime until she could find a hematologist she'd feel comfortable recommending me to. I was not stoked about this in the slightest but I obliged and left the appointment feeling like a stroke or something was imminent because that was the impression she left me with.
So I went down to this super piddly little dose--lower than the vast majority of starter doses I've seen, even--and within a couple weeks started feeling major shifts. Low energy, low interest, hugely decreased sex drive and general sluggishness came first. Over time, this has developed into irritability, random anxious episodes (I'm not an anxious person at all), edginess and a definite stagnation in physical changes. I reported these things to her on our next appointment and she gave me the runaround and said she hadn't found a hematologist yet() and I should just continue on this dose. She ran a blood test to check my T levels and RBC count.
As to be expected, I haven't been feeling any better at all and I don't recall having felt this terrible or out of sorts since pre-HRT.
The other night on Thursday, I did something I've only done two other times in my life to someone I never would do this to: I got into a yelling match with my fiancee of ten years. I started it. I don't yell unless the circumstance really necessitates doing so because I think it's an illogical, emotionally heady way to approach a situation.
The next night on Friday, I got the voicemail with her calling back regarding my levels. The hemoglobin has dropped to 14.1 and the hematocrit decreased to 44.1. She was thrilled with these levels and talked about them for a while in the message before quickly and unceremoniously saying that my T count was at 238. She finished off the message by saying, "Stay the course, you're still within a male range".

This is absolutely unacceptable to me. The initial problem had a very simple solution to which I, without hesitation, agreed to undergo. Now my counts are in the ****ter, I feel like garbage and I'm angry. This would be an entirely different situation if all my counts had been off--ridiculously high cholesterol, liver function issues, etc.--but they weren't. There was never a need for me to feel like this right now.

She's not in her office again until Monday but a very lengthy discussion is going to be had. If she balks, I walk.

[AnonyMs]

I'd find another doctor before leaving her. Low is better than zero.

[TransAm]

I'm lining up my options as we speak. Thankfully, I still have almost an entire 10ml vial of T left at this point.

[Kylo]

238 is quite low isn't it. Just because it's on the bottom of the 'male' range doesn't mean it's right for you nor that she should be dictating what is and isn't. I'd do the same and get another GP if she isn't listening to your concerns. I've had an issue with a doctor lowering dose spontaneously on my auto-renew prescriptions as well and I've gone and amended them at the surgery myself with a different doctor.

[AnonyMs]

Your doctor seems to think that the higher levels you were on are dangerous. I had something similar once, and a specialist (not HRT) told me I should stop estrogen as it increased the risk of something very bad happening. I believe he was correct, but I didn't stop because I couldn't live like that. I wasn't getting my HRT from him, so he couldn't stop me anyway.

I'd get a second and third opinion as to the risks. Whatever you decide to do I think you should do it with full knowledge of what you're choosing. Are you prepared to risk dying over it? I was.

[TransAm]

Your doctor seems to think that the higher levels you were on are dangerous. I had something similar once, and a specialist (not HRT) told me I should stop estrogen as it increased the risk of something very bad happening. I believe he was correct, but I didn't stop because I couldn't live like that. I wasn't getting my HRT from him, so he couldn't stop me anyway.

I'd get a second and third opinion as to the risks. Whatever you decide to do I think you should do it with full knowledge of what you're choosing. Are you prepared to risk dying over it? I was.

I highly doubt death is on the table in my situation. Two of my levels were elevated, yes, but not to extreme proportions (the staff at the UR the nurse at the clinic sent me to looked at me like I was nuts when I mentioned it) and all my other levels are fine. I think she's just being ridiculously conservative for whatever reason; if any other 30 year old man walked into a clinic with a T level of 238 complaining of the symptoms I'm experiencing, they'd put him on T. But for me, these levels are just super dandy and I should stay the course.

Donating my blood every three months would've completely resolved this (relatively minor) issue and I was lead to believe that was what she was getting in touch with a hematologist for, thus rendering this lowered dose a temporary situation. I should've known something was amiss when it took her 2 1/2 months to "find" a hematologist in a highly populated, very liberal city. She was dragging her feet and I think, in her mind, this was never meant to be temporary. They deal with a lot of children and adolescents at this clinic so I'm wondering if they're just used to being more cautious in general.

238 is quite low isn't it. Just because it's on the bottom of the 'male' range doesn't mean it's right for you nor that she should be dictating what is and isn't. I'd do the same and get another GP if she isn't listening to your concerns. I've had an issue with a doctor lowering dose spontaneously on my auto-renew prescriptions as well and I've gone and amended them at the surgery myself with a different doctor.

It definitely is and I'm hardcore feeling the effects. Honestly, I feel way worse for men suffering from low T than I ever have. And yeah, I think I'm going to have to end up doing just that unfortunately. Not particularly looking forward to the commute to Minneapolis, but Saint Paul's resources are scant.

[AnonyMs]

I highly doubt death is on the table in my situation.

Did you ask what the risk is? It should be your choice how you wish to proceed.

In my case stress was making me quite unhealthy all by itself, far more than any increased risk from the HRT. Luckily my endo understood that.

[TransAm]

Did you ask what the risk is? It should be your choice how you wish to proceed.

In my case stress was making me quite unhealthy all by itself, far more than any increased risk from the HRT. Luckily my endo understood that.

The risk doesn't really start until the hematocrit level reaches 55%+ (which is considered polycythemia). Their lab just 'caps' the level at 50% so a red flag was shot off when mine got to 51% and stabilized. When this occurred, she initially led me to believe I was, at that point, polycythemic and made a rather grand spectacle out of halving my dose after supposedly consulting all her colleagues. Later, when I was on the lowered dose, I started getting odd symptoms in my right hand (tingling in my fingers and such). This was when I was working out constantly and must have tweaked something in my elbow on a bench press. Not putting two and two together initially, I called the clinic and inquired about the symptom at which point I was told to go to the UR and tell them about my blood levels. Slightly panicked at the time, I did so. The doctor stood there and said, "Uh... 51% isn't high. That's pretty normal, we see levels like that or higher pretty frequently at my other job at the ER". He then explained to me that I was fine--something no one else at the clinic had expressed to me--and we deduced that the issue was a stressed nerve.
When I brought this information back to the endo, she backpedaled a little and admitted I was in no danger but that she still wanted to see my level decrease. Fair enough.
That's when the therapeutic bloodletting concept was thrown about and so forth, so on.

So yeah. While I do agree that my levels could stand to decrease, I'd rather see them do so through donating my blood than sacrificing my emotional/sexual/mental/physical well-being.

[Kylo]

I reckon you should remind her your physiology is running male now, with no additional T or E produced of your own, and your body is suffering the effects of hormone deficit.

IIRC that feels like hell and severely impacts ability to heal, energy levels and mental wellbeing. If I were in your shoes I would put it to her first that you'd like to be mid normal male range at least, not low (can't see how she can begrudge you wishing to be in the "normal" and average bracket for a male provided you're otherwise in fairly good health) and that you're happy to resolve any RBC issues with venesection. If she still insists I'd put it to her you are suffering and will get another GP if she isn't going to address your concerns.

I guess I'm lucky my GP consults directly with the GIC on this sort of thing. She's no expert on FTM treatment but she only sought to reduce my dose when I looked set to exceed normal male ranges.

[Jak]

Not particularly looking forward to the commute to Minneapolis, but Saint Paul's resources are scant.

Yes, Family Tree isn't seeing adults for hormone therapy, though they tell me they plan to start scheduling again in January. They provided a document re other resources, but I don't see a way to attach it here. Message me if you want to see if I can send it that way. Though it just dawned on me that that could be where you've been going. Yikes. Good luck!