Looking for a doctor and advice. Lansing Michigan area

[chevrolet572]

I am in the lansing Michigan area and am currently seeing a Dr carella an endocrinologist for trt. I would like to find a new doctor that won't do the cookie cutter approach and will actually make me feel like he cares. I have insurance and would like to find a doctor that accepts my insurance. Some of the clinics don't and I can't afford to do it out of pocket. I am new to the forum and trying to get the hang of it. There is so much information and I'm trying to find the specifics I am looking for... Any help would be appreciated, any questions I will answer if you have any.

Thanks in advance.

M

 

[a_crossfitter]

"There is so much information and I'm trying to find the specifics I am looking for..."

What exactly does the above mean?

It seems like you are not getting your endocrinologists attention when you go to appointments....., are you well prepared with what you'd like to discuss with him when you go see him?

What is it that you don't like about Dr. Carella?

 

[chevrolet572]

I have been on Testosterone for 4 months now. During month 2 and 3 things were awesome and I could really tell the difference and that things were working. In the last month i keep having side effects/symptoms.
· Decrease in strength
· Extremely Low libido
· Soft erections
· Depressed/anxious
· Energy, Mental focus and “sharpness” is gone (feel like I’m in a fog)
· Fatigued (certain days more than others Sun-Tues.)
· Urinate very frequently

I want to figure out what is causing that and how to raise my testosterone levels more. My total T was 384 and my e2 was 39 last week when i had my blood tested. I have to wait till my appointment tomorrow to get the rest of my results. So I just want to figure out how to get all of that to go away and feel good again.

Dr Carella just seems to want to get on to the next patient each time I go. He didnt even want to order an e2 test and actually ordered a total estrogen test to begin with so it seems like he doesnt know what he is talking about... I have all my questions written down along with all my symptoms to go over but I just dont know what to say to him or ask to see if he is a doctor I should continue on with.

I must seem like an idiot but I am new to all of this and until now I didnt know my testosterone was low doctors just kept pushing depression meds. I want my sex drive and strength back and to just feel good. I know what its like so I know its possible I just dont know where to go or what to do...

 

[a_crossfitter]

How's your sleep?
Are you overweight?
How's your diet?
What's your TRT protocol?
Do you exercise?
Are you stressed out?



Testosterone isn't a miracle drug that'll bring homeostasis to your endocrine system. You need to cooperate with your body both physically and mentally.

Regarding Dr. Carella: I believe that it is your duty to stop him on his tracks and have him take his time with you. However, you must be prepared on the subject too. My Dr is very sensitive when I question him (he takes things like an attack.....which btw, don't take my responses to you as an attack) so all I do is steer the conversation to where I want it to go by asking questions and acting semi dumb. That way I get the drugs I think I can benefit from after reading this forum.

 

[chevrolet572]

I weigh 210 pounds. 2 years ago way before trt I weighed 322.
I track everything I eat. 245 carbs, 82 grams of fat and 182 grams of protein a day. I do one cheat meal a week.
I sleep ok, I wake up two or three times to pee though.
I lift weights 4 days a week and do cardio 2 to 3.
100mg Test Cypionate IM Injection Weekly
I am stressed but it's mostly over this.


I get what you mean and ask away. I just want help. I am going to have a long conversation with Dr carella tomorrow and hope for the best. Any advice to use some im there is appreciated as well.

Thanks

 

[JMP]

What is your protocol? What type of testosterone (gel, cream, injection), what dosage, any other supporting drugs like HCG or an AI? If you have been on for 4 months and your TT is 384, my first thought is that your dosage is too low. I will guess that you are on Androgel or something similar. Also your frequent urination could be a prostate related or could be that you drink lots of fluids before going to sleep and at the times that you wake up. I would suggest testing your DHT levels to see where they are at as I believe they can affect your prostate. The fact that you need to go through insurance limits you to the care that you can receive. Dr Crisler is in Michigan, but I don't think he takes insurance although I am not 100% sure. I would tell your doctor that from your research, most men don't feel the effects of TRT until they are over the 500-600 level minimum. As long as your other blood work looks OK, why not go up in dose to see if you feel better? I wish you the best of luck.

 

[chevrolet572]

100mg Test Cypionate IM Injection Weekly. No Other drugs at this time. Dr Crisler does not take insurance. Why does having insurance hinder me in this is what I dont get ? I worked hard to have insurance but now that I do it apparently doesnt help.... Not being rude I am just confused at all of this and dont know where to turn or what to do. Which is what brought me here and to buy the book. I do plan to ask if I can go up in my dose I just dont want to feel worse. When I first started it was horrible , I could barely function and felt like shit...

 

[JMP]

OK, interesting. Yes, I would ask him to increase your dose to 120mg tomorrow. Is the dose once per week? My comment on insurance was just related to the fact that many of the top doctors for TRT don't take insurance. With that said, you have a doctor that is giving you injectable testosterone which is good. You just need to dial yourself in, and that takes time. You must be patient. My opinion is that if the bills are being paid by insurance and you don't have the funds to go to a place like Defy then try to work with your doctor. You might not that be far off.

 

[chevrolet572]

It is once per week. So far I'm not a fan of sticking myself so doing it more doesn't sound good to me... So far I only inject into my quads. I would like to find better places and try something new. Sometimes my muscles start jumping /throbbing as soon as sick the needle in. Any advice on that? I will make sure I talk to my doctor and make him answer all my questions. If I feel like crap when I up my dose, how long do I continue with it to see if it will get better? Hopefully that made sense

 

[a_crossfitter]

Chevy,

I suggest starting the conversation with the doc saying something along the lines like:
Q: doc why is the range so wide?
A: well Chevy, its because test varies from person to person.
Q: Ohh, so then could it be possible that when I was in my 20s my natural test production was in the upper range...bc I know I did not feel like shit, didn't have erectile dysfunction or no libido....but wait, there's really no way of knowing right?
A: no Chevy, there's really no way of knowing what your natural levels were...
Q: well since we are replacing what my body used to produce naturally and since you are giving me 100mg/week, why don't we try upping MY DOSE up to 200mg/week and let's see how I FEEL IN A COUPLE OF WEEKS. Perhaps I need more testosterone to be where my body naturally had me.
Q: well Chevy, I'm concerned that blah blah.. (You interrupt him)
A: doc, we are just raising the dose to what could be my optimal levels.....btw, my estrogen will go up too and I might need an aromatase inhibitor..such as anastrozole.

You guide him were you want the conversation to go.

 

[ratbag]

Dr. Crisler is in Lansing isn't he... spend the $$ and dispense with your insurance accepting endocrinologist before he drives you to insanity.

 

[chevrolet572]

I am going to get my dose upped. Probably not go drastically to 200 this fast, I don't want to aromatase and feel like shit. Has anyone had any experience with an AI? I keep hearing horror stories. Is it true if you split a pill that It reacts much faster and doesn't work like it's supposed to? I am going to ask about an AI today but the side effects kind of scare me away from wanting to try it...

 

[CoastWatcher]

I am going to get my dose upped. Probably not go drastically to 200 this fast, I don't want to aromatase and feel like shit. Has anyone had any experience with an AI? I keep hearing horror stories. Is it true if you split a pill that It reacts much faster and doesn't work like it's supposed to? I am going to ask about an AI today but the side effects kind of scare me away from wanting to try it...

Before an AI is prescribed you should have both blood work showing elevated levels of estradiol (and those levels should be obtained via the sensitive, LC, MS/MS, lab test), as well as symptoms attributable to high e2. To simply add an AI when it may not be needed is a ticket to a quick ride to hormone hell.

The entire issue of elevated estradiol can often be sidestepped with a change to the injection schedule. Twice weekly, every other day, or (as I do) every day injections lower estradiol spikes. They also are - essentially - mandatory if you're dealing with lower SHBG numbers. Where does your SHBG sit?

There's a great deal of information here in the sticky posts in estradiol and anastrozole. Spend some time, read, ask questions. Don't assume it is needed.

 

[Sean Mosher]

Your doctor works for you, not vice versa.
If he doesn't want to learn, work with you, and properly address all your questions/concerns, then fire him.
I totally get the insurance thing, but I also don't understand the concept of getting poor treatment just because it is paid for.
Dr. Crisler would be an excellent switch if you can't get this Dr. Carella to get with the program.

And posting labs here will get you very good protocol/treatment advise in the meantime.

 

[captain]

100mg Test Cypionate IM Injection Weekly. No Other drugs at this time. Dr Crisler does not take insurance. Why does having insurance hinder me in this is what I dont get ? I worked hard to have insurance but now that I do it apparently doesnt help.... Not being rude I am just confused at all of this and dont know where to turn or what to do. Which is what brought me here and to buy the book. I do plan to ask if I can go up in my dose I just dont want to feel worse. When I first started it was horrible , I could barely function and felt like shit...

Dr Crisler is not restrained by what your insurance says they will cover. Your Doctor has to explain why you and your Doctor thinks you would need higher levels of T when your in normal range in the insurance eyes. Dr Crisler can do what ever he wants. You can still go to your Endocrinologists and get prior authorization for your T and see Dr Crisler. You have to be carful with your T level when you see the Endocrinologists. The Endocrinologists has to deal with the insurance co and Endocrinologists may not agree with the level. Like I was told you have to do what's best for you. It's a lot of money up front to see Dr Crisler but you live there. I drove 7hrs to see him. If it's not worth it to you just stick with the program. It took me 3 years to get there and should have done it in 3 months like you and not wasted my time.

 

[Dr Justin Saya MD]

Dr Crisler is not restrained by what your insurance says they will cover. Your Doctor has to explain why you and your Doctor thinks you would need higher levels of T when your in normal range in the insurance eyes. Dr Crisler can do what ever he wants. You can still go to your Endocrinologists and get prior authorization for your T and see Dr Crisler. You have to be carful with your T level when you see the Endocrinologists. The Endocrinologists has to deal with the insurance co and Endocrinologists may not agree with the level. Like I was told you have to do what's best for you. It's a lot of money up front to see Dr Crisler but you live there. I drove 7hrs to see him. If it's not worth it to you just stick with the program. It took me 3 years to get there and should have done it in 3 months like you and not wasted my time.

Nicely said...some of the best and open-minded physicians simply don't want insurance companies dictating what they can and can't do to help their patients....not to mention requiring 2-3 full time employees JUST to deal with the insurance company hassles.

 

[HarryCat]

Dr Crisler can do what ever he wants.

Not exactly. He still has to answer to the state medical board if things get out of hand in their opinion. I know of one TRT doc who lost his license, several docs that treat chronic Lyme disease have been warned (don't know if any have lost their license), and I also know of some docs who were hauled in front of their medical board for prescribing Armour thyroid.

 

[Gene Devine]

Dr. John Crisler @ All Things Male Medical Center...he's in your back yard and we sell his book on this site.

Tell him Gene sent you

 

[chevrolet572]

I really appreciate everyones input so far, wanted to make sure I said that. I went to see the doctor today, it went ok..better than I expected but still need to go see someone else. My new protocol is 80mg twice a week of Cypionate. I also got different syringes 27 x 1/2" 1ml so that should be better than 23 x 1 1/2" ! I also will start taking vitamin D as that is really low. He wants to see me back in 6 weeks but refuses to test estradiol level, I insisted that he works for me and needed to answer all my questions he did and the bloodwork I had done last week he tested my total estrogen level ... not even sure that helps anything but none the less I am going to try this and see what happens. I do have a few questions if you dont mind answering ..

Is it ok to preload a syringe the night before so I can inject it in the am ? I am going to do Monday mornings now along with thursday nights. They give me 1 ml bottles and its a pain the ass to load it so thats why i ask. Or

Could I do an injection Thursday night and Sunday night instead of Monday morning? Is the 12 hour actually less difference a big deal?

I also got my bloodwork results is there anything i should be worried about ? see them below

if I am jumping from 100 to 160 a week should i ease into a few weeks or just make the jump ?I am splitting it obviously now but I really dont want the side effects i have had when i started.



Thanks again guys

Total Test - 384 (240-950)
Free Test - 11 (4.85-19)
SHBG - 31 (10-57)
Total Estrogen.... 141(<41-350) - is that bad or does it matter even ???
hemaocrit - 48.2 (42-49.5).. is that high ?
Vitamin d total - 20.1 (25-80)

 

[CoastWatcher]

I really appreciate everyones input so far, wanted to make sure I said that. I went to see the doctor today, it went ok..better than I expected but still need to go see someone else. My new protocol is 80mg twice a week of Cypionate. I also got different syringes 27 x 1/2" 1ml so that should be better than 23 x 1 1/2" ! I also will start taking vitamin D as that is really low. He wants to see me back in 6 weeks but refuses to test estradiol level, I insisted that he works for me and needed to answer all my questions he did and the bloodwork I had done last week he tested my total estrogen level ... not even sure that helps anything but none the less I am going to try this and see what happens. I do have a few questions if you dont mind answering ..

Is it ok to preload a syringe the night before so I can inject it in the am ? I am going to do Monday mornings now along with thursday nights. Thy give me 1 ml bottles and its a pain the ass to load it so thats why i ask.

I also got my bloodwork results is there anything i should be worried about ? see them below

if I am jumping from 100 to 160 a week should i ease into a few weeks or just make the jump ?I am splitting it obviously now but I really dont want the side effects i have had when i started.

As for Dr Crisler , if you dont mind me asking what does it cost to go to him ? Could i goto my other doctor and use that bloodwork to see him to save on the cost ? Hopefully that makes sense.

Thanks again guys

Total Test - 384
Free Test - 11
SHBG - 31
Total Estrogen.... 141 - is that bad or does it matter even ???
hemaocrit - 48.2 .. is that high ?
Vitamin d total - 20.1

You can load a syringe the night before for convenience; it's not a problem.

Without the ranges of the tests, we're flying blind (every lab establishes their own specific ranges). However, why was total estrogen tested (and paid for)? It's a test that provides no information for a man on TRT. That your doctor would order it speaks volumes about his knowledge of how this game is played.