Testosterone Truths: Why Primary Care and Guidelines Fail You

While primary care providers would not purposely want to make their patients feel lousy, they are succeeding. Primary Care Providers (PCPs) attempt to help their male patients in one of two ways. First, they attempt to talk them out of exploring testosterone treatment or (possibly worse) prescribe testosterone following flawed guidelines. We will explore both of these scenarios.

One of the most popular topics male patients encounter while researching health topics is testosterone. They read how “T Levels” impact their energy levels and day-to-day life. Some providers are willing to succumb to a patient’s request to look into their testosterone levels.

Providers who find their patients have testosterone at the lower reference range might outline treatment options. These options range from pellets to creams to injections. The patient may even excitedly choose an option to begin treatment, and sadly, the day will come when he will question that decision.

The biggest problem with the above scenario (besides that it is way too common) is that medicine is an art. And medicine has niches called specialties. The other problem is guidelines. Guidelines do not care about the individual patient, nor do insurance companies.

The Guidelines to Treat Low Testosterone are Biased and Flawed

The top online resource for practicing providers is UpToDate. This site has hundreds of thousands of medical topics and discusses diagnostics and practice guidelines. It is helpful to a provider who wants a dry, boring breakdown of nearly any disease. However, it is flawed. It discusses the treatment of theoretical, generic patients based on a statistical amalgamation of data strewn together over many (possibly flawed) studies. While it can be helpful, it is not personalized, does not leave room for the art of medicine, and does not offer room for “anecdata” (anecdotal experiences + data) that specialty practitioners discover, discuss, and hone over decades.

In regards to testosterone, UpToDate makes it a point to mention: “There has been a dramatic increase in inappropriate use of testosterone therapy in healthy, middle-aged and older men. Testosterone should not be prescribed for men with vague symptoms (such as fatigue)...” and continues further discouraging the “...use of testosterone products for nonspecific symptoms, such as decreased energy and sexual interest.”

These guidelines are biased out of the gate, leaving no room for interpretation. The advice is straightforward: do not treat males with fatigue, decreased energy, or essentially low libido with testosterone.

“These guidelines are biased out of the gate, leaving no room for interpretation. The advice is straightforward: do not treat males with fatigue, decreased energy, or essentially low libido with testosterone. ”

Sorry to say, but men with low testosterone often feel fatigued, and the symptoms of fatigue are not vague in the least. While UpToDate will spend exponential time treating fibromyalgia (a vague disease of fatigue most often in women), it says to ignore fatigue in men. Its experts then describe low libido and decreased energy as nonspecific. How much more specific should men be? Energy, libido, and drive are very specific characteristics that help define a man. These should not be ignored.

While we won’t go into great detail, insurance companies do not want to pay for men to feel better. Most often, insurance companies will not cover testosterone replacement unless a man’s levels fall well below the guidelines (which are abominably low).

As a quick reference, a level of testosterone below 300 ng/dL is the lower end of normal according to the guidelines. UpToDate sadly suggests not treating a patient above the mid-range of 500-600 ng/dL and stopping treatment if this occurs with therapy. Most men only begin to feel benefits above 800-900 ng/dL to an upper limit approaching 1100-1400 ng/dL.

Insurance does not care that testosterone replacement therapy (TRT) might help you recover from low energy, lack of focus, and decreased libido. They care about money. They do not want to pay for individualized treatment. If, by chance, you are approved for testosterone therapy, then we can only hope your primary provider knows what they are doing. Most likely, they do not.

How Testosterone Replacement Therapy (TRT) is Done Wrong

If you do begin testosterone replacement with your primary practitioner, you might be lucky to have an injection every week, two weeks, or (heaven forbid) every month. You’ll get to visit your doctor’s office, sit there, and then have an injection. Or, they may entrust you to inject yourself at home, albeit rarely.

As an aside and warning, many private testosterone companies will take advantage of you and your insurance company. They will gladly see you as a patient (charging insurance), treat you for low testosterone (which you pay for since insurance will not), and then see you each week for your injection (both charging you for the testosterone and your insurance for the visit).

UpToDate directs practitioners to have the patient inject 50 to 100 mg once weekly, or even worse, 100 to 200 mg every two weeks.

In a clinical setting, a 100 mg dose of testosterone might raise a person's testosterone levels by approximately 400 to 700 ng/dL, depending on individual physiology and metabolism factors. By the time you inject again one week later, your testosterone will have dwindled. Levels plummet even further if injections occur every two weeks.

This treatment regimen with testosterone results in the inadvertent maltreatment of patients - a roller coaster on male physiology with fluctuations in energy, along with detriment to the emotional and sexual well-being of the patient.

“This treatment regimen with testosterone results in the inadvertent maltreatment of patients - a roller coaster on male physiology with fluctuations in energy, along with detriment to the emotional and sexual well-being of the patient.”

That’s why most primary care providers do testosterone wrong. They either ignore the concept or attempt to treat low testosterone without a deep understanding of the intricacies of the art of hormone therapy. Even if a practitioner gets it right and the patient is “dialed in,” then continued monitoring, assessment of symptoms, and intermittent fine-tuning need to occur to ensure the patient is safe and feels well for as long as they choose.

Why Lucidity Men’s Clinic Exists

These reasons are why companies like Lucidity Men’s Clinic exist. We are here to not only fill the void of treatment but also act as advocates and specialists for men who want to overcome fatigue, low energy, depressed mood, and faltering libido. We talk openly to our patients about these topics. Because of the flaws of insurance and guidelines and the lack of treatment available to men, we charge rates we feel are fair for access to expertise and treatments that safely benefit our patients. You’ll find all sorts of options, but we hope you discover why we are different, focused, and offer personalized treatment unheard of in our specialty sphere.