Unfortunately that’s not true any more. TRT over prescribing is a major problem right now.
Studies of TRT patients have even shown that 1/4 of TRT patients may not have had their testosterone levels measured before being prescribed TRT: (Source https://pmc.ncbi.nlm.nih.gov/articles/PMC6406807/ ) Completely unacceptable given how cheap testosterone testing is, but its happening.
TRT clinics have also become a big business. Their business model relies on prescribing TRT to anyone and then charging them monthly or quarterly to continue receiving those prescriptions, which as the parent comment noted become physically necessary after TRT causes the testes to atrophy.
The trick the clinics are using now is “diagnosing by symptoms”. They have a long list of “symptoms of low T” and the patient is basically prompted to check off enough boxes to justify TRT. It’s the same model as the medical marijuana card businesses where you can go in and the doctor will “find” a reason to give you the prescription.
It’s a real problem when combined with social media influencers who tell people that everything is a symptom of low testosterone and TRT will fix it.
>>The trick the clinics are using now is “diagnosing by symptoms”.
You can't really diagnose by levels, though, unless you knew what that person's previous levels were. Setting an average across a population is not really realistic - you can't say Shaq should work to the same levels as, say, Emo Phillips.
TRT is normally used due to aging, though, so you are unlikely to have your testosterone levels spontaneously recover as you get older. You do tend to need to be on it for life, in the same way that women stay on HRT.
However, if you did need to get off, bodybuilders have "post cycle therapies" to kick start production so it seems to be possible.
If someone shows up with a testosterone level of 700 you can (and should) explain that low testosterone is not the explanation for whatever they’re suffering from.
The TRT clinics are ignoring levels or even not testing at all. They’ll find an excuse to prescribe to someone even who has clinically high levels because they want the monthly recurring revenue from keeping that customer for life.
> If someone shows up with a testosterone level of 700 you can (and should) explain that low testosterone is not the explanation for whatever they’re suffering from.
I'm not going to say TRT clinics are the best actors here, but to an actual endocrinologist, diagnosing hormone issues isn't so simple as looking at single point-in-time measurement of total testosterone.
Testosterone levels naturally vary even for a given individual - two readings at the same time of day on different days even a short period apart can be dramatically different - and that's not even taking into consideration the fact that total testosterone levels aren't the sole (or even primary) mechanism for diagnosing androgenic endocrine issues.
Yup that's right. I had multiple low (<200) tests over 3 years, and finally was able to get on it (haven't actually started it yet to be fair).
Now I am worried about the long term effects, but it's been so long that if I am on it for the rest of my life and it does help me, that's good enough.
What if the person complaining had spent all their life at a base level of 1000? Diagnosing off population base levels is a very blunt tool.
I don't disagree that there are some bad actors out there - the bar to getting it under 40 or 50 should be very high. But honestly, I think everyone's levels should be checked before being put on an SSRI for depression.
>You can't really diagnose by levels, though, unless you knew what that person's previous levels were.
Exactly. Before suggesting it. my doctor had more than a year's worth of data. (I have some blood tests done quarterly; so, he added one for testosterone.) Even then, he sent the results to my urologist.
But also - say over your 55th year your levels were 800, but when you felt your best and most confident at 35, your levels were 1000. What is the correct level for you?
TBD. I was told you start TRT and then check the level in three months. Based on the new level and symptoms, the dosage gets adjusted. That's the difference between doing actually in consultation with a doctor, as opposed to a one-time phone/internet "consult."
I’m getting downvoted in another comment for saying this, but it’s a growing problem. In some surveys of TRT patients up to 1/4 of them didn’t even have their testosterone levels measured before being prescribed TRT. The men’s health clinics are finding excuses to diagnose everyone who calls. The lifetime value of a monthly TRT customer is very high.
> Saying that the men's vitality clinic "pushed you" into a treatment protocol is like saying that a fertility clinic pushed you into getting pregnant.
No, it isn't. “Men’s vitality” doesn’t mean “getting pumped with testosterone regardless of indications” the way “fertility” means “getting pregnant” in either literal denotation of words or the understanding of the general population.
> Sure, it's a common outcome, but you had an idea of what you wanted out of it before you walked in the door.
Yes, but in the case of fertility clinics, getting pregnant aas definitely the outcome beinf sought. Being pumped with testosterone isn’t the outcome being sought from a men’s vitality clinic, it is (even for the people who are actively thinking about it) a mechanism (and not an appropriate one for every patient) for atteempting to acheive the desired outcome.
If you go to a fertility clinic and they don't attempt to identify the source of your fertility issues and just pump you with hormones not indicated for your specific issue, that would be wrong, too.
> No, it isn't. “Men’s vitality” doesn’t mean “getting pumped with testosterone regardless of indications”
When I Google "men's vitality clinic", the top result I see is titled "Your experts for testosterone replacement therapy...". TRT is front and center.
> Being pumped with testosterone isn’t the outcome being sought from a men’s vitality clinic, it is (even for the people who are actively thinking about it) a mechanism (and not an appropriate one for every patient) for atteempting to acheive the desired outcome.
This is such a weird distinction to try and make.
I frequently see ads for these services, and even when they're not so explicit as that one is about what they're selling, it's extremely clear what demographic they're going after and what the hook is.
Testosterone being a Schedule III substance, "men's vitality" is the way that they can legally advertise an service that prescribes AAS. It's no more of a secret that men's vitality clinics prescribe testosterone than it is that fertility clinics are prescribing estradiol. Both of these are sex hormones that induce a specific effect on the body which the patient is looking for.
Can I imagine someone walking into a men's vitality clinic and being surprised that they're getting offered testosterone? Sure, and there's also that German couple who went to a fertility clinic because they weren't having a baby, and were surprised to learn that they needed to start having sex.
Clueless people exist. That doesn't mean that it's not readily obvious to anyone who's paying attention what these clinics exist to do, and how they do it.
