Hormone Therapy! (Where To Go?)

[PaulKemp]

Hey everyone,

I wonder if some of you who have gone through the process could lend me some help.

I am 32 years old. Active in the gym and I eat healthy. Dont drink or smoke regularly.

I went to an Endocrinologist recently at Bumrungrad and had some blood tests done.

It cost me 9,000thb for the tests, then the visit fee.

The results came back and showed low testosterone.

I did another test a few weeks later (5,000thb), which also showed low test, low lh and low fsh.

The doctor wrote that I had hypogonadism on the medical form. He suggested I should get TRT.

I did an MRI (24,000thb) and the results came back normal.

He did not test for estrogen, or my liver condition.

I had a visit with him recently, and he reversed his position, and said that my T “wasn’t that low anyway.”

He wanted to prescribe Andriol, and when I asked about the problems with this drug and the liver he said there was no problem- nothing to worry about. He also said that I would not need to worry about anti-estrogen drugs! And that my levels were “probably” ok.

I asked him a few questions about getting T injections- which would probably be preferrable than the T cream, or the pills, he said he would have to refer me to a fertility clinic as he “didn’t know about them, but they are more expensive.”

Feeling a little strange, after having spent close to 50,000thb on a doctor who seemed not to know anything at all- or was willing to explain just what to do, and how, I walked out of the hospital and vowed to never return there.

Does anyone else know about a GOOD clinic for TRT, HRT or the like that can answer my questions and not cost a dam_n fortune for tests and drugs?

Many, many thanks in advance!

(Test results, just in case)

March:

Free T4 1.00 ng/dl (0.65 - 1.26)

TSH 1.299 uU/ml (0.340-5.6)

Cortisol 15.8 ug/dl

ACTH 27.4 pg/ml

Total T 438 ng/dl

SHBG 49. nmol/l (10-60)

Albumin 39 gm/l (38 - 50)

Free Androgen Index 30

Free T 72 pg/ml (90-300)

% Free T 1.63% (2-4.8)

Bioavailable T 153 ng/dl

May

Total T 377 ng/dl

SHBG 37.2 nmol/l

Albumin 38 gm/l

Free androgen index 35

Free T 75 pg/ml

% Free T 1.99

Bioavailable T 156 ng/dl

[Mobi]

I've been seeing the same endocrinologist, a female doctor, at Bumrungrad since 2001, and she has been very satisfactory in all respects.

A few years back, I too had a problems with libido and testosterone levels. She sorted me out and I have been fine ever since.

She always discusses all my blood results with me and explains them in a rational and easy to understand way and occasionally suggests adjustments to my meds if any results are showing anything outside the recommended range.

I have found through the years that there are different ways of achieving more or less the same results - and being a top private hospital, they will always initially recommend the best, latest and obviously most expensive treatment available. A good example is the testosterone shots which i initially received every 90 days but were extremely expensive. I chatted to the doc and she switched me to 3 weekly shots which do the job equally as well and are a fraction of the price.

I always buy my meds outside of Bumrungrad - just tell the doctor and he/she will not prescribe for you - or if it is a new drug, the just get a few days supply and then buy the rest outside.

As Sheryl has stated on many occasions - it is really more down to the doctor rather than the hospital. Choose carefully and if you are not happy, then change. You must also use the methods suggested above to keep your costs down.

Good luck

BTW I distinctly recall asking my doc about Andriol and that she was not a fan of that drug at all.....

[Sheryl]

Mobi,

Since you are happy with your endocrinologist could you perhaps share the name?

[PaulKemp]

Anyone have any information they don't mind passing on?

Thanks

[Mobi]

Mobi,

Since you are happy with your endocrinologist could you perhaps share the name?

Sorry, I was a bit distracted.

My endoctronolist at Bumrungrad is

Dr. Chorthip N. Phattanasri

Specialty: Medicine - Medicine, Endocrinology (Diabetes, Thyroid, Hormone, Nutrition)

Language Spoken: Spoken: English, Thai

Qualifications:Medical School:

- M.D., Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Thailand, 1995

Board Certifications:

- Diplomate of The American Board of Internal Medicine, 2001

- Diplomate of The American Board of Endocrinology, Diabetes & Metabolism, 2004

- Diploma of The Thai Board of Endocrinology & Metabolism, 2006

Fellowships:

- Clinical Nutrition, Tufts-New England Medical Center, USA, 2002-2003

- Endocrinology, Diabetes and Metabolism Tufts-New England Medical Center, USA, 2002-2004

Special Clinical Interests:

- Diabetes, Lipid, General Endocrinology

She may not have a lot of grey hair, but she is very personable, speaks good English and always has the time to discuss things with you. She understands that not everyone is made of money and is quite happy for you to buy your meds outside the hospital and to discuss cheaper alternatives.

She also travels frequently to seminars etc in the USA and elsewhere and keeps bang up to date with all the latest procedures, meds and treatments. She is very bright.

I have generally found that most MD's of internal medicine and endoctrinoligists in Thailand seem to be stuck in a 1980's time warp as far as developments in diabetes is concerned and that quite often, I know more than they do on the latest treatments for diabetics.

I am always a bit reluctant to suggest the names of anyone these days, be they plumbers, electricians or doctors as I have found through the years that someone who suits me, often has the opposite effect on someone else, and I am sometimes subjected to vitriolic complaints from those who do not like my recommendations.

So if anyone wishes to try the good doc, be it on your own head and please don't complain to me if you don't like her.

Edited June 5, 2012 by Mobi

[Sheryl]

Her qualifications are certainly impressive. It is especially unusual and valuable that one of her fellowships was in nutrition.

[moe666]

Anyone have any information they don't mind passing on?

Thanks

Paul your T is low and your free is very low. You need to have an estrogen and DHT test as well to determine there values. I would recommend some liquid zinc which you can order from Iherb and they will ship to you no problem. The zinc blocks amratese which converts T to estrogen. You may also want to go to LEF.org they have some very good info on Hormone replacement Therapy. Your shbg is also very high as well which indicates elevated estrogen, stinging nettles is a herbal product to help this situation. You T levels are in the mid range you could use some replacement therapy for this as well but then you need to monitor your estrogen levels, dht, shbg I would also consider a psa test for your prostate especially if your dht is high. Good luck I would recommend you start doing a lot of reserch on the web for these issues as Drs. unless they are trained in hormone therapy donot know squat.

I took an old girlfrind to the clinic in Bumragard and I was not impressed with there recommendations it was a waste of 10,000baht

[PaulKemp]

Yes, thats a big problem- I am definitely not impressed with the Doctors at Bumrungrad.

Hey, whats wrong with me?

"I don't know, here- take this medication."

...?

I often get that. The same applies for this latest Dr.

As I understand it, its very important to check estrogen, PSA, and liver enzymes BEFORE you prescribe treatment! ..He never did.

Anyway- I am looking elsewhere for a good Dr. Bumrungrad is a money collection point, no more.

Edited June 11, 2012 by PaulKemp

[Sheryl]

there is a huge variation among doctors at Bumrungrad, just as there is at any hospital. Some excellent doctors there who do explain things and are thorough, and some just as you describe.

Same will be true elsewhere.

it is the doctor, not the hospital, that you need to choose.