As pioneers in TRT since 1999, we have watched with interest as the testosterone therapy landscape has shifted over the years. Thankfully, there are many qualified providers in the marketplace who follow best practice when treating their patients. We consider ourselves to be among them.
However, there continue to be many providers engaging in questionable practices. Broadly speaking, we find the following to be concerning:
- Practitioners prescribing TRT without the expertise necessary to do so safely and effectively.
- Practitioners who jeopardize safety and effectiveness by cutting corners during the execution of treatment (generally in an effort to reduce costs).
- Practitioners not following best practice because doing so requires too much time, patience, and attention to detail.
Following are just a few of the widespread issues we hear about from new clients who come to us after trying one of these providers:
- In many cases, these providers prescribe TRT to their patients without sufficient or proper lab testing. This can mean ordering lab tests too infrequently; it can mean necessary tests being omitted from what it ordered; and it can mean substandard testing modalities.
- Treatment protocols are often inadequate, incomplete, or don’t follow best practice.
- Medications are often prescribed on a one-size-fits-all basis.
- Intake procedures are often inadequate or non-existent.
- There are frequent logistical issues with everything from credit card transactions to medication orders because customer service infrastructure is lacking.
- Clinical staffing is limited, making it difficult for patients to get help if they need it.
- Many of these providers communicate with their patients primarily via messaging. It can take days to get a response (if a response is provided at all), and we understand it can be virtually impossible to speak with a competent human in real time.
- Clinical and customer service staff often lack the training and expertise necessary for proper execution of treatment. Turnover is rapid, and patients are unlikely to develop ongoing relationships with the people providing their care.
- Patient education related to how TRT works, what to expect, and how medications should be taken is frequently lacking.
- Patients often have little to no interaction with a physician. Turnover can be an issue here, as well, and there may not be an ongoing relationship with any particular physician.
- Record-keeping is often inadequate.
- Monitoring progress on an ongoing basis via regular interaction with clinical staff is often inadequate or non-existent.
We’re Talking About Your Health—Don’t Settle for Less Than You Deserve
There are areas in life where bargain shopping makes sense. Our strong feeling is that your health and your TRT shouldn’t be among them.
Following are some important considerations when looking for a TRT provider:
- Insist upon having lab work done before you start treatment, and every 6 months thereafter (at a minimum). Many providers cut corners by only lab testing annually. This might be OK if your physiology were static, but it isn’t. How your body metabolizes hormones shifts over time. As a consequence, dosing should be managed at regular intervals for treatment to be safe and effective. Anything less than every 6 months jeopardizes patient safety, and a provider doing anything less is cutting corners.
- Insist that your provider order all of the tests necessary for TRT to be safe and effective. At a minimum this means checking testosterone (both total and free), estrogen, a PSA, and a CBC (also known as a complete blood count). If your total testosterone is checked but your free testosterone is missed, your provider will have an incomplete picture relative to your testosterone levels (which could result in a regimen that is incomplete and/or dosing that is improper). If your provider isn’t checking your estrogen level, safety will be compromised, and the chance for developing side effects increases dramatically. And if your provider isn’t ordering a CBC on a regular basis, they will not know if your hemoglobin is increasing as a consequence of your treatment (which is another safety issue). Again, a provider who isn’t ordering these tests every 6 months (at a minimum) is cutting corners.
- Make sure your provider is ordering your lab work via venipuncture (meaning your blood is drawn by a phlebotomist and is then processed by a lab). Many providers use blood spot or saliva testing. This is problematic for two reasons. First, neither of these are sufficiently accurate. And for the reasons described above, accuracy is important. Second, ordering a CBC regularly is essential for treatment to be safe; and it is not possible to run a CBC via blood spot or saliva testing. Anything other than lab testing via venipuncture is sacrificing safety for convenience.
- Ensure your treatment is comprehensive enough to where safety and effectiveness are not compromised. Testosterone alone is generally not enough. When TRT is done correctly, it will almost always include an estrogen blocker. Without a properly dosed estrogen blocker, side effects are likely. A testicular stimulant should be prescribed for men who wish to preserve fertility and/or who wish to prevent testicular atrophy. And men who develop elevated hemoglobin as a consequence of treatment should be directed to donate blood at an interval that keeps levels within a healthy range.
- Don’t settle for substandard methods of delivery. There are multiple methods for getting testosterone into a man’s body, but there are only two that are sufficiently precise and free of complications: injections and transdermal cream. For a variety of reasons, the vast majority of our male clients take their testosterone by injection. For those who have issues with needles, transdermal cream is the next best option. Pellets, patches, and oral testosterone each have their own unique issues. Call us if you’d like to know more about what those issues are and why we don’t use them in our protocols.
- Insist that your medications and dosing be individualized and finetuned to your body’s unique needs. One size does not fit all when it comes to testosterone therapy. Likewise, your dosing should be tweaked and adjusted over time as your physiology and your lab levels shift. If your provider does not take the time to make sure your levels remain optimized over time, this is a red flag.
- Pay attention to your provider’s intake procedures. Apart from ordering lab tests, your provider should know a lot about you before any prescriptions are written. A detailed health history should be taken (and updated at regular intervals); a complete inventory of symptoms should be taken (and tracked over time); and patient goals, objectives, and areas of concern should be discussed. Patient education is also important. Your provider should review your lab results with you and explain to you what they mean each time your lab test; they should talk with you about how TRT works and about what you can expect from treatment; and they should review with you how your medications should be taken.
- Ask about your provider’s approach to customer service and inquire as to what their structure is in this regard. Ensure that you will be able to reach someone in real time within a reasonable amount of time if you have a question or need help. If your provider communicates primarily by message with long periods of time passing between a question being asked and answered, consider whether this will be tolerable for you in the long run.
- Make sure your provider’s staff are knowledgeable. Ask a lot of questions. If your provider’s clinical and customer service staff cannot answer your questions or won’t take the time to do so thoroughly, look elsewhere. It also doesn’t hurt to ask if there are specific staff members you will communicate with on a regular basis. You want to build relationships over time with the people who will be overseeing your care.
- Make sure you will have an appointment with a physician at least one time per year, and that there will be regular physician oversight in between those appointments as needed. Anything less is bad medicine. Also, continuity of care is important. While there can be instances where the physician overseeing your care may legitimately need to change, such changes should be the exception as opposed to the rule.
Renew Youth has been providing best-in-class TRT to our clients for more than 26 years. Call us. Ask us questions. Get to know us and allow us to get to know you. We think you’ll be glad you did. You can reach us at 800-859-7511. Or fill out our easy contact form.