Why Won't My Doctor Prescribe Testosterone? Legal Considerations for Patients on TRT
As men get older, many will begin experiencing symptoms related
to low T. Symptoms like feeling tired all the time, having a decreased sex
drive, losing muscle mass, and even experiencing mood changes are just a few of
the more common symptoms associated with age related testosterone decline. With
so much media attention, clinical research and information regarding TRT that
people now have access to, the thought of boosting testosterone levels seems
like a straightforward solution for many men. Yet, we continuously hear from a
significant number of patients that come to us that their doctors are hesitant
or unwilling to test for or prescribe testosterone replacement therapy (TRT).
This obviously is a source of frustration and confusion, leading many to come
to us and seek answers regarding how to best move forward with optimizing their
testosterone levels. At NovaGenix Health and Wellness, we believe in empowering
our patients with knowledge. So, let's look into and discuss some of the
complex reasons why doctors might be reluctant to prescribe testosterone and
what you need to know about TRT before starting therapy.
The FDA's Stance and Evolving Research
One of the biggest reasons for physician caution stems from the evolving understanding and regulatory oversight of testosterone therapy by governing organizations, like state health boards and the FDA or even DEA. Going back a long ways, there was a perception, or MISCONCEPTION, fueled by some earlier research and studies and even media reports, that there was a potential link between TRT and increased cardiovascular risks, like heart attacks and strokes. It was so widely believed that in 2015, the FDA even issued a warning to pharmacies requiring a label change on all testosterone products to reflect these possible risks.
While more recent, robust research, including large-scale
randomized trials, has provided reassuring evidence suggesting that
testosterone treatment, when prescribed appropriately, does not necessarily
increase the risk of cardiovascular events in the short- to medium-term, the
earlier warnings have left a lasting impression on the medical community. In Fact,
just this past February of 2025, the FDA
has REMOVED the boxed warning about testosterone and any increased risk of cardiovascular
events. These findings were prompted by the TRAVERSE
trial which showed that there were no elevated risks or major
cardiovascular events (MACE) in males who use TRT to treat hypogonadism. Doctors,
understandably, prioritize their patient safety, are fearful of potential
litigation and action against their medical license will often adopt a
conservative approach when faced with even a hint of potential risk. Due to
their past belief that there were risks, many are unwilling to change their
stance as they don’t see a need to risk THEIR practice, despite overwhelming
evidence that testosterone therapy is both safe and beneficial when prescribed appropriately.
The Challenge of Diagnosis: Is it Truly Low T?
Another major hurdle for patients getting an Rx for TRT is the accurate diagnosis of hypogonadism (clinically low testosterone). Lots of the signs and symptoms associated with low testosterone – fatigue, low energy, mood changes, decreased libido, etc… – are also common signs of aging or may be caused by a myriad of other underlying health conditions such as sleep apnea, thyroid disorders, diabetes, alcohol, tobacco or drug use. Sometimes it could even be caused by stress or may be psychological in nature like with depression. Figuring out the cause of the suboptimal hormones or low T can be tricky and often many doctors don’t feel comfortable looking into the root cause.
Doctors are trained to rule out these other possibilities
first but don’t really train in medical school on the nuances of hormone replacement
therapy and when it’s appropriate to consider HRT for a patient’s treatment. Usually,
the first part of this process involves proper blood testing. Getting
blood work with both free and total testosterone levels is important. Other
tests can check for things like LH, FSH, SHBG, estradiol and TSH for thyroid functioning.
Medical guidelines usually recommend at least two early morning tests (when the
levels are the highest) to get the best reading. Often doctors will prefer to
get blood taken between 8 AM and 10 AM for serum testosterone measurements on
separate days to confirm persistently low levels. Furthermore, understanding
the difference between total testosterone, bound testosterone, and free
testosterone is vital, as a patient might have a seemingly "normal"
total testosterone but still suffer from a deficiency in free, bioavailable
testosterone. We have seen patients will clinically high total testosterone
levels but due to SHBG levels being higher than normal, their free and
bio-available levels were low, which lead to them being symptomatic.
Some of the more cautious primary care physicians also worry
about the potential for over-prescription and misuse of TRT for non-medical
reasons, like improving athletic performance, muscle building or enhancement or
general anti-aging purposes, when a clinical need just isn't present. This
concern emphasizes the importance of a thorough diagnostic process from a
specialist in the field of testosterone therapy. We often have to turn away patients who tell
us that they just want to “do a cycle of testosterone for a few months to get
bigger…” as that is not what TRT is used for and any reputable clinic or
physician will not prescribe testosterone under those circumstances.
Every Patients is Unique and Monitoring Can Be Challenging
No two patients are alike. Each patient presents with different labs, signs, symptoms, possible side effects and goals and challenges with monitoring. Even when a diagnosis of hypogonadism is confirmed, doctors recognize that not everyone responds to TRT in the same way. The same dose may cause levels to rise significantly higher for one person than the next as well as cause changes in blood pressure, hematocrit or estrogen level increases. Because individual responses can vary significantly, with some patients experiencing profound benefits and others seeing little to no changes or improvement in their symptoms, some doctors prefer to not deal with those challenges. This variability makes it tough for doctors to predict how a patient will react to therapy, adding an element of uncertainty thus making the amount of work required on their end as a clinician not worth it in their eyes.
Furthermore, ongoing monitoring is essential once TRT is
initiated. This includes regular checks of testosterone levels to ensure they
are within the therapeutic range, as well as monitoring for potential side
effects such as an increase in red blood cell count (which can thicken the
blood and increase clot risk), prostate stimulation, and worsening of sleep
apnea. Some doctors may be hesitant to take on the responsibility of this
intensive monitoring, especially if they are not specialists in endocrinology
or men's health.
Physician Specialty and Training Differences
The medical training landscape also plays a big role. While
many primary care physicians can initiate the diagnostic process via writing a
prescription for labs and blood work, many feel more comfortable referring
patients with complex hormonal issues to certain specialists like a urologist
or an endocrinologist for the cases of men with suspected hypogonadism,
andropause, relative
androgen deficiency or age-related Low T. These specialists have advanced
training in hormone systems, the HPG axis, HRT and are often more familiar with
the nuances of testosterone therapy, including different formulations of medications,
dosing
and potential interactions with other medications. However, even among these specialists,
opinions and approaches can vary greatly based on their experience,
interpretation of the latest research and clinical guidelines. Finding a doctor
who is experienced in TRT is important to maximize the benefits of treatment.
Comprehensive and Personalized Care
A good physician will understand these complexities and the frustration that can arise when seeking help for low testosterone. Our approach has always been rooted in comprehensive, personalized care for our patients who all have unique treatment needs. It’s vital to start with a thorough evaluation, including detailed symptom analysis, comprehensive lab testing (looking at both total and free testosterone, among other vital markers), and a review of your past medical history to accurately test, diagnose and treat the patient with Low T.
Find a clinic and doctor that believes in educating their
patients about both the risks and benefits of TRT, exploring all potential
causes of their symptoms, and developing a treatment plan that is tailored to
their individual needs and health goals. It’s important to work with a health care
professional who stays abreast of the latest research and guidelines to ensure they
provide the safest and most effective care for their patients.
If you suspect you may be experiencing symptoms of low
testosterone, don't let past experiences with reluctant doctors deter you. There
is always options to be proactive about your health. Schedule a consultation
with NovaGenix Health and Wellness if you’d like to know more. We are dedicated
to providing clear answers, thorough diagnostics, and effective solutions to
help you regain your vitality and well-being and finding experienced
doctors who prescribe testosterone.
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