The cool thing about where I live is that I don't have to see a GP at all. I can go straight to the specialist and get seen. No consultation is needed. Specialists here are surprisingly on top of current research, but, then again, they often make trips to Europe for seminars.
Everybody has to start somewhere, but I think the cookie cutter protocols a lot of doctors hand out are often too aggressive. I think a slow, methodical approach is probably best. Of course, it doesn't give the patient instant gratification, but I think it ultimately serves the patient's best interest.
So is TRT pretty advanced where you are at - lots of options, good understanding of fertility, etc.?
Yes and no. It still depends on who you see, unfortunately. They have specialty clinics in Manila, and where I'm at there is a good fertility doctor that has a good handle on male hypogonadism treatment. What is lacking here is a sensitive Estradiol test. Fortunately, for me, the only time estrogen has been a problem was when I was taking anastrozole as part of my protocol. That stuff knocked my E2 into the dirt, and it was really a very low dose. I just respond too much to it, I guess. Labs can be pretty expensive, some medications can be expensive, but the visits to the doctor are cheap. I paid the equivalent of $16 for my last fertility consultation with my wife. I'm due for a knee surgery next month, and that is going to cost me $3,000. Compared to the US, that's super cheap.
I don't think anyone here has a handle on TRT like some of the physicians who engage in the comments here.