Where to get Testosterone prescriptions?

[DocGeezer]

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

 

[testiculus]

Try a local urologist. In general urologists are more informed than other medical specialities with TRT. If you're in a major metro area look for a urologist that did a fellowship at Baylor in Houston under Lipshultz or Harvard in Boston under Morgentaler. If you're unable to find a good urologist locally. Defy would probably be your best option.

 

[Golfboy307]

If you are with a good doctor not trying to mark up prescriptions like crazy, get a 90-120 day supply from Wells or APS compounding pharmacies. I pay about $100 for a 10ml vial delivered.

 

[DocGeezer]

Try a local urologist. In general urologists are more informed than other medical specialities with TRT. If you're in a major metro area look for a urologist that did a fellowship at Baylor in Houston under Lipshultz or Harvard in Boston under Morgentaler. If you're unable to find a good urologist locally. Defy would probably be your best option.

I'm in Texas so finding a urologist educated at Baylor is very easy, actually rather hard to find any not educated at Baylor. How would you search for Fellowships under Lipshultz?

...and when did 155-721 (ng/dL) become the range, I thought everyone was shooting for 800 to 1100?

 

[testiculus]

I'm in Texas so finding a urologist educated at Baylor is very easy, actually rather hard to find any not educated at Baylor. How would you search for Fellowships under Lipshultz?

...and when did 155-721 (ng/dL) become the range, I thought everyone was shooting for 800 to 1100?

I don't have a good answer. The only thing I can suggest is to look at each Urologist's background and see if they mention a residency or fellowship in Lipshultz's clinic. He usually has 2 research fellows and 2 clinical fellows every year, plus who knows how many residents.

Each lab has their own range and in general labs have been lowering their "normal" range which really just represents the 2.5 percentile cutoff, not really normal. So going by the lab range as a treatment guideline is meaningless.

In general a good urologist will look to find the lowest dose that fully resolves your symptoms of hypogonadism rather treating to a number.

 

[Sergel]

You also have to consider what level of free/bio available T this 800~1000 total T takes you... Total T is not very useful. What is your SHBG/Free T number?

1000 is high, unless you have high SHBG this puts most males in superphysiological free T ...

I think you need a good TRT doc... I would not knock the lower doses until you have tried them, you might feel better... many, including me do...

 

[Daveleeander]

With telehealth or clinic you’re certainly gonna pay a considerable bit more than $25/ month. I pay $175/month for telehealth thru a clinic. If you’re looking for inexpensive go over to naps and order some. Or answer one of those ads on fb where you call in, get diagnosed and get a script. Don’t know what that costs though

 

[Cataceous]

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.
...

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

 

[FunkOdyssey]

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

You make a bunch of good points as usual. I would personally be hesitant to make changes to a protocol described as "dialed-in, "life changing," and has delivered consistent results over a relatively long period of two years. Yes, check your HCT, lipids, blood pressure, etc, and read up on the risks of supraphysiologic levels so you are well-informed. However, if everything looks good and the only cause we have for alarm is your Total T lab result, I'd be on team "find a new doctor".

 

[sammmy]

I'd say, try to lower the dose to get around 700 total T, to satisfy the new doctor. I don't believe a trough level of 700 and "between 800-1000" is a massive difference in terms of effects or side effects.

 

[testiculus]

Don't be so quick to dismiss the new doctor. It sounds like you're taking 180-200 mg of testosterone enanthate once a week, is this right? If so then you are taking about triple the testosterone the average healthy young guy makes naturally. This is not TRT. Feeling good in the short term is not the whole story. How are hematocrit and lipids? As @Sergel notes, free testosterone is more important than total, but at this dose yours is pretty much guaranteed to be high. If you are injecting once a week and measuring at trough then your peak serum testosterone is probably 2,000-3,000 ng/dL. Your doctor is right to want to avoid this. Of course, as an adult you are free to disregard cautionary advice, but you should try to understand the uncertain long-term risks related to blood viscosity and cardiotoxicity, in case they end up applying to you.

If he had never tried a lower dose, I would agree with you. But it sounds like he already went through titration with his previous physician and knows that it takes 180 mg/week to resolve his symptoms. Just because someone is taking a higher dose than most need doesn't mean it's inappropriate. Too much weight is placed on serum levels. Find the lowest dose that fully resolves symptoms. Otherwise what's the point. Why feel like crap all the time and lead a miserable life when you know you can be normal - it just takes a little higher dose.

 

[Cataceous]

If he had never tried a lower dose, I would agree with you. But it sounds like he already went through titration with his previous physician and knows that it takes 180 mg/week to resolve his symptoms. Just because someone is taking a higher dose than most need doesn't mean it's inappropriate. Too much weight is placed on serum levels. Find the lowest dose that fully resolves symptoms. Otherwise what's the point. Why feel like crap all the time and lead a miserable life when you know you can be normal - it just takes a little higher dose.

My suspicion is that this is yet another case of "start high, go higher", very common with injections. But maybe he's an exception. It's highly questionable that a guy needs more testosterone than any man on the planet could make naturally. But sure, if he's tried a range of physiological doses with long stabilization periods, and understands the risks, then have at it.

 

[tumbleweed]

Defy Medical. Been there 10 years. Pay for what you get. Reasonable prices. They go by how you feel. They don't care about 1000+ test levels.

 

[Wilson7]

My non-medical two cents. GoodRx 10 cc 200 mg/ml is about $40. This business of HRT clinics is the equiv of pill mills for opioids IMO and they can rape you on cost and unnecessary labs that they get kick backs on bc they can, knowing most docs either won't or under treat with T. I've seen nothing in the lit that suggests that 800 - 1200 is going to put anyone in the grave faster than 400 - 800. Watch BP, HCT and PSA, other that that general chems once or twice year. It takes +300 mg/wk to affect lipids (Bhasin et al) and HDL is overrated esp if > 35 regardless. I am lucky I have had the same urologist for 30 yrs, at some point he'll retire and I'll sort it out. If you do your own injections, through Walk in labs (unless you live in a nanny state) do serial measures every 4 days for 2 weeks post inj and figure out how long after an inj you need to go to fall within a given lab value range (start from steady state not your first inj). Ask your doc what his/her sweet spot is and make it work. As long as the rest of your labs are good, keep it where you feel your best (as long as its not averaging >1000).

 

[cowhow]

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

If you’re in the DFW area I can recommend an outstanding urologist. I had the same issue with my PCP. As a rule they simply don’t have sufficient experience managing TRT. Anyone can prescribe it but not everyone can properly manage it.

I recently relocated out of the country and I have the same fear of getting a new doc as you. Fortunately where I’m located testosterone is OTC and far easier to get. So, I know what works for me and am really hesitant to tinker with it. If it ain’t broke don’t fix it.

 

[jayt]

Been on TRT for almost two years. It's been life changing. I take .9 to 1cc per week of Enanthate injected.

Took a while to dial it in, but 800 to 1000 seems to be the sweet spot for me. Then primary care physician retired, new guy want's it to be below 750. "Don't care how you feel, it's too high!!!" I'm thinking I may need a new doctor.

I check the local TRT type places and they're 400 a month and they require you go into their office 4 times a month for injections and I already do my own. I pay 25 bucks a month for 1 vial of enanthate at CVS.

I pay out of pocket anyway since it's cheaper than going through insurance. What's the best way to get a prescription called into my pharmacy. What types of medical options are there? Online options?
-Thanks

12 years ago I went to Boston Medical Group, they did blood tests and prescribed T and Viagra. Charged me $300. I then decided to go to a Urologist on my med plan. They did the same thing, blood tests and prescribed me T and Viagra. The office visit cost me $20 copay and both the T and Viagra were prescribed thru CVS. I have continued with visits to my Urologist 4 times a year and 5 years ago used GoodRX for the prescriptions at CVS. Today, T is covered by my health insurance 100% and I have moved from Viagra to Trimix. Trimix is prescribed and filled by a local compounding pharmacy and costs me $99 for 5ml, which is approximately 40 injections, lasting me about 3 months. My advice is simple.... go to a Urologist and forget the "male" clinics. "Male" clinics overcharge for blood work and the prescriptions, they prey on men's desires...

 

[amphibiousnick]

12 years ago I went to Boston Medical Group, they did blood tests and prescribed T and Viagra. Charged me $300. I then decided to go to a Urologist on my med plan. They did the same thing, blood tests and prescribed me T and Viagra. The office visit cost me $20 copay and both the T and Viagra were prescribed thru CVS. I have continued with visits to my Urologist 4 times a year and 5 years ago used GoodRX for the prescriptions at CVS. Today, T is covered by my health insurance 100% and I have moved from Viagra to Trimix. Trimix is prescribed and filled by a local compounding pharmacy and costs me $99 for 5ml, which is approximately 40 injections, lasting me about 3 months. My advice is simple.... go to a Urologist and forget the "male" clinics. "Male" clinics overcharge for blood work and the prescriptions, they prey on men's desires...

Agreed about male clinics. They are mostly experts in marketing. The only other thing I would recommend is finding a good naturopathic doctor that well-versed in TRT instead of a urologist if you can afford to. They will lookout for your health in a much more holisitic manner than a urologist would.

 

[tropicaldaze1950]

Call the urology department at Baylor, tell them where you're located and that you're looking for a urologist who prescribes TRT. I've read that Dr. Lipshultz prescribes 200 mg, weekly. If you feel good physically/mentally on your dose, labs and BP are in range, no problem. This isn't about how everyone else feels; it's about you.