Reference ranges and TRT treatment?

Great thread from Dr Justin Saya, MD about LabCorp changing their reference range for total testosterone measurement in adult males, (DECREASING) to 264 - 916 ng/dL (previously 348 - 1197 ng/dL).

https://www.excelmale.com/forum/showthread.php?11061&p=74903#post74903

This is for those men that fall into the “normal range”?
Is insurance the main driver of doctor’s failure to treat symptoms of TRT, or is it a legal fear or is it ignorance?

Those men that have low testosterone but aren’t below the 264 ng/dl level? If your TT is 300, but your free T is 5.5 pg/ml (6.6-18.1), most doctors seem to focus on the TT and not the FreeT.

My primary doctor said that he very often gets turned down by insurance if he tries to treat someone with test testosterone that falls into the “normal” range.

So is complying with insurance the big driver for most Doctor’s. It certainly seems so since most anti-ageing clinic don’t accept insurance and they have more liberal policies.

If you inform your primary doctor that you don’t mind self paying is they are turned down when they send in your bill to insurance, does that make a difference?

BTW, I have read that many doctors who are in insurance networks cannot accept self pay from a patient who does have insurance. But I do believe the doctor can file a claim then bill you if they get turned down. I am not to sure about this either.

As a Canadian, I am not in a position to address the issue of how American patients and their doctors address the confounding question of insurance coverage.

I do know, and it has been commented on many times, that very little time is devoted to androgen issues in medical school, residency, or fellowship training in North America (and it seems that's the case in the rest of the world). Doctors don't know how to treat the hypogonadal patient, and aren't aware that they are so poorly trained.

One can't rely on board specialty designation, on medical school affiliation, or any other external ratification. The men and women who know how to play this game could be certified in family practice, my doctor is, urology, internal medicine, or endocrinology.

Take the typical doctor's lack of knowledge, combine it all too frequently with a level of arrogance many of us have encountered in the medical system, and mix in a societal fear of testosterone (it's a scary steroid)...you find a lot of men finding it next to impossible to obtain treatment.

CoastWatcher said:

As a Canadian, I am not in a position to address the issue of how American patients and their doctors address the confounding question of insurance coverage.

I do know, and it has been commented on many times, that very little time is devoted to androgen issues in medical school, residency, or fellowship training in North America (and it seems that's the case in the rest of the world). Doctors don't know how to treat the hypogonadal patient, and aren't aware that they are so poorly trained.

One can't rely on board specialty designation, on medical school affiliation, or any other external ratification. The men and women who know how to play this game could be certified in family practice, my doctor is, urology, internal medicine, or endocrinology.

Take the typical doctor's lack of knowledge, combine it all too frequently with a level of arrogance many of us have encountered in the medical system, and mix in a societal fear of testosterone (it's a scary steroid)...you find a lot of men finding it next to impossible to obtain treatment.

Click to expand...

I money drives most decisions.

The doctors / clinics that don't take insurance tend to prescribe testosterone, while most doctors operate under guide lines that are issued by the CDC, urology etc. And it appears those guide lines are strongly influenced by big pharma and the health insurance industry. What I call the medical industrial complex.

Two doctors I have gone to, my PCP and urologist both mentioned that without insurance testosterone would be very expensive, and my PCP also said that urologists tend to be approved more often.

I am sure my PCP is knowledgeable about testosterone, at one time he was a bodybuilder and is in very good shape. I have no idea if he ever used testosterone, he tends to be a naturalist melding eastern and western therapies, both conventional and alternative.

I have asked this question to see what doctors would say about this, and the experience of other posters had with their own doctors.

For sure, doctors in general don't consider making people healthier if they don't already have clear signed of disease. They find it easier to treat if you are already falling apart. Not just an issue with testosterone, I see it with other issues like knee replacement surgery.

DragonBits said:

I money drives most decisions.

The doctors / clinics that don't take insurance tend to prescribe testosterone, while most doctors operate under guide lines that are issued by the CDC, urology etc. And it appears those guide lines are strongly influenced by big pharma and the health insurance industry. What I call the medical industrial complex.

Two doctors I have gone to, my PCP and urologist both mentioned that without insurance testosterone would be very expensive, and my PCP also said that urologists tend to be approved more often.

I am sure my PCP is knowledgeable about testosterone, at one time he was a bodybuilder and is in very good shape. I have no idea if he ever used testosterone, he tends to be a naturalist melding eastern and western therapies, both conventional and alternative.

I have asked this question to see what doctors would say about this, and the experience of other posters had with their own doctors.

For sure, doctors in general don't consider making people healthier if they don't already have clear signed of disease. They find it easier to treat if you are already falling apart. Not just an issue with testosterone, I see it with other issues like knee replacement surgery.

Click to expand...

What do you mean, "without insurance testosterone would be very expensive?" Are you referring to the all-in cost of treatment, doctor, labs, prescriptions? It may well be cheaper than you think. Many of our American members budget and pursue treatment outside their insurance network.

CoastWatcher said:

What do you mean, "without insurance testosterone would be very expensive?" Are you referring to the all-in cost of treatment, doctor, labs, prescriptions? It may well be cheaper than you think. Many of our American members budget and pursue treatment outside their insurance network.

Click to expand...

You misunderstood me.

Two DOCTORs had told me this, I personally don't think it's all that expensive. I didn't have the chance to quiz them on this, so I am not sure why exactly they held that belief. Something like Aveed would be expensive, but testosterone cypionate not that expensive if you shop around. I have no idea what creams and gels cost and I am not interesting in that route.

If you can get a prescription for the meds you need locally, likely that is the cheapest but most difficult and time consuming route. (Without estimating what the initial appointment might cost, but let's say $250.) As often discussed, many doctors don't want to write those prescriptions.

My next best choice would be Defy, who I consider very reasonable in price. If I were considering my time then I would go with Defy as my first choice.

I have seen ads for local clinics run about $200 a month, but I don't see any reason to pay that much.

Defy seems the most reasonable,flexible and time efficient.

DragonBits said:

You misunderstood me.

Two DOCTORs had told me this, I personally don't think it's all that expensive. I didn't have the chance to quiz them on this, so I am not sure why exactly they held that belief. Something like Aveed would be expensive, but testosterone cypionate not that expensive if you shop around. I have no idea what creams and gels cost and I am not interesting in that route.

If you can get a prescription for the meds you need locally, likely that is the cheapest but most difficult and time consuming route. (Without estimating what the initial appointment might cost, but let's say $250.) As often discussed, many doctors don't want to write those prescriptions.

My next best choice would be Defy, who I consider very reasonable in price. If I were considering my time then I would go with Defy as my first choice.

I have seen ads for local clinics run about $200 a month, but I don't see any reason to pay that much.

Defy seems the most reasonable,flexible and time efficient.

Click to expand...

Got you. I have many friends, and some family members, in the States who have decided to abandon insurance networks and become patients of a concierge medical clinic - pay as you go (with a hefty annual retainer paid up front). Still, I have great sympathy for those with the resources to do this.

DragonBits said:

My primary doctor said that he very often gets turned down by insurance if he tries to treat someone with test testosterone that falls into the “normal” range.

Click to expand...

My insurance company (Blue Cross) will pay for testosterone only as long as my T stays below 800. They also pay for labs 100% and doctor visits (although the visits are labeled as general and not specifically for TRT.)

My doctor wants my T levels to stay within the normal range. Quest labs currently has a normal range from 250 to 1100.