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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Hematocrit: How Doctors Respond
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<blockquote data-quote="DragonBits" data-source="post: 138710" data-attributes="member: 18023"><p>Broadly, you can break up the reasons for medical choices into 4 categories.</p><p></p><p>Financial: We are all victims of the medical / industrial complex, doctors just as much as patients. Some of the smartest people in the world work hard to figure you how to get consumers to pay as much they can get. But I think this often drives suboptimal choices.</p><p></p><p>Regulatory: Regulations are either created out of safety concerns, or financial issues masquerading as safety issues.</p><p></p><p>Psychological: Men like to tinker, there isn’t a lot of tinkering with TU and perceptions can be ingrained.</p><p></p><p>Medical: Real issues related to the protocol.</p><p></p><p>FINANCIAL: TU in castor oil is Nebido, roughly about $140 cash pay for 4 ML outside of the USA. But it isn’t approved in the USA. Endo Pharmaceuticals got the approval for Aveed, I used to trade biotech stocks and followed them. They claimed safety concerns and got TU 3 ml ampule approve. They did it that way so they could solely control the product in the US market, reap all the profits and charge what they wanted to, cash pay is ~ $1,176 for 3 ML. Same exact product, just 1 ML less product.</p><p></p><p>The only TU product a US based doctor can prescribe is Aveed. Most clinics like Defy don’t take insurance, those of us that are low T but not below 264 mg/dl Total T aren’t going to get a regular doctor that needs to work with insurance to approve their choice to even prescribe testosterone, and if by chance you do find a doctor willing to prescribe Aveed, insurance won’t pay for it.</p><p></p><p>If insurance covers it, great, but I doubt TRT clinics / doctors will get a lot of patients to self-pay that sort of money. And there is no profit for a compounding pharmacy in that situation.</p><p></p><p>MEDICAL ISSUES: I never get a high HCT, only inject every 3 months. It is an IM injection into the glute, not the easiest to do.</p><p></p><p>3 days after injection, and for ~ 18 days, you get fairly high levels of TT, FT and E2. At day 16 I measured 1380 TT, FT 28 and E2 56. It starts to decline and level off after that. At 109 days post injection I measured 690 TT, FT 20 and E2 20.</p><p></p><p></p><p>I did gain water weight during those 18 days, then it all went away in 2-3 days. My blood pressure went up also, then went down. I could take an AI, in the past I didn’t really notice the water weight though I did record that my BP went up in Jan 2014, now I think it was elevated E2. I keep a spread sheet, but don’t always record or check BP.</p><p></p><p>You can’t really fine tune TU/Nebido/Aveed. You can raise your T higher by using a gel/cream or injectable TC + TU, it works well if you are at 690 TT and want higher. Not so easy to lower TT/FT, though I think there are supplements that do lower FT, not many really want to lower FT. Lower FT and you lower E2..</p><p></p><p></p><p>I think the longer cycle of when your E2 is elevated is an advantage, it’s not up and down every X days, it goes up and gradually falls over 12 weeks, likely reaches a better spot after 3 weeks. I am thinking one can use an AI during the first two weeks and it will work well and easier to figure out a dose if the higher E2 is a concern. But it does down naturally so one could just wait. But once you pass 3 weeks your T/E2 is in a pretty sweet spot fpr 9 weeks.</p><p></p><p>So IMO the disadvantaged of Aveed is that I don’t think any TRT clinic prescribes it, it isn’t a money maker for a compounding pharmacy, it’s very expensive if you can’t get insurance to cover it and you can’t easily tinker with the levels, at least not if the same way you can with TC. BUT for me at least, I don't need to tinker with the levels. My SHBG is about 40, I am not sure if your SHBG is very low or very high you will get the same results.</p><p></p><p>Another disadvantage a doctor might consider, once you first inject Nebido/Aveed/TU, your T levels will be high for at least 8-10 weeks after the first injection. If for some reason higher T is causing a problem, you are stuck for a couple of months.</p><p></p><p>For me, ~$50 a month for Nebido is reasonable, if I had to pay $380+ a month for Aveed (keep in mind you need to inject Aveed more often than Nebido which I haven’t factored in), I would elect either a cream/gel or frequent TC injections. You get more side effects with TC, but it’s far cheaper than in those circumstances that I have outlined with Aveed. If Nebido needs to be imported into the USA by some means. Mexico has Nebido, Canada does not. BTW, I have seen generic TU for sale in other esters from Chinese markets, it isn't going to work the same way, but it will be similar, but you are getting into the gray market with unknown risks.</p></blockquote><p></p>
[QUOTE="DragonBits, post: 138710, member: 18023"] Broadly, you can break up the reasons for medical choices into 4 categories. Financial: We are all victims of the medical / industrial complex, doctors just as much as patients. Some of the smartest people in the world work hard to figure you how to get consumers to pay as much they can get. But I think this often drives suboptimal choices. Regulatory: Regulations are either created out of safety concerns, or financial issues masquerading as safety issues. Psychological: Men like to tinker, there isn’t a lot of tinkering with TU and perceptions can be ingrained. Medical: Real issues related to the protocol. FINANCIAL: TU in castor oil is Nebido, roughly about $140 cash pay for 4 ML outside of the USA. But it isn’t approved in the USA. Endo Pharmaceuticals got the approval for Aveed, I used to trade biotech stocks and followed them. They claimed safety concerns and got TU 3 ml ampule approve. They did it that way so they could solely control the product in the US market, reap all the profits and charge what they wanted to, cash pay is ~ $1,176 for 3 ML. Same exact product, just 1 ML less product. The only TU product a US based doctor can prescribe is Aveed. Most clinics like Defy don’t take insurance, those of us that are low T but not below 264 mg/dl Total T aren’t going to get a regular doctor that needs to work with insurance to approve their choice to even prescribe testosterone, and if by chance you do find a doctor willing to prescribe Aveed, insurance won’t pay for it. If insurance covers it, great, but I doubt TRT clinics / doctors will get a lot of patients to self-pay that sort of money. And there is no profit for a compounding pharmacy in that situation. MEDICAL ISSUES: I never get a high HCT, only inject every 3 months. It is an IM injection into the glute, not the easiest to do. 3 days after injection, and for ~ 18 days, you get fairly high levels of TT, FT and E2. At day 16 I measured 1380 TT, FT 28 and E2 56. It starts to decline and level off after that. At 109 days post injection I measured 690 TT, FT 20 and E2 20. I did gain water weight during those 18 days, then it all went away in 2-3 days. My blood pressure went up also, then went down. I could take an AI, in the past I didn’t really notice the water weight though I did record that my BP went up in Jan 2014, now I think it was elevated E2. I keep a spread sheet, but don’t always record or check BP. You can’t really fine tune TU/Nebido/Aveed. You can raise your T higher by using a gel/cream or injectable TC + TU, it works well if you are at 690 TT and want higher. Not so easy to lower TT/FT, though I think there are supplements that do lower FT, not many really want to lower FT. Lower FT and you lower E2.. I think the longer cycle of when your E2 is elevated is an advantage, it’s not up and down every X days, it goes up and gradually falls over 12 weeks, likely reaches a better spot after 3 weeks. I am thinking one can use an AI during the first two weeks and it will work well and easier to figure out a dose if the higher E2 is a concern. But it does down naturally so one could just wait. But once you pass 3 weeks your T/E2 is in a pretty sweet spot fpr 9 weeks. So IMO the disadvantaged of Aveed is that I don’t think any TRT clinic prescribes it, it isn’t a money maker for a compounding pharmacy, it’s very expensive if you can’t get insurance to cover it and you can’t easily tinker with the levels, at least not if the same way you can with TC. BUT for me at least, I don't need to tinker with the levels. My SHBG is about 40, I am not sure if your SHBG is very low or very high you will get the same results. Another disadvantage a doctor might consider, once you first inject Nebido/Aveed/TU, your T levels will be high for at least 8-10 weeks after the first injection. If for some reason higher T is causing a problem, you are stuck for a couple of months. For me, ~$50 a month for Nebido is reasonable, if I had to pay $380+ a month for Aveed (keep in mind you need to inject Aveed more often than Nebido which I haven’t factored in), I would elect either a cream/gel or frequent TC injections. You get more side effects with TC, but it’s far cheaper than in those circumstances that I have outlined with Aveed. If Nebido needs to be imported into the USA by some means. Mexico has Nebido, Canada does not. BTW, I have seen generic TU for sale in other esters from Chinese markets, it isn't going to work the same way, but it will be similar, but you are getting into the gray market with unknown risks. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Hematocrit: How Doctors Respond
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