My current hunt for TRT, Help!

[shan1784]

Hi Everyone...

I'm a 40 year old guy who's had issues with test every since about 30. Never really got the treatment I needed for this as I had a doctor put me on androgel then take me off then put me back on etc... Not sure what caused my issues to begin with.. I was hospitalized with pretty bad case of pnemonia years back, had a vasectomy if that matters, was diagnosed with hashimoto's and hypothyroidism as well..

so as of 3 years ago a new doc put me on Test Cyp, 100mg weekly and it was a life changer. First few months I was on top of the world, felt amazing. Well that doc left and I switched offices where the new doc continued the treatment I was on but never considered increase in dose even though my levels were dropping per my lab results. Sitting at 280 as of right now per my last results. That was about 6 days after last pin. So a year ago I addressed concerns with doc and told him that maybe estrogen maybe up and I'd like that checked... Nope, he wouldn't do it. After going back and forth he sent me to an Endo. This doc is against TRT in a harsh way. Told me I'm going to develop heart and prostate disease if I don't go off... He's only allowing another 6 months of treatment before he wants to take me off completely and see if my body can make test on it's own and after numerous blood tests that show i'm still low on my own he said we can talk about HCG or clomid, not at the same time though, one or the other. Test is out of the question with him... I'm in a place where I'm scared to death.

With me when my levels are low physically it sucks yes, but mentally it's unbearable. I hate life, suck to be around, and only imagine the stress it puts on my wife.. It's not fair to her or my kids. I honestly just want to be happy, wake up and want to be awake essentially... I had that for a few months and was great.. Don't get me wrong, right now on my low dose of test I'm on now is better then nothing but mentally not in the best place, physically fatigue setting in, just feel very achy, weight gain and water retention is getting very bad despite working out twice 5 days a week and eating about 1700 cals with macro's in check. This is what I have to do to maintain a weight in the 220's... I'm down from about 285 as of over a year ago but to get here was serious calorie restriction over about a 9 month period. Incredibly hard but to maintain that was impossible. If I stray on the weekends and go out to eat and be normal, my weight will easily spike a good 12-15lbs or so. I know it's water but why am I such a sponge?

So with my pending TRT coming to an end I looked around, locally and online. Talked to several clinics and wow $$$... I found one local to me here in Grand Rapids MI called Physoiage. Seems to be the same as any other, bio-hormone replacement program.
Cost is as follows -
Lab free with insurance
$350 for initial visit with doc to go over results and get recommendation
$400 to get into program, get scripts written
$75 monthly "service" fee


So I will be paying out of pocket for some, HSA for others costs. How does this setup look? He's local, about 10 mins from my work. Just want honest help and it's a shame I have to pay this much for it, really not fair to go through this to feel healthy. One mail order clinic I talked to was $399 to start with labs included and $350 every 10weeks for meds. The sales guy told me I would start on 200mg of test cyp, along with HCG, and an AI. To me this was a red flag as he's a sales guy not a doc and haven't even seen my labs. Also told me that it opens the door to get other things from their pharmacy to try out. So I opted to go local so I could actually see someone and hopefully get meds through scripts where ins will cover. My hopes at least...

Looking for feedback on this. Should I stay on this route, look elsewhere, is there something I'm not aware of... Please reply or PM if need be... I just want some direction, want my healthy mind and body back...

 

[ERO]

Call Defy Medical. Many of us here use and highly recommend them, plus their prices are better than what you are considering.

 

[Vince]

It's hard trying to find a good TRT doctor, I use Defy Medical. Because I couldn't find anyone local, I'm very happy with them. You could see if they are affordable for you. http://www.defylowt.com/contact-us

 

[shan1784]

I'm open to contacting Defy sure... How do the meds work though? Would I be able to use my insurance for the meds?

 

[Vince]

I'm open to contacting Defy sure... How do the meds work though? Would I be able to use my insurance for the meds?

Everything is out of pocket, your meds are sent to you ups. Their prices are excellent. Very good doctors and staff.

 

[Fireproof]

Defy is awesome and who I am using (as well as a number of guys here).

But at the risk of this site becoming an advertisement for Defy, ha ha, here's a great thread Nelson created about different options you can look into. If using insurance is a requirement - you may find some options here. They'll likely make their money from a monthly membership fee (which I've seen range from $200-300/month). But check out the thread for lots of great info:

https://www.excelmale.com/forum/sho...-of-testosterone-clinics-in-the-United-States

 

[John O'Connor]

I'm confused. Why would Defy have an issue writing a scrip for bloodwork & meds if patients insurance would cover that? They would still make $$$ on consultation.

Note I'm on medicaid (student making less than $15K/year). All labs & meds are covered by medicaid. I just pay for needles out of pocket. Luckily my doctor is not like the doctor described above, but if he was - I don't understand why Defy would not work with me to just provide consult and let Medicaid pay everything else. And just to be clear - the labs are the expensive part. Meds are relatively inexpensive. Please explain.

 

[ERO]

Sadly, the reality these days is that one can have cutting edge TRT care or 100% covered TRT care. You may pick ONE of those...

Insurance companies dictate to the doctor what they will and will not pay for and they normally will not cover HCG, may only cover one kind of Testosterone (say Testim brand from Big Pharma), etc...it makes it impossible for a doctor to provide TRT care that actually works.

 

[John O'Connor]

Shan1784 - you do have the right to ask for another Endo or PCP. Don't simply sit back and allow an ignorant doctor to limit your choices. If your insurance will cover it - keep switching doctors until you find a good one.

Also - just to clarify. Hashimoto's thyroiditis is a type of hypothyroidism, not 2 seperate diagnoses. I also have Hashimoto's. Is your Hashimoto's well managed? What med do you take & what are recent TSH levels? Have you checked your Vitamin D levels?

Big links between low D, and thyroid issues. Seems like I'm posting links to these studies every day now. I'm shocked how common Low T & hypothyroid are seen together on this forum.

2011 study http://www.ncbi.nlm.nih.gov/pubmed/21751884
CONCLUSION: Vitamin D insufficiency is associated with HT. Further studies are needed to determine whether vitamin D insufficiency is a casual factor in the pathogenesis of HT or rather a consequence of the disease.

2013 study http://www.ncbi.nlm.nih.gov/pubmed/23337162
The association between severity of vitamin D deficiency and Hashimoto's thyroiditis.

2015 study http://www.ncbi.nlm.nih.gov/pubmed/26637501
These findings suggest that vitamin D deficiency may be related to pathogenesis of HT and that its supplementation could contribute to the treatment of patients with HT.

And other auto-immune diseases (Multiple Sclerosis, Rheumatoid Arthritis...)
http://www.ncbi.nlm.nih.gov/pubmed/26751969
Serum Vitamin D Level and Rheumatoid Arthritis Disease

2013 http://www.ncbi.nlm.nih.gov/pubmed/23052893
Because of its suggested immunomodulatory capacity vitamin D deficiency or disturbance in the vitamin D metabolism might be a risk factor for the development of autoimmune diseases, such as multiple sclerosis; but supplementation with vitamin D might also be a therapeutic option. Substantial epidemiologic evidence indicates an association between vitamin D levels and risk of multiple sclerosis, suggesting vitamin D to be one of the long searched environmental factors for the development of this most common chronic inflammatory disease of the central nervous system.

http://www.ncbi.nlm.nih.gov/pubmed/24358684
2013 Impact of vitamin D in neurological diseases and neurorehabilitation: from dementia to multiple sclerosis

 

[John O'Connor]

Also - it seems crazy for any doctor to start treatment without investigating cause of problem first. Did you have FSH & LH checked prior to starting TRT? Watch this for more info: https://www.youtube.com/watch?v=fUitMlwMlkw

And as Alison Woodworth states at 1:00 minute mark- Many doctors simply match symptoms to = diagnoses & then just treat those symptoms with meds, instead of figuring out ultimate cause of those symptoms. https://www.youtube.com/watch?v=4AZKZiESgyM

 

[shan1784]

Shan1784 - you do have the right to ask for another Endo or PCP. Don't simply sit back and allow an ignorant doctor to limit your choices. If your insurance will cover it - keep switching doctors until you find a good one.

Also - just to clarify. Hashimoto's thyroiditis is a type of hypothyroidism, not 2 seperate diagnoses. I also have Hashimoto's. Is your Hashimoto's well managed? What med do you take & what are recent TSH levels? Have you checked your Vitamin D levels?

Big links between low D, and thyroid issues. Seems like I'm posting links to these studies every day now. I'm shocked how common Low T & hypothyroid are seen together on this forum.

2011 study http://www.ncbi.nlm.nih.gov/pubmed/21751884
CONCLUSION: Vitamin D insufficiency is associated with HT. Further studies are needed to determine whether vitamin D insufficiency is a casual factor in the pathogenesis of HT or rather a consequence of the disease.

2013 study http://www.ncbi.nlm.nih.gov/pubmed/23337162
The association between severity of vitamin D deficiency and Hashimoto's thyroiditis.

2015 study http://www.ncbi.nlm.nih.gov/pubmed/26637501
These findings suggest that vitamin D deficiency may be related to pathogenesis of HT and that its supplementation could contribute to the treatment of patients with HT.

And other auto-immune diseases (Multiple Sclerosis, Rheumatoid Arthritis...)
http://www.ncbi.nlm.nih.gov/pubmed/26751969
Serum Vitamin D Level and Rheumatoid Arthritis Disease

2013 http://www.ncbi.nlm.nih.gov/pubmed/23052893
Because of its suggested immunomodulatory capacity vitamin D deficiency or disturbance in the vitamin D metabolism might be a risk factor for the development of autoimmune diseases, such as multiple sclerosis; but supplementation with vitamin D might also be a therapeutic option. Substantial epidemiologic evidence indicates an association between vitamin D levels and risk of multiple sclerosis, suggesting vitamin D to be one of the long searched environmental factors for the development of this most common chronic inflammatory disease of the central nervous system.

http://www.ncbi.nlm.nih.gov/pubmed/24358684
2013 Impact of vitamin D in neurological diseases and neurorehabilitation: from dementia to multiple sclerosis

First off thank you all for the response..

As far as thyroid treatment I'm on 1.37mcg (I think) of synthroid... No tests or mention of vit D, so prob not getting attention needed to this either.

As far as docs go, counting the endo now, this is 4 docs that I've worked with. First 2 were half assed attempts at treatment, second 2 are against it.

 

[ERO]

I'm confused. Why would Defy have an issue writing a scrip for bloodwork & meds if patients insurance would cover that? They would still make $$$ on consultation.

Note I'm on medicaid (student making less than $15K/year). All labs & meds are covered by medicaid. I just pay for needles out of pocket. Luckily my doctor is not like the doctor described above, but if he was - I don't understand why Defy would not work with me to just provide consult and let Medicaid pay everything else. And just to be clear - the labs are the expensive part. Meds are relatively inexpensive. Please explain.

I am sure you could just do an out of pocket consult with Defy Medical. I am not sure if they could prescribe for a different provider though. It would not hurt to call and ask them.

 

[John O'Connor]

There may be an issue writing scrip for labs & meds in different state. I've heard some states require prescribing doctor to be in the state, while other states will allow it. Can anyone clarify this? Also - would blood work orders be similarly scrutinized for out-of-state doctor?

 

[shan1784]

I think someone asked about TSH levels or something about my thyroid so here are all my latest labs pulled by my current Endo I just had done on 2/27/16...


COMPREHENSIVE METABOLIC PANEL -
Details
About This Test
Component Your Value Standard Range
Glucose 92 MG/DL 70 - 99 MG/DL
Fas2ng
BUN 26 MG/DL 6 - 20 MG/DL
Crea"nine 1.1 MG/DL 0.7 - 1.3 MG/DL
BUN/Creat Ra"o 24 6 - 20
Glom Filt Rate, Est >60 ML/MIN >60 ML/MIN
NOTE: For Black Pa2ents, Mul2ply by 1.2
Na2onal Kidney Founda2on Guidelines:
-Chronic Kidney Disease: GFR less than 60
-Kidney Failure: GFR less than 15
Na 142 MMOL/L 135 - 145 MMOL/L
K 4.7 MMOL/L 3.5 - 5.3 MMOL/L
CL 101 MMOL/L 98 - 108 MMOL/L
CO2 28 MMOL/L 23 - 32 MMOL/L
Anion Gap 18 MMOL/L 10 - 18 MMOL/L
Calcium 9.4 MG/DL 8.6 - 10.3 MG/DL
Protein Total 6.5 G/DL 6.4 - 8.3 G/DL
Albumin 4.3 G/DL 3.5 - 5.0 G/DL
Globulin 2.2 G/DL 2.0 - 3.9 G/DL
Albumin/Globulin Ra"o 2.0 1.0 - 2.7
AST 20 U/L 0 - 37 U/L
Component Results
Component Your Value Standard Range
ALT 27 U/L 6 - 45 U/L
ALP 44 U/L 39 - 117 U/L
Bilirubin-Total 0.2 MG/DL 0.0 - 1.2 MG/DL



HEMATOCRIT - Details
About This Test
Component Your Value Standard Range
HCT 48.4 % 41.0 - 51.0 %
Component Results



LIPID PANEL - Details
About This Test
Component Your Value Standard Range
Cholesterol 228 MG/DL <200 MG/DL
Triglycerides 78 MG/DL <150 MG/DL
Fas2ng
HDL 56 MG/DL >39 MG/DL
LDL Calculated 156 MG/DL <100 MG/DL
Non HDL Chol. (LDL+VLDL) 172 MG/DL <130 MG/DL
Chol/HDL Ra+o 4.1 <5.0
NOTE: Reference ranges reflect the NIH Na2onal Cholesterol Educa2on Program op2mal targets for
lipid levels.
TOTAL CHOLESTEROL (mg/dl)
<200 Op2mal
200-239 Borderline high
>or= 240 High
TRIGLYCERIDE (mg/dl)
<150 Acceptable
150-199 Borderline high
200-499 High
>or= 500 Very high
HDL CHOLESTEROL (mg/dl)
<40 Low
40-60 Acceptable
>or= 60 Op2mal
LDL CHOLESTEROL (mg/dl)
<100 Op2mal
100-129 Low Risk
130-159 Borderline high
160-189 High
>or= 190 Very high
NON HDL CHOLESTEROL (mg/dl)
<130 Op2mal
Component Results
1 of 2 3/28/2016 10:20 AM
Component Your Value Standard Range
130-159 Bo
rderline high
160-189 High
>or= 190 Very high
RELATIVE CHD RISK (Male)
1/2 Average 3.4
Average 5.0
2 X Average 10.0
3 X Average 24.0



TESTOSTERONE - Details
About This Test
Component Your Value Standard Range
Testosterone 283.8 ng/dl 249 - 836 ng/dl
Component Results




TSH - Details
About This Test
Component Your Value Standard Range
TSH 2.57 uIU/ML 0.27 - 4.2 uIU/ML
Component Results

 

[John O'Connor]

3 comments after quick look.
1. get Vitamin D checked.
2. I wish my HDL cholesterol was 56. - good job.
3. TSH at 2.57 is still high. What medication/dose are you on? Target should be 1.0, but I'm not sure the range above (0.27 -4.2) is standard. What lab did you use? Quest range = (0.40-4.50 mIU/L) . But even range given on your test would suggest 1.0 or lower is optimal target.

Note there is disagreement on whether target TSH should be 1.0 or 2.0. Most say 1.0 is better, as that is where the majority of healthy people are. I would run from any doctor telling me 2.0 TSH is good enough.

 

[shan1784]

3 comments after quick look.
1. get Vitamin D checked.
2. I wish my HDL cholesterol was 56. - good job.
3. TSH at 2.57 is still high. What medication/dose are you on? Target should be 1.0, but I'm not sure the range above (0.27 -4.2) is standard. What lab did you use? Quest range = (0.40-4.50 mIU/L) . But even range given on your test would suggest 1.0 or lower is optimal target.

Note there is disagreement on whether target TSH should be 1.0 or 2.0. Most say 1.0 is better, as that is where the majority of healthy people are. I would run from any doctor telling me 2.0 TSH is good enough.

Thank you for the response and looking that over... I've tried going to my doc and asking to have things checked, like my estrogen level, in the past only to be told no... He will not order my labs unless he deems it necessary. As for the lab that was used, it was just what the hospital has in house I guess, not sure on that... I know the ranges they use is gospel and if you fall in the range to them you are fine... I don't agree with this and find it very irritating...

 

[ERO]

If you are in the US, you can get your own labs very inexpensively at www.discountedlabs.com

 

[shan1784]

If you are in the US, you can get your own labs very inexpensively at www.discountedlabs.com

I'm currently looking to go with Defy, just filled out most paperwork except for physical exam form. Going to fax it in right now. Was curious on the lab work if I can submit my labs from a month ago to save $$$.. Anyone have any ideas on this. I emailed Defy asking so I'm sure they will get back with me but just curious if anyone has had experience with this...

 

[Fireproof]

I'm currently looking to go with Defy, just filled out most paperwork except for physical exam form. Going to fax it in right now. Was curious on the lab work if I can submit my labs from a month ago to save $$$.. Anyone have any ideas on this. I emailed Defy asking so I'm sure they will get back with me but just curious if anyone has had experience with this...

When I got started with them - they told me they required to see blood test within 30 day window. Mine were out about 2 months so I had to do another one. But if you have some that were done inside of 30 days you may be golden.

I sent them my last 2 blood tests anyway - just so they could see trends / history.

Good luck.

 

[shan1784]

When I got started with them - they told me they required to see blood test within 30 day window. Mine were out about 2 months so I had to do another one. But if you have some that were done inside of 30 days you may be golden.

I sent them my last 2 blood tests anyway - just so they could see trends / history.

Good luck.

Shoot, looks like I missed that window then. I just emailed them all anyway just in case it's "close enough"... Also sent all past labs like you did to show a trend, specifically my test which shows -

10/18/13 828.1
5/17/14 789.1
11/8/14 772.3
5/16/15 552
2/27/16 283.8


Treatment stared 9/13 which was 100mg weekly of test cyp. To me it doesn't look right as the trend is kinda ugly...