New Member - 10 Years on TRT, Now Dealing With Problems

[Mrchuck2000]

This is Chuck from Los Angeles California. I'm 56 years old and have been on TRT for approximately 10 years I take a weekly injection of depth-testosterone at 200 mg/mL. I have been HIV-positive since 1987, currently undetectable. I'm dealing with testicular atrophy and diminished libido at present. I'm interested in HCG as a possible remedy.

 

[Mrchuck2000]

Looking for ongoing treatment with Testosterone Cypionate (currently prescribed, 200mg/ml weekly injection) with added, ongoing HCG therapy for restoral of testicular size. (I have also lost almost all sexual interest in last 2 years, despite weekly TRT, very unusual for me.) My testes are currently in a drastically atrophied state. I used HCG treatment once before, with great results in size restoral, but shrinkage resumed after treatment due to ongoing TRT for my very low T-levels. I saw a urologist who wasn't willing to do ongoing HCG, only short-term Rx. Following this, I was referred to an endocrinologist who had no idea about the protocol I wanted to follow. Not a clue about male problems at all, it seemed. (Her waiting room was filled with Russian grannies. Not a good sign.)
I live in Los Angeles, have Medicare as my primary, with Medi-Cal (Medi-medi). Can any members help point me toward an informed urologist or endocrinologist who is aware and sympathetic to these issues? I am not resigned to have this level of testicular deformity, nor am I ready to say farewell to a healthy sex life, as I had before. I could use some doctor referrals, guidance from other members. Whaddaya say??

 

[CoastWatcher]

Welcome to Excelmale. May I ask some questions? Do you have recent lab results that you can post (including the reference ranges)? A bit more detail on your protocol - your dose is administered in a single injection, or do you split that (significant) amount of testosterone into smaller shots over the course of the week? Historically - in the ten years on TRT, how has your protocol been adjusted? Other medications you are currently taking?

With a bit more information the discussion will be more focused.

We hope you'll be an active member!

 

[Sean Mosher]

Sorry to hear you are dealing with that.
As said above, please post labs.
You will definitely get great advice/direction here.
Welcome!

 

[Mrchuck2000]

I should be getting bloodwork done on the 23rd (2 days away). Here's a good question: Should I administer my weekly shot today, as is typical? Or should I allow my levels to drop so the doc can see where I am at the END of the week?

I do the shot only once a week, and typically the full 200mg/1ml vial. I just noticed the Rx is actually for a 150 mg! They've been delivering me 0.25ml extra, and I hadn't even noticed.

I am currently taking:
Triumeq for my HIV,
FloMax (tamsulosin)
Effexor
Abilify
Vitamin D3
Oxycodone as needed, chronic back issues.

 

[Vince]

I inject 500iu of HCG and 100mg T every 3 1/2 days to keep my balls alive. It will take a few months to wake them up. If you get a script you can get HCG through Empower Pharmacy.

 

[Mrchuck2000]

Thank you, Vince. I wonder if HCG is covered under my Medicare plan. And I'm still in need of some Los Angeles doctor recommendations so I can even get an Rx. This is a great site I should have signed up ages ago.

 

[ERO]

It is unlikely that HCG will be covered under your insurance as this is considered an "off label" use. However, its like $70 for an 11,000 IU bottle through Defy Medical. Also, Defy has an HCG program for guys that get their TRT care elsewhere but need HCG.

 

[Mrchuck2000]

Thanks! That's very helpful.

 

[CoastWatcher]

I should be getting bloodwork done on the 23rd (2 days away). Here's a good question: Should I administer my weekly shot today, as is typical? Or should I allow my levels to drop so the doc can see where I am at the END of the week?

I do the shot only once a week, and typically the full 200mg/1ml vial. I just noticed the Rx is actually for a 150 mg! They've been delivering me 0.25ml extra, and I hadn't even noticed.

I am currently taking:
Triumeq for my HIV,
FloMax (tamsulosin)
Effexor
Abilify
Vitamin D3
Oxycodone as needed, chronic back issues.

Where does your estradiol typically sit? Are you measuring it with the sensitive, LC, MS/MS, test?

 

[Mrchuck2000]

Where does your estradiol typically sit? Are you measuring it with the sensitive, LC, MS/MS, test?

I'm totally not sure! This is all very new terrain for me. Any input you can suggest would be helpful to me. I'm planning to take in as much info as I have when I see my PCP on Monday. I will ask for the ultra-sensitive test (?), and go from there. I would prefer to go in to my PCP with a urologist/endocrinologist already vetted by this community whom I could ask to be referred to. Anyone out there who knows informed and willing docs in the Los Angeles area?

 

[CoastWatcher]

I'm totally not sure! This is all very new terrain for me. Any input you can suggest would be helpful to me. I'm planning to take in as much info as I have when I see my PCP on Monday. I will ask for the ultra-sensitive test (?), and go from there. I would prefer to go in to my PCP with a urologist/endocrinologist already vetted by this community whom I could ask to be referred to. Anyone out there who knows informed and willing docs in the Los Angeles area?

Wow - ten years and no estradiol testing...and other labs? Well, better late than never.

First of all, let's talk lab tests. Total and free testosterone, SHBG, CBC, estradiol/sensitive or, depending on the lab you visit, it may be called ultra-sensitive (LC, MS/MS), PSA, and CMP. Have your thyroid markers been monitored over the years? If not, you want to add TSH, t3, t4, rt3, and thyroid antibodies. Prolactin and DHT would also be of interest if they have not been checked in, well, however long it's been.

In the greater Los Angeles area, Rand McClain is a friend of EM and a fine doctor. EM is sponsored by both Defy Medical and Prime Body, national practices serving many of our members; they would be able to provide treatment that is highly regarded. All of these practices have websites you should consult, and they operate on a fee-for-service basis.

 

[johndoesmith]

I should be getting bloodwork done on the 23rd (2 days away). Here's a good question: Should I administer my weekly shot today, as is typical? Or should I allow my levels to drop so the doc can see where I am at the END of the week?

I do the shot only once a week, and typically the full 200mg/1ml vial. I just noticed the Rx is actually for a 150 mg! They've been delivering me 0.25ml extra, and I hadn't even noticed.

I am currently taking:
Triumeq for my HIV,
FloMax (tamsulosin)
Effexor
Abilify
Vitamin D3
Oxycodone as needed, chronic back issues.

You should always test at trough. Day of injection, but before injection, what you're getting is a "peak" level and offers little to no actionable information.

Not having E2 tested is just purely awful, especially on as high a dose as you are.

It certainly explains your issues.

If your doctor isn't testing E2, 99% chance they go "huh?" or "that's a female hormone" when you request it, otherwise they'd already be testing it.

Unfortunately medicaid will make it much harder to find a qualified TRT doctor. Most are cash based. You can find a diamond in the rough on insurance though. Especially with you having other medical issues, and presumably being >40? They're more sympathetic.

I'd ask them about E2. Their response will tell you a lot about what kind of care you'll be receiving.

 

[Mrchuck2000]

Coastwatcher, this is fantastic info. I can't thank you enough! I'll post results as things progress.

 

[Mrchuck2000]

This is great back-up for what I sensed was a pretty neglect-based approach to my health and safety during the past decade. I don't mind saying that the lack of attention to this issue was at the hands of AHF--AIDS Healthcare Foundation--and I have finally parted company with that (corrupt, IMO) organization for good. They are not doing good work for their patients.
Your response to my post is of great help to me. MUCH appreciated!

 

[Mountain Man]

I should be getting bloodwork done on the 23rd (2 days away). Here's a good question: Should I administer my weekly shot today, as is typical? Or should I allow my levels to drop so the doc can see where I am at the END of the week?

I do the shot only once a week, and typically the full 200mg/1ml vial. I just noticed the Rx is actually for a 150 mg! They've been delivering me 0.25ml extra, and I hadn't even noticed.

I am currently taking:
Triumeq for my HIV,
FloMax (tamsulosin)
Effexor
Abilify
Vitamin D3
Oxycodone as needed, chronic back issues.

Don't rule out the possibility that the Effexor and Abilify are playing a role in this. If all other blood work comes back ok, I'd suggest a look at that. Both are known to be killers of libido, especially Effexor.

 

[Vince]

Thank you, Vince. I wonder if HCG is covered under my Medicare plan. And I'm still in need of some Los Angeles doctor recommendations so I can even get an Rx. This is a great site I should have signed up ages ago.

I've never have but you can buy it from https://www.reliablerxpharmacy.com/. I use reliable Rx for my ED meds.