The TRT Blog - Testosterone Replacement Therapy

Mail Order Testosterone: Legal TRT?

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Being an American, the first thing I worried about when my doctor said I needed to be on TRT (testosterone replacement therapy) for the rest of my life was: How is this going to affect my health insurance costs?

Maybe you have health insurance, but they won't cover testosterone injections unless the doctor gives them to you. Since most people can't afford to take time off work every week to visit a doctor's office, they're stuck taking either Testim or Androgel or getting testosterone by other means.

Some choose to contact a mail order compounding pharmacy, get some independent lab tests done, and have a "phone consultation" with one of their doctors.

The Nuts and Bolts of DIY Testosterone Injections

If you think you might need TRT and haven't been officially diagnosed as hypogonadal by a doctor yet there is an option that doesn't involve the record-hungry healthcare system: Get the test done privately and pay in cash. You don't need a doctor to read the test results. If your testosterone is low, contact a compounding pharmacy or hormone replacement / anti-aging clinic that doesn't take health insurance. You can take the shots yourself in the privacy and comfort of your own home; it won't be on your medical records; and you won't end up spending much more than you would with co-pays to the doctor and pharmacy if you'd gone the traditional route.

The Legality of Mail Order Testosterone:

This is a gray area. Testosterone is a schedule III drug and is illegal to obtain without a prescription. The compounding pharmacies and male HRT clinics (also many anti-aging clinics) often have a doctor in-house that will interpret your test results and have a phone consultation with you. That doctor, who you never see in person, will prescribe your testosterone (as well as growth hormone, which is an even grayer area) and any other ancillary drugs (such as Nolvadex or Arimidex to prevent side effects like gynecomastia). They usually don't accept insurance and will ship your HRT drugs out by mail within one week. SO... technically, you're getting your drugs from a legal pharmacy, which also happens to have a doctor on staff to provide the prescription. I don't think you'd have anything to worry about in court. The HRT or Anti-Aging clinic, on the other hand, might have some legal questions to answer should the DA or DEA ever decide to pay them a visit, which has happened in the past.

Tips on Ordering Testosterone Online
If you order testosterone online, follow these tips to stay as close as you can to being "legitimate" in the eyes of the American court system...

Never order from overseas
Always obtain test results from a legitimate lab showing abnormally low testosterone and/or growth hormone
Never deal with a compounding pharmacy, HRT or Anti-Aging clinic that does not have a legitimate doctor on staff. Get the doctor's name, find out what medical school they attended, and verify that they are still recognized by the appropriate boards.
Never send cash in the mail. A legitimate HRT clinic will usually accept credit cards, but if you feel uncomfortable with that you can send a check, cashier's check or money order.

Please read this disclaimer: I am not a doctor. I am not an attorney. I am not qualified to dispense legal or medical advice. The information above are only my opinions and should not be taken as legal or medical advice. Always speak to a qualified attorney when you have legal questions. Always see a qualified health professional when you have medical questions.

Menopur - An alternative to TRT for men with secondary hypogonadism?

ERT Vs TRT: The Great HRT Double Standard

Why is it ok for post-menopausal women to take estrogen, which is known to increase the risk of breast cancer, but it is taboo for men to take testosterone? What is the difference between estrogen replacement therapy (ERT) and testosterone replacement therapy (TRT)? They are both forms of hormone replacement therapy (HRT) designed to return hormone levels to the normal range for someone of a certain age and gender.

Do we care more about creating a "level playing field" in baseball than we do about our own health and wellbeing? The word "steroids" has been victim to so much stereotyping, so many unfounded rumors and quick-science, that the mere mention that you're taking testosterone sends friends and family members into a panic - as if you're setting out to destroy your life and become some gigantic freak bodybuilder.

Speaking of gigantic freak bodybuilders, I don't see anything wrong with that either. If an adult wants to risk their own health to change the way they look, what business is that of federal, state and local governments? Are they going to make plastic surgery illegal? It is essentially the same issue (risking your health to look "better") with the only difference being that many, MANY more people die, are disfigured permanently, and are permanently disabled due to plastic surgery every year than those who take steroids.

But back to the point at hand... It is a double standard, a downright sickening hypocrisy, that HRT for women is almost universally accepted as "healthcare", while HRT for men is almost universally rejected as "steroid abuse". As this website matures I will be further elaborating on this issue, as it is one that happens to be of great interest to me.

Primary Hypogonadism VS Secondary Hypogonadism

Most men who require hormone replacement therapy with testosterone have some form of testicular injury or primary hypogonadism. In other words, the problem is all in their balls. Those of us who have secondary hypogonadism often have perfectly functioning testes, but the problem lies elsewhere in what's known as the Hypothalamus Pituitary Testicular Axis (HPTA), which is responsible for keeping our male hormones in proper balance.

The problem with secondary hypogonadism, is that the treatment actually CAUSES primary hypogonadism by introducing exogenous (external) testosterone into the system. To understand that, first let's go over some basics...

Hypothalamus:
Among other things, this part of your brain sends GnRH (gonadotropin releasing hormone) down to instruct the pituitary gland to create more LH and FSH.

Pituitary Gland:
Among other things (like growth hormone), this gland at the base of your brain secretes LH (luteinizing hormone) and FSH (follicle stimulating hormone), which travel down to the testes / gonads to instruct them to create more testosterone.

Testes / Gonads:
Endocrinologists might get upset that I use these terms interchangeably. Oh well, screw 'em. You get the point. Your "balls" get the message from your pituitary gland to make more testosterone.

The Axis:
The important thing to remember about the hypothalamus pituitary testicular axis (HPTA), also sometimes called thehypothalamic-pituitary-gonadal axis (HPG), is that it does not run only in one direction. The body tries to reach homeostasis - a healthy balance of these hormones - and the entire system can fall out of whack once you start introducing any of these hormones from outside sources. Which brings me to...

The Problem With Taking Testosterone to Treat Secondary Hypogonadism:
First of all, let's be clear - I take testosterone to treat my secondary hypogonadism. That's because there is currently no choice. Why "cure" something when you can have a customer for life? Why treat my body's inability to create enough GnRH when that would require research money and you already have a product that fixes my "symptoms" ?

Digression aside, the problem with introducing an external source of testosterone is that eventually your gonads see that they are no longer needed. They pack their bags, or - rather - pack INTO their bags, and practically disappear over time. Now guess what? Not only do I have secondary hypogonadism, which might have been made even worse, but I now have a classic case of primary hypogonadism to deal with if I the medical community should ever find a treatment for secondary hypogonadism.

Here's an idea - Why don't pharmaceutical companies make GnRH and market that to the endocrinologists so they can treat the source of my problem? Am I being naive here? Is there more to it than my not-medically-trained mind understands?

All gripes aside, I do feel great. Sure I'll be tied to this drug like a prisoner for the rest of my life, but I feel ten years younger. I'm happy, confident, strong, lean, sharp, motivated, and a lot more fun in the bedroom. And I've yet to see any CONVINCING studies about the long-term health dangers of testosterone replacement in hypogonadal men. Heart disease? Prostate cancer? Show me the studies? These are often-quoted side-effects, but all I hear are doctors "deducing" them because, for instance, taking away a man's testosterone seems to help with pre-existing conditions of prostate cancer. But that is not a cause-and-effect relationship. Just because removing testosterone helps treat or minimizes the recurrence of prostate cancer, doesn't mean it causes prostate cancer. Does it? OK, ok, that's anothe post entirely...