Angry about the US Healthcare System

A Testosterone Pellet Patient’s Review

I've tried it all: Gels, shots and pills. The gel was terrible. The pills will destroy your liver. The shots were OK for the first five years, but the weekly (or bi-weekly if you want to avoid the peaks and valleys) testosterone shots got old after awhile. Switching between shoulders, thighs and gluts each week felt like doing The Macarena and I still felt like a pin cushion.

That left only the pellets and, I gotta say, I was very disappointed. Had I opted for the name-brand Testopel version, things may have gone better. The ones I got from the Trader Joe's compounding pharamcy were not good at all.

The biggest problem with pellets is if it's not working for you, you'll still have to wait for them to dissolve to get another type of testosterone. That means 3-6 months of waiting. I lost muscle, got depressed and was super lethargic for a couple of months. My review of testosterone pellet therapy? It sucked.

Back to injections for me! "Heeeey Macarena!"

Red Blood Cells in Vials

What to Do About High Red Blood Cell Count while on TRT

Give Blood Save Your LifeTestosterone replacement therapy can increase hemoglobin and hematocrit production beyond normal/safe levels, a condition known clinically as polycythemia. If you are on TRT it is important to be regularly tested for this condition, as it may increase the risk of thrombosis and stroke.

Hemoglobin is an iron-containing biomolecule that can bind oxygen, and is responsible for the red color of blood cells. Hematocrit levels refer to the percentage of blood volume occupied by red blood cells. The test I get is a red blood cell (RBC) count, which measures the number of red blood cells per volume of blood and includes readings for both hemoglobin and hematocrit.

How to Lower RBC while on TRT

If your RBC test results come back abnormally high, treatment options given by the doctor might involve lowering your testosterone dosage or discontinuing your hormone therapy. Personally, neither of these is an acceptable option so I opt for a third: Donating Blood. The doctor could theoretically prescribe a therapeutic phlebotomy (draining some of your blood, which would be destroyed instead of donated). However, it is not a widely adopted practice and is unlikely to be prescribed. Besides that, I'd rather my blood be donated to someone in need.

Can You Donate Blood if You Take Testosterone?
The RedDouble Red Blood Cell Donation Cross form you fill out will ask if you take any injectable drugs, and may even specifically mention testosterone, but the fine print says "Without a prescription" so you can answer "No" to that question. As long as you are taking doctor prescribed testosterone for hormone replacement (Not 500mg + every week like a bodybuilder) it should be OK to donate because there is only a normal amount of testosterone in the blood stream.

I donate blood to the Red Cross about once every three or four months. If they have the facilities at the donation center I'll even opt for a Double Red Blood Cell Donation, and it feels much like I'd imagine an oil change might feel to a sentient vehicle.

Click Here to find a Red Cross blood donation opportunity near you.

Stockpiling Testosterone and Thyroid Medications

Apotek © by Sunfox

I'm the type that plans for the worst and hopes for the best. We have a pantry full of canned food from the garden, a gas generator for power outages, and long-term supply of clean drinking water and several first-aid kits throughout the house. That's why I read this blog, which inspired me to write my own post about stockpiling medication. I don't think the zombie-apocalypse is coming and I'm only half-sure that we could face some kind of long-term economic meltdown. I'm not a conspiracy nut and I don't have a bomb shelter. I'm a pretty normal guy, actually. But in the event that something catastrophic does happen - economically, socially or environmentally - I wouldn't want to be put in the situation where I only have 1-3 months worth of medication on-hand. In my case, I depend on testosterone and thyroid hormones. Without them life gets pretty bleak for me. With them I not only feel "normal" - I feel great.

All of this is to bring up the topic of stockpiling testosterone, thyroid hormone and any other medication you have to take long-term. Here are some options we can consider:

  1. Ask your doctor if he/she would prescribe you enough to last a year. I don't mean enough "refills" but enough at once. A refill does precious-little if the pharmacies have all been pillaged. Pro: It is perfectly legal. Con: Fat chance you'll get them to agree, and it would be very expensive if you did because insurance is unlikely to cover that.
  2. Head down to Mexico or another country that has cheap meds and shady doctors who will prescribe you whatever you want. Pro: It comes with a vacation. Con: Crossing the border with a year's worth of any medication is going to be risky - especially controlled substances like testosterone.
  3. Find a compounding pharmacy or HRT clinic (if hormone meds are what you need) and ask for the year's supply. Pro: They tend to be a little more understanding than the average endocrinologist and, when it comes to uninsured meds, a little cheaper than the local pharmacy. Con: You have to find one you can trust.
  4. Start skipping a dose now and then, or taking less for awhile, and gradually build up a stockpile. Pro: Easy, cheap and legal. Con: It would take a very long time and I don't like the idea of skipping doses.
  5. Tell your doctor you're on vacation and forgot your prescription next time you're out of town. Pro: They'll usually write you a new prescription, which is often covered by insurance. Con: You can only use this trick once or twice a year without raising suspicions.

In the end I think I'm going to combine several of the options above for a multifaceted approach to stockpiling my meds in case of a long-term shortage or emergency. Hopefully it will never come to the point where I'd not be able to obtain my medications, but I'd rather be safe than sorry when it comes to something as important as access to my thyroid medication or testosterone.

A note about expiration dates: The pharmaceutical companies like to make money. That much is obvious. One way they generate more revenue is by making expiration dates much sooner than they need to be. This keeps them safe from lawsuits regarding under-dosed meds (they start gradually losing potency after expiration, but don't just suddenly become "no good") and keeps you buying more medication. The best thing to do once you build up a stock-pile is to rotate your meds so you are using the oldest from the shelf and replacing them with the ones you just got from the pharmacy. In this way you'll never be using expired medication, and will always have a surplus to cover you for long-term shortages and emergency situations.

Anyone have any better ideas about this topic, or anything else to ad?

Fight Club Hug - Gynecomastia

How Much Is Gynecomastia Removal Surgery?

GynoLuckily mine isn't so bad that I would consider gynecomastia removal surgery at this point, but I do get the "sensitive" and "itchy" nipple feeling from time to time and I can feel a pea-sized bit of tissue on the right side. It comes and goes. Sometimes I'll take some Nolvadex if I happen to have any on hand. I've asked my doctor about prescribing me Arimidex or some other aromatase inhibitor but he maintains that they are not needed at my dosage. He also doesn't want to test me for estrogen levels because he says what really matters is that the balance is in favor of testosterone. So, meh... I have some good and bad things to say about my endocrinologist.

The average amount charged by the plastic surgeons is about $2,000 - $3,000 for both sides. I also found out that some doctors recommend getting both sides done even if your problem is in one side since eventually you'll probably have to deal with the other side anyway. Of course, they may just be wanting more of your money.

I guess I could afford $3,000 at the high end of the range if it came to that. I've heard that it's a one-time surgery because they take out the tissue and it doesn't grow back. I'm not sure how true that is. Anyone know? For now I'll just try to keep it from getting worse. It's not anything anyone would be able to see at this point, even with my shirt off.

Got a gyno-related story? I'm sure the other visitors would love to hear about this topic that affects a lot of guys, especially those with endocrine problems, but one which we are unlikely to be able to talk about to our friends and family.

Testosterone Replacement Therapy B&W Logo

Three Month Update on TRT

Fight Club Hug - GynecomastiaI'm not sure exactly how long I've been on TRT now, but I think it's been about three months. I haven't done the blast-cruise thing because I ran into some other health problems (benign thyroid tumors that my doctor thought "could be" malignant at the time) that took awhile to figure out, and longer to heal from surgery. I figured it would be pointless to take more than prescribed if I can't make the best of it in the gym. Also, the wife is pregnant (WAY pregnant) so having a better libido is kind of superfluous unless I feel like jerking off more often. TMI? IDGAF.

I've been taking 100mg per week of testosterone enanthate and feel pretty good. I don't feel like I do when I take 200mg per week, but I don't feel like crap - which is how I feel when I'm not on TRT. The only problem is I think I'm developing a small case of gynecomastia. It's nothing you can see, but I can feel it under my skin and sometimes that area is itchy or sensitive. The doctor assured me that this wouldn't happen on normal doses - which was his reasoning for refusing to prescribe me Nolvadex or an aromatase inhibitor like Arimidex - so it should be an interesting conversation when I go in for my appointment in a few weeks and he feels the lumps.

I'm not all that concerned though. A: It's easily taken care of with a relatively simple surgery and B: I can probably keep it from progressing as long as I start taking Nolvadex or Arimidex.

Having been on just "normal" levels of testosterone, and having been out of the gym for several months, I'm not feeling in the greatest shape. The fact that your thyroid is responsible for your much of your metabolism (and mind has been completely removed) probably doesn't help matters. There's one more medication that I'm on for life, and that I haven't fully dialed in the dosage on yet. But I'm confident that I will be able to get the dosage right with time, afterwhich I look forward to getting in the best shape of my life by the age of 36. :-D

So that's my update. How are YOU doing?

Two Ways to Save on Testosterone Medication

The American Healthcare Plan for MedicationSo I've been taking testosterone enanthate for a few weeks now and feel good. I have another appointment with the endo tomorrow that I will update you on, but I'm hoping it checks out. They did an ultrasound on my thyroid because the doctor said it was swollen. I also have some symptoms of hypothydroidism (nervousness, trouble sleeping, twitching eyelid...) but that could all be stress. I'll get the pre-testosterone blood tests back, and I'm hoping he'll order another one to see where I'm at now - but that probably won't happen for a few more months, as I think he'll just want me to "stay the course" for awhile since I feel better.

But that's not what this post is about. I wanted to compare prices on the three options I had for buying my testosterone medication (200mg / mil bottles of testosterone enanthate for injection) so you can see how much money can be saved when you shop around.

Option #1 ($210 for 10mil) was going through the regular pharmacy, and that was after insurance coverage.
Option #2 ($75 for 5mil) was going through my insurance company's pharmacy, or at least one that they have some sort of monetary relationship with. I'm not sure how it all works, but this is a mail order deal and they usually send you three month's supply up front for most drugs, but will only do 1 month at a time for controlled substances like testosterone.
Option #3 ($100 for 10mil) from a mail order HRT clinic (the kind I discussed in this post about if you order testosterone online and whether that is legal) and this place didn't take insurance.

I'm going to take 150mg per week of testosterone. The doctor prescribes 100mg, but I have a some left over from when I tried to get off TRT and, frankly, I feel better on 150mg per week while still being in the normal range. I need to get another blood test done, but I've been on this roller coaster long enough to know my body and I'm feeling in the mid-to-upper ranges of "normal" at this dose. I will give you hard numbers when I get another blood test done. What I'm getting at is how much this costs per week for each option:

#1 = $31.50 (CVS, Walgreens, Etc...)
#2 = $22.50 (Medco via my health insurance company)
#3 = $15.00 (Online HRT clinic)

Clearly the HRT clinic is the better option for those without health insurance (or without insurance that will cover TRT), or who don't want to go through their health insurance, or who have high deductables and copays, etc... It is just cheaper, and my experience has been that it can be very reliable if you find the right place.

HOWEVER - if your insurance covers testosterone injections that you can do at home and your deductible is low enough that you're going to meet it ever year - option #2 (if something similar is offered by your provided. You should ask.) is actually the better option in the long run. This is what I'm probably going to end up going with, although I may use the HRT clinic from time to time.

Option #1, unfortunately, is what most Americans tend to go with. Don't ask me why. I guess we've just been conditioned to accept our lot as having one of the worst healthcare systems in the developed world. I don't mean to bitch or be unpatriotic here. I'm not trying to get into a discussion about the Big Healthcare Debate. All I want to say is that you have other options and exploring them could save you hundreds, possibly thousands, of dollars every year over the course of the rest of your life. It's worth making a few phone calls.

I guess there's a fourth option: Drive down to Mexico. But I'm not so sure I'd trust a pharmacy like the one pictured in the photo above when it comes to something I'm injection into my body ever week. ;-)

Good luck!

The End of Hope for Natural Testosterone Production & The Beginning of Lifelong TRT

Between the Testim yesterday and today, and the HCG I've been taking - I feel great. I'm not back to "normal" yet, but I'm getting there and it's not just placebo. I'll probably have to switch to Androgel if I want my insurance to cover it, but there isn't much of a difference, other than smell and stickyness.

A long hard road.It has been a long, hard, six-month road of trying to get my natural testosterone production back up. I've tried several alternative treatments for low-T, including - for six months - only natural things like zinc, magnesium, tribulus and deadlifts at the gym. I didn't want to go on life-long TRT at my age, so my hope (once it was clear that my secondary hypogonadism was here to stay, and that I wasn't going to produce enough LH and FSH to make adequate testosterone) was that I could take Menopur or HCG instead of testosterone. That way at least my testes would stay "normal" and I'd be treating the problem at its source, rather than the symptom down below. But, alas, the US medical system wore me down. I just couldn't live like that anymore. I was depressed, losing more weight every month (185, 182, 179, 175, 170, 169... how low can I go?); was losing motivation and memory by the day; and generally just felt like CRAP.

The doctor still won't prescribe me injectable testosterone, and I'll be damned if I'm going to give those idiots $40 twice a month to stick a needle in my ass. So I'll continue to get my Testim or Androgel so I can stock-pile it away (because I'm paranoid about not having access to testosterone at some point in my life now that I'll be on it forever and life is miserable without it) and will instead be ordering injectable testosterone online from a compounding pharmacy somewhere. I'll be sure to use up the gel stuff before it expires, but they generally last 2-3 years unopened under the right storage conditions. And that's just the labels expiration date. They probably last a lot longer than that.


I'm back on TRT. For good this time... unless something better comes along that is affordable (unlike menopur) and works without shutting down my testes directly (testosterone), or downregulating / desensitizing the leydig cells in the testes indirectly (HCG).

I feel good. I'm sure in six months I'll be back to feeling like I wish I didn't have to take this damn shot, or rub this damn gel in all the time - but right now I feel good. I'm looking forward to getting my life back. If you want to follow along the journey of a young man (33 now, 30 when I was first diagnosed, 31 when I started TRT, 32 when I tried to come off it and use alternatives) who has to take testosterone for the rest of his life - stick around. This blog is going to be up a looooooooooong time - providing, of course, that I don't get prostate cancer at an early age and die. If I do I'll try and let you know.


Angry about the US Healthcare System

Doc Says NO to Self-Administered HCG. Insurance says NO to Menopur and HCG

Sometimes it seems like the healthCARE industry is more like a healthWON'T industry. Why do we always have to color within their lines when everyone's situation is different? I don't get it.

If the insurance company wants me to NOT have to buy medication, why don't they let the doctor prescribe me something that could help me without causing me to be a lifelong dependent of a drug that THEY would have to pay for? Why not let me try Menopur, or HCG instead of only giving me one option: Testosterone?

Angry about the US Healthcare SystemI decided at first to say F*&^ YOU to the insurance companies and just pay for HCG out of my own pocket. I've read a lot about using HCG for hormone replacement and I like the idea that I could stop at any time and still have working testes (providing I don't go higher than about 500 IU 3x per week, above which the leydig cells can become desensitized to FSH and LH). So I got the doctor to prescribe me HCG. First, he doesn't want to do less than 1,000 IU per injection, and no less than 3 injections per week. Good grief. Did you read the part in the parentheses?

OK, I was willing to work with the guy and let them give me 1,000 IU for a few weeks, then tell him to give me an E2 test and use that as evidence for him to reduce the doses since my E2 would probably be sky high. BUT...

Then it turns out that they are going to charge me $40 for every shot (not the medication, mind you, just the activity of injecting me) which would be $480 a month! Just for them to inject me!?!?! So I asked if I could inject myself at home. This way, not only could I reduce my dosage, but I could actually AFFORD to take this stuff. But noooooooo, they just can't do that. Why? Because. What if I take a class on injecting safely? No.

So now what? Now I'm going to have to go with one of these compounding pharmacies out there. A few of them are legit alternative resources. But many more of them are very shady and could be mixing up "dirty" medicine that could give me a major infection, at worst, or maybe even giving me under/over dosed medication, or no medication at all, or the wrong medication.... I am being FORCED to go underground to treat a legitimate health issue.


Excuse my language. I hate the healthcare system here. I really do.

Kickboxers fighting

Testim VS Androgel

The two major testosterone gel brands are Testim and Androgel. They are very similar and generally prescribed interchangeably, but sometimes insurance won't cover one or the other. Often, I hear that they won't cover Testim and people want to know if Androgel is just as good. So here is a general guide to choosing - if you are lucky enough to have the choice - which one is right for you.

Testim Vs Androgel

I would try whichever your insurance covers first. If your insurance covers both medications, try whichever one has coupons or kickbacks.

Fight Club scene representing Testim Vs Androgel

Now that price and availability are out of the way, lets deal with smell: Testim smells. Some people think it smells good, and some can't stand it. Either way, it's a strong scent! Personally, I like it and my wife likes it. I've found that women ask me what "cologne" I'm wearing, and mention that they like it too. Still, if you or your wife don't like the smell of something you have to put on every day, that would be a deal-breaker. So try out a tube and see what you and, if applicable, your partner thinks about the Testim scent. Androgel doesn't have much of a smell at all.

Testim is sticky. Androgel goes on much like that hand-sanitizer stuff, while Testim seems to remain stickier longer. Some say this is why Testim seems to work better for them: Because it stays on the skin and "soaks in" better.

These personal statements of efficacy can't be relied on as empirical data, however. But the fact that you can feel it on your skin longer, does bring up a question about Testim gel Vs Androgel: Does it take longer to soak in and, if so, does that increase the exposure time I have to worry about when it comes to my wife and children? The short answer is: NO. In-fact, according to US National Library of Medicine's website, the wait-time for AndrogGel is much longer:

You should not shower, bathe, swim, or wash the place where you applied the medication for at least 2 hours after you apply Testim® gel or at least 5-6 hours after you apply AndroGel ®.

Testim comes in little single-use tubes so you go through more of them and it generates more waste. If you are eco-minded this may factor into your decision. Androgel comes in a dispenser with a little pump on it (like soap) so there is less waste.

But the real question when considering AndroGel Vs Testim is: Which works better? Which is the best? Which testosterone topical gel is going to get my testosterone levels on track fast, keep my levels steady, and keep me there for the long term since I'll be taking this stuff for many years to come? As you might guess, both brands have their fans. Personally, I like Testim. And here is a study to back up my personal preference:

Efficacy of changing testosterone gel preparations (Androgel or Testim) among suboptimally responsive hypogonadal men.
Grober ED, Khera M, Soni SD, Espinoza MG, Lipshultz LI.
Division of Urology, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.

Summary of the study:

A change in testosterone gel preparation among initially unresponsive hypogonadal men is justified prior to abandoning or considering more invasive TRT. Changing from Androgel to Testim offers hypogonadal men the potential for improved clinical and biochemical responsiveness. Changing from Testim to Androgel is indicated to eliminate or minimize unwanted side effects.

Note: This study was done to find out if switching brands would help men who were unresponsive to one brand or the other.

More important to me than such a study is to find out from others who have been on TRT for more than a year, preferably several years or more, and hear about their experiences with both or either drug. Please comment below with your own experiences.

I am inclined toward a weekly or bi-weekly injection over a daily testosterone gel application, but what does one's rear-end feel like after being used as a pin-cushion for decades? I dunno... any bodybuilders out there want to elaborate on that?

Health Test

Final Test Results Are Back: Time to Go Back on TRT

Well I finally got the test results back from when I had my testosterone levels checked last week. Here is what the report says:

Total Testosterone: 254
The range for men from 18-69 years old is 250-1100. So I am 4 points above the lowest level you can have and still be considered in the normal range at the age of 69. I am 33.

I have old man testosterone.Free Testosterone: 46.2
The range for men from 18-69 years old is 35 - 155.

% Free Testosterone: 1.82
The range for men from 18-69 years old is 1.50 - 2.20

And this was on a good day. I just went to the gym and had a great workout the day before, a good night's rest that evening and was feeling good. I even skipped coffee in the morning.

I felt the worst the last several days than I have in the last few weeks. It's not getting better so...

I am going to start back on HRT tomorrow. I'll need to figure out the insurance situation and if I'm going to try HCG-only as HRT for awhile, or the drug Menopur I wrote about awhile back. Or - If I'm just going to give-in and take testosterone as a gel or injections. And if I'm taking gel, will it be Testim or Androgel (depends on what is covered).

Stay tuned for lots more posts about hormone replacement therapy. I'll have the next 40-60 years to write about it from first-hand experience. I am inclined to start with HCG only and see if I can stay in normal ranges with that and nothing else. I've heard it can desensitize the testes over time, but I don't see that as being an issue since the alternative is to go on permanent TRT anyway.

Menopur is still new to the world of HRT, but some doctors have started prescribing it for secondary hypogonadism. The thing I don't understand is why they usually combine it with HCG. Can anyone explain that to me?