Testim working, but thinking of shots.

[TheOldFart]

I've been using Testim, with good results, for 8 years now. I switched to the generic Testim last year because my insurance wouldn't cover brand Testim. My last TT was 720 (Labcorp 348-1197) using 1/2 tube daily of the generic. It was 979 on 1/2 tube of brand Testim.

The reason I'm thinking of shots is because of the cost of Testim and the insurance companies are making it more difficult to get it. I'm 71 and on a Medicare advantage plan. My insurance now requires annual prior approval for any T gel, requiring the doctor to submit 2 lab reports and submit progress notes. This is for continuing patients. We haven't tried for the approval yet. The cost is also high. My copay for 3 months is $238, even for the generic. The generic copay last year was $20. The cost also puts me in the doughnut hole late in the year, where I would have to pay about $800 for brand Testim.

My previous PCP, who retired 3 years ago, was willing to let me try shots early on when I wasn't doing well on Androgel, but then Testim worked well, so we never discussed it again. My new PCP has no experience with shots, so she wants me to see an endo. I've requested an appointment, but all of the endos work at the diabetes center, so their main focus is diabetes. My previous PCP said that he never had much success sending patients to an endo for TRT, so he just gave up and treated himself. He believed, from patient experience, that men had to be at least 500 to feel well and that's how it is for me.

If I go on shots, I'd like to try bi-weekly subQ, but that will probably be a hard sell. I guess I don't have a specific question here, except to ask how much trouble people have had finding an endo who wants to do shots in a meaningful way and not just the old standard of coming in for a shot every 2 weeks. I don't know how long it will take to see one of the endos, but I will likely have to get more T gel soon if I can't go on shots in the next month.

 

[Kinetic]

I'd just be honest with your endo and let him/her know that the co-pays are a limiting factor for you and you don't want to be on the dreaded two week TRT roller coaster.

As for sub-Q injections over IM, I'm not sure how well that will fly with a traditional endo. My understanding, and I could be wrong about this, is that sub-Q injections need to be more frequent to achieve there same levels as IM... BUT, many guys find that TT/FT levels tend to be lower with sub-Q.

For what it's worth, IM injections are not bad at all as long as you aren't using a harpoon to pin yourself. I've stuck with a 1" 25g for a while and haven't noticed any problems. I mostly pin my quads because it's easier for me to do myself and I barely feel it most of the time. That's also pinning 2x per week.

 

[TheOldFart]

Thanks for the reply. Isn't there a danger of hitting a major blood vessel or nerve injecting into the quads? I don't know much about injections, but I thought I remember reading that a while back.

 

[TheOldFart]

Do you use the same needle to withdraw and inject or a larger needle to withdraw?

 

[Kinetic]

I don't know of any major nerves running through the quads, but you will probably find more veins and blood vessels there than you wound in your glutes. If you're aspirating, you'll know if you accidentally found a vein.

I switched from glutes mainly because it was just a pain in the ass (literally) to pin myself there. You also have the sciatic nerve you have to watch out for.

There are plenty of other areas you can pin, I just find quads the easiest for me. I never have PIP there anymore, even doing 250mg in each quad per week on a blast. But you'll find what works best for you if you decide to go the IM route.

 

[Kinetic]

Do you use the same needle to withdraw and inject or a larger needle to withdraw?

I use an 18g 1" to draw and a 25g 1" to inject. An 18g is quicker to load and you don't have to worry about dulling the same needle you'll be using to pin yourself.

 

[TheOldFart]

Thanks again. I would prefer quads if using IM, as that is the easiest to reach. I just watched a couple of videos and it seems easy. I have to wait until the endo office calls back to see when I can get an appointment.

 

[Kinetic]

No problem, brother. Best of luck with the appointment.

 

[Tyler81]

My personal opinion is if the T gel is working and working well for you for the past 8 years I wouldnt change it.

Gels have always felt the best for me (mimics the natural rhythms) and the DHT also gives a feel good effect. While I have tried the switch to injects a few times and currently do an inject/gel combo if my gel protocol was working like yours is i would find a way to scrap together the money.

It doesnt seem like a big deal to submit two bloodtests and a doctors letter once/year?

I had to do something similar when my insurance company didnt want to cover Testim.

However, some guys do well on injects so i am just speaking from personal experience.

Gel always worked best for me.

 

[Tyler81]

It will take you time to find the right dose, right dosing protocol, find your sweet spot etc etc on the injections.

I am not trying to deter you from injections necessarily but dont expect it to be just a smooth transition where you feel like you felt on the gel.

It is not quite the same feeling.

 

[Tyler81]

Also considering HALF A TUBE puts you at those levels that's pretty damn good.

 

[TheOldFart]

Even 2 tubes of Testim didn't work well for me early on. When I showered in the evening and applied in the morning I got a TT of 348 (Quest 250-1100). When I showered in the morning and applied shortly after then I had readings of 644 and 862 (again Quest). I figured that the time of shower had something to do with this. It was then that I read something by Dr. Crisler about scrubbing the area improving absorption.

I started to scrub with a defoliating glove wetted with hot water, drying with a towel and then applying. I got a reading of 1235 (Quest). I dropped the dose to 1 tube of Testim and TT was 1276. E2 for both was above the top of the male range and I didn't feel well if my E2 was in range but at the higher end. After that and for the past 5 years I've used between 1/3 and 1/2 tube and have had readings of 461 and 979 (now Labcorp). All blood draws are between 3.5 and 4.5 hours after applying Testim. Over the past 4 years years I have 3 readings on 1/3 tube of Testim and they are 534, 618 and 474.

I had to switch to generic Testim last year and my TT readings appear to be about 25% lower than on brand Testim.

I may very well stay with Testim, but I want to investigate shots. Based on what my previous PCP told me, I don't have a lot of hope that the endo will have much of a clue about TRT. I still read recommendations in medical papers of giving T cyp shots every 4 weeks.

 

[Tyler81]

Testim worked very well for me for about a year. I only needed 1 tube per day, and then i would do +0.5 extra on workout days after workouts. After a year my levels dropped and i went upto 1.5 tubes per day, then 2.0 tubes per day.

Then eventually 2.0 tubes am AND pm. So four tubes per day to achieve the same levels.

I probably have a thyroid issue which caused absorption problems. I may try thyroid meds and see if this helps.

 

[Raven101]

Theoldfrt
Any prostate issues while using Testim?
I know testim and gels seem to elevate dht a lot more than shots.

Tyler
What are your dht levels?

 

[TheOldFart]

I haven't had any more prostate issues than I think I would have had without Testim. I had mild to moderate BPH a few years before starting Testim and it's only gotten slightly worse. It probably would have without any TRT.

My PSA also has not changed. It ran 0.78 to 0.88 before starting Testim and has been 0.82 to 0.84 since on Testim. This is with the same lab equipment at the same lab. My previous PCP said that my PSA is the most stable of any patient he had ever seen.

I've had my DHT tested 4 times since on Testim. It was above the top lab limit every time. It was 132 (Quest 25-75) when my TT was 862 (Quest 250-1100). I never had it checked before TRT.

 

[Tyler81]

No idea about my DHT levels. I never test it. Cant be bothered.

I only do labs for testosterone a few times a year just to make sure its in the 500ish range.

 

[Raven101]

Oldfrt
Are you taking anything fpr your prostate issues?
Are you able to get a strong urine stream?

 

[TheOldFart]

I use doxazosin for BPH, 8 mg daily. It works pretty well. I've read that it works as well as finasteride, but without the possible sexual side effects. I also tried 8 mg doxazosin + 2.5 mg Cialis and it worked a little better than just the doxazosin, but the copay for thirty 5 mg tabs is $95. That would be $570 per year, as I could split the 5 mg tabs. I didn't think the difference was worth the cost.

I have a good stream during the day, but it is somewhat weak when I get up during the night. I have to get up twice during the night, but if I drink too much the last 2 hours before bed then it can be 3 or 4 times that night. I'm talking coffee or tea and not alcohol.

 

[CubbieBlue]

Another option besides injections would be to find a compounding pharmacy that can make a T cream/gel. They can probably do this for anywhere between $25 and $100 per month.

I get my T and hcg from a compounding pharmacy for around $115 every 2-3 months.

Google your city name plus compounding pharmacy to find one. Most of them can refer you to one or more docs that use the pharmacy to fill the compounded T gel.



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[TheOldFart]

I finally heard back from the endo office. It took them 2 weeks to review my referral and I have an appointment for August 4. I'm getting a bit concerned about switching to shots, as it took me 3 years before I got my Testim protocol really working right. It's been good for 5 years now, except for having to increase the dose of the generic. I've been reading many discussions about difficulty of getting the shot dose and frequency right and thinking that Tyler is correct about it not being a smooth transition.

I got the approval from the insurance to continue Testim and just got 90 days, which will last me 6 to 9 months. The total cost (copay + insurance) was also $400 less than was listed, so that will keep me out of the Medicare donut hole if I need 2 90 day supplies a year if the price doesn't jump too much next year.

I'm thinking of keeping the appointment, but wondering what would happen if the endo decides that I don't need HRT and the PCP will need to follow what the "expert" says. They're all part of the same medical group.