T-Meds and Insurance

so assuming they also pay for the tests it's a bit like saying, "Well save money by paying for two tests and annoying the patient into dropping the whole thing."

Andrew

Steve,

Yeah, I did about two years on Androgel, then switched to testosterone cypionate injections for a year. Went off the shots in Feb. to try to figure out why my uPSA went detectable at .025 sometime during the 12 months preceding that. That would have been during the year I was on injections. Have been monitoring closely about monthly since then, hasn't varied much, and a uPSA check this week showed it at .018. So if it goes down another .004, I will again be "uPSA undetectable", at least on the LabCorp panel I get (lower limit .015).

When on the Androgel, did get into one go-round with BCBS. It did seem they were being kinda "unhelpful" about a renewal. But not for sure--coulda been my uro's nurse dropping the ball on paperwork. Never did get a clear explain. Like you, I used the three weeks without Androgel to get a T test (just before starting gel again). T was still pretty low. Actually found out in later tests that I was pretty low even on the gels.

Sorry the 850 T level is not doing much for you. My uro likes his guys 700 - 750 on TRT. I have hit low 700's at mid-cycle on injections. I feel so much better at that level than on the much lower T levels I got while on gel or when untreated. Much less fatigue, more mental clarity, seem calmer. Enough different that my wife notices and comments. Yes, could be mental only, and each man is different, but I really think it does something for me physically, too.

Was your 850 T test a while ago? Possible you are not absorbing the gel well anymore? Read the lit online, and you will see this is the case in a surprising percent of the gel users. Sure happened with me. So I discussed with my uro, and we agreed to try the injections. After his nurse trained me properly, and we settled on the dose that produced a good T level at midpoint of injection cycle, they have let me do all the shots at home now. On my last uro visit, he commented that switching to shots was the right thing to do.

Have you considered switching to shots? If you price T-cyp on web, you will see you can get a couple 10ml 200mg/ml bottles of T-cyp, with GoodRx coupon, for around $100 -- and that lasts me over a year. A couple bags full of syringes and needles are dirt cheap (I get the BD interlock syringes so you can easily switch out between 18 gauge needles to draw up the liquid, and 22 gauge to inject less painfully). So even if you went around BCBS and just paid out of pocket, you're looking at a whole year's worth for close to (I'll bet) what you pay for your part of about one month of Androgel. Give or take.

I actually did pay part of one of my semi-annual shot refills because, again, BCBS was being kinda “unhelpful” about some aspect of it. I just told the pharmacist, oh he**, here's cash instead. Insurance companies sure must not like the idea of testosterone replacement.

If you do wanna switch, be aware of:

-- your doc has to be ok with you self injecting, else the time/expense of weekly/biweekly office visits will kinda screw the whole deal (imho).

-- there is a normal up/down cycle in T blood level on shots -- way high for a few days after injecting, then way low just before time for next shot. Takes getting used to. Taking a half dose weekly, rather than full dose every other week, may ease this problem, if you don't mind sticking yourself more often.
I rarely bleed much after a shot and had no thigh scars after my year of injections.

-- frequent travelers will most likely find the gel packets more convenient

-- as Tall Allen guessed in my case (and it's looking like he was right), you may see a small amount of uPSA, perhaps from some unknown effect on some stray benign or bph tissue. This is really disconcerting if you have always been undetectable. And it may overcomplicate uPSA monitoring for recurrent cancer in any case. There does not seem to be much/any current literature that indicates TRT encourages PCa recurrence (excepting at low castrate t levels) -- though that is something you (and I) need to be aware of on TRT, because who knows for sure, right?

Good luck with your situation.

Robert

I've been using Testim gel for about 5 years now. I tried Testim first, it works fine for me, keeping my level at a 500-600 range consistently. That range works for me. I did try Androgel for one month, and I didn't absorb it anywhere near as well as the Testim, so back I went.

The only insurance issue I've had is that my insurance company requires that I hand-carry a hard copy prescription to the pharmacy every 6 months, as the T is a controlled substance and they want the hard copy as a "statement of medical necessity."

My uro, my RO and I agree that the T "may" cause some noise in my PSA readings, but with the daily gel application, it is probably minimized, as the daily dose mimics the body's natural production cycle. We are working under Dr. Morgentaler's assertion that "my body cannot tell if I make T internally or buy it at the Pharmacy."

Bobbiesan - I have been flying all around the country and even internationally, with nary a peep from TSA or airport security about the Testim tubes. When I went to Europe, I carried a copy of my scrip, and was never asked.

As for Dr. Morgentaler's input, I would probably not have opted for any treatment had I not been referred to him. My uro and the first RO I met with originally simply said of my TRT, "You have to stop this. This is what we do." No explanation, no ongoing plan. Just stop. Any of you who have been on ADT (or have been hypo gonadal as am I) know how the SE's can whup the stuffing out of some men. That's me. I'm the poster child for bad SE's as soon as my T gets down below 200. Weight gain, brain fog, mood swings, loss of muscle mass, depression. . . and so forth. Not a life I signed up for, hence my start of TRT back 5 years. I did not want to be consigned to "collateral ADT" with no medical benefit for my favorable intermediate risk PCa. I met with another RO - one who cared about the patient as well as the disease. She said "This is not my specialty, let me reach out to a colleague for advice. She wrote to her colleague, Dr. Howard Scher at MSKCC. (Look him up - he is another "notable.") Dr. Scher said "This is not in my wheelhouse. I recommend you consult with Dr. Morgentaler in Boston." My RO reached out to him and discussed my case. He said that he would be more than willing to see me, consult with me, and work with my local docs to manage my ongoing care. I could write a book about the part of an afternoon I spent at Dr. Morgentaler's clinic in suburban Boston. He is one impressive man. He has spent much of his last 20 years researching the intersect of T, TRT and PCa. I've read a lot of his work, and it "gave me my life back." Suffice it to say, though, that my local docs are happy to work with his input, and I have had the benefit of my TRT before, during and after PCa treatment. So far, so good - and I don't know of any reason to expect otherwise. Of course, if I had unfavorable intermediate or high risk PCa, things would be different. If the standard of care for my pathology had included ADT, I would have to have just gone that route. I consider that to be where I was lucky even though I have PCa.

BTW, to be official, I have no affiliation with Dr. Morgentaler. I am just a very happy patient.

Bobbiesan - Funny that you mention the "light bulb" effect. That is almost how I described it to my uro, and again to Dr. Morgentaler. My world was in a fog, I was making mistakes in my work, my self confidence was nowhere to be found.

Add the TRT, and not only did the lights go on, but my life went from "black and white" to "Technicolor" - in a very big way. I guess that after so many years of undiagnosed hypogonadism, I was more sensitive than many patients are.

P.S. Testim comes in single-dose tubes. When I travel, I only carry enough for the duration of the trip. I guess it never caught anyone's attention.