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Still Hung Like a Hamster : an Update.

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Posted 1/12/2018 9:10 PM (GMT 0)
Those of you who have been around for a while may remember this thread from six months ago -- Hung Like a Hamster -- in which I complained about the sluggishness of my testosterone recovery after my two years of ADT from July of 2012 through July of 2014. In that previous post -- on July 11, 2017 -- I announced the failure of Plan C (clonidine citrate) and announced the next plan (Plan D) which was to add Human Chorionic Gonadotrophin injections to see if they wouldn't encourage my testes to stop their dillydallying and start producing. For the past six months I have been poking myself several time a week -- three times a week with 1666 units of hCG for the first two weeks and 1250 units twice a week after the first two weeks.

After Monday's most recent blood work I am here to announce the failure of Plan D and to announce Plan F (see footnote*). Plan F is testosterone gel. I talked to my MO on Wednesday and, considering that I have been undetectable for six years and it has been 3 1/2 years since the completion of treatment, we decided it would be OK to supplement.

Here's a link to a graph showing my lackluster T recovery: Graph of PDA's T Recovery After ADT
Key dates -- June 2012: RP, Aug 2012-Aug 2014: ADT, Sept 2014-July 2016: natural recovery, Aug 2016-July 2017: Plan C, Aug 2017-Jan 2018: Plan D, Starting today: Plan F.

One thing I have learned since Wednesday is that, while there are generics for the 1% gel, there are no generics for the 1.62% T gel. The first scrip I got from my doctor was for the 1.62 percent gel and, even with the GoodRx discount the brand name AndroGel rang up at almost $600 for the first month. When she rang it up I did my W. C. Fields impression: Godfrey Daniel!! and fell back to regroup. After doing a bit more research and getting my (very patient) MO to rewrite the scrip I managed to reduce the cost to $149.00 for the month.

I'll keep you posted.

*footnote: Some of you may be wondering what happened to Plan E? Plan E (suggested by Tall Allen) consisted of ice baths and self flagellation and I've decided to adjust the task order and delay that part. I'm sure that would all be great fun and all, but it sounds like the kind of thing that requires testoterone to make it sound like a good idea. Thus the Catch 22 aspect...
Posted 1/13/2018 3:08 AM (GMT 0)
My urologist mentioned injections as a more affordable option than Androgel, and I think he said something about getting it from a compounding pharmacy to reduce the costs even more (it's been a while now and I might have that mixed up).

The downside is if you react badly to an injection it will remain in your system for a while. The gel is more forgiving. However, if you try the gel and have no problems, injections might be an option for you.

Good luck; I hope you get the results you want.
Posted 1/13/2018 3:10 PM (GMT 0)
As I recall from our meeting in Anchorage a few years back, you're a pretty tall fellow. So, maybe it's just a proportional thing. Those parts might be more impressive on a smaller man. Just a theory.
Posted 1/13/2018 5:29 PM (GMT 0)
Status update: There may be a brief delay in implementation of Plan F. I am still working to find a way to bridge the gap between the negotiated discounts that can be accessed using my GoodRx coupon and the text that has to appear on my prescription. GoodRx shows a price of $149.88 for a 30 day's supply at a local pharmacy. I have made two attempts to access that price. The first attempt failed because my MO wrote the scrip for the newer 1.62% gel for which I have since discovered that there is no generic substitution. I had him issue a second scrip for the 1% gel packets for which there are generics available. When I tried to use that scrip with my coupon yesterday it rang up at $287. I had a three-way conversation with the pharmacist and the GoodRx help desk guy and we were unable to resolve the problem so I declined and asked for my scrip back. I'll try the next lowest price GoodRx coupon for a different local pharmacy chain for $164.86. I may first try a different store in the lower-priced pharmacy (I expect the previous pharmacist is tired of seeing me) just to see if I can figure out what didn't work.

Jazz: Yes, the injections are less expensive. If I can get any of the discounts to work I still prefer the gel. The gels are similarly effective and have a slightly smaller risk of heart problems and strokes. But we'll see.

Clock: "Tall?" Yes, I guess I'm tall. But I don't get called "pretty" very often.
Posted 1/13/2018 8:53 PM (GMT 0)
There are mail order compounding pharmacies where they can make up creams or gels to the desired T concentration (up to about 20%). I know a doctor who claims that the lecithin-based cream gets absorbed better than the alcohol-based gel, and it is certainly less irritating. I suspect the pricing will be cheaper (less than $100/mo) than any pre-packaged stuff sold at retail.
Posted 1/13/2018 11:01 PM (GMT 0)
Peter - I hear you. Much the same end result here, but a different path to needing it. I've been using Testim gel for over 5 years now, and for me, it works fine. One tube per day keeps my T level around 700 or so. Testim branded gel stinks, though, so wife hates it.

I may be looking for a different brand soon, as my medical insurance will likely change on April 1. Hope the new one (BCBS Federal Plan) covers Testim, as my trial of Androgel didn't absorb well for me.
Posted 1/15/2018 4:49 AM (GMT 0)
Tall:

I used a local compounder for several years for Trimix without any issues. The main barrier to using a compounding pharmacy for this is simply figuring out what sort of a scrip I need and educating my doctor on how it needs to be written. I may quiz you later for suggestions if I can't make the more conventional channels work for me.

Paxton:

One pharmacist told me that my insurance company won't pay for Androgel but encourages their subscribers to switch to Testim. So, Testim may have negotiated some attractive prices for insurance companies and you might be OK after the change of insurance. Failing that, you and I can pester the Tall one for compounding pharmacy recommendations.
Posted 1/15/2018 5:47 PM (GMT 0)
I've been doing self injections for years. Before PCa, I did intramuscular injections in the thigh and I hated them. I had to stop for about a year during my PCa treatment.

When I resumed, I switched to subcutaneous injections in the stomach. Nearly painless with an insulin needle and way cheaper than the gels. And, doing it once a week or so is not nearly as much hassle as daily gel application. I do heat up the syringe with hot water after I fill it so that the oil flows more smoothly. I fill the insulin syringe from the top by using a large gauge syringe to draw the suspension from the bottle and then injecting it into the insulin syringe. It's easier than it sounds.

The injected T is cheaper than the gels as well.
Posted 1/15/2018 8:07 PM (GMT 0)
Let me give you the Rx off a 16 y.o. bottle (I'm a rat-packer):

60 gm testosterone (pump) 10% in PLO (Pluronic Lecithin Organogel)

Apply 2 pumps topically once daily or 1 pump twice daily (shake well)


One pump is 1 ml. Each pump bottle lasts a month. If I remember correctly, each bottle cost $60. After a month of use, you can see what your serum T level is and adjust the concentration up or down (absorption rates vary with the person). It was completely non-irritating and vanished completely into my skin.
Posted 1/16/2018 8:36 PM (GMT 0)
Tall:

Thanks for the info. It encouraged me to talk to some of our local compounders and I found one about three miles from my house that can hook me up for $65-$90 (depending on the dose) which is a tenth of the cash price of the brand name drugs and less than half of the best discounted prices I could find for generics.

The pharmacist offered to work with my doctor to establish an initial dose and help with the wording of the scrip. I sent a note to my doctor through Duke's online patient portal thingie. He's usually pretty responsive. We'll see if I can make things work this time...

Oh, and by the way. I haven't been able to find anyone local who does the PLO base. If I have absorption problems or irritation with the gel I may circle back on that.
Posted 1/16/2018 11:11 PM (GMT 0)
PDA-

I wonder if online compounding pharmacies are cheaper. That's how I did it - I sent them a scrip and payment, and they sent me a new bottle every month.
Posted 1/17/2018 4:51 AM (GMT 0)
Tall,

That may be. But I think I will use the local one for a while until I have settled on a dose. After that I might try to find an online pharmacy although my local one offers discounts for buying three months at a time and might be competitive.
Posted 1/17/2018 4:08 PM (GMT 0)
TA and Peter - Thanks for all the valuable info. I have been following this thread, as my insurance will probably change at the beginning of April. Thus far, my group insurance has been fine covering Testim, but I don't know which topicals the next plan will cover. (I will be switching to the BCBS Federal Employee/Retiree Plan, if anyone knows its coverage.) If the new plan tries to force me to Androgel, I know from past experience that I do not absorb that gel well at all, and would then look for alternatives.
Posted 1/17/2018 6:03 PM (GMT 0)
Paxton-

My experience was that the PLO cream absorbed easily. It was pleasant and non-irritating. If I remember correctly, my T level reached about 1000 with that concentration, but everyone absorbs differently through the skin.
Posted 1/27/2018 5:33 AM (GMT 0)
So, after slightly more than two weeks of farting around with coupons and insurance and other unavailing rubbish, trying to find a financially feasible source for mass produced T gels, I have finally brought home a three-month supply of a compounded gel that will only cost me $60 a month.

I tried to quiz the pharmacist about the gel base to see if it is similar to the PLO base that Tall liked back in the day. She was quite effusive about the base -- it's called "Atrevis" and it's only used for testosterone, and only for men. It seems it is much better absorbed than some unspecified competitor. I Googled for it, looking for research, or a patent, or something to tell me what, exactly, it contains, but all I could find is trademark applications and this flyer:

Atrevis(TM) Hydrogel

It'll be several weeks before I have any notion how well it works and a couple of months before I my next T blood test. I'll probably start a new thread to report my progress. The title of this thread -- the part about being hung like a hamster -- may become embarrassing since the T supplementation will probably continue to make Dexter and Lefty shrink...
Posted 1/27/2018 5:57 AM (GMT 0)
It looks interesting. I did some marketing for a company that used liposomal delivery of peptides, and it seems to work similarly. What concentration will you be starting with - 10%?

A friend of mine on TRT takes clomid everyday to keep Dexter and Lefty engorged. But I wonder if when they're smaller they make the rest of the package look larger. I hope it produces the expected results.
Posted 1/28/2018 7:32 PM (GMT 0)
The label says testosterone 100mg/ml which is 10% if 1 ml of the gel weighs 1g (the same as water).

I still have some clomid on hand so I'll probably continue that until my supply runs out. Then I'll decide whether or not it makes sense to continue paying for it.

I also have some hCG in the fridge which I will probably throw away. With my trimix-trained eyes the 1 inch IM needles were never that appealing.
Posted 1/28/2018 7:47 PM (GMT 0)
hCG is water-based -- you can use insulin needles and inject subcutaneously.
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