Back off the T a bit...

[Don Schultz]

My T levels are slightly high. I have been doing e3d injections and am going to lower the dose just a tiny bit. Theoretically, how long before my T levels will decline a little?

 

[Vettester Chris]

It won't take long at all ... Within a week you will it trending towards the lower desired serum level, and by two weeks you should be at your sustained serum level that's relevant to your dose.

Just for curiosity, do you mind sharing what your serum level is/was, what level you're aiming for, and current dosage -vs- adjusted dosage? Not to be snooping in your bizzness or anything, but your experiences and how you are reacting to them might be beneficial for others that are (or will be) facing a similar ordeal ... Thanks

 

[Don Schultz]

I have been taking .21 ML E3D T Cyp 200mg and my last T level was 940 (193-740 mg/dL). I am going to try .18 and see where I end up. Don't mind being a little high but 940 might be stretching it.

 

[Vettester Chris]

By chance are you also tracking your free testosterone?

 

[Don Schultz]

No but I used to. I recently was switched to Kaiser SoCal and they are pretty much worthless as far a TRT goes, they won't pay for any blood tests that they don't deem necessary and the won't let you self inject. Fortunately I had a 18 months of TRT under my belt when I switched so I more or less knew what I was doing. I am going to pay for the Men's Profile blood test on Discount Labs after a couple of weeks of the new dose so I know a little better where I am at. I am on HCG and Anastrozole with Empower so I think my E levels are okay. I feel fine but am guessing based upon the 940 that my free T might be high as well. What do you think?

 

[Vettester Chris]

Don, I'm a KP So Cal guy also. That's where it all started for me over 6 years ago. That was my wake-up call to start doing some serious research ... I have all sorts of stories, sad but true, here's one example ...

My GP referred me to an endo at one of the main facilities in the IE. She had me on 100mg of Cyp, 1x per week, that was my program. I picked the stuff up at their pharmacy per her Rx, and injected at home. I met the endo and he said 100mg was way toooo much, it might could get my serum over 650ng/dl, which would be dangerous! Then he said ALL shots had to be administered by him or a nurse. I asked why, he said because testosterone is a "Schedule III Controlled Substance". He claimed that the word "Controlled" meant that it had to be controlled in their possession. I asked about vicodin and other "controlled" medications that patients take home?? He got pissed and told me to talk to him when I get my medical degree, which then I would understand how this all works. Don, kid you not, this all happened at KP, and that was only the starting point with this clown!

OK, back on topic .. Yeah, just bite the bullet and get some of these labs through Discount. Free test can also be calculated from SHBG and albumin, so in the event you end up having those with your total serum, we can calculate it from there. As far as my thoughts on it ... It's really anyone's guess. Depending again on SHBG, you could be really anywhere from 1% to 4% of total serum; ideally IMO 2% to 3% is an ideal area to be. Mine is around the 3.3% range, but then again my SHBG has always been in the high single digits. For that purpose, I usually keep my total serum in the Low 600's ng/dl to low 700's range, which works for me, with upper teens low 20's for free test.

Hope that gives you some additional perspective, and maybe some support to know that KP can actually be a great motivator with getting familiar with all of this!

 

[Vettester Chris]

BTW, my KP GP is great! She isn't overly up to speed on the HRT side of it, but she acknowledges that, and she NEVER lets her ego get in the way with learning more. She has supported me with aligning up with other physicians and specialists that focus in this area, and she collaborates (where she can) with labs and other areas of treatment pertaining to the HRT side of it. LOL, I have had some great conversations with her on HCG, Reverse T3, E2 management, etc.

 

[Don Schultz]

I had nearly the exact conversation early 2014. They will not let me self inject because its a "controlled substance", after I had already been self administering for over a year. I refuse to waste my time going in every week to do something at takes me 2 min at home. KP has been good for my wife and 2 kids, just too much BS on TRT for me. Thanks for your help!

 

[Nelson Vergel]

Testosterone is a class 3 controlled substance that can be self-administered at home. Even in NY state, where it is a class 2, you can self-inject.

The reason they want you to come every week for a shot is to charge your insurance.

 

[Vince Carter]

Testosterone is a class 3 controlled substance that can be self-administered at home. Even in NY state, where it is a class 2, you can self-inject.

The reason they want you to come every week for a shot is to charge your insurance.

That's exactly right. No doubt it.

 

[Vettester Chris]

Testosterone is a class 3 controlled substance that can be self-administered at home. Even in NY state, where it is a class 2, you can self-inject.

The reason they want you to come every week for a shot is to charge your insurance.

With Kaiser, the injections are No Charge and No Copay, they just make you sign in with the nurses and get it done. My GP had set me up with doing the injections at my house, by myself. It was my mistake having her refer me to their endo, who tried to pull the plug on that. In this case, it's really just ignorance and arrogance on their part.

 

[Don Schultz]

Can you clarify this for me (again) so I understand. My syringe is 3 ml (3 CC). I am injecting .2 ML e3d T 200mg. How many mg am I taking?

 

[Someguy]

If you're taking .2 ml at 200mg/ml then you're taking 40mg. (.2 x 200)

 

[Don Schultz]

Okay, that makes sense. Thanks!

 

[Someguy]

The reason they want you to come every week for a shot is to charge your insurance.

At one point early in my TRT adventure I was calling around and interviewing various local TRT clinics trying to find one that would let me self inject. I was speaking to the PA in charge of one of the clinics and asked him about self injecting at home. He said no, because there's too much potential for abuse.

Half joking and half out of frustration, I busted out with, "Come on! You and I both know it's really about billing for each weekly injection!" He laughed and said "you're not wrong."

I said, so can I self inject at home?" He immediately went back into serious, business mode and repeated, "Our policy is to require all injections be given at the clinic by our staff due to the potential for abuse." It was nice to see a glimmer of honesty there for a second though.

 

[Don Schultz]

Kaiser Permanente is a health care organization in California and many other states. Its not insurance. KP has all their own docs, clinics, hospitals, etc etc. Its a closed system. The individual KP docs have no authority to go outside KP protocol and they are quick with their answers if you question them on things like HRT protocols. In this case their decision not to allow self injection is made high up the chain of command and the GPs and the Endos can not go outside KPs procedure, virtually no matter what, so I would be surprised to hear if ANY KP doc ever allowed self injection. In this case, it DOES cost KP more to require nurse injections. That does not minimize Nelson's assertion that most times this is motivated by insurance billing. KP is wonderful in many ways. I have 2 kids and my wife on KP after 30 years with Anthem. KP has wonderful access to nearly everything online including the ability to email docs who actually respond. I work with a cardiologist, an endo and a GP and they coordinate with each other in a very efficicent way. If one of my docs orders a blood test (done in house at KP), my other docs are notified and may times will order tests on my drawn blood that apply to their specialty. I switched because KP is now way cheaper than Anthem with my current employer. KP is great but for TRT, its rough going. My previous Anthem doc could prescribe HCG, and, although Anthem would not pay for it, at least I could get it on my own. KP will not prescribe HCG and will not allow home injection. I predict that they might allow self-injection some day. I will still have the issue with the HCG and some might say I could let the HCG go but for now I feel better taking it.

 

[Don Schultz]

Chris: can I get the name of your Kaiser GP?