Personal experiences with both HCG Monotherapy and TRT?

[CSI007]

HCG SHOULD suppress the LH production. After several months on HCG monotherapy my LH dropped from 4/6 down to less then .5

HCG does not register as LH in any blood test. There is a blood test for HCG though. I think they use it also to detect testicular cancer as some (all?) testicular cancer produce HCG.

 

[johndoesmith]

R. Do you have a link to the article that explains this?

I have a post where Dr saya agrees that hCG is suppressive to the HPTA. It's tough to find anything online regarding hCG mono as it's fairly uncommon compared to TRT.

https://www.excelmale.com/forum/sho...-HCG-monotherapy&p=50319&viewfull=1#post50319



R. Mostly HCG, correct.

Well if it's mostly hCG, and some clomid, it matters how much clomid, as that can explain the lack of HPTA suppression.


R. My thinking is if you inject HCG, you raise your LH levels accordingly. The HCG mimics LH and binds to the LH receptors, which means your natural LH gets suppressed. So it stands to reason the HCG is doing the work.

No, hCG does NOT raise LH levels. It mimics them, therefore LH isn't needed anymore.

You just said yourself, your natural LH gets suppressed. But yours is not. I personally think that's due to insufficient replacement.



R. My 8/31/16 labs showed a Free Test: 23.6 High pg/mL, Ref. Range: 6.6 - 18.1. So the HCG elevated my LH levels in order to produce that Free Test lab reading, which seems pretty sufficient to me. The LH levels should be high considering I inject HCG 3-4 times a week.

I've never seen any labs where a person is not completely suppressed when taking an exogenous source of testosterone or hCG.

hCG does not raise LH, it does not appear on a lab test as LH, they are separate chemicals with enough differences that lab tests can tell them apart, it's just the body that cannot.

R. So that's what I'm not getting, you believe the more HCG one injects the lower your LH levels should be...? If you can provide me a link that explains that, maybe I would understand.

I don't just believe, it's fact. Once you administer an exogenous source of hormones, the HPTA shuts down. You are administering exogenous hormones.


R. Again, I will need a link that explains this theory.

https://en.wikipedia.org/wiki/Hypothalamic–pituitary–gonadal_axis#Suppression

That's an article regarding HPTA suppression. Like I said, it's tough to find info on hCG monotherapy online, other than forum posts, but if you do google it, you'll notice every single forum post says it's suppressive.



R. 12.5mg of Aromasin EOD is a less than a half a normal dose of 25mg every day. I have no clue what others are taking for an AI dosage or what brand name? Those on HCG Monotherapy should use a AI to control excess estrogen caused by HCG in order to reap any benefits from the HCG monotherapy.

There's no such thing as a "normal dose" of AI. Many men do NOT take AI, and it's not a necessary element of TRT. Men that ARE taking AI, are not taking anywhere near 25mg aromasin a day, I am fairly sure that is a dose that will achieve near 99% aromatase inhibition, therefore leaving a person with near zero estradiol production. In other words that's a breast cancer treatment dose.



Likely most of the estrogen conversion is from HCG and why I take low dose Aromasin EOD. Also the DHEA and elevated Test levels are also converting to estrogen to a degree.

You're correct.





R. If I was on TRT my HCG dose would probably be the same.

Why would that be? hCG's purpose on TRT is to maintain testicular function, not produce replacement of testosterone levels. Therefore a lower dose is used.




R. Maybe, but I believe about the same...1000IU per week or maybe 500IU?

You're taking minimum 250IU a day. Multiply that by 7 and it's 1750IU per week.

You said up to 350IU a day. So that's between 1750IU - 2450IU per week. Not the same as 500-1000.




R. FSH.

The testes do not make FSH. I was referring to the production of pregnenolone, which actually I don't believe is entirely produced in the testes, but there are also LH receptors found in the body, that hCG is used to stimulate in the HPTA suppressed man.


R. And why I and others on HCG Monotherapy should use a low dose AI like Aromasin EOD.

Which makes sense if they're achieving a level which is fully suppressing them, you are not, which I find odd. I believe you consult Dr saya, so if that's true, and he thinks it's fine, ignore what I'm saying haha. He's way way more informed than I am so listen to that man over me.

I don't intend any of that in a rude way, or a "I'm smarter than you" way, so don't take it that way. I simply am passing on what I have learned.

 

[newguy128]

HCG SHOULD suppress the LH production.

R. Agree here.

HCG does not register as LH in any blood test.

R. Do you have any authorities that support this assertion?

There is a blood test for HCG though.

R. Do you know the name of this blood test you refer to?

I think they use it also to detect testicular cancer as some (all?) testicular cancer produce HCG.

R. Interesting?

...........................

 

[newguy128]

JDS: I have a post where Dr saya agrees that hCG is suppressive to the HPTA. It's tough to find anything online regarding hCG mono as it's fairly uncommon compared to TRT.

https://www.excelmale.com/showthread...ll=1#post50319

R. 09-15-2016, 02:12 PM #10Dr Justin Saya, MD: Certainly review the previous discussion about gradual shutdown of endogenous LH/FSH as noted.

I have no argument with this. I'm not sure why you think, I think otherwise? I've stated this throughout my posts that HCG shuts down endogenous (natural) LH. So I'm not sure why you are trying to convince me of this fact?

JDS: On 8/31/16 your LH was 15 while you were injecting hCG but NOT taking clomid, correct?

R. Mostly HCG, correct.

JDS: Well if it's mostly hCG, and some clomid, it matters how much clomid, as that can explain the lack of HPTA suppression.

R. Again, I'm not sure what you mean when you say: "as that can explain the lack of HPTA suppression."

It is a given that when you inject exogenous HCG, you are gradually shutting down your endogenous LH/FSH as Dr. Saya states. Your endogenous LH/FSH levels are already suppressed. There's nothing to explain, its a given you will shutdown your endogenous LH/FSH when injecting HCG.

R. My thinking is if you inject HCG, you raise your LH levels accordingly. The HCG mimics LH and binds to the LH receptors, which means your natural LH gets suppressed. So it stands to reason the HCG is doing the work.

JDS: No, hCG does NOT raise LH levels. It mimics them, therefore LH isn't needed anymore.

R. Can you post a study or article that explains your first assertion that: "hCG does NOT raise LH levels."

As to your second assertion that: "It mimics them, therefore LH isn't needed anymore."

I agree here that LH mimics endogenous LH and the body thinks it has enough LH and stops production of same. But again, I'm not sure why you are trying to convince me of this? If the production of endogenous LH is stopped there is nothing to measure, except for the exogenous HCG you inject.

JDS: You just said yourself, your natural LH gets suppressed.

R. Correct, so what's the beef?

JDS: But yours is not. I personally think that's due to insufficient replacement.

R. Correct on the first statement. But respectfully, and this is where I believe your wires are crossed. Its a grey area to explain, its easy to get confused, but I'll give it a try. Appears you are looking at my elevated LH labs and wondering why are my LH levels are elevated? Something has got to be wrong? Actually, nothing is wrong, my labs indicate that.

It appears you are confusing endogenous and exogenous LH with one another. My exogenous LH levels will show elevation on my labs. While my endogenous levels are suppressed/shutdown at the same time and there is nothing to read. Same concept as doing exogenous Test and being shutdown/suppressed, its a given.

Ex: If you inject 500 mgs. of Test, will your labs reflect your endogenous Test that has been suppressed/shutdown by your exogenous 500mgs of Test? Or will your labs reflect the 500mgs of Test you injected? The answer is fairly obvious.

JDS: I've never seen any labs where a person is not completely suppressed when taking an exogenous source of testosterone or hCG.

R. Again, I'm not sure why you keep trying to convince me of this fact when I agree with this as noted above.

JDS: hCG does not raise LH,

R. Can you post a study or article that supports this assertion?

JDS: it does not appear on a lab test as LH,

R. Ditto, can you post a study or article supporting this assertion?

JDS: they are separate chemicals with enough differences that lab tests can tell them apart,

R. Can you post a study/article supporting this assertion?

JDS: it's just the body that cannot.

R. This part I agree with.

So that's what I'm not getting, you believe the more HCG one injects the lower your LH levels should be...? If you can post a link that supports that assertion, maybe I would understand.

JDS: I don't just believe, it's fact. Once you administer an exogenous source of hormones, the HPTA shuts down. You are administering exogenous hormones.

R. Once again, what makes you think I don't understand this? That's pretty basic stuff. But my question was: You believe the more HCG one injects the lower your LH levels should be...? Your LH shouldn't be elevated, something is wrong?

As you stated previously: JDS: Either way, you are not sufficiently replacing your testosterone.

R. Even though my after HCG labs showed an increase in bot Tot. and Free Test?

JDS: Your body is screaming for more, as evidenced by the 15 LH level. It's higher than BEFORE you started hCG.

R. Again, respectfully, this is where I believe you have your wires crossed. The 15 LH level is attributed to the exogenous HCG, not my bodies endogenous LH which was replaced with the HCG and is shutdown and should be non-detectable.

JDS: but if you do google it, you'll notice every single forum post says it's suppressive.

R. Noooooooooo....really???

newguy128 R. 12.5mg of Aromasin EOD is a less than a half a normal dose of 25mg every day. Those on HCG Monotherapy should use a AI to control excess estrogen caused by HCG in order to reap any benefits from the HCG monotherapy.

JDS: There's no such thing as a "normal dose" of AI.

R. According to the Aromasin dosage info there is. You are generalizing my statement by saying "There's no such thing as a "normal dose" of a AI." When I am in fact speaking specifically of Aromasin, not any or all other "AI's."

JDS: Many men do NOT take AI,

R. If we polled 10,000,000 men in the USA, likely less than 1% would be taking an AI or even know what it is?

JDS: and it's not a necessary element of TRT.

R. Not necessary, but helps eliminate excess estrogen.

JDS: Men that ARE taking AI, are not taking anywhere near 25mg aromasin a day,

R. The first part is generally vague as to what name brand of AI are you referring to? What dosages of Test are they taking? What is their lifestyle like, diet, general health, etc. etc?

JDS: I am fairly sure that is a dose that will achieve near 99% aromatase inhibition, therefore leaving a person with near zero estradiol production.

R. I'm not taking 25mgs every day, rather only 12.5mgs EOD of Aromasin, big difference.

JDS: In other words that's a breast cancer treatment dose.

R. Correct, 25mgs is a daily dose for breast cancer treatment.

newguy128: R. If I was on TRT my HCG dose would probably be the same.

JDS: Why would that be?

R. Reread my posts on my HCG dosages...EOD.

JDS: hCG's purpose on TRT is to maintain testicular function, not produce replacement of testosterone levels.

R. I'm not on TRT, but thanks for the enlightment.

JDS: Therefore a lower dose is used.

R. Generally speaking yes, but I take what I would consider a equivalent TRT dose of 500-1000IU per week, so amounts to about the same.

JDS: You're taking minimum 250IU a day. Multiply that by 7 and it's 1750IU per week.

R. Respectfully, that's totally incorrect and why you need to reread my HCG dosage posts.

JDS: You said up to 350IU a day. So that's between 1750IU - 2450IU per week. Not the same as 500-1000.

R. Once again, totally incorrect and way off base, take another look at my posted HCG EOD dosages.

newguy128: R. FSH. HCG supplies LH/FSH.

R. And why I and others on HCG Monotherapy should use a low dose AI like Aromasin EOD.

JDS: Which makes sense if they're achieving a level which is fully suppressing them, you are not, which I find odd.

R. Redundantly, I don't understand why you keep saying I am not suppressed? When in fact my endogenous LH and likely my FSH are both suppressed.

The whole idea of my statement to use an AI like Aromasin is to control excess estrogen caused by the HCG. And to keep the T/E ratio balanced to an optimal level.

JDS: I believe you consult Dr saya, so if that's true, and he thinks it's fine, ignore what I'm saying haha. He's way way more informed than I am so listen to that man over me.

R. Fer sure, 10-4 that!

JDS: I don't intend any of that in a rude way, or a "I'm smarter than you" way, so don't take it that way.

R. Thanks, but I'm not taking it out of context. Its just that you believe you are correct in what you said and I don't understand some of your assertions. But if you can post supporting evidence to your assertions, then I will be more than willing to read it to learn new stuff. That's what the forum is for, to hopefully educate one another on various subjects.

JDS: I simply am passing on what I have learned.

R. Thanks, I appreciate input, but sometimes we learn things the wrong way or get accustomed to thinking a certain way whether its right or wrong. If I am wrong after reading any studies or articles supporting your assertions, then I've learned something new and I'll retract whatever I've said if its wrong or I've given incorrect info. So as to not mislead any future readers, including myself.

 

[CSI007]

R. Do you have any authorities that support this assertion?

HCG is not LH. So if you test for one you won't get the value of the other and vs versa.

Look at the last test on my lab report to see what this test is called.

 

[johndoesmith]

Okay, this is going to be too long, so I am going to respond to the most important parts:

R. 09-15-2016, 02:12 PM #10Dr Justin Saya, MD: Certainly review the previous discussion about gradual shutdown of endogenous LH/FSH as noted.

I have no argument with this. I'm not sure why you think, I think otherwise? I've stated this throughout my posts that HCG shuts down endogenous (natural) LH. So I'm not sure why you are trying to convince me of this fact?

Okay cool, but you've been asking me for a study as here "R. This part I agree with.

So that's what I'm not getting, you believe the more HCG one injects the lower your LH levels should be...? If you can post a link that supports that assertion, maybe I would understand."

That's why I am trying to convince you of that.

It appears you are confusing endogenous and exogenous LH with one another

There is no such thing as exogenous LH. You are confusing an endogenous ligand, with an exogenous agonist. Just because something binds to a receptor, does not mean it is the same chemical the naturally binds to that receptor.

Cabergoline is a man made drug, it is not naturally produced in the body, yet it binds to dopamine receptors. It is NOT dopamine though.

If you inject 500 mgs. of Test, will your labs reflect your endogenous Test that has been suppressed/shutdown by your exogenous 500mgs of Test? Or will your labs reflect the 500mgs of Test you injected? The answer is fairly obvious

That is not an apples to apples comparison. Testosterone is called testosterone. hCG is not called LH. Therefore, they are not the same.
You ask me to prove this, and it's somewhat like asking me to prove that water and gasoline are not the same, and gasoline can be used to fight fire because they're both liquids.

I mean no disrespect at all in any way, I'm not trying to be aggressive or anything, but you have a lot of misconceptions, and it's good that you're asking for proof, it is. The problem is that you're asking for proof of things, that don't need to be proven, therefore it doesn't exist.

I may be able to pull up the cross reactivity of the LH assay. I'll look for it.

I did in fact read your hCG dose incorrectly. You're right about that.

You mentioned about AI use, and polling 10,000,000 men, well I'm not talking about normal men. I am talking about TRT guys. Yes, you're not on TRT, that's correct, but I mean in terms of hormone replacement, most guys are not on AI.

I hope this helps, and causes you to do research, and I find it amazing that at 70years old you haven't stopped asking questions, truly, but I think your questioning of some things is a bit unreasonable.

 

[newguy128]

HCG is not LH. So if you test for one you won't get the value of the other and vs versa.

Look at the last test on my lab report to see what this test is called.

What is the reason you use the HCG, Beta Subunit test for?

 

[johndoesmith]

What is the reason you use the HCG, Beta Subunit test for?

It measures hCG levels in the blood, generally it's pregnancy test for women, or certain types of testicular cancer screening for men.

LH and hCG do not appear on each other's tests.

 

[newguy128]

Okay, this is going to be too long, so I am going to respond to the most important parts:

09-15-2016, 02:12 PM #10Dr Justin Saya, MD: Certainly review the previous discussion about gradual shutdown of endogenous LH/FSH as noted.

R. I have no argument with this. I'm not sure why you think, I think otherwise? I've stated this throughout my posts that HCG shuts down endogenous (natural) LH. So I'm not sure why you are trying to convince me of this fact?

JDS: Okay cool, but you've been asking me for a study as here "R. This part I agree with.

R. Not sure which post you got this from? Might help if you pasted the other half of the post in order to follow it?

And not sure why you say this if I agree with your response? If I agreed with the response obviously I didn't ask for a study, so a bit confused here?

So that's what I'm not getting, you believe the more HCG one injects the lower your LH levels should be...? If you can post a link that supports that assertion, maybe I would understand."

JDS: That's why I am trying to convince you of that.

R. But you haven't posted any supporting links, articles or studies that would allow me to understand your assertions?

It appears you are confusing endogenous and exogenous LH with one another.

JDS: There is no such thing as exogenous LH.

R. I was referring to HCG.

JDS: You are confusing an endogenous ligand, with an exogenous agonist.

R. Can you enlighten me on this?

JDS: Just because something binds to a receptor, does not mean it is the same chemical the naturally binds to that receptor.

R. The first part I understand, the 2nd part is a bit confusing, but it looks like you are saying: does not mean it (HCG) is the same chemical as the natural (endogenous) LH that binds to that receptor. If this is correct, I understand that, as I have said that several times previously. And again, not sure why you are still trying to convince me of this fact? But thanks for the reminder though.

JDS: Cabergoline is a man made drug, it is not naturally produced in the body, yet it binds to dopamine receptors. It is NOT dopamine though.

R. Okay.

If you inject 500 mgs. of Test, will your labs reflect your endogenous Test that has been suppressed/shutdown by your exogenous 500mgs of Test? Or will your labs reflect the 500mgs of Test you injected? The answer is fairly obvious.

JDS: That is not an apples to apples comparison. Testosterone is called testosterone. hCG is not called LH. Therefore, they are not the same.

R. I think your being a bit argumentative here. So I referred to HCG as LH previously, I used the wrong letters....sorry?

But its okay for you to compare and note the difference between Cabergoline and dopamine, but if I do the same with Testosterone, its totally irrelevant as apples to apples comparison? Bit argumentative here guy.

JDS: You ask me to prove this, and it's somewhat like asking me to prove that water and gasoline are not the same, and gasoline can be used to fight fire because they're both liquids.

R. ??? Not sure what gasoline, fire, water and liquids have to do with someone asking for supporting evidence guy?

I mean no disrespect at all in any way, I'm not trying to be aggressive or anything,

R. Just a bit argumentative.

JDS: but you have a lot of misconceptions, and it's good that you're asking for proof, it is.

R. I don't know about misconceptions, I'm just trying to understand your assertions to eliminate any of the perceived misconceptions you believe I have. Everything you have been saying relevant to HCG, etc. may all be true fact.

But when I ask you for links to articles or studies that support or explain your assertions, so I can have a better understanding of what you are saying, but you have yet to supply any of those links?

JDS: The problem is that you're asking for proof of things, that don't need to be proven,

R. Maybe in your mind it doesn't need to be proven because you already have that knowledge by reading somewhere in a study or article to make your assertions. That you say I have misconceptions about or lack knowledge of. And that may be true? That's why I ask for links to that info you may have already read and understand ... so I can understand what you already understand.

That's not an unreasonable request, is it?

In a lot of the above posts it seems as though you are trying to convince me of facts I am already aware of or have agreed with, so...?

JDS: therefore it doesn't exist.

R. Looks like I'll never know if you don't want to post any supporting links to some of the assertions you seem to already have knowledge of. That as you claim, I either don't understand or have knowledge of?

JDS: I may be able to pull up the cross reactivity of the LH assay. I'll look for it.

R. Thanks.

JDS: I did in fact read your hCG dose incorrectly. You're right about that.

R. Thanks.

JDS: You mentioned about AI use, and polling 10,000,000 men, well I'm not talking about normal men. I am talking about TRT guys. Yes, you're not on TRT, that's correct, but I mean in terms of hormone replacement, most guys are not on AI.

R. Okay, I never polled guys on TRT, but I have read quite often, that some guys use an AI and some don't. So I presume your correct on that. If you can control estrogen with diet, lower more frequent lower T dosages, etc., then that's one less drug in your body.

As you have acknowledged above, I am not on TRT, but rather HCG monotherapy. Which in my readings requires an AI due to estrogen conversion from the HCG. So what may apply relevant to AI use with guys on TRT, doesn't necessarily apply to guys on HCG Monotherapy. Therefore, using 12.5mgs of Aromasin in my situation is warranted given my lab results.

JDS: I hope this helps, and causes you to do research,

R. I do more than enough research, but if you could provide the requested research links to support some of your assertions I don't currently understand, then that would be helpful. But it appears from your posts your not really interested in doing that, so...?

JDS: and I find it amazing that at 70years old you haven't stopped asking questions,

R. Not sure if this is supposed to be a compliment or because of my age I shouldn't be asking questions, asking for supporting evidence, posting replies in a forum? I believe that is common practice in a forum, so I've read ...

JDS: truly, but I think your questioning of some things is a bit unreasonable.

R. Respectfully, because maybe I don't understand some of your assertions and ask for supporting links or articles that you may have already read and understand. That explains your assertions, that you don't appear to want to provide that info, that makes me unreasonable... Don't think so.

I do think you are a bit on the argumentative side though.

Hope you enjoy your holidays. Don't drink & drive!

 

[johndoesmith]

Hope you enjoy your holidays. Don't drink & drive!

I'm not a big holiday guy myself, I had a root canal done 2 days ago, so I have an "out" for dealing with the annoying dinner parties

Look, I wasn't meaning any condescension, disrespect, or insulting of your intelligence. I may have be a bit harsh, but keep in mind, root canal.

It's starting to get confusing and all, and I think the biggest misconception you have, is that because hCG acts as LH, that they are one and the same. They are not, hCG is an LH receptor agonist, which is entirely different from being LH. You've said that hCG should raise LH levels much like clomid does, which is not the case. The gasoline example was an oversimplified metaphor that seems to have been taken the wrong way, that is my fault for phrasing it that way.

Asking for proof that hCG does not raise LH levels, is difficult to find hardcore evidence of mainly because any person with an understanding of the HPTA and it's regulation know it not to be true, thus no one has spent time or money to PROVE that it doesn't.

You simultaneously stated that we both agree hCG shuts down the HPTA, but then you say that you'd like proof that the more hCG one injects, the lower one's LH levels are.


Those are contradictory beliefs, hence why I tried to convince you of the notion that hCG is suppressive to the HPTA(thus lower LH levels), but I simply don't know of any research stating this, there's no need for anyone to research this AFAIK.

All the while you're saying you agree that hCG is suppressive, but disagreeing with me that your specific HPTA is NOT suppressed. It's entirely confusing. You're agreeing with me, but simultaneously not agreeing with me, and asking for proof of what I am saying.

R. I think your being a bit argumentative here. So I referred to HCG as LH previously, I used the wrong letters....sorry?

I am not being argumentative because you confused a few letters. It's like confusing numbers, because in this scientific context, the exact name of a specific substance matters significantly. I meant no offense by that.

R. I do more than enough research, but if you could provide the requested research links to support some of your assertions I don't currently understand, then that would be helpful. But it appears from your posts your not really interested in doing that, so...?

I am entirely confused on what assertions of mine you would like research on, it seems as if you're agreeing with me, then not agreeing with me on certain things, and I don't know exactly what it is you want evidence of.

Some things are a given, and evidence of them does not exist, therefore it's hard to provide evidence of these things.

R. Not sure if this is supposed to be a compliment or because of my age I shouldn't be asking questions, asking for supporting evidence, posting replies in a forum? I believe that is common practice in a forum, so I've read ...

No it's a sincere compliment! People I know who are younger than you have stopped asking questions, don't care to learn more, or "have learned enough". So I respect that you are still learning!

I'm a bit confused by all of this, and honestly, it'd be best if you just gave me specific things I said that you don't understand and want further research on.

 

[CSI007]

What johndoesmith said.

 

[Sakuraba39]

Neither the VA, nor my VA-PC Doc, deals with or prescribe hormones or ancillaries unless it is service connected. I did HCG on my own w/o a Doc based on my prior lab results.

Newguy, I am a non-SC vet and have been getting my Test from the VA for nearly 15 years. In fact, over the years, I've been Rx-ed T, thyroid, hydrocortisone, Vit-D, sleep meds, chiropractic, acupuncture, physical therapy and a host of other medications/treatments.

Your primary CAN do all these things for you. In my experience, however, I would advise to stay away from VA endos. They are way behind on current protocols.

The only time I ever heard of them withholding certain treatments for SC is for things like dental and even then you can get waivers and/or significant discounts.

In fact, I know a guy (I hesitate to call him a vet) that was thrown out of basic with a DD and he still gets his HIV meds covered. Others here might know more about the exact drugs, but it was trio of pills that came to over $3k a month.

 

[newguy128]

Newguy, I am a non-SC vet and have been getting my Test from the VA for nearly 15 years. In fact, over the years, I've been Rx-ed T, thyroid, hydrocortisone, Vit-D, sleep meds, chiropractic, acupuncture, physical therapy and a host of other medications/treatments.

R. How did you do that? You must have been below the low normal range to the point you had trouble functioning for the VA to assist with TRT?

Does the VA mail you your TRT supplies or do you have to go into the clinic every week or two to get your shots? Do they prescribe HCG or Arimidex with the TRT?

My Test levels where within the range even tho I was experiencing low-T symptoms. So probably why they wouldn't consider me for TRT. When I asked my PC Doc who he has on TRT and for what reasons? He explained that one of his Vet's had his nuts injured during battle. So I figured he wouldn't even consider me unless I had some SC injury to my nuts or something similar.

Your primary CAN do all these things for you. In my experience, however, I would advise to stay away from VA endos. They are way behind on current protocols.

R. From what I understand only the VA Endo's can prescribe Test. But I agree they in my experience are way behind times. I asked my PC Doc for Metaformin to lower my insulin levels. He wanted me stop all medications for a month and redo labs and then go see an VA Endo. Even tho I already had labs done showing elevated insulin levels or borderline diabetic. So I had to pay for a script from my TRT clinic to get Metformin which I got for free from a Publix pharmacy. Go figure?

The VA has helped me in other medical areas tho which I am grateful for.

The only time I ever heard of them withholding certain treatments for SC is for things like dental and even then you can get waivers and/or significant discounts.

R. VA dental is a joke in my book, did totally nothing for me when I went there with an infected/swollen and excruciating painful molar abscess, wouldn't even drain it. Then wanted to bang on my abscessed molar with the thick end of her stainless steel tooth picking tool. No thanks honey! She got pissed and wanted to call security? WTF lady?

I never heard of any kind of dental waivers or significant dental discounts? Want to tell me how to get those?

 

[Sakuraba39]

newguy,


There's a lot to go over, so I hope that I get to it all.

1. Yes, I was/am definitely low-T (secondary hypogonadism, but the VA doesn't even know what that means...low-T = low-T). Many times, even on the highest amount of they can Rx (200mg a week), I would still be borderline. After several low labs, my PC finally put me on it. I wasn't even really looking for it because I was there for a different reason.

2. Yes, the VA mails me my T every month. They used to mail me a 5ml vial of 200mg/per, but that changed a few years back. Now it's 4 1ml vials. They change suppliers every so often. I've had many different companies supply it and every now and then it switches between cypionate and enanthate. I have not noticed a difference.


3. I do my own shots, but they would do it for me if I chose. HINT: never choose that. The less they interfere with your care, the better. Their protocol is ancient. They'd be injecting me once every two weeks with 20g needles if I let them. It wasn't until I found a Yahoo group specifically dedicated to secondary hypogonadism that I got stable levels. Now, I'm on 80mg E3D….sometimes a little less, sometimes a little more.


4. They will not Rx HCG to a man unless you are of a certain (reproductive) age. Don't even bother. I'm 50+ and they're not giving a guy my age HCG. I tell them that I do it, but it ends there. That's another story, too. You sometimes have to be selective as to what you tell them. I see a specialist outside the VA that has his own opinions and they will often not be in concert with VA practices. I learned this the hard way. I once had a consult with an Endo at another VA and once she found out I was taking Cytomel she threatened to pull all my meds. I had to file a complaint with the Patient Advocate (remember that as it may come in handy in the future).


5. Arimidex…I don't know as I've never had issues with E2. It's been a few years since I've had a sensitive test, but I've never had a troublesome lab in the past and never suffered from any of the symptoms of elevated E2. My experience has been that if anything is off-label, good luck convincing them. As far as i know, they don't have the sensitive E2 test for men in their system. You would have to have it tested privately and bring in the labs and make your case. Knowing the VA, instead of providing it, they would want to take you off T entirely.


6. If you have legit low-T on multiple labs, they have to provide it for you. Not symptoms of low-T, but documented physiological issues (primary or secondary). Seriously, it took me a while to understand how they work….because it's not always rational. I've had endos want to take me off because I once (once!!) got a normal T lab (400-something). I've never had an elevated PSA in 15 +/- years of TRT. Some Docs tell me that I metabolize this stuff quickly (or whatever).


7. Your PC CAN prescribe T. Every one of mine has. They may tell you that they can't, but this is false. Your specific VA may have a preference, but by their own by-laws, PCs can, if you have clear evidence via your labs, Rx you damn near anything.


8. “Borderline” or high/low-normal will get you nothing at the VA. Most times, it's not the Drs fault as they have protocols they must abide by. Private Drs can whatever they want, but not the VA. They have to answer for the things they prescribe (in your chart).


9. The VA can be very helpful in certain instances, I agree. They will do my labs at least twice a year, no questions asked. They will often do labs that my private Dr requests. They will honor some Rx he requests, assuming I have a lab to back it up and the med isn't off-label. They will x-ray or MRI just about anytime I need it. I've been to the ER a couple of times in the last 2 years for bursitis and cellulitis and gotten antibiotics within 20 mins. I have gotten physical therapy there, too. They have a library with a printer/fax machine I use to make copies of my records and fax results to the private Dr.


10. From what I have hear, VA dental is bad. I'm not saying that I would never go there, but, fortunately, I have not needed their services (yet).


11. They will call security on you for any type of display of anger. I've seen many things there (I'll get to that shortly). The VA is full of PTSD vets with all sorts of issues and they don't often know the difference between “quit picking at my access, you crazy b#$ch” and a guy from ‘nam or OIF/OEF about to lose his shit. Especially the women…and the VA is run by women.


12. Waivers and discounts. This is an issue directly related to whatever Tier/classification you are in. It's based upon your income and/or need. If you have a full-time job and can support yourself, the programs available to you are limited (unless, of course, you have a Purple Heart, Medal of Honor, were a POW, etc). I am (non-SC) disabled and live only on SSI and the good graces of family. I qualify for everything but dental (perhaps Vision, too. I'm unsure). I don't have a co-pay for Rx. I'm eligible for a one-time dental appointment, so I've been told to make it count (as opposed to a cleaning). Beyond that I can get discounted care.


A fair amount of my disability $ goes to private medical expenses. Stuff that the VA either refuses to do or simple cannot do (yet).


NOTE: At one time, I “worked” at the VA in a program for disabled vets. It's was through the Social Work department. They give you a couple bucks an hour, but it gets you out of the house.


Most of the guys in the program are/were substance abusers, shiftless and/or scammers looking for the free stuff available at the VA (beyond medical care…like food, clothes, toiletries, etc). Having no substance baggage, an advanced college education and a better work ethic than 99% of government employees (it isn't difficult) it didn't take long to gain the trust of a few department heads.


I worked in a number of areas, but mainly in the mailroom. I delivered both packages and letters. When you work in a mailroom, you interact with a lot of people and departments throughout the entire VA campus. You see things….like crazy vets that threaten employees dragged away by VA police….just walking through the halls I've seen people die, seizures, fights, …and this is just in the hallways! I went every where that campus had …and you hear things, like people getting waivers for certain care, among other things.


One thing I learned is that there are rules for everything at the VA and that there are exceptions to every one of these rules. They will not advertise these things. You have to find out for yourself. Every department has discretionary funds that they use for …well, whatever they want. There's a LOT of waste going on. That's for another post.


Our Director had a philosophy of never turning anybody away, which is why that guy I mentioned with a Dishonorable and a weeks worth of “service” was able to get 50k a year of free healthcare.


I hope I covered what you asked. If there's anything else, please let me know. I will do what I can to help a fellow vet.

 

[newguy128]

Thanks for the detailed response.

Their protocol is ancient. They'd be injecting me once every two weeks with 20g needles if I let them.

R. Ouch!

It wasn't until I found a Yahoo group specifically dedicated to secondary hypogonadism that I got stable levels. Now, I'm on 80mg E3D….sometimes a little less, sometimes a little more.

R. About the same here, 350IU or about 70mg twice a week I figure.

They will not Rx HCG to a man unless you are of a certain (reproductive) age. Don't even bother.

R. That's why I got my HCG/Clomid from other sources. Wouldn't ask them for it as it is likely off-label use to the VA, even tho both raise Test levels. Same with anti-estrogens (AI), they won't prescribe AI's to males 50+ unless they have breast cancer. They won't use AI's for excessive estrogen in males...? But I guess the VA Docs have their hands tied by VA rules?

As far as i know, they don't have the sensitive E2 test for men in their system.

R. I haven't seen one yet from the VA? Usually estradiol, but the sensitive test is more accurate.

You would have to have it tested privately and bring in the labs and make your case.

R. Which is what I had to do out of pocket, no insurance.

I've had endos want to take me off because I once (once!!) got a normal T lab (400-something).

R. Like if they take you off TRT, your Test levels are supposed to stay at 400 or something? Ridiculous thinking, Lol.

I've never had an elevated PSA in 15 +/- years of TRT.

R. That's interesting, although many clinicians say TRT may raise PSA levels or may cause/exacerbate testicular or prostrate cancer. Which could happen, but usually its the 50+ guys who develop elevated PSA levels. Due to elevated estrogen levels. 50+ males have higher estrogen than females.

Never heard of a young guy having elevated PSA levels, prostrate hypertrophy or prostrate cancer issues? As most young males have higher Test and lower estrogen levels than 50+ males.

“Borderline” or high/low-normal will get you nothing at the VA. Most times, it's not the Drs fault as they have protocols they must abide by. Private Drs can whatever they want, but not the VA. They have to answer for the things they prescribe (in your chart).

R. I agree. The VA doesn't understand what is low for a person who has had higher T levels most of their life (700-900). Then when they drop down to 400 or so, they don't look at it as a 50% drop in Test. They look at it as "You are within the range", your okay. The patient is like...but I don't feel okay? Then has to resort to his own means.

They will do my labs at least twice a year, no questions asked. They will often do labs that my private Dr requests. They will honor some Rx he requests, assuming I have a lab to back it up and the med isn't off-label. They will x-ray or MRI just about anytime I need it.

R. Same. Labs are costly and add up, so appreciate that.

I've been to the ER a couple of times in the last 2 years for bursitis and cellulitis and gotten antibiotics within 20 mins.

R. Going to a non-VA emergency room can cause a "who is going to pay for the very expensive emergency room bill issue?"

I was advised by a visiting nurse who took my BP where I live, to go to the emergency room because of a high BP reading. I sat in the ER for 4 hours, then the ER Doc tells me it could be caused by any number of things and shrugged his shoulders? They didn't advise me to do anything, didn't prescribe any meds, then gave me several pieces of empty papers with nothing related to high BP and sent me home.

Even tho I told the ER intake I had no insurance and was with the VA soon after my ER visit I got a $600.00 ER bill I couldn't pay. They had a credit collection agency come after me for payment. Took awhile before I found out the VA has a department (Forgot the name) that pays for non-VA ER visits. The VA paid the bill, but the FN collection agency still hassled me for overdue payments, something like $21 or something...WTF?

I qualify for everything but dental (perhaps Vision, too. I'm unsure). I don't have a co-pay for Rx.

R. If you need glasses they will send you to a VA optometrist. That's where I got my glasses from. I don't have a co-pay either, lucky me. The VA will also give you hearing aids if needed, which are very expensive.

Thanks, again.

 

[Sakuraba39]

“You would have to have it tested privately and bring in the labs and make your case.


R. Which is what I had to do out of pocket, no insurance.”




** Do you not have any insurance (ACA)/medicare/medicaid?








“I've never had an elevated PSA in 15 +/- years of TRT.


R. That's interesting, although many clinicians say TRT may raise PSA levels or may cause/exacerbate testicular or prostrate cancer. Which could happen, but usually its the 50+ guys who develop elevated PSA levels. Due to elevated estrogen levels. 50+ males have higher estrogen than females.


Never heard of a young guy having elevated PSA levels, prostrate hypertrophy or prostrate cancer issues? As most young males have higher Test and lower estrogen levels than 50+ males.”


** I feel that my lack of E2/PSA issues are due to me having such low T in the first place. Maybe having PSA issues are due to the T being too much or non-therapeutic dosages. Some threads on here start with a guy having “symptoms” and the next thing you know they're on 200mg of T and 200mg on nandrolone a week. These are not therapeutic dosages.


I feel fortunate that I don't have some of these issues. A lot of the guys on my Yahoo group are really ”dosage fragile” (I just made that up). A small amount of meds here/there and they go into a tailspin. I don't sweat my T or HCG dosages all that much. I try to stay at certain levels, but if there's 70mg left in the vial, that's what I'll take. If there's 90, I'm fine with that, too. The same with my HCG. I put all of it in syringes as soon as I get and freeze what I won't use in a month. After 20, 30, 40 syringes, you can really lose interest as to whether there's 200 or 250 in there.








“I've been to the ER a couple of times in the last 2 years for bursitis and cellulitis and gotten antibiotics within 20 mins.


R. Going to a non-VA emergency room can cause a "who is going to pay for the very expensive emergency room bill issue?"


I was advised by a visiting nurse who took my BP where I live, to go to the emergency room because of a high BP reading. I sat in the ER for 4 hours, then the ER Doc tells me it could be caused by any number of things and shrugged his shoulders? They didn't advise me to do anything, didn't prescribe any meds, then gave me several pieces of empty papers with nothing related to high BP and sent me home.


Even tho I told the ER intake I had no insurance and was with the VA soon after my ER visit I got a $600.00 ER bill I couldn't pay. They had a credit collection agency come after me for payment. Took awhile before I found out the VA has a department (Forgot the name) that pays for non-VA ER visits. The VA paid the bill, but the FN collection agency still hassled me for overdue payments, something like $21 or something…WTF?”






** That department is called FEE BASIS. The VA's policy is that if you are forced to go to a hospital in an emergency situation and there are no VAs near you, they will pay for your expenses. They handle billing with outside agencies for nearly everything that happens on the medical side of things there (as opposed to departmental discretionary spending).


If you have some sort of medical issue that the VA recognizes, but does not have the ability to cover, they will pay for that. Many VAs are not set up to cover certain medical issues, so, in the instance that it's not feasible to send you to another regional VA facility, they will allow Vets to seek treatment in their community.


It is often difficult to get this process started. Payment punctuality (past due, etc) and comprehension (the VA covering everything that takes place at the private facility) are often headaches for the patient. Fee Basis and the private hospital will continuously fight over costs, leaving the Vet holding the balance of the bill. Things typically get worked out, but it's very stressful for the financially challenged patient.


Have you ever had a minor auto accident? The repair shop says $2500…the other driver's insurance company says $800? After a month or so of expletives, threats and haggling, everything gets worked out. This is what happens between Fee Basis and the private hospital.




“I qualify for everything but dental (perhaps Vision, too. I'm unsure). I don't have a co-pay for Rx.


R. If you need glasses they will send you to a VA optometrist. That's where I got my glasses from. I don't have a co-pay either, lucky me. The VA will also give you hearing aids if needed, which are very expensive.”




** Because I am on SNAP, I get some sort of state supplemental coverage. I don't know exactly what all it entails, but I did manage to get an eye exam and new glasses. It qualifies me for Rx coverage, but like most standard insurance companies, those drugs are not all relevant for what we need. And sometimes it's such an additional hassle, I just pay out of pocket.




I have to take a break now…Hogan's Heroes is starting in 5 minutes! hahaha

 

[newguy128]

Meant to reply, but got consumed with life details.

** Do you not have any insurance (ACA)/medicare/medicaid?

R. Nope, talking to a neighbor it just seemed to be way too much work and paper shuffling just to get a very small discount out of it all, just didn't appear to be worthwhile?

Some threads on here start with a guy having “symptoms” and the next thing you know they’re on 200mg of T and 200mg on nandrolone a week. These are not therapeutic dosages.

R. True. More of a low-dose cycle. But sometimes I wonder how old these posters are? Myself I am 70 and feel like it most of the time even on low-dose TRT. I have several soft tissue injuries that just don't want to heal even using peptides like TB-4. So I myself wonder if anabolics like Deca can heal soft tissue or tendon issues? Which a lot of people and studies have eluded/concluded that Deca can heal these type of injuries. So maybe its a combo of them trying to heal these type injuries and maybe gain some muscle at the same time as an extra benefit.

If I felt confident that using Deca for several weeks would heal my soft tissue injuries I would consider it for that reason alone. Of course the muscle building attributes are and added benefit. 200mg a week is a fairly low dose. So it could be a valid reason why some may want to combine the two. Bodybuilding doses would be a lot higher 400-600mgs of each a week or 800-1200mgs a week and sometimes more!

My VA-PC Doc refused to do my labs recently that my TRT clinic requested. Which my VA-PC had done several times previously with no problem. He's mad at me because he didn't understand my lows/highs in my prior labs. Even tho I explained it all w/notes on my labs as to why they were high or low. ie; My test was high because I was using Clomid and then later HCG. Or my estrogen was a bit high so I used an AI to bring it down. This is all off label no-no stuff to the VA. They just don't understand?

So my VA-PC wanted me to stop doing all meds and supps for a month and then call back in a month to set a lab appointment and then go see a VA Endo for evaluation. This was about the same time I was ready to go on TRT and had spent my own cash on labs and a appointment with my TRT clinic to discuss all that. So I didn't stop all meds/supps and didn't see their Endo, so my VA-PC is mad at me!

All I wanted from the VA was a script for Metformin for my borderline diabetic A1a levels. But they wanted me to stop all meds/supps for a month and do labs, then schedule an appointment with their Endo? When I/they had already done an A1a lab previously that showed I was borderline diabetic? Made no sense to me? So I had to pay my TRT clinic to write me a Metformin script. TF?

So waiting on my labs to see if I can up my TRT dose a bit. The only thing I have noticed changing with my TRT is a deepening of my vocal chords, that's about it? I don't feel any increase in energy, physically or mentally, if anything I feel less energy, sleep more or over sleep and have a difficult time waking up, just takes so long to wake up.

 

[Sakuraba39]

^ - Myself I am 70 and feel like it most of the time even on low-dose TRT. I have several soft tissue injuries that just don't want to heal even using peptides like TB-4. So I myself wonder if anabolics like Deca can heal soft tissue or tendon issues? Which a lot of people and studies have eluded/concluded that Deca can heal these type of injuries. So maybe its a combo of them trying to heal these type injuries and maybe gain some muscle at the same time as an extra benefit.


**I'll start nandrolone soon, mainly for this reason. I'll let you know how it goes.




^ - If I felt confident that using Deca for several weeks would heal my soft tissue injuries I would consider it for that reason alone. Of course the muscle building attributes are and added benefit. 200mg a week is a fairly low dose.


**Since I'll be doing an equal amount of TCyp with nandrolone, there's no way I'll be doing 200mg of ND. If things work out extremely well as I go, I might beef up dosages.




^ - My VA-PC Doc refused to do my labs recently that my TRT clinic requested. Which my VA-PC had done several times previously with no problem.


**I guess it depends on what your clinic requested, but they pretty much have to give you, at least, 2 basic CBCs and chem panels a year. Some of the more “fringe” labs that we typically need are likely up to the discretion of the PC.




^ - He's mad at me because he didn't understand my lows/highs in my prior labs. Even tho I explained it all w/notes on my labs as to why they were high or low. ie; My test was high because I was using Clomid and then later HCG. Or my estrogen was a bit high so I used an AI to bring it down. This is all off label no-no stuff to the VA. They just don't understand?


**I might have mentioned this to you before, but I have learned to not even mention what you're doing with off-label meds to VA docs. I've had certain ones threaten to pull me off everything due to trying out Cytomel. Lesson learned. You have to work the system when you have what we have, at the VA.


My private doc knows everything I am doing and did a rotation at a VA in med school, so he understands what I/we are up against. It can often be adversarial. Use the VA what they can/will provide and offer nothing more to them. Nothing.




^ - So I didn't stop all meds/supps and didn't see their Endo, so my VA-PC is mad at me!


**I wouldn't have either. I would not tell them anything I was up to, especially stuff we find on this board/online. The most I will do is cut back on some things so as to not set off any unusual lab results. I'm not giving them any reason, whatsoever, to alter what they already provide.


^ - All I wanted from the VA was a script for Metformin for my borderline diabetic A1a levels. But they wanted me to stop all meds/supps for a month and do labs, then schedule an appointment with their Endo? When I/they had already done an A1a lab previously that showed I was borderline diabetic? Made no sense to me? So I had to pay my TRT clinic to write me a Metformin script. TF?


**I have never had, nor I have I ever heard of, and interaction with an Endo that was positive for people like us. Never. Avoid them like the plague. Especially at the VA.

Again, I'm not sure what borderline-anything will get you at the VA.


You paid your clinic to write you a script or you had to pay for the Metformin out of pocket? Do you have a normal doc-patient relationship with a non-VA clinic or are you just using one of these online/phone situations like a lot of guys on this site?


^ - So waiting on my labs to see if I can up my TRT dose a bit. The only thing I have noticed changing with my TRT is a deepening of my vocal chords, that's about it? I don't feel any increase in energy, physically or mentally, if anything I feel less energy, sleep more or over sleep and have a difficult time waking up, just takes so long to wake up .




**I can't advocate anything, but I will say that I don't wait to make changes based upon labs. I do some research, read forums, talk to guys in similar situations and, sometimes, email my private Drs office. Then I do it (whatever “it” is) and then see what the labs indicate. You'll know if you're feeling better or worse. You'll notice side-effects. I plan my experiments for a given period of time, then I have labs done. Then I make adjustments from there.


Again, I can't advocate. Also, I've never had one E2 issue, but I have been on a dozen or more meds in the last 15 years (thyroid, cortisol, D3, viral, bacterial, fungal, coagulation, etc.) So, small experiments have rarely led to anything serious.

 

[newguy128]

**I'll start nandrolone soon, mainly for this reason. I'll let you know how it goes.

R. I look forward to your results. I doubt the VA would ever entertain this protocol. I presume you have a private Doc that may entertain prescribing this for the reasons given or will you procure this by other means?

**Since I'll be doing an equal amount of TCyp with nandrolone, there's no way I'll be doing 200mg of ND. If things work out extremely well as I go, I might beef up dosages.

R. So what dose will you be starting with, 100mgs Deca a week? Less is usually best, unless competing in bodybuilding.

**I guess it depends on what your clinic requested, but they pretty much have to give you, at least, 2 basic CBCs and chem panels a year. Some of the more “fringe” labs that we typically need are likely up to the discretion of the PC.

R. Testosterone (F&T): (They usually do this one, but refused to do this for me and didn't schedule it in my next lab
draw).
Estradiol Sensitive: (VA doesn't list this lab, but should use this test as it is more accurate than the regular estradiol
lab they do).
CBC W/Differential: (I think they scheduled this one in my next lab)?
CMP-14: (VA refused this one, and didn't list this lab in my next lab draw)?
Lipid Panel: (VA normally does this lab, but not at my next scheduled lab draw)?
IGF-1: (VA doesn't list this lab either).
Prolactin: (VA did this lab previously. They know my prolactin is high, but they refused to add this to my current and
next labs. Not have the attempted to provide any meds for this).
A1a: (They did this lab previously and know it is high, but refused to schedule it on my current and future labs. Nor
would they write me a script for Metformin)?
PSA: (They always do this lab). But not this time, nor on my next scheduled labs)?
DHEA-S: (The VA has done this lab several times previously, but refused to do it this time nor in my next labs)?
THS: (The VA refused to do this one when I requested it, but added it to my next lab draw).
SHBG: (The VA refused to do this lab, although they have done this one previously)?

The only labs they scheduled for July was CBC & Thyroid (whatever that means-TSH)? As there are several other Thyroid tests available to accurately detect any potential thyroid issues). Like: T3 and T4, to get a full REAL picture of thyroid should be:TSH, T3, T4, Free T3, Free T4, Reverse T3 (not to many people get this one done-not has the VA ever done this lab for me). Not sure if it is even available w/the VA?

I have learned to not even mention what you're doing with off-label meds to VA docs. I've had certain ones threaten to pull me off everything due to trying out Cytomel. Lesson learned. You have to work the system when you have what we have, at the VA.

R. Have to agree at this point, sometimes being honest and up front hoping to get a proper diagnosis obviously can be to your detriment when dealing with the VA's rigid policies and attitude. Did the Cytomel work for you?

**I wouldn't have either. I would not tell them anything I was up to, especially stuff we find on this board/online. The most I will do is cut back on some things so as to not set off any unusual lab results. I'm not giving them any reason, whatsoever, to alter what they already provide.

R. Sad, but true, you have to play the VA-BS game in order to get what you want or need.

**I have never had, nor I have I ever heard of, and interaction with an Endo that was positive for people like us. Never. Avoid them like the plague. Especially at the VA.

R. Funny thing is I eluded something similar to this point to my VA nurse and she looked at me with those WTF are you talking about eyes? Lol.

I remember about 10-15 years ago spending a whole day traveling back & forth to a VA facility 300+ miles away to see a VA Endo about acquiring an anti-estrogen for high estrogen levels I had. (Mid-age male). AI's didn't exist at the time and again, they won't prescribe stuff for off-label use anyways. Only for female breast cancer patients. But I didn't know this at the time? That was the last time I saw a VA Endo and justly so. Why bother if you know whatever it is you want or need is considered "Off-Label use" to the VA?

The Endo made me feel as if I was asking for a script of pain killers or something and ultimately wouldn't prescribe an anti-estrogen because of the off label use.

Again, I'm not sure what borderline-anything will get you at the VA.

R. True, but more specifically, my A1a labs told me I was pre-diabetic.

You paid your clinic to write you a script or you had to pay for the Metformin out of pocket?

R. I paid my TRT clinic $25 to write me a script for Metformin, as are all their scripts they write or call in. The script itself was filled for no cost by Publix because I presume the med is so cheap to produce and they do that as a service for the general public who can't afford health insurance, which I think is pretty cool! Which is another reason the VA didn't make me too happy because of this fact and the fact they knew I am pre-diabetic. WTF again?

Do you have a normal doc-patient relationship with a non-VA clinic or are you just using one of these online/phone situations like a lot of guys on this site?

R. My relationship with my TRT clinic (Defy Medical) is done over the phone for consults and online to make various payments for their services. Which suits me fine as I have no vehicle anyway to get there. They offer in clinic services for those that are local and have transportation to their office in Tampa, Fl.

They are pretty thorough with labs, moreso than the VA is. They are more progressive than the VA is, at least they will listen to your symptoms as part of the exam/evaluation/diagnosis, etc.

They have you do a complete physical with your private or VA Doc (which the VA surprisingly did)! And they understand if you start talking about AI, anti-estrogens, or talk about off label items to help normalize various labs. They don't go into panic mode when a lab is abnormal and tell you to stop all meds/supps because they don't understand, etc., etc.

I can't imagine telling a TRT patient to stop his TRT and HCG injections or anti-estrogens for a month because various labs were elevated...WTF?

There is a TRT clinic in my town I could see with fair prices...$100 a month for all supplies. But then I would have to go through the initial expenses again of the initial physical, labs, initial doctor consult fees, etc. Doesn't make much sense financially or otherwise, other than maybe convenience?

So for now the online thing with Defy is sufficient. I got my 2nd Test Cyp script for $41.45 + $25 to call in my script at Walgreen's w/a goodrx coupon. Normally a 10ml, 200mg/ml Test Cyp vial would cost me $129.00 through my TRT clinics compounding pharmacy. So I save some money w/the goodrx coupon at Walgreen's (Watson Test Cyp-10ml/200mg/ml vial).

 

[Sakuraba39]

R. I look forward to your results. I doubt the VA would ever entertain this protocol. I presume you have a private Doc that may entertain prescribing this for the reasons given or will you procure this by other means?


**Yes, this ND script is from my private doc faxed to Empower. Due to some spinal issues, I have a bit of polyneuropathy and we've noticed that over the last 2 years that my left side is now about the same as my right (I'm left-handed/leg and that side has atrophied a small amount).






R. So what dose will you be starting with, 100mgs Deca a week? Less is usually best, unless competing in bodybuilding.


**To start off with, no, but I'm open to it IF I notice any positive side effects from ND use. Several posters here have indicated that you should take an equal amount of T to ND. However, I am not against ramping up ND if I feel/sense any benefit beyond that of T.


If it's the same, well, ND costs me and T is free. I will increase the dosage before I make any decisions to cease. I'l probably start at 80/80 (ND/T).






R. Testosterone (F&T): (They usually do this one, but refused to do this for me and didn't schedule it in my next lab
draw).
Estradiol Sensitive: (VA doesn't list this lab, but should use this test as it is more accurate than the regular estradiol
lab they do).
CBC W/Differential: (I think they scheduled this one in my next lab)?
CMP-14: (VA refused this one, and didn't list this lab in my next lab draw)?
Lipid Panel: (VA normally does this lab, but not at my next scheduled lab draw)?
IGF-1: (VA doesn't list this lab either).
Prolactin: (VA did this lab previously. They know my prolactin is high, but they refused to add this to my current and
next labs. Not have the attempted to provide any meds for this).
A1a: (They did this lab previously and know it is high, but refused to schedule it on my current and future labs. Nor
would they write me a script for Metformin)?
PSA: (They always do this lab). But not this time, nor on my next scheduled labs)?
DHEA-S: (The VA has done this lab several times previously, but refused to do it this time nor in my next labs)?
THS: (The VA refused to do this one when I requested it, but added it to my next lab draw).
SHBG: (The VA refused to do this lab, although they have done this one previously)?




**I get my IGF-1 done once a year by the VA, buy my private doc has to request it. It's not a standard test. Honestly, though, I don't even think I need it any more. It's be well within range for the last year. Once I got leveled off a lot of these labs became unnecessary, IMO. But, they do it and they're already poking a needle in my vein….


Don't quote me, but I believe that Nelson has posted an E panel on here for about 40-50$.


R. The only labs they scheduled for July was CBC & Thyroid (whatever that means-TSH)? As there are several other Thyroid tests available to accurately detect any potential thyroid issues). Like: T3 and T4, to get a full REAL picture of thyroid should be:TSH, T3, T4, Free T3, Free T4, Reverse T3 (not to many people get this one done-not has the VA ever done this lab for me). Not sure if it is even available w/the VA?


**RT3 IS available at the VA and I just had mine done in May. Again, however, it's not standard. My private doc requests it. Perusing my labs I see that the VA has run: total t4, free t4, TSH, t3 uptake, parathyroid, serum t3, RT3, free t3, and calculated my RT3/FT3 ratio (should be over 20).


My guess is that your doc would have to have a “legit” reason to request these labs. I have been to many docs before I had to go into the VA system and several since. I have “documented” medical reasons to run these labs. I use quotation marks to denote what the VA would consider. If all you have are VA doctors and labs, you will likely never be fully treated






R. Have to agree at this point, sometimes being honest and up front hoping to get a proper diagnosis obviously can be to your detriment when dealing with the VA's rigid policies and attitude. Did the Cytomel work for you?




**No, I quit taking it because even though it got my labs within range, it made me feel jittery and gave me heart palpitations. My body prefers hypo-everything, it seems. I broke it up into smaller dodges, but it came down to either feeling nothing at all or arrhythmia. So, I quit it and my other thyroid me (Westhroid).






R. Sad, but true, you have to play the VA-BS game in order to get what you want or need.


**Yes, my advice is not tell them anything that you KNOW they disapprove of. Avoid the hassle. I do most of my communicating with them via Myhealthyvet. Do you have that? It's free and you can access all of your records on line. You can even request labs, refills via secure email. The less you have to deal with them, the better.






R. Funny thing is I eluded something similar to this point to my VA nurse and she looked at me with those WTF are you talking about eyes? Lol.


**Perhaps, for your pre-diabetes, a Endo would be helpful. That's it, however. I wouldn't even tell that doc what else I was doing. Volunteer nothing, just like when you were in active duty! Never volunteer! No good ever came from it.




R. I remember about 10-15 years ago spending a whole day traveling back & forth to a VA facility 300+ miles away to see a VA Endo about acquiring an anti-estrogen for high estrogen levels I had. (Mid-age male). AI's didn't exist at the time and again, they won't prescribe stuff for off-label use anyways. Only for female breast cancer patients. But I didn't know this at the time? That was the last time I saw a VA Endo and justly so. Why bother if you know whatever it is you want or need is considered "Off-Label use" to the VA?


The Endo made me feel as if I was asking for a script of pain killers or something and ultimately wouldn't prescribe an anti-estrogen because of the off label use.




**I hope you got travel pay! When they make me go to my regional VA, I get about $80 in travel pay. Other than the wear on my truck, it's a good deal.


For what Arimidex costs, you might as well at that to the list of things to avoid discussing with the VA.


R. True, but more specifically, my A1a labs told me I was pre-diabetic.




**”pre-“ at the VA is like calling the police to tell them that you are subject to being pre-robbed.




R. I paid my TRT clinic $25 to write me a script for Metformin, as are all their scripts they write or call in. The script itself was filled for no cost by Publix because I presume the med is so cheap to produce and they do that as a service for the general public who can't afford health insurance, which I think is pretty cool! Which is another reason the VA didn't make me too happy because of this fact and the fact they knew I am pre-diabetic. WTF again?


**The best bet, I think, if possible, is to find a doc that specializes in this sort of thing and make a visit to his/her office. Then all your consultations can take place over the phone. That's what I do. If I ever need anything, they are on it….scripts, disability forms, jury duty letters, lab requests… .


They get back to me that day or first thing the next. My doc also has his own pharmacy on site, so you don't have to f' around with petty local pharmacies…. Haggling over bullshit like scripts that don't differentiate between 5ml @200mg or 10ml @100mg…15 pill of 10mg or 30 of 5….


His pharmacy can/will get Nandrolone, but they charge more than Empower. I wouldn't have even known about Empower if it wasn't for the GoodRx app. So I had his office fax a Rx to them.






R. There is a TRT clinic in my town I could see with fair prices...$100 a month for all supplies. But then I would have to go through the initial expenses again of the initial physical, labs, initial doctor consult fees, etc. Doesn't make much sense financially or otherwise, other than maybe convenience?


**Couldn't you have all your paperwork faxed to the (potentially) new clinic? It might be worth a shot. Convenience has price, too. I think we'd all be willing pay a bit more to avoid unnecesarry aggravation ….but that's up to the individual.


R. So for now the online thing with Defy is sufficient. I got my 2nd Test Cyp script for $41.45 + $25 to call in my script at Walgreen's w/a goodrx coupon. Normally a 10ml, 200mg/ml Test Cyp vial would cost me $129.00 through my TRT clinics compounding pharmacy. So I save some money w/the goodrx coupon at Walgreen's (Watson Test Cyp-10ml/200mg/ml vial).


**That IS nice. I thought they were getting rid of 10ml vials…or maybe that was only for insurance, not out of pocket.