It's a delicate dance with trying to balance costs for cash paying patients when it comes to required labs (I know you are VERY fortunate to have your insurance cover every penny of your labs, but the vast majority are not so lucky).
I'd personally love to have EVERY lab for EVERY patient (we call it the "shotgun approach"), but it's simply not economically feasible for the bulk of our patient population as we don't cater to only the wealthy. Up to a certain point, we were NOT requiring SHBG as a mandatory test, but were simply adding it as an "additional" follow-up lab (and hence additional follow-up cost) for cases where it was deemed necessary. Those of us that know Vince's history, including yourself, know that he has been perfectly dialed in essentially from day one and, consequently, never required the additional expense of the additional labs. My approach changed about 6 months ago as we were able to obtain a more favorable price point for the SHBG test (in addition to booting progesterone from the required panel due to the LabCorp reference range snafu) and, consequently, began adding it as a mandatory test for all initial and follow-up labs without creating too much additional financial burden for patients.
On a side note, VC, you know I love your contributions both here and more recently on PeakTestosterone as well as our long history of doctor-patient relationship (forgive my assumption, but if you are not "HRTGuru" over on PeakT then I believe you have a long-lost twin as some of the main talking points and punchlines are almost identical...and yes I do pay that much attention to the writings of my fellow community members, lol), but I've sensed a decidedly more antagonistic tone over the past several months (not towards me, but towards
Defy in general). To my eyes it seems this started with some of your potential gripes with Hallandale pharmacy and then transcended more recently into views on our newer providers, Melissa our PA and Dr Calkins (anastrozole prescribing, etc). I hope all is going well with your treatment and there isn't a bigger source of discontent at the root of this? If so, please discuss with me.