TRT clinics and compounding pharmacies

[Chiefy]

Are you sure this is testosterone from one of our pharmacies? How come we haven't heard about this through email first? Is this enanthate?

Compounding pharmacy practices have changed in the past 2.5 years. Before compounding pharmacies could make a batch of meds, pull a sample and then send it to a separate testing facility. They could dispense the medication immediately, they did not have to wait for the results.

Now they have to send it to 3 different testing facilities and receive the results before dispensing the medication.

This all changed when some pharmacy (we had no affiliation) dispensed Cortico-steroids that gave a bunch of people meningitis. Here is a related article:

Victims in meningitis outbreak hope for criminal charges against compounding pharmacy - NBC News

So im not sure how it would be under dosed, or more importantly why. The actual testosterone powder is so cheap these days it is not logical to under dose testosterone. Even for like 1,000 vials it may save them 40 bucks.

If this is from IMT you need to get with them directly, I HIGHLY doubt its the testosterone BUT they may try a different pharmacy for you.

Interesting, I always wondered how they handled quality control at these places.

How did Strohecker's manage to push out their product without one of the 3 testing facilities picking up on their error (see link in my post above)?

 

[DucBase]

I agree with you for the most part. I don't think any compounding pharmacy would see it as worthwhile to underdose their testosterone. It's not worth ruining their reputation or putting their business in jeopardy. They're not some UGL trying to make a few extra bucks.

On the other hand, mistakes happen at CP's sometimes. Usually it's something minor, but let's not forget about the error that Strohecker's made a little while back...which was pretty significant:

Enforcement Report - Week of June 3, 2015

Holy shit! Getting something underdosed is one thing, getting estradiol when you're supposed to be getting test would really suck :O

 

[AverageMan]

I'm having the same issue at Rite-Aid. Where are you getting 10ML vials?

I had the same issue at walgreens. I found a local small pharmacy that will give out the 10 ml vials. I asked my TRT doc and he pointed me to them.

You may want to ask your doc as well.

 

[Cap'n]

I had the same issue at walgreens. I found a local small pharmacy that will give out the 10 ml vials. I asked my TRT doc and he pointed me to them.

You may want to ask your doc as well.

This may explain why.

It seems pharmacists are more actively following a rule clarification that came down from the FDA several years ago. It is called the ***8220;28-day rule***8221;. It states that any sterile injectable vial must be discarded within 4 weeks after it has been punctured (exposed to air and bacteria) for the first time. Note that some solutions may have longer or shorter shelf lives after first use. Such information must be presented on the product packaging, however. Otherwise, the 28-day rule applies....

Simply put, 4 weeks is the standard threshold that the pharmaceutical companies are required to meet in testing. They can***8217;t guarantee sterility beyond that. The 28-day rule is, likewise, an important safety measure. The use of preservative agents in injectable solutions generally doesn***8217;t protect them from bacterial contamination completely. They slow development, not eliminate it. Bactera can actually grow in these vials just fine, albeit more slowly in comparison to most water-based solutions. Case in point, the most bacteria-laden steroid vial I ever sent to an analytical lab was a vial of oil-based testosterone that had been punctured months earlier but not completely used. This change is a concern for many U.S. patients. Using these smaller 1mL vials considerably increases the overall cost of medication, especially if paying out of pocket. Typically, we***8217;re seeing the cost of four (4) 1mL vials of testosterone cypionate running about the same as a single 10mL vial. That***8217;s roughly $100 at the pharmacy! Therefore, this switch in prescription can represent an increase in the cost of treatment by 2.5 times, overnight. It also seems there would be little incentive to continue making 10ml vials, as they provide simply too much hormone for the 28-day rule...

 

[AverageMan]

This may explain why.

interesting - my Endo (before i stopped seeing him) was convinced it was due to DEA crack down on steroids.

 

[halfwit]

This may explain why.

Article you quoted is flawed, the "28-day rule" is a suggestion, NOT a mandate. They're enforcing it because they can charge 300% more for 1ml vials, not because they give two shits about our health or what the FDA recommended.

 

[daleb]

Article you quoted is flawed, the "28-day rule" is a suggestion, NOT a mandate. They're enforcing it because they can charge 300% more for 1ml vials, not because they give two shits about our health or what the FDA recommended.

In some cases it is more...a lot more. My local pharmacy out in the sticks wanted to charge me more for a 1ml/200mg vial than the 10ml/200mg vial. I had things set up with the head pharmacist to get the 10ml/200mg vial, told them I would pay cash. When it was delivered one of the newer hires sent it back and replaced it with the 1ml/200mg. Leads me to believe its something they are teaching them to do in skrewel.

 

[halfwit]

In some cases it is more...a lot more. My local pharmacy out in the sticks wanted to charge me more for a 1ml/200mg vial than the 10ml/200mg vial. I had things set up with the head pharmacist to get the 10ml/200mg vial, told them I would pay cash. When it was delivered one of the newer hires sent it back and replaced it with the 1ml/200mg. Leads me to believe its something they are teaching them to do in skrewel.

Nah, company policy. The technicians don't go to school for their jobs. Insurance companies are actually the ones that started the madness, which does lend some credibility to the FDA and DEA concerns. Although it wouldn't surprise me if they get a kickback from the drug manufacturers.

 

[Cap'n]

Article you quoted is flawed, the "28-day rule" is a suggestion, NOT a mandate. They're enforcing it because they can charge 300% more for 1ml vials, not because they give two shits about our health or what the FDA recommended.

Just a little Google-Fu. Thanks for clarifying.

 

[halfwit]

Just a little Google-Fu. Thanks for clarifying.

All good man, I looked into this when my old pharmacy refused to sell me 10ml vials even though I pay cash. They cited some FDA ruling leading to a policy change, which I researched and tried to fight. After speaking to the regional pharmacy manager, it became apparent that it was more about the ridiculous mark up than anything else.

CVS and Walgreens are two pharmacies that I know of that won't refuse cash payers 10ml vials as long as you get your doctor to state explicitly in the script that's what you are to receive. Costco are the dbags that wouldn't listen to reason.

 

[Cap'n]

CVS and Walgreens are two pharmacies that I know of that won't refuse cash payers 10ml vials as long as you get your doctor to state explicitly in the script that's what you are to receive. Costco are the dbags that wouldn't listen to reason.

I'll definitely check with my local CVS, thanks for the tip. Rite-Aid and Costco both gave me the run around and told me I could only purchase the 1ml from them. It was around $40 for 3 vials.

 

[Megatron28]

All good man, I looked into this when my old pharmacy refused to sell me 10ml vials even though I pay cash. They cited some FDA ruling leading to a policy change, which I researched and tried to fight. After speaking to the regional pharmacy manager, it became apparent that it was more about the ridiculous mark up than anything else.

CVS and Walgreens are two pharmacies that I know of that won't refuse cash payers 10ml vials as long as you get your doctor to state explicitly in the script that's what you are to receive. Costco are the dbags that wouldn't listen to reason.

I get 10ml vials from Walgreen and use a GoodRX coupon to pay for it. It is cheaper than paying with my insurance. Costs about $43 for one 10ml 200mg/ml vial.

 

[Megatron28]

I did, and this is why I'm so confused. Buying raws and oil costs next to nothing. This test is definitely underdosed though. I just got an email from another guy I know that's using a different branch of the same clinic. Same compounding pharmacy. His TT numbers came in around half what they should have been, just like mine.

They know about it now so I'll try and be patient and let them sort it out. Part of my frustration stems from their reluctance to just give me a script so I could go to CVS/Walgreens and buy some Watson on my own dime.

Sometimes the simple explanation is the answer. Perhaps they mislabeled the Test. It may be 100mg/ml instead of 200mg/ml. They could have made a mistake.

 

[Megatron28]

I'm noticing a trend (at least locally), that clinics are insisting on getting the test through compounding pharmacies in lieu of just giving you a script. It only bugged me a little at first...I was getting the stuff delivered to my door and that was nice. But come to find out I've been injecting severely underdosed test for about six months now.

Is this common practice? IMT, can you guys shed any light on this?

I imagine they make you go through a compounding pharmacy of their choice because it increases their profits. They get a markup and/or kickback on the medications they sell you.

It is like doing a plumbing project at your house. You can buy all the materials directly or you can buy it through your plumber who will mark up the cost to you. But maybe you are willing to pay that markup because it is more convenient for you (no shopping) and if there is an issue with the faucet or whatever it is the plumber's problem to address.

 

[DucBase]

I imagine they make you go through a compounding pharmacy of their choice because it increases their profits. They get a markup and/or kickback on the medications they sell you.

It is like doing a plumbing project at your house. You can buy all the materials directly or you can buy it through your plumber who will mark up the cost to you. But maybe you are willing to pay that markup because it is more convenient for you (no shopping) and if there is an issue with the faucet or whatever it is the plumber's problem to address.

Yeah, now that I think about it that makes sense. They probably sell a quite a bit of the stuff and it's no doubt cheaper, plus quantity discounts or kickbacks would probably all add up.

I'm just finishing up the 3rd underdosed vial (3 different lot #'s), so I'm running out of patience. My wife is too, she says I've turned back into the asshole I was before I went on TRT. There may be silver lining to this mess though: We had been thinking about having one more kid but I wasn't making any swimmers. Now my nuts seem to have fired back up and are producing low normal levels of swimmers without HCG. I was really reluctant to even waste the money on the test but it seems there may be something to reducing dosage for guys who are wanting to get their fertility back.