TST beginner

[MotionLotion]

Hey guys, I'm new to the forum and looking for advice.

I went to my doctor after experiencing ED and muscle loss; it turns out my test levels (both taken early in the morning) were 275 ng/dl and 260 ng/dl respectively. He told me for a 22 year old male, this is extremely low and went through a list of symptoms, all of which I had (lack of body hair, weak muscles, low sex drive, etc). After running what seemed like endless tests to make sure everything else in my body was normal, he diagnosed me with hypogonadism and said I would benefit from testosterone replacement therapy (TRT). There's just one problem: my insurance company refuses to cover testosterone replacement therapy (TRT) because 260 ng/dl is 'within the normal range for healthy males.'

The doc outright said this is BS as those levels would be expected in a 60 year old with diabetes, not an active guy my age. Basically it's just a way for the insurance to avoid having to pay. I have another bloodtest test in just under 2 weeks, and if I get lower than 250 ng/dl, my insurance will have to cover it. Is there a healthy way to drop my levels in such a short amount of time? It's not like I have that far to go. I do a normal 4 day split and do cardio twice a week and was thinking of not lifting until then. What else can I do?

Thanks guys, any advice would be greatly appreciated.

 

[halfwit]

Since when does an insurance company dictate what the range is for healthy levels? My insurance won't cover it either, but that's because of a technicality where they just keep looping paper work back and forth between offices. You may want to call someone higher up at the insurance company and make sure your doc sends in all the proper forms. The accepted range for Total testosterone is 348-1197ng/dL by the way, so not sure wtf they're doing.

Worst case scenario, work out REALLY hard, cut back on calories and get little sleep for a few days prior to the blood draw. That should knock you down the extra 10 points needed, but don't be surprised if they give you some other reason to decline payment. I don't understand why insurance companies would decline testosterone replacement therapy (TRT) when 30-40 a month is WAY cheaper than the 500-1500 a month they would have to pay if you let hypogonadism ruin your health as it did mine. (Diabetes/elevated bp/etc.)

Good luck, let us know how it goes!

 

[MotionLotion]

Since when does an insurance company dictate what the range is for healthy levels? My insurance won't cover it either, but that's because of a technicality where they just keep looping paper work back and forth between offices. You may want to call someone higher up at the insurance company and make sure your doc sends in all the proper forms. The accepted range for Total testosterone is 348-1197ng/dL by the way, so not sure wtf they're doing.

Agreed with those ranges, 250 ng/dl is way too low, but they go by a chart to determine who's eligible. My doc said it's garbage and we might as well be in the dark ages as far as testosterone replacement therapy (TRT) is concerned, but he was very thorough trying to get insurance to cover it. Unless I get below 250 ng/dl, I'm paying out of pocket!

Worst case scenario, work out REALLY hard, cut back on calories and get little sleep for a few days prior to the blood draw. That should knock you down the extra 10 points needed, but don't be surprised if they give you some other reason to decline payment. I don't understand why insurance companies would decline testosterone replacement therapy (TRT) when 30-40 a month is WAY cheaper than the 500-1500 a month they would have to pay if you let hypogonadism ruin your health as it did mine. (Diabetes/elevated bp/etc.)

Good luck, let us know how it goes!

Thanks man, much appreciated. I'll let you know how it goes!

 

[bizguy]

In most cases with insurance prior authorization is needed from the doctor to deem that there is a medical need for treatment. If the insurance denies coverage usually this would take care of the problem. I have Blue Cross Blue Sheild. That's how they structure things, but I choose not to run through insurance for other reasons. It's tuff to find insurance companies that will cover hrt. A lot of the times they only will cover it for so long.

 

[Megatron28]

Also drink a decent amount of alcohol the night before your lab test.

Don't sleep the night before your lab test. Stay up all night.

Don't go in first thing in the morning. Your levels tend to drop as the day goes on.

This should do it. If it doesn't there are more extreme ways of lowering your T but I think this will get you your 10 points.

For what it is worth, I have Blue Cross and they pay for my testosterone replacement therapy (TRT). I was coming in with Total T of about 200 though. You could try getting your state insurance regulator involved. Write a letter complaining to them and I bet you suddenly get your testosterone replacement therapy (TRT) approved.

Good luck!

 

[JM750]

I'm not on testosterone replacement therapy (TRT), but cant he give you a script for some test and you just inject yourself? How much can a 10ml bottle of test cost at the pharmacy? I still agree, fucken Insurance company's suck!

 

[THE-DET-OAK]

Since when does an insurance company dictate what the range is for healthy levels? My insurance won't cover it either, but that's because of a technicality where they just keep looping paper work back and forth between offices. You may want to call someone higher up at the insurance company and make sure your doc sends in all the proper forms. The accepted range for Total testosterone is 348-1197ng/dL by the way, so not sure wtf they're doing.

Worst case scenario, work out REALLY hard, cut back on calories and get little sleep for a few days prior to the blood draw. That should knock you down the extra 10 points needed, but don't be surprised if they give you some other reason to decline payment. I don't understand why insurance companies would decline TRT when 30-40 a month is WAY cheaper than the 500-1500 a month they would have to pay if you let hypogonadism ruin your health as it did mine. (Diabetes/elevated bp/etc.)

Good luck, let us know how it goes!

Honestly I have learned a lot about the insurance companies lately, most doctors are sick of them. The really good doctors only take cash nowadays, since insurance dictates what they make. I just ran into someone the other day that works for a company that purchases big time real estate. It was her job to help the owner find a specialist for his hip replacement, he traveled and paid 19,000 cash for it because the doctor did not take insurance.

As part of the ARRA all doctors have to change the way the bill, if they do not update to a digital record keeping software system then they can not bill medicaid or medicare. If they do not use E prescription they get penalized 1.5%.

The government is also giving them money to go digital sooner and they have to comply with "meaningful use" in order to get reimbursement. Part of these requirements are asking questions to patients, like do you smoke, track BMI and what medications you are on.

This is so the government can get a better patient history and now they can decide who gets charged more. All insurance companies will follow suit.

One day everyone is going to sit back and wish they paid cash for their specialty medical services. You can write all cash paid medical services off on your taxes too.

Just Sayin

 

[MotionLotion]

In most cases with insurance prior authorization is needed from the doctor to deem that there is a medical need for treatment. If the insurance denies coverage usually this would take care of the problem. I have Blue Cross Blue Sheild. That's how they structure things, but I choose not to run through insurance for other reasons. It's tuff to find insurance companies that will cover hrt. A lot of the times they only will cover it for so long.

Yeah, they really do everything they can to get out of covering HRT. Hell, that's the reason we still see that outdated chart which shows 250 ng/dl as normal. The doc authorized the testosterone replacement therapy (TRT), but insurance denied it because they said I fell within the normal range. He's pretty sure if I get under 250, they will be forced to cover it. If not, should I just pay out of pocket?

I figure for a 22 year old, 260-275 is way too low, it's definitely worth getting the treatment, right?

Also drink a decent amount of alcohol the night before your lab test.

Don't sleep the night before your lab test. Stay up all night.

Don't go in first thing in the morning. Your levels tend to drop as the day goes on.

This should do it. If it doesn't there are more extreme ways of lowering your T but I think this will get you your 10 points.

For what it is worth, I have Blue Cross and they pay for my testosterone replacement therapy (TRT). I was coming in with Total T of about 200 though. You could try getting your state insurance regulator involved. Write a letter complaining to them and I bet you suddenly get your testosterone replacement therapy (TRT) approved.

Good luck!

Thanks for the advice! I'm going to take the day off, drink my ass off the night before and skip lifting the entire week. If that doesn't drop my test 10 points, I don't know what will. Hopefully, I'll be able to avoid writing that letter.

I'm not on testosterone replacement therapy (TRT), but cant he give you a script for some test and you just inject yourself? How much can a 10ml bottle of test cost at the pharmacy? I still agree, fucken Insurance company's suck!

Yes, he offered this, injecting it himself, some sort of gel or a patch I wear on my shoulders. Assuming insurance denies me again, I'll probably just pay out of pocket and go that route. Would the inject-able test be my best bet?

 

[Megatron28]

Injections are your best AND cheapest option. Test Cyp cost about $70 for a 2000mg bottle from a pharmacy with a prescription. Typical testosterone replacement therapy (TRT) dose is 100-200mg per week. So you get 10-20 weeks out of one bottle. Not too bad cost-wise. Syringes cost pennies if you buy them in bulk.

 

[MotionLotion]

Finally an update!

After months of going from from doctor to doctor, I finally got some help -- all recommended I start testosterone replacement therapy (TRT) for low test, but no docs wanted to touch me with a ten ft pole. Months later, I found an endocrinologist who insisted I try the gel first before going with test cyp claiming it would give me roid rage. Anyway, since the gel did absolutely nothing but irritate the hell out of my shoulders, eventually he caved in.

I felt nothing for a few weeks, but once it kicked in it was like waking up again. I feel incredibly confident and energetic, my motivation is through the roof at work, and best of all, I'm tearing it up in the bedroom. Although I haven't told my girlfriend about the testosterone replacement therapy (TRT) yet, she has definitely noticed a difference and even said she loves how dominant and passionate I am now. I was very nervous at first, but I'm glad I followed the advice here and went for it.

My only complaint is the results of my recent bloodwork: a day after injecting, my test level was 650ng/dl. That sounds normal to me, but the doc claims this is way too high for a 22 year old. I tried to bring up some studies I found online, but he shrugged it off and said he's going to reduce the dose if it doesn't drop a bit. I really don't want to go through the gauntlet of doctors again until I can find one who prescribes test, nor do I want to drop the dose -- what do you guys recommend?

 

[1693]

You should have got your trough TT level....blood being drawn at the point where you are the farthest in time from your last test injection....

Guess if you need to and are giving yourself the shots, you could skip one before the blood draw so it reads lower.

A day after injecting your TT was climbing but hadn't peaked yet...650 wasn't high though...if it was 1300 I'd maybe agree.

You could tell us your protocol....what dose, how often, pinning yourself, Human Chorionic Gonadotropin (HCG), Aromatase inhibitor (AI) ??????

 

[totalburnout]

This is so the government can get a better patient history and now they can decide who gets charged more. All insurance companies will follow suit.

One day everyone is going to sit back and wish they paid cash for their specialty medical services. You can write all cash paid medical services off on your taxes too.

Just Sayin

Although we butt heads, I'm going to agree with what you said up until this point. This point about getting a better patient history TO CHARGE MORE is absolutely inaccurate.

Effective 1/1/2014, the Affordable Care Act (Obamacare) that goes into place, restricts the ability to underwrite based on pre existing conditions, sex, health and a number of other different factors. Essentially the ACA is stripping health insurance companies of the ability to 'underwrite' their patients. Underwriting is essentially a fancy way to say analyzing the risk ("exposure") and charging a cost ("premium") to match the risk. That's the entire job of underwriting, to collect enough premium to match exposure. I.e., that's why if you're unhealthy, you currently get charged a boatload. Your risk is higher, so your premium is higher.

Quote:
"Community Rating Under the Affordable Care Act

Under the law, an individual health plan selling policies in the small-group and nongroup market — whether it sells policies through the state’s exchange or not — will be free to set its own premium for a given policy. But within a given age group, it must apply the same premium to all comers, regardless of their health and their gender. Furthermore, the health plan cannot reject any applicant willing to pay that premium, a provision called “guaranteed issue,” or cancel existing policies."
Link - 'Premium Shock' and 'Premium Joy' Under the Affordable Care Act - NYTimes.com

The deductions on taxes is technically accurate, but you have to hit a level first that would allow you to take those medical expenses as deductions - otherwise the standard deduction will apply and there will be no additional benefit. Medical costs have to exceed 7.5% of your adjusted gross income before you can claim them (technically you can claim them, regardless, but if they don't exceed 7.5% then they won't do a lick of good from a preferential tax treatment standpoint).
Link.
Can I Claim Medical Expenses on My Taxes? - TurboTax® Tax Tips & Videos

 

[totalburnout]

Finally an update!

After months of going from from doctor to doctor, I finally got some help -- all recommended I start testosterone replacement therapy (TRT) for low test, but no docs wanted to touch me with a ten ft pole. Months later, I found an endocrinologist who insisted I try the gel first before going with test cyp claiming it would give me roid rage. Anyway, since the gel did absolutely nothing but irritate the hell out of my shoulders, eventually he caved in.

I felt nothing for a few weeks, but once it kicked in it was like waking up again. I feel incredibly confident and energetic, my motivation is through the roof at work, and best of all, I'm tearing it up in the bedroom. Although I haven't told my girlfriend about the testosterone replacement therapy (TRT) yet, she has definitely noticed a difference and even said she loves how dominant and passionate I am now. I was very nervous at first, but I'm glad I followed the advice here and went for it.

My only complaint is the results of my recent bloodwork: a day after injecting, my test level was 650ng/dl. That sounds normal to me, but the doc claims this is way too high for a 22 year old. I tried to bring up some studies I found online, but he shrugged it off and said he's going to reduce the dose if it doesn't drop a bit. I really don't want to go through the gauntlet of doctors again until I can find one who prescribes test, nor do I want to drop the dose -- what do you guys recommend?

Do what 1693 said. Test the day of your next injection, prior to the injection. This isn't dishonest or inaccurate, so long as the doctor doesn't instruct you to come in exactly two days after your last Test injection for blood work. Skipping a shot would be pretty deceitful but it's also an option if you're self injecting.

 

[Ocdude]

This thread pissed me off this morning... So much misinformation amongst the medical community and insurance companies deciding what they'll pay for instead of what makes us healthier people!!

I feel for you OP, it's a suck ass situation you're going through. It almost sounds like your original doc may be a good candidate to move back to once you get things settled. My doc has me do peak and trough draws, so he can see both ends of the week. It's a way better method of deciding what level is appropriate. I was on 100mg/week and my trough was coming back at 250, and expectedly I was feeling like crap by then. So thankful my doc listens to me!

 

[THE-DET-OAK]

Although we butt heads, I'm going to agree with what you said up until this point. This point about getting a better patient history TO CHARGE MORE is absolutely inaccurate.

Effective 1/1/2014, the Affordable Care Act (Obamacare) that goes into place, restricts the ability to underwrite based on pre existing conditions, sex, health and a number of other different factors. Essentially the ACA is stripping health insurance companies of the ability to 'underwrite' their patients. Underwriting is essentially a fancy way to say analyzing the risk ("exposure") and charging a cost ("premium") to match the risk. That's the entire job of underwriting, to collect enough premium to match exposure. I.e., that's why if you're unhealthy, you currently get charged a boatload. Your risk is higher, so your premium is higher.

Quote:
"Community Rating Under the Affordable Care Act

Under the law, an individual health plan selling policies in the small-group and nongroup market ***8212; whether it sells policies through the state***8217;s exchange or not ***8212; will be free to set its own premium for a given policy. But within a given age group, it must apply the same premium to all comers, regardless of their health and their gender. Furthermore, the health plan cannot reject any applicant willing to pay that premium, a provision called ***8220;guaranteed issue,***8221; or cancel existing policies."
Link - 'Premium Shock' and 'Premium Joy' Under the Affordable Care Act - NYTimes.com

The deductions on taxes is technically accurate, but you have to hit a level first that would allow you to take those medical expenses as deductions - otherwise the standard deduction will apply and there will be no additional benefit. Medical costs have to exceed 7.5% of your adjusted gross income before you can claim them (technically you can claim them, regardless, but if they don't exceed 7.5% then they won't do a lick of good from a preferential tax treatment standpoint).
Link.
Can I Claim Medical Expenses on My Taxes? - TurboTax® Tax Tips & Videos

Again this is exactly why having experience in the field differentiates me from you

There are a million different ways to to increase the rate of pay by the individual, yea they may not call it adjusting your premiums anymore but there are many different ways to do this, one of which by telling you what you "qualify for". If you don't think you will be adjusted in one way or another go ahead and claim your meds on your insurance, what do I know anyway

It clearly says they are free to set premiums, and there will be many other benefits like lower deductibles for people not being treated with specialty injectable medications for chronic conditions.

Doing this as a whole, instead of an individual basis, makes my post even more noteworthy.

 

[halfwit]

Finally an update!

After months of going from from doctor to doctor, I finally got some help -- all recommended I start testosterone replacement therapy (TRT) for low test, but no docs wanted to touch me with a ten ft pole. Months later, I found an endocrinologist who insisted I try the gel first before going with test cyp claiming it would give me roid rage. Anyway, since the gel did absolutely nothing but irritate the hell out of my shoulders, eventually he caved in.

I felt nothing for a few weeks, but once it kicked in it was like waking up again. I feel incredibly confident and energetic, my motivation is through the roof at work, and best of all, I'm tearing it up in the bedroom. Although I haven't told my girlfriend about the testosterone replacement therapy (TRT) yet, she has definitely noticed a difference and even said she loves how dominant and passionate I am now. I was very nervous at first, but I'm glad I followed the advice here and went for it.

My only complaint is the results of my recent bloodwork: a day after injecting, my test level was 650ng/dl. That sounds normal to me, but the doc claims this is way too high for a 22 year old. I tried to bring up some studies I found online, but he shrugged it off and said he's going to reduce the dose if it doesn't drop a bit. I really don't want to go through the gauntlet of doctors again until I can find one who prescribes test, nor do I want to drop the dose -- what do you guys recommend?

I like 1693's advice and aim more for a trough level. Your doctor really upsets me and it's a good thing he's not my doc or he would see some 'roid rage' as he is not qualified to tell you what a high level of testosterone is nor can he insist on what causes 'roid rage'. ESTROGEN is responsible for so many of the side effects attributed to testosterone supplementation, it's not even funny. Testosterone goes up, estrogen (estradiol) goes up. You would be shocked how many doctors DO NOT know this. FYI: I am 37 and my total testosterone comes in at 900-1100ng/dL and my doctor wants to give me a hug for being a "success" on testosterone replacement therapy (TRT).

These fruitcake bastards that want the extra money from treating testosterone deficiency need to stop taking on patients if they seriously don't understand the mechanics behind it and how to properly provide OPTIMAL treatment to their patients. I'm glad you're feeling better, but I think you need to continue shopping around for a doctor worth two shits, instead of another guy that thinks since he can prescribe insulin/metformin for diabetes he is now a mini-endocrinologist and has male hormones mastered. I'm scared to ask if this guy has even looked at your estradiol, or if he thinks it's unnecessary. Sorry for the semi-rant, but this stuff really irritates me when grown men are being told that they have to live a certain way because some bozo completed 8 years of school decades ago and wants to make these decisions for you.

 

[Ocdude]

There are a million different ways to to increase the rate of pay by the individual, yea they may not call it adjusting your premiums anymore but there are many different ways to do this, one of which by telling you what you "qualify for". If you don't think you will be adjusted in one way or another go ahead and claim your meds on your insurance, what do I know anyway

It clearly says they are free to set premiums, and there will be many other benefits like lower deductibles for people not being treated with specialty injectable medications for chronic conditions.

Doing this as a whole, instead of an individual basis, makes my post even more noteworthy.

Hey Det oak, where do you see testosterone replacement therapy (TRT) heading with Obamacare? Is it just going to turn into one of those things we might as well do outside of insurance and keep them out of the loop altogether? Currently I get a great price on the generic 90 days mail order.... Hate to see that get screwed up!

 

[konared]

When I lived in the US (Hawaii) I got tested and I was at about 240 which they told me I was within normal ranges. I am a medical student now and I am learning that normal range is like 250-1200. So yeah I was within normal ranges for an 80 year old (Im 33). regardless they wouldn't help me and told me I was fine.

 

[Megatron28]

When I lived in the US (Hawaii) I got tested and I was at about 240 which they told me I was within normal ranges. I am a medical student now and I am learning that normal range is like 250-1200. So yeah I was within normal ranges for an 80 year old (Im 33). regardless they wouldn't help me and told me I was fine.

That sounds fairly typical of the profession you hope to join unfortunately. There are some great docs out there though. I hope you strive to be one of the great ones. Remember to actually listen to you patients.

 

[totalburnout]

Again this is exactly why having experience in the field differentiates me from you

There are a million different ways to to increase the rate of pay by the individual, yea they may not call it adjusting your premiums anymore but there are many different ways to do this, one of which by telling you what you "qualify for". If you don't think you will be adjusted in one way or another go ahead and claim your meds on your insurance, what do I know anyway

It clearly says they are free to set premiums, and there will be many other benefits like lower deductibles for people not being treated with specialty injectable medications for chronic conditions.

Doing this as a whole, instead of an individual basis, makes my post even more noteworthy.

You really are a meathead moron that has a superiority complex, aren't you?

I linked you to one article because it was the top result in a google search. I work for an insurance company. I understand the regulations and how underwriting works. I field underwrite and I'm on the phone with a home office underwriter on a daily basis.

Please do tell me how you think the industry works when you're completely off base. There's a reason why there's great concern amongst insurance companies that are book of business will suddenly become unprofitable after ACA is fully implemented.

But you go ahead and explain to someone who works at an insurer how this works.