T Nation

Game Plan for T Replacement

I have been lurking on these forums for a couple of years and am finally jumping in with my first post.

I have been lifting seriously for just over three years and have been working with a very qualified trainer online for the past 18 months.

In that time, I have seen my weight drop from 205 to a low of 172 and then to my current of 180. Body fat has gone from 22% to about 9%.

After going through a 3 month cut that produced the above results, I began a bulking program. I cut back on cardio and really pushed the weight and increased my calories (I eat about 98% clean). Unfortunately, I simply did not add any size or bulk. (I have posted an “after” picture above)

I decided to have my T levels checked and got the following results:

337 total and 6.52 free

This is down from a total level of 500 a year ago. I am 47 (almost 48).

My doc will (I think) agree to get me going on T replacement and I would like some views on how to best design a program. I have read through many of the threads here and know that I need to both boost T and control E. Are there other areas I need to consider?

Thanks in advance.

For what it’s worth, I am also posting a “before” picture that was taken just prior to my cut…

Thanks. I wrote to them to see if they take insurance.

Need to talk with my PCP – he suggested sending me to a urologist although I wonder if an endocrine doc would be better.

Don’t waste your time with either of those doctors. Use renewman.com or go see Dr Crisler.

The renewman offering looks good. I do not know about Dr. Crisler.

For me, it is important to have the treatment covered by my health insurance. I assume it is expensive and ongoing.

Does anyone have experience with getting coverage for TRT?

Sometimes finding a good HRT Doc in your insurance plan can be quite a problem.

You can try here:

http://www.medaus.com/index.php?option=com_content&view=article&id=58&Itemid=30

This is a compunding pharmacy that fills orders for Docs who are known to prescribe testosterone. Some Docs freak out when you ask them for it. Some will RX the gels, and not do the injections.

Now … can you share that diet plan with me that got you those results !

You can also try other compunding pharmacies. Just do a google for testoterone and phamrancy.

I ended up having to pay out of pocket for what I wanted/needed.

I found a local guy that has similar credentials as Dr Crisler, and about the same price.

GO here for lots of info.

BTW … can you share that diet plan you followed to get those results ?

I ended up using renewman as well. As far as the insurance I do know that they will not file for you. You will have to do that on your own. My insurance plan will not pay a dime and yes, it is expensive.

It would be great if you could post your diet for the cut. Those are amazing results.

Thanks for the advice on the TRT. I will talk with my PCP this week and see where it goes. My wife is a doctor as well, but we keep careful boundaries in terms of her writing RXs for me.

Ahh, the cut…seems there is a lot of interest. I can post it here or do a new thread. Or maybe both. Suggestions?

Anyway, I am working with a top level trainer who structured my workout plan. Lots of HIIT and mostly full body compounds. A fair amount of complex routines as well which are pretty demanding.

The diet was simple, but not easy:

I eliminated all carbs except for green veggies and berries. I ate 6 times a day using a model of:

Meal 1: 6 oz protein and some sort of veggie

Meal 2: Metabolic Drive shake and 1 cup berries

Meal 3: 6 oz protein and green salad

Meal 4: same as Meal 2

Meal 5: same a Meal 3

Meal 6: MD shake and celery with cashew butter

I drank a least a gallon of water a day and used HOT-ROX Extreme daily. I also used Carlson’s lemon fish oil at 1 TBSP twice a day. I did not cheat at all, ever.

I am trying to bulk and this is where I discovered the low T levels. I have continued to eat really clean and have added back limited carbs – Surge pre and post workout, plus some oatmeal and sweet potatoes. The workouts have gotten really punishing – heavy weights and lots of reps and sets. Net result was only an added 5 pounds (no fat luckily) and it seemed something was holding back the muscle growth. This appears to be the very crappy T levels.

Hope this helps.

Dr Crisler is dirt cheap and you only have to see him once. Ongoing treatment will cost about $30 a month without insurance. My insurance covers my treatment through him without a problem.

He submits my scripts to my local pharmacy and I just send his bills into my insurance company for coverage. After your second set of labs you only have to have a virtual office visit with him every 6 months. The VOV is only $60.

Thanks. I assume you have to travel to see him at least once?

Is there an option of him coordinating with a local doc?

[quote]thr61 wrote:
The renewman offering looks good. I do not know about Dr. Crisler.

For me, it is important to have the treatment covered by my health insurance. I assume it is expensive and ongoing.

Does anyone have experience with getting coverage for TRT?[/quote]

With renewman, you pay upfront, they send you the receipts which you copy and send to insurance. The only prob is if you have no upfront cash. If that’s the case, then you’re stuck with endos/uros, you poor prick (and I mean that in a sympathtic way, bro).

Keep us updated.

[quote]brentf13 wrote:
Dr Crisler is dirt cheap and you only have to see him once. Ongoing treatment will cost about $30 a month without insurance. My insurance covers my treatment through him without a problem.

He submits my scripts to my local pharmacy and I just send his bills into my insurance company for coverage. After your second set of labs you only have to have a virtual office visit with him every 6 months. The VOV is only $60. [/quote]

He lives in Massachusetts, and Crisler is in Lansing, MI. If he can afford the airfare, he can afford the upfront for renewman, who’ll give him a local doc.

Update:

I spoke with my GP who told me my levels were “low normal” and that he wanted to send me to a urologist. I told him that I would like to explore other options and then told him about an endocrinologist I located locally.

I was able to reach this endo on the phone to screen him for treatment approach. He treats a significant number of men for TRT and is completely on board with T replacement, clsely monitoring E and using E suppression as needed, and using specific medication to avoid testicular atrophy. He has written a book on hormone replacement essentially answered all my questions in the ways I had hoped.

My GP was fine with me seeing him, although he told me not to expect much. His feeling was that decreasing T levels was just something that happened as one gets older and to accept it. I politely disagreed and plan to see this new doc at the end of next month (first available appointment).

I feel more comfortable seeing this guy than with renewman who I did speak with. They clearly get it, but I don’t think my insurance will cover any of their costs and they quoted me something $200-300 a month out of pocket.

I will update once I have my appointment.

I’m getting hit with $200 office visits. One visit for the initial consult and then again at six weeks. After that, every six months. Initial labs were $250 so I’m expecting to pay that again when I retest. Guess that will set me back $450 and then I’ll get hit with another $600 for two months of the scripts. My insurance will pay none of this.
Think I’m getting screwed???

Insurance: it is all about money

If your GP writes does it, it is cheap.

Big RX transdermals are very costly. Injected can be least cost. Some compounded creams may be a good option if you are an absorber.

Do not forget 250iu hCG SC EOD.

Hate to say it … but UG sources may be the way to go.

Can buy 10ml CYp for under $100.00
HCG is $65.00 for 3 5000IU amps (Total 15K iu)
A-dex with a reasearch Chem place is VERY cost effective.

Using UG … you would be around $ 60.00 per month for total treatment.

Just a thought …when times are tough.

I pay all out of pocket, but have an HSA that provides 100% tax deductability.

10mg test cyp is around $45 at Sam’s Club with a business membership, similar at Costco last I heard.

10,000iu hCG same price point at Sam’s… if hCG can be found.

Double costs for the above at main street pharmacies.

Arimidex is expensive, go with ldex if you must.

Syringes are cheap when you buy boxes of 100. Never purchase by tbe unit!!!

My doctor consults are the same as your costs.

Yes, labs are expensive. I use the male hormone panel at LEF and my doc works with that. My costs for scripts are quite low.

Good news: I caught a cancellation and am seeing the endocrine doc on Monday!

Bringing my existing labs and will likely have more run.

Will get his opinion on T goals. I have read that:

800-1200 for total test
250-350 for free

would be a good goal.

Thoughts?