Testosterone Therapy options

[chandlerman4649]

Readers,

I am searching for information about testosterone replacement therapy. My urologist put me on Axiron to increase my testosterone level from the high 200s. I used one sample container and then filled a prescription for one month supply. My insurance company (Aetna) informed the urologist that he needed to switch my prescription to AndroGel. I have had great luck with both of those options.

I turned 65 this past April and changed to Medicare with supplemental insurance and a Humana drug prescription plan. In order to keep using AndroGel I will need to fork out $485.00 per prescription. My urologist is going to start me on testosterone injections (every two weeks) and at the same time see if Medicare and insurance will cover Testopel implanted pellets.

Have any of you had experience with the injections and implanted pellets? Are they as effective as other options? Any problems with testosterone injections?

Any advice and information will be appreciated.

Bob

[tomas1]

I live in Tempe and get injectable T at Community Clinical Pharmacy in the medical complex by Banner Desert Hospital.
It costs $60 for a vial that gives 25 or 26 injections. I inject once a week and haven't had any problems doing it.
You have the same Uro as me, but I get the prescription from another doctor. That doctor runs Testosterone trials, and may possible accept you?
You can PM me if you want the doc's name?
I've never heard of the injectable pellets. I wonder what that costs and is it covered by Medicare?
I also choked at the price of Androgel.

[chandlerman4649]

Thanks for responding tomas1. I would appreciate knowing which doctor is running testosterone trials. I really like Dr. Avila because he takes a genuine interest in me as a person and I appreciate his impeccable bedside manner. His staff is currently working with Medicare and my supplemental insurance to see if they can get the Testopel covered as an office procedure rather than just a medication.

The implant procedure for Testopel is that they numb an area on the buttocks and after the medicine stops the pain, they inject deep tissue numbing meds. Then a small knife blade is used to cut a puncture slot about 1 inch deep into the tissue. A fairly large tube is then slid into the slot and pushed about 4 inches across the buttock tissue just under the skin. Ten or more pellets of Testosterone are pushed through the tube and planted into the buttock tissue. Usually the bleeding is minimal and some bandage tape is used to cover the puncture area. An ice bag is placed over the area for about 30-45 minutes before you are released. This is an office procedure and the testosterone pellets should last for 3-4 months before needing replacement. The pellets dissolve so there is no need to remove the old ones.

He had me get my Tri-Mix injections from Community Pharmacy. I will need to compare their price with my pharmacist at Walgreens.

Bob

[Anonymous1]

I've been doing injections on my own now for about a year and a half. My plan is 50mg (25 units on a 50 unit syringe) every 4 days in a rotating pattern around my naval. This keeps my T level around 700 all the time without the spikes that typical weekly or bi-weekly injections do. I don't use the gels because of the amount of testosterone that can congregate in the skin locally and because of the hassle of having to keep the area covered and washed and such so that you don't spread T to other folks - I spend a lot of time in the gym and it is not male only and I also have a house full of females. So for me shots are the bomb.

In my case T has radically shrank my testicles - RADICALLY and reduced the volume and "texture" of my ejaculate. I can live with those things but looking back I think I would have done things a bit differently. First I would have really tried to push for Clomid instead of directly going onto T. Second I would have made sure my thyroid is healthy. Back then I didn't know that the hormone axis consists of Pituitary - Hypothalamus - Adrenals and Thyroid. Pituitary and Hypothalamus are those most responsible for testosterone production as they release a prohormone that causes the testes to synthesize cholesterol into testosterone. I now know that my hypothalamus/pituitary connection is somewhat damaged by white-matter scars caused by migraine headaches (at least that is what the MRI shows). Clomid can help make up the difference and stimulate the testicles to produce more T. HCG (human chorionic gonadatropin) can also do that but if you take HCG you run the risk of become insensitive to what your hypothalamus/pituitary produce naturally. Also on T you run the risk of elevated estrogen production and some guys benefit from extremely low doses of arimidex - believe it or not, to properly function sexually - erection, desire and orgasm you must have a very narrow band of estrogen. Exogenous T can cause extreme swings in that amount. On the two week interval shots I was experiencing hot flashes and PMS symptoms - I don't get that now with my regimen.

Anyways - it's not as simple as just taking T - you need to be on top of the game with it. You need to get regularly tested and you need to really know what this is doing to you.

[chandlerman4649]

RF8877,

Thanks for the information. I will have a discussion with my urologist concerning the issues and meds you raise along with your T regimen. I think I am a normal man with some pride in how I am built so I am really concerned about the shrinkage of my testicles. I am not super endowed in penis size (5-3/4" length x 5-1/2" girth) but I have significantly large testicles, so large that on three occasions my general practitioners have asked me if "they are always this large" during routine physicals. I may need to swallow my pride and look more accurately at the bigger picture....more energy and better sex drive as I begin a different T regimen. I wonder if the Testopel pellet implants have the same kind of affect as some of the other forms of T.

I have been on Axiron and AndroGel for only 6 months and have really felt a difference in energy level and a significant increase in sex drive. My PSA is always under 1.0 and my testosterone level went from 294 to 857 after only two months use. Right now I am trying to maintain a 700 level of testosterone. And so far I have not noticed any shrinkage, hot flashes or mood swings (I take antidepressant meds along with meds to control my normally high level of anxiety).

Thanks again for the info. I will study the information so I can have an intelligent conversation with Dr. Avila (Ironwood Urology, Phoenix, AZ). He is EXTREMELY patient with me, has always been willing to answer my questions (I had many before implant surgery) and has an impeccable bedside manner. He is undoubtedly the BEST physician I have ever seen.

Bob

[Anonymous1]

Some guys don't experience shrinkage...I envy them. Mine are now roughly the size of a large almond or a grape - still fun to play with but just not as much there. From what I understand they are in "hibernation" because they're really lazy at making T and don't have to now. Clomid can make them much less lazy but to stop T now would be difficult. My ejaculate is about 1/2 what it used to be and is very thin and watery - not clumpy, thick, white and uber creamy (I really miss that). I think shrinkage happened with me at about 4 months after starting T therapy.

At this point I don't think I'd ever want to be without a significant level of T. My anxiety level decreased significantly, my adverse reactions to things decreased and my overall ability to enjoy being a man increased greatly - it's very strange. I've never felt all that manly but with my T level where it is and with time I'm feeling more and more like a man (the significant increase in body hair is one very nice psychological component though). Unfortunately my libido has not significantly increased. This has been the most disheartening thing about the whole experience. I'm not a raging, intercourse occupied guy. I wish that I was! But I'm convinced that my issue is with estrogen but it takes a very specific, male version of the test and most general tests for estrogen use the female model.

My endocrinologist has suggested that I may have a variation of a genetic syndrome called Kallmanns ... if i do that could account for the massive shrinkage of my testicles and my lack of raging libido. Unfortunately the test for the condition is very expensive.

All told I love having my T level where it is and I love what it has and continues to do to me and maybe in time I will develop the libido that me and my wife would really like to make use of. Until then I have to accept that this is a long term investment in my overall health and well being with hopefully some good side effects in the sex department a little further down the path.

[dg_moore]

I just started on T replacement. I am using Androderm patches for now, but they are pretty clumsy - I'm fairly active and two patches fell off the first week (you use one patch per day), and they come loose along the long edges during normal activity. I went with Androderm because Medicare doesn't pay for Axiron, and I've been avoiding Androgel because of the transfer issue - my wife is paranoid that I will somehow contaminate her, and no amount of explanation from my doc has convinced her otherwise. I do notice an improvement in energy and mood after just a week, but I don't know if the patches will bring my numbers up sufficiently, and I am not confident that they are a long term solution for me. If they were more flexible I think they would stick better - don't know why they went with this particular design. I may wind up with injections, which my doc doesn't like because your T levels fluctuate too much. I'd consider Testopel if Medicare will pay for it, but my doc expressed concern that they are not manufactured by a big pharm company with rigorous quality control - apparently they are made by some compounding pharmacy. So it's complicated.

[chandlerman4649]

dg_moore,

Thanks for your response. My primary care physician put me on Androderm patches but after about two weeks, she took my off because the patches were burning my skin so much that it blistered in spots. So when I talked to my urologist and shared my experience about the patches, he didn't feel comfortable trying them again. That's how I got on Axiron and AndroGel.

I get my first testosterone injection in about 45 minutes. The nurse will inject the first time and if I feel OK about my body's reaction to the injection in two weeks, then I will go back in to have them show me how to do injections. She asked me if I just wanted to come into the office every two weeks to get the injection or if I would feel comfortable doing them myself. I told her that I had been injecting Tri-Mix into my penis for the past 8 years so this should be much simpler.

Thanks again for your response.

Bob

[dg_moore]

dg_moore,

Thanks for your response. My primary care physician put me on Androderm patches but after about two weeks, she took my off because the patches were burning my skin so much that it blistered in spots. So when I talked to my urologist and shared my experience about the patches, he didn't feel comfortable trying them again. That's how I got on Axiron and AndroGel.

I get my first testosterone injection in about 45 minutes. The nurse will inject the first time and if I feel OK about my body's reaction to the injection in two weeks, then I will go back in to have them show me how to do injections. She asked me if I just wanted to come into the office every two weeks to get the injection or if I would feel comfortable doing them myself. I told her that I had been injecting Tri-Mix into my penis for the past 8 years so this should be much simpler.

Thanks again for your response.

Bob

Bob,
I understand that many users have an allergic reaction to the patches. So far (only 8 days) I haven't seen any sign of rash or irritation, but that's another potential downside of the patch. Unless I can figure out secure locations for the patches for extended use (so they don't keep coming loose) I'm going to want another solution. One step at a time...

Thanks
Dave

[tomas1]

Bob,
I was a bit squeamish about giving myself the T injections since I'd never given myself an injection before. This was before trimix.
I started off shooting in the butt alternating cheeks and that worked ok, but it was a little clumsy. I finally got nerve up to shoot in the thigh with the 1" needle. I try not to insert it completely in though. If I'm sufficiently relaxed, I have very little discomfort, and seldom get any noticeable blood.