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Author Topic: Care at the VA  (Read 158 times)

Paco1973

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Care at the VA
« on: August 10, 2018, 08:24:41 am »
I went to the VA to see if I can at least get some of my meds and supplies free m them. It would save me a little from paying out of pocket through Defy. I’m on propionate, so the endo has to put a special request in for that medication. They are willing to give me cypionate for free, but I don’t know if I am willing to go down that road again when propionate is working so well. The endo was confused as to why I am on HCG, and recommended stopping it. What is up with doctors being so clueless on trt? He was also trying to encourage me to do another restart. He wanted to see how I’d be if I was ‘optimized.’  I told him I tried that for a year, and it was a no-go. He said that trt is for life and he didn’t recommend committing to it. Do these people have a clue about the health risks and quality of life issues with hypogonadism? He was more worried about the health risks with testosterone. The VA has been guilty of over-prescribing testosterone, so I understand that doctors are apprehensive about prescribing it... it’s just that these people are in the stone ages when it comes to trt. After my appointment, I did the math, and I would only save about $25 per month for medications ( the VA won’t prescribe HCG, so that would be out of pocket anyway). It may be more costly to go to Defy, but the quality of care is worth it.

Cataceous

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Re: Care at the VA
« Reply #1 on: August 10, 2018, 12:43:55 pm »
Of course it's not just the VA. I've discussed TRT with two different GPs, a urologist and an endo, and not one of them had what we would consider current knowledge.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 50 mcg anastrozole qod, 6.25 mg DHEA orally bid, 4 mg preg. orally qd
7/2018 test results: TT: 800 ng/dL, E2: 50 pg/mL immunoassay, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

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Re: Care at the VA
« Reply #1 on: August 10, 2018, 12:43:55 pm »

Paco1973

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Re: Care at the VA
« Reply #2 on: August 10, 2018, 01:35:44 pm »
Of course it's not just the VA. I've discussed TRT with two different GPs, a urologist and an endo, and not one of them had what we would consider current knowledge.

Yeah, I hear you. Overseas they have to go to seminars and continuing education all the time. Here, I don't know. At least some physicians try to stay ahead of the game. Otherwise, we'd still be injecting once every 2 weeks and riding the hormonal roller coaster.

Still, I have to give the endo props. He was open to talking about it. He didn't act like he knew everything. Who knows? Maybe he will be encouraged to do some reading to see what's up with my protocol.

Joe Sixpack

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Re: Care at the VA
« Reply #3 on: August 10, 2018, 08:17:38 pm »
The VA has overprescribed testosterone?  No kidding.  I would not have expected that.  I would have figured that the VA would be more likely to stay as far away from T as possible, not wanting to get involved.  Sort of like what the National Health Service does in England.  If you have total T levels > 300 or so, they tell you that you are normal and send you home with antidepressants.
Age: 55, Ht: 5'08", Wt: 155 lbs
Protocol: 30mg T Cyp + 30 IU HCG M,W,F + 2 clicks T Cream + 15mg DHEA + 15mg Pregnenalone daily.
1/2018 test results: TT: 1123 ng/dL (264-916), FT: 22.6 pg/mL (7.2-24), E2: 37.3 pg/mL sensitive (8.0-35.0)

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Re: Care at the VA
« Reply #3 on: August 10, 2018, 08:17:38 pm »


HRT Guru

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Re: Care at the VA
« Reply #4 on: August 12, 2018, 10:48:32 am »
I refrain from the VA as long as they send my check every month, I pay for health insurance, pay Defy OOP of just avoid it altogether.

oldolylifter

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Re: Care at the VA
« Reply #5 on: August 12, 2018, 11:37:32 am »
The VA has been guilty of over-prescribing testosterone, so I understand that doctors are apprehensive about prescribing it... it’s just that these people are in the stone ages when it comes to trt.

Where did you get that?  From what I hear, it's the opposite.  The VA really needs to take a look at this.  Some of these guys are subject to repeated concussive forces and I understand it takes a toll, even if they are not rendered unconscious.  Many diagnosed with PTSD have found TRT to be a life saver.  Literally, in some cases.     

Paco1973

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Re: Care at the VA
« Reply #6 on: August 12, 2018, 04:33:10 pm »
The VA has been guilty of over-prescribing testosterone, so I understand that doctors are apprehensive about prescribing it... it’s just that these people are in the stone ages when it comes to trt.

Where did you get that?  From what I hear, it's the opposite.  The VA really needs to take a look at this.  Some of these guys are subject to repeated concussive forces and I understand it takes a toll, even if they are not rendered unconscious.  Many diagnosed with PTSD have found TRT to be a life saver.  Literally, in some cases.     

A simple Google search will give you a few articles on the VA's opinion that testosterone has been over prescribed. Now, what lab parameters they are using to support their claims is anybody's guess, because I haven't seen them cited specifically in any article I've read. The VA already prescribes testosterone for TBI. Of course, the quality of the treatment you get is going to vary from facility to facility. I've been to several across the country, and even to the one in Manila. The doctors in Manila were more knowledgeable and had a better bedside manner than most of the ones I saw in the US.

Coming back to the VA in the US has been an absolute shit-show. Hopefully it will smooth out soon.

Anyhow, what I can tell you is that the VA is in the dark ages when it comes to managing trt. At least, that has been my experience at every facility I've been to. Part of this is due to the cumbersome bureaucratic process that physicians have to utilize in order to write prescriptions. The VA will not prescribe medications for off label use (i.e. HCG for treating testicular atrophy that accompanies trt). When it comes to testosterone, the VA doesn't check estrogen at all. They look at total and free testosterone. If you're over the minimum, you're good as far as they are concerned. When it comes to dosing and route of administration, I've seen every 2 weeks and once a week cypionate protocols, and patients are expected to inject IM. It's an archaic system. If your doctor wants to give you a medication that isn't on the formulary, he has to provide justification for it. Ultimately, it depends upon the mood of the pharmacist if you can get the medication or not. The pharmacist can simply tell the physician to prescribe something on the formulary, even if it has failed in the past. Free medical is great, no doubt. It's the bureaucratic red tape and the complete absence of a patient-centered approach that makes the VA a miserable failure. I seriously got better healthcare in a third-world country. My physicians were more up to date on current medical treatments, and I didn't get treated like a cog in a wheel.   

oldolylifter

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Re: Care at the VA
« Reply #7 on: August 12, 2018, 05:38:30 pm »
http://www.usmedicine.com/agencies/department-of-veterans-affairs/va-educates-patients-about-who-really-needs-testosterone-therapy/

Wow, talk about outdated.  Has been overprescribed?  Not anymore.  So much for them considering anything except for the very lowest lab levels, and it sounds as though that may be tough. 

Cataceous

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Re: Care at the VA
« Reply #8 on: August 12, 2018, 05:51:51 pm »
The cost of treatment from a quality place like Defy is not so high that any guy should be groveling to a doctor for "free" but substandard care.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 50 mcg anastrozole qod, 6.25 mg DHEA orally bid, 4 mg preg. orally qd
7/2018 test results: TT: 800 ng/dL, E2: 50 pg/mL immunoassay, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

HRT Guru

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Re: Care at the VA
« Reply #9 on: August 13, 2018, 06:54:39 am »
The cost of treatment from a quality place like Defy is not so high that any guy should be groveling to a doctor for "free" but substandard care.

...this.

JRS1

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Re: Care at the VA
« Reply #10 on: August 13, 2018, 08:41:41 am »
I refrain from the VA as long as they send my check every month, I pay for health insurance, pay Defy OOP of just avoid it altogether.
                If you don’t mind me asking, what is your monthly out of pocket payment to Defy Medical? Not counting the blood work in the beginning and consultation. I’m thinking of pulling the trigger and committing to them but I don’t have an idea of monthly cost. I know everyone is different. Just as a ballpark estimate. Thanks

Cataceous

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Re: Care at the VA
« Reply #11 on: August 13, 2018, 11:44:50 am »
I can give a generic estimate for Defy costs. Assuming you're dialed in with no changes expected in your protocol:

For six months:
$237 follow-up lab panel
$171 testosterone cypionate @ 100 mg/week
$131 hCG @ 750 IU/week
$12 S&H
$13 syringes @ 4/week
$50 nurse follow-up

The total is $614, so you're looking at a little over $100 a month.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 57, Ht: 5'10", Wt: 158 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 50 mcg anastrozole qod, 6.25 mg DHEA orally bid, 4 mg preg. orally qd
7/2018 test results: TT: 800 ng/dL, E2: 50 pg/mL immunoassay, DHEA-S: 264 ug/dL (49-344)—SHBG ~30 nmol/L

Paco1973

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Re: Care at the VA
« Reply #12 on: August 16, 2018, 08:18:55 am »
The cost of treatment from a quality place like Defy is not so high that any guy should be groveling to a doctor for "free" but substandard care.

Defy isn't too expensive, that's a fact. I'll save a dollar where I can, though. The VA is shipping me some needles and syringes. At least the endocrinologist was able to do that. The propionate was a no-go. The VA will only prescribe gel or cypionate. For me, it's not worth it to switch when I'm feeling great right now.

Nothing ventured nothing gained.

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Re: Care at the VA
« Reply #12 on: August 16, 2018, 08:18:55 am »