What Is Androgel And How Does It Work
AndroGel is synthetic testosterone mixed into a gel with alcohol that is applied to the skin once daily. The testosterone is absorbed into the skin for continuous 24-hour delivery into the body. The medication can cost as much as $500 a month, but some insurance companies cover it.
The drug is available in two strengths: 1 percent and 1.62 percent. Patients dispense the gel through a multi-dose pump or use single-dose packets. It is quick-drying, clear and odorless when dry.
The two dose strengths have different application sites. Patients can apply the 1-percent gel to the upper arms and shoulders as well as on both sides of the abdomen. For the 1.62-percent gel, the gel should only be applied to the upper arms and shoulders.
In men with Low T, the medication is intended to increase the total amount of circulating testosterone in the body to a normal range found in healthy men. According to the drug insert, this measurement is somewhere between 298 1043 ng/dl . If men use lotion or sunscreen, the amount of testosterone absorbed increases.
After applying AndroGel, men should wash their hands thoroughly with soap and water. It is also important to know that the drug is flammable until dry, and patients should avoid flames, smoking or fire.
Testosterone Replacement Therapy With Injections
Injecting an oil of Testosterone Cypionate, Testosterone Enanthate, or Testosterone Propionate is a common form of Testosterone Replacement Therapy . These oil solutions are fairly inexpensive and quite cost-effective. Testosterone injections work quite well and provide good levels of serum testosterone when dosed appropriately.
If hypogonadism is documented as discussed previously then insurance may cover testosterone replacement with testosterone injections. The price for testosterone injections covered by insurance depends on your specific insurance plan and coverage.
Ive seen patients pay as low as $10 per month for their testosterone prescription. However, they have to get their syringes and needles separately. Many times they end up pay $10-20 per month for their needles and syringes as well making their total about $20-30 per month.
If you elect to pay cash for your testosterone cypionate the price varies based on pharmacy. Some of the larger chains tend to be more expensive in our experience. It is common to find it for around $130 for a 10mL vial. You can certainly find it less expensive at some of the other pharmacies. For example, we charge $75 for a 10mL vial. That is the same price charged by NextGenRx. Needles and syringes are included in this price. Depending on dose, your monthly cost ends up being $15-30 month without having to deal with the headaches of insurance.
Do You Take Insurance
Insurance is accepted for your bloodwork. Most treatments are considered elective care and are not covered by insurance, but we will provide you with special documentation that you can submit to your insurance company, if you elect to do so.
If there is a clinic that claims they take insurance for TRT treatment be sure to understand the cost first before assuming they are going to be a less expensive option.
Health savings accounts and benefit cards are accepted.
Signs And Symptoms Of Hyperandrogenism In Women
A range of symptoms and signs from hirsutism to virilisation may occur. The Endocrine Society recommends testing for hyperandrogenism in women with hirsutism that is moderate or severe, of rapid onset, or accompanied by menstrual dysfunction, obesity or clitoromegaly.18 Other indications for referral are outlined at the end of this document.
Irreversible Surgical Interventions For Minors
The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention.” The WPATH guidelines state that “Chest surgery in FtM patients could be carried out earlier, preferably after ample time of living in the desired gender role and after one year of testosterone treatment. The intent of this suggested sequence is to give adolescents sufficient opportunity to experience and socially adjust in a more masculine gender role, before undergoing irreversible surgery. However, different approaches may be more suitable, depending on an adolescents specific clinical situation and goals for gender identity expression.
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Diagnosis Of The Cause Of Hyperandrogenism In Women
The diagnosis of testosterone excess is based on medical history and physical findings, followed by investigational tests. The most common cause of hirsutism20 and of excess androgen production in pre-menopausal women18 is polycystic ovary syndrome . It is important to rule out non-classic congenital adrenal hyperplasia, which occurs in 1.56.8% of women with hyperandrogenism.21 A history of rapid virilization is suggestive of ovarian or adrenal malignancy and such patients should be immediately referred. For more information refer to Appendix B: Conditions Associated with Alterations in SHBG Concentration in Men and Women and Appendix C: Medications that May alter Testosterone Levels in Men and Women . Complete guidance for the investigation and diagnosis of female hyperandrogenism is beyond the scope of this document. Indications for urgent or non-urgent referral are outlined in Table 2 below.
What Are Some Cautions
The evidence from studies isn’t clear about whether taking testosterone lowers or increases the risk of heart attack, stroke, or blood clots in the veins.
Experts don’t know for sure if taking testosterone affects the risk of prostate cancer. Your doctor may recommend regular exams and blood tests to check for problems.
Testosterone can affect your fertility. If you are trying to have a child, you may want to ask your doctor if you can take a medicine that doesn’t affect fertility.
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Testosterone Replacement Therapy With Pellets
Weve been using pellets for several years with excellent results. There are some commercially available, FDA approved testosterone pellets Testopel. These pellets are 75mg and FDA approved for dosages of 150mg to 450mg. Again, we are looking for optimal and most of our patients look, feel, and perform their best when their testosterone levels range between 800mg to 1200mg. There is simply no way a dose of 450mg is going to get most patients into this range and keep them there for 3 to 6 months as recommended by Testopel.
We use compounded pellets. They are, as we always expect in any of our services, of the highest quality available. These pellets are not FDA approved. Ive spoken about this on the podcast as well as other posts. Basically, this simply means that the medication and the specific dose have been tested and proven in clinical trials to be both safe and effective. In dealing with compounded medications, there is simply no way to test each specific dose and or combination and develop a study proving safety and effectiveness. It would be extremely cost prohibitive.
Again, our focus is optimal. Based on the medical literature, a level of around 1000 seems to be ideal. We dont get these levels with commercially available Testopel nor testosterone creams and gels that are often covered by insurance.
Is Hormone Replacement Therapy Covered By Medicare
Traditional Medicare plans are unlikely to cover hormone replacement therapy unless you’re receiving in-person care. Medicare Advantage plans are facilitated by private insurers, so you might be able to receive coverage if you have an Advantage plan that offers coverage. Check with your health care provider and insurance company to determine if you can receive reimbursement for treatment and to learn about other payment options available.
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Fertility Preservation For Children And Adolescents
It is recommended that transgender children and adolescents, and their guardians, also be informed and counseled regarding options for fertility preservation prior to the initiation of pubertal suppression and treatment with gender affirming hormones. In children who have initiated natal puberty, fertility preservation options include sperm, oocyte, and embryo cryopreservation. Currently it is not possible for children who have not undergone natal puberty to preserve gametes.
Prolonged pubertal suppression using gonadotropin releasing hormone analogs is usually reversible and should not impair resumption of puberty upon cessation, though most children who undergo pubertal suppression go on to begin gender affirming hormone therapy without undergoing natal puberty.
Further discussion of pubertal suppression, and the decision to undergo gonadectomy prior to the legal age of majority, is included in the guidelines for transgender children and adolescents.
Signs And Symptoms Of Low Testosterone
In past decades, males were less educated about testosterone many were not aware that hypogonadism could be contributing to their reduced vitality, lack of libido, brain fog, fatigue, and loss of motivation. Make no mistake, an occasional “lazy day” where all you want to do is hang out on the couch and watch Netflix can be a nice respite, but something is wrong when that’s all you feel like doing.
Due to recent advances in our understanding of testosterone deficiency and its prevalence, endocrinologists and pharmaceutical companies alike have been strategic about direct-to-consumer marketing. Men are now more aware than ever that they should have their testosterone levels checked regularly, especially as they age into their 30s.
Naturally, that has led to rising diagnoses of men with testosterone deficiency . But what exactly are the symptoms and signs that you have low testosterone levels? Here’s an abridged list of what you might experience:
- Erectile dysfunction
- Low red blood cell count
- Loss of bone mass and joint integrity
- Loss of body and pubic hair
- Increased body fat
- Sleep apnea
- Development of breast tissue
In some cases, the cause of hypogonadism may be idiopathic. But the innate decline in testosterone levels as men age does not automatically warrant medical intervention.
If you’re experiencing symptoms of low testosterone, but your levels are consistently in the normal/healthy range, TRT isn’t going to solve anything it might even lead to more health problems.
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What Is Testosterone Injection
Testosterone is a naturally occurring sex hormone produced in a man’s testicles. Small amounts of testosterone are also produced in a woman’s ovaries and adrenal system.
Testosterone injection is used in men and boys to treat conditions caused by a lack of this hormone, such as delayed puberty, impotence, or other hormonal imbalances. Testosterone injection is not for use in treating low testosterone without certain medical conditions or due to getting older.
Testosterone enanthate is used in women to treat breast cancer that has spread to other parts of the body and cannot be treated with surgery.
Testosterone will not enhance athletic performance and should not be used for that purpose.
Testosterone injection may also be used for purposes not listed in this medication guide.
How Is Testosterone Injection Given
Testosterone is injected under the skin or into a muscle, usually given every 2 to 4 weeks. Testosterone injections should be given only by a healthcare professional.
The length of treatment with testosterone injection will depend on the condition being treated.
Testosterone can raise your blood pressure, which could increase your risk of heart attack, stroke, or death. Your blood pressure will need to be checked often. You may need to stop using testosterone or start taking blood pressure medication.
You will need frequent blood tests.
Testosterone can affect bone growth in boys who are treated for delayed puberty. Bone development may need to be checked with x-rays every 6 months during treatment.
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using testosterone.
Misuse of testosterone can cause dangerous or irreversible effects, such as enlarged breasts, small testicles, infertility, high blood pressure, heart attack, stroke, liver disease, bone growth problems, addiction, and mental effects such as aggression and violence. Stealing, selling, or giving away this medicine is against the law.
If you have used too much testosterone, stopping the medicine may caused unpleasant withdrawal symptoms, such as depression, tiredness, irritability, loss of appetite, sleep problems, or decreased libido.
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Testosterone For Transgender Men And Transmasculine People
Transgender men and other transmasculine individuals may use testosterone to masculinize their bodies in order to align their bodies with their gender identity.
Unlike transfeminine people who need to use a testosterone blocker in order for gender-affirming hormone therapy to be effective, there is no need to block the production of estrogen when taking testosterone. Testosterone is a more biologically effective hormone, and it will induce changes when taken on its own.
Note On Breast Reduction/mastectomy And Nipple Reconstruction
The CPT codes for mastectomy are for breast cancer, and are not appropriate to bill for reduction mammaplasty for female to male gender affirmation surgery. CPT 2020 states that Mastectomy procedures are performed either for treatment or prevention of breast cancer. CPT 2020 also states that “Code 19303 describes total removal of ipsilateral breast tissue with or without removal of skin and/or nipples , for treatment or prevention of breast cancer. There are important differences between a mastectomy for breast cancer and a mastectomy for gender reassignment. The former requires careful attention to removal of all breast tissue to reduce the risk of cancer. By contrast, careful removal of all breast tissue is not essential in mastectomy for gender reassignment. In mastectomy for gender reassignment, the nipple areola complex typically can be preserved.
Thus, Aetna considers nipple reconstruction, as defined by CPT code 19350, as cosmetic/not medically necessary for mastectomy for transmasculine gender reassignment, and that CPT code 19318 includes the extra work that may be necessary to reshape the nipple and create an aesthetically pleasing male chest.
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Study: Fewer Men Receive Testosterone Replacement Therapy After Fda Warnings
Sept. 29 — Use of testosterone replacement therapy among older men in the United States declined after warnings about the risks to those with heart disease, a study published Wednesday by JAMA Network Open found.
Prescriptions for the hormone replacement therapy fell by about one-third between 2011 and 2018, even in men without pre-existing heart disease, the data showed.
The drop in prescriptions coincided with warnings from the Food and Drug Administration and the Endocrine Society about the “potential risks for men with heart disease using testosterone,” the researchers said.
“The public should be aware that there isn’t good evidence showing that testosterone replacement therapy is safe or effective for older men with low testosterone levels unless they are caused by specific medical conditions,” study co-author Alex Everhart told UPI in an email.
“However, there have been several studies showing that testosterone replacement therapy may increase risk of heart attacks and strokes,” said Everhart, a post-doctoral research fellow at Harvard Medical School in Boston.
Testosterone is a hormone produced primarily in the testicles that, in men, helps maintain bone density, muscle strength, facial and body hair, sex drive and sperm production, according to the Mayo Clinic.
Why Is My Estradiol Important I Thought Estrogen Was A Female Hormone
Traditionally, testosterone and estrogen have been considered to be male and female sex hormones, respectively. However, estradiol, the predominant form of estrogen, also plays a critical role in male sexual function. Estradiol in men is essential for modulating libido, erectile function, and spermatogenesis.
If you are currently on testosterone therapy and you dont know your estradiol level, you need to find a specialist that understands the importance of both testosterone and estradiol. You cant have one without the other.
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Case 2 Denied: Testosterone Therapy In Klinefelter’s Syndrome
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Patient 2 is a 43-year-old-man with hypogonadism due to Klinefelters syndrome treated with transdermal testosterone gel. He had done well without adverse drug reactions or side effects of therapy. He had been on the same dose for years thus, we had decreased the frequency of routine lab testing to annually.
He transitioned over to new insurance. Before agreeing to cover the testosterone therapy, they demanded that I provide copies of his pre-treatment testosterone levels proving that they were below the normal range.
I sent my first letter explaining how such results were unavailable as the patient was diagnosed with Klinefelters syndrome at age 13. He had been on some form of testosterone replacement therapy for decades.
We received a response that said that they have a new process for prior authorization. They said that they now require all patients on testosterone to have testosterone levels, complete blood count and prostate-specific antigen drawn every 3 to 6 months while they are on therapy. Because I had not done this, my request was denied.
I found it interesting how there was no mention of these requirements on any of the previous prior authorization forms.
Were they simply changing the rules on us so they could just find an excuse to deny?
To be continued
My Pcp Doesn’t Think I Need Testosterone Therapy Why Is That He Or She Says My Levels Are Normal Or Low Normal
There are many different blood tests that all have different reference ranges. However, it is important to understand how those reference ranges are determined. For purposes of serum testosterone reference ranges, the norms are not age-adjusted, in other words, men ages 18-80 are thrown in to the same patient population, thus a wide spectrum from 250-1100 is now considered normal. However, it is our belief that a 20 year old should not have the same testosterone level as an average 70 year old and be considered in the range of normal orlow normal. Multiple studies have demonstrated that testosterone levels should not be expected to drop significantly just due to aging. Thus, for those men with Low-T symptoms who have what some consider borderline levels treatment with testosterone is often clinically supported and recommended.