Note – This is the final of a four-part series. Click here for Part 1, here for Part 2 on symptoms, and here for Part 3 regarding my TRT results.
Update 2/01/2016: After a brief hiatus, LowTestosterone.com (now PrimeBody.com) is once again taking patients. Use the code Lewis27 to get a free consultation, $25 off your monthly fee, and another 10% off your first month.
After my low testosterone diagnosis in March 2014, I was chomping at the bit to begin correcting my problem.
Little did I know at that time that I was still 5 months away from finding a medical provider who understood what I needed and was ready to help me receive adequate treatment.
If you're struggling with low T symptoms or a low T diagnosis, the last thing you should have to deal with is a resistant medical professional.
Many doctors are hesitant to provide treatment, while others are willing but unfamiliar with the most current, safe, and effective methods and complementary medications.
These are major barriers to entry for most guys in need of TRT.
I encountered all of this first hand and, after many hours of online research, was relieved to find LowTestosterone.com (PrimeBody.com).
I've been a customer with them for a little over a year now and the difference between them and my previous doctors is unbelievable.
Below, I'm going to share my struggles with two different doctors and then my experience with the good folks at LowTestosterone.com (PrimeBody.com).
But, before you know what to look for in a care provider, it's important to know what constitutes optimal treatment.
What is the ideal treatment protocol?
While testosterone replacement therapy is still a relatively young field and will likely continue to evolve over time, there are definitely better approaches to treatment emerging.
Not all delivery methods are created equal, sometimes other medications are needed, and the timing of all these factors can play a huge role in your results.
So let's take some time to discuss these factors in greater detail.
The problem with testosterone gels
Although extremely popular due to heavy marketing, gels tend to be hit or miss.
They’re highly dependent on absorbency, which can vary from person to person and day to day.
Most men have great success with gels at first as they’re very fast acting (peak within a day), but first hand accounts report that they become less effective over time.
The thickness of the skin at the application site can affect absorbency. So applying to your shoulders one day and your flanks the next may result in slightly different dosing.
Whether or not you use your hands or another object for application is also a factor as a portion of the medication can be lost in the thick skin of the palms and never make it to the blood stream.
The hydration status of the your skin should be considered. Moisturizing is important, but you have to be careful not to use a lotion with an oil base as it'll block absorption of your gel.
There's also the risk of transferring testosterone to others through physical contact. At the time I was seeking treatment, my wife and I were trying to conceive, so gels were definitely out for me.
There's also the inconvenience of daily application and timing considerations for water sports or extreme sweat-inducing activities.
In a nutshell, there are simply too many variables with topical applications.
One thing to note about using creams and gels is that they closely mimic the natural fluctuations in testosterone throughout the day. You get a spike of testosterone in the morning after application, and then a dip as the day goes on.
Whether or not there is any benefit to this isn't apparent, but it's worth mentioning that gels provide a more natural hormonal rhythm which may prove to be beneficial in the future.
Why choose injections
When manipulating hormones, accuracy and consistency are essential. And that means injections are best.
What is the ideal injection frequency?
If a doctor is pushing anything less frequent than once weekly injections, run the other way.
Guys who receive large but infrequent injections typically feel like Superman for the first 5 to 7 days, but feel worse than before they started treatment in the next week or weeks that follow.
This is due to the exogenous testosterone suppressing natural production. So once the supplemental testosterone leaves the body (with a half life of 8 to 12 days), you're left with levels worse than when you started.
So you're basically out of luck until your next injection.
Just know that weekly or twice weekly injections are best. And for that, your doctor needs to be okay with you doing self-injections.
One shortcoming of injections, aside from having to stab yourself, is that they don't provide a normal fluctuation throughout the day as gels do.
After injection, testosterone levels slowly rise, peak around Day 3, and then slowly diminish over the next few days.
hCG and AI
As I mentioned in An Intro to Testosterone and TRT, it's important to be mindful of the body's response to hormone manipulation
This is a major pain point for most patients. Not because it's difficult to manage, but because a lot of care providers prescribe the bare minimum medications and don't pursue optimal treatment.
Even if guys do manage to find a doctor willing to accept their symptoms as legitimate and prescribe testosterone, many have difficultly obtaining the supporting medications involved in optimal TRT.
Countless accounts of doctors refusing to prescribe hCG and an AI can be found on any forum.
Even in the presence of estrogenic side effects (like sore, puffy nipples) and atrophied testicles, many doctors will decline to prescribe an aromatase inhibitor or hCG.
This forces many patients to rely on inferior over-the-counter substitutes, make illegal purchases, or live with unnecessary side effects.
My experience finding treatment
I've mentioned that I had a difficult time finding the right doctor, but what was the process like, exactly?
Here's my experience from beginning to end.
Strike 1: General Practitioner
My first step was to see my existing general practitioner.
I told her about my symptoms, describing my anxiety, depression, and complete inability to gain muscle.
I’m pretty sure she just heard that I wanted to be a bodybuilder and was looking for legal steroids, because she completely disregarded everything I said.
She actually commented that, “all these things are probably just mental.”
This felt like a slap in the face. I'm generally a very private person and have never felt comfortable talking about medical issues, even with doctors.
It took a lot for me to admit these weaknesses, as I tend to take the “show no vulnerability” approach to life.
But I could feel that something was wrong with me and I needed help.
Her resistance to even consider a blood test infuriated me. After some convincing though, she finally agreed to order the hormone screening (just to humor me).
If you want to skip this haggling process, get your blood work done through Primebody.com and get a free consultation, $25 off your monthly fee, and an additional 10% off your first month and when you use the code Lewis27.
When my total testosterone came back at 289 ng/dL, she thought there must’ve been a mistake (even though the test was taken under ideal conditions – within two hours of waking up and fasted).
She had me come in for blood work again, and this time the results were 287 ng/dL.
Despite initially thinking my results were so low there was an error, she concluded that since I was near the very bottom of the reference range that particular lab was using, everything was fine.
Never mind my description of symptoms.
It was a very helpless, lonely feeling to finally figure out what could be causing all of my problems, but to not have anyone in my corner to help me with a real solution.
I insisted on discussing treatment, so she reluctantly referred me to a urologist.
Strike 2: Urologist
The urologist wanted me to have blood drawn again and it came back at 292 ng/dL. This was obviously low but he wanted to test for additional hormones, so he ordered yet another draw.
The fourth came back with a total testosterone of 225 ng/dL. This blood test was taken about 3 or 4 hours after I woke up so I was showing a normal decline throughout the day.
This makes 4 needles in my arm, many tubes of blood, and a significant time frame just to come to the same conclusion:
My testosterone was low as fuck!
Because he didn’t want to rush into putting a 28-year old man on testosterone (a very wise choice), my doctor put me on hCG mono therapy which is a lower intervention attempt at raising testosterone levels.
The idea is that, rather than introducing a synthetic version of testosterone, using hCG to mimic luteinizing hormone (LH) will stimulate the testes to produce more testosterone.
There was some initial lag time between being prescribed hCG and actually beginning my treatment.
At first, my insurance company refused to pay for the medication since they classified it as a fertility treatment and not hormone replacement.
Without insurance, a single vial of hCG was going to cost $270! I declined until I could straighten things out.
Luckily, I was able to get the medication approved over the course of many weeks and dozens of phone calls acting as a middleman between my urologist and the insurance company.
When I went in for my follow-up blood work after 6 weeks of hCG, I no longer had insurance, and was paying out of pocket.
I ended up being billed $930 for blood work alone!
I received a discount for paying in full up front, but it was still an outrageous sum.
Six weeks of hCG mono therapy brought my TT up to 451 ng/dL. However, my free T was still at 7.2 with a reference range of 9.3 – 26.5. So the number that actually mattered wasn’t even in the ball park.
Basically, a sedentary, 80-year old man still had higher free testosterone than myself.
Since the hCG was marginally effective at best (I didn’t actually feel a relief of symptoms), I inquired about testosterone.
My urologist started talking about creams and gels. Given the hit-or-miss nature of topicals, I wasn't interested in taking a gamble on manipulating my hormones and asked about injections.
At that point, he looked toward the ceiling, thought for a minute, and said that he was pretty sure he could do an in-office injection every month or maybe every two weeks if I wanted to go that route.
And that was it for me.
These medical professionals were basically useless and I was tired of being jerked around.
It was becoming emotionally and financially exhausting bouncing around from doctor to doctor.
So it was back to the drawing board for a while, but after much research, I finally found LowTestosterone.com (now PrimeBody.com).
And it changed my life.
Home run: LowTestosterone.com (Now PrimeBody.com)
The first thing that I have to point out is that this isn't an anti-aging clinic with salesmen dressed in lab coats.
All of the doctors in the network are legitimate, licensed professionals. My doctor, for example, has been practicing family medicine for over 25 years.
Blood is drawn by phlebotomists and analyzed by established labs (I use LabCorp).
LowTestosterone.com (PrimeBody.com) essentially acts as a manager between you and a network of doctors, labs, and a pharmacy that provides your treatment. Through sheer numbers, they’ve been able to negotiate very reasonable rates for TRT.
As an Iron & Tweed reader, all you pay is a $225 (regular $250) flat fee per month.
This covers the cost of everything you need including doctors visits, blood work (remember my $930 bill?), medications, and medical supplies.
The medications included are testosterone, hCG, and an aromatize inhibitor if you need it. This is the most current and safe combination for lifelong hormone replacement therapy.
There are no initiation fees, co-pays, or other hidden charges, just $225 per month for life changing treatment.
I've been using this company for a little over a year now and have never paid a single dollar other than the above mentioned costs.
My Experience with LowTestosterone.com (PrimeBody.com)
I currently get all of my TRT-related medical care through LowTestosterone.com (PrimeBody.com) and it's been an overwhelming positive experience.
Here is my breakdown of the different components that comprise my care with LowTestosterone.com (Primebody.com).
As I noted earlier, I initially struggled with doctors who either didn't care or didn't know how to properly treat me.
Having a severe hormone deficiency was bad enough without adding an adversarial relationship with my doctor and having to direct the diagnostic and treatment process to the list.
I've actually been severely underwhelmed by every doctor I've had in my entire life.
They all seemed to dismiss any symptoms I brought up (from my back pain, which I later found out was due to a herniated disk and broken vertebrae, to scary headaches brought on during heavy lifting), so I'd never had a positive experience with a medical professional.
Since my first two doctors were under-educated on TRT and resistant to provide treatment, much of the burden of learning about proper treatment fell on me.
So I was pleasantly surprised to find that my doctor through LowTestosterone.com (PrimeBody.com) was very knowledgeable.
When I went in for my first visit, he told me that my levels were low enough to proceed and he began discussing treatment.
I was impressed because everything he was saying aligned with the most current and optimal treatment procedures and medications I'd spent so long researching.
What a relief to have a doctor I trusted to take the reigns on my treatment!
Not only does he excel at treating low testosterone, he puts me at ease when I'm discussing my treatment. I can tell him about my initially shrunken testes, emotional progress, and body composition changes without fear.
While I can't vouch for every doctor in the LowTestosterone.com (PrimeBody.com) network, it should at least be reassuring that all of these doctors have willingly joined a network of medical professionals who specialize in providing TRT.
Medications and Supplies
After the first visit, your doctor will call in the necessary prescriptions.
The pharmacy will then call you to confirm your address, and the medications and supplies are shipped right to your door.
This includes testosterone cypionate, hCG, an aromatase inhibitor, syringes, needles, mixing supplies, and even alcohol wipes.
I was relieved when my first shipments arrived in discrete packaging (from LT LLC) with all the medications and supplies carefully packed away inside.
Regardless of how many medications you need and in what quantities, the monthly price is the same $225 when you use the code Lewis27.
When you're two weeks out from needing a refill, you'll login to your user account, fill out a simple refill request, and wait for the pharmacy to call you.
USER TIP: To ensure prompt refills, I like to call customer service after my prescription arrives and ask when the earliest date that I can request my next refill will be. I then set a reminder in my phone for that date. When my alarm goes off, I hop online and complete the form to order the refill.
After the initial blood test to determine whether you qualify for treatment, once TRT begins, you're scheduled for further blood work at the 6-week mark, the 6-month mark, and then every 6 months after that.
The process of arranging blood tests is all done online.
You login to your user account, download and print the forms, and make an appointment at the lab nearest to you.
You head into the lab for blood draw and they take care of the rest.
The doctors partnered with LowTestosterone.com (PrimeBody.com) actually know what hormones need to be screened so you don't have to mess around with inept doctors and numerous, unnecessary blood draws like I did.
When the lab finishes the analysis, the results are provided directly to your doctor and uploaded to your account so you can view them before going for the annual in office visit.
If you're anything like me and enjoy being a proactive participant in your medical care, this is a perfect set-up.
My experience with LowTestosterone.com's (PrimeBody.com) customer service has been quite positive.
I haven't had much need to use them, since the program is so well constructed, but I have called on a few occasions.
The main reason I've had to reach out to customer service was because I missed a dose of testosterone.
That was entirely my fault because I waited until a few days before my next scheduled dose (which happened to be the day before a holiday weekend) to request my first refill.
They were very courteous in explaining where I had dropped the ball and how I could avoid the situation in the future and it hasn't been a problem since.
Every other time I've had to call them my questions and concerns were always addressed appropriately.
In addition to the administrators who provide general customer service, I can also speak with a nurse 24 hours a day with my immediate medical questions.
In the first few weeks of treatment, I was getting hard knots and soreness at the injection site and I was able to call a nurse and get advice on injection techniques.
The real value with LowTestosterone.com (PrimeBody.com) is skipping the stage where you go to multiple doctors, have blood drawn repeatedly, argue about treatment, drop a shit load of cash, and still end up unsatisfied with spotty, inadequate, or inappropriate treatment.
Please feel free to do your own research and read forums on the subject. If you do, you'll see that the vast majority of men have a really difficult time finding doctors willing to provide the treatment they need.
From a monetary standpoint, this is still a good deal.
There is a flat fee of $225 per month with the Iron & Tweed discount (Lewis27).
So I pay $45 dollars for refills every two and a half months (which totals a little over $200 a year on refills).
And that's with the highest commonly prescribed dose of testosterone, so I have to get a refill more often than others.
You'll end up paying roughly $2,700 per year to completely change your life.
You could easily spend that much going through your insurance company with co-pays and meeting deductibles.
How to Get TRT
If you’ve read this far in the series (roughly 11,000 words in), you’re likely concerned about your own testosterone levels.
Maybe some of these symptoms sound familiar to you and you’re wondering if a simple vial of oil can drastically improve your quality of life.
If you've already corrected any major lifestyle factors that needed to be addressed, but still aren't feeling the way you want, do yourself a favor and at least get your levels checked.
Update 2/01/2016: After a brief hiatus, LowTestosterone.com (now PrimeBody.com) is once again taking patients. Use the code Lewis27 to get a free consultation, $25 off your monthly fee, and 10% off your first month.
If everything comes back normal, great! You can move on.
And if you find out that you have a deficiency, you'll then have the opportunity to take control and live a better life.
Now, if your current doctor is on board with the tests (and potential treatments) necessary and you're able to get the doctor visits, diagnostics, and medications/supplies covered through your insurance, by all means, DO THAT!
No need to change course.
If, however, you're experiencing road block after road block like I did, I highly recommend LowTestosterone.com (PrimeBody.com).
Make sure to use the code Lewis27 to get a free consultation 10% off your first month.
If you choose to get tested through LowTestosterone.com (PrimeBody.com) and your levels come back just fine, they cover the cost of your initial blood work and you won't owe them anything.
And if you find that you do have low T, you'll have a team of doctors, nurses, administrators, and lab techs at the ready to help you deal with that diagnosis and start turning things around.
My Final Thoughts
I've shared a lot with you throughout the articles in this low T series.
But let me leave you with this – I now view my life as having two chapters:
Before testosterone and after testosterone.
Before testosterone, I was physically, emotionally, and mentally weak.
After testosterone, I’m a confident, strong, man who's improved every aspect of his life.
Iron & Tweed wouldn’t exist without TRT.
What's even better is knowing that this is just the beginning for me and there's plenty more ass to kick!
All the best!