FAQ's

Maybe.  As health insurance costs continue to skyrocket many people are choosing high-deductible health plans (HDHP) with annual family deductibles as high as $10,000.  This means that you will pay the first $10,000 of health care expenses each year out of pocket!  In order to encourage saving money to help pay these inevitable expenses, HDHPs make the participant eligible to participate in a tax advantaged health savings accounts (HSA).  An HSA is a savings account specifically designed to offset the expenses of an HDHP and it can be used to cover the cost of a wide variety of health care expenditures.  Unfortunately, under current tax law the IRS views direct pay membership, like Primal, as a form of “health plan”.  In the eyes of the IRS your HDHP would be your “primary” plan and your Primal membership would be considered a “secondary” plan which makes it a nonqualified HSA expense.  Hopefully this changes someday, but as of right now you cannot use your HSA to pay your Primal membership fees. 

While your membership fee can’t be paid using an HSA, the initial evaluation fee and costs of any medications and labs can be paid directly from your HSA.  

No.  Currently all of our providers only maintain Washington state medical licenses.

Yes.  The DEA has temporarily changed the controlled substances prescribing guidelines because of COVID-19.  In order to initiate therapy, you do not need an in person visit at the clinic.  You must have a real-time, audio-visual telehealth visit in addition to having the symptoms and supporting laboratory values demonstrating the medical need for TRT.  Patients can still come to the clinic for evaluation by appointment and we offer in-home visits* for patients in Thurston County, but 100% telehealth TRT is now available.

*In home visits temporarily suspended due to COVID-19

This depends on the type of membership you have selected.  Our Primal Foundations membership includes your ongoing personalized treatmentent plan with discounted lab fees and supplements.  The Primal Foundations plan is great for individuals who don’t require controlled substance prescriptions for their medical therapy.  Our Primal Flex plan is designed for indviduals who need prescritpions for controlled substances to manage their hormone optimization needs.  Specifically, this plan is for individuals requiring testosterone and/or growth hormone as part of their plans.  

In both programs your membership fee covers our operating costs, professional fees, program adjustments, all appointments, communications, and writing of prescriptions.

Your membership DOES NOT cover the cost of medications, supplements, or labs.

Medication costs are paid directly to the pharmacy.  Supplements may be sourced from anywhere, but those purchased through the clinic are eligible for your member discount or 10% (Primal Foundations) or 15% (Primal Flex).

All labs are billed through the clinic with your member discount applied.

Complete blood count (CBC) – measurement of your blood cell lines including red blood cells, white blood cells, and platelets.  Monitored primarily for polycythemia to determine if blood donation is required but can be used to diagnose a wide range of medical conditions.

Comprehensive metabolic panel (CMP) – evaluation of your electrolytes and functioning of your kidneys and liver.

DHEA – hormone produced mainly in adrenal glands which is converted into testosterone.  Used to assess adrenal function and assist in diagnosing cause of low testosterone levels.

Estradiol, sensitive – estrogen found in low levels in men, requiring sensitive assay that can more accurately report low levels.  Aromatized from testosterone which can lead to increased levels in men on TRT.

Follicle stimulating hormone (FSH) – hormone released from the pituitary gland in response to gonadotropin releasing hormone (GnRH).  Stimulates Sertoli cells in the testicles for the production of sperm.  Helps to determine cause of low testosterone.

Luteinizing hormone (LH) – hormone released from the pituitary gland in response to GnRH.  Stimulates Leydig cells in the testicles for the production of testosterone.  Helps to determine cause of low testosterone.

Lipid Panel – cholesterol measurements to assess cardiovascular risk over time and monitor for HDL suppression on TRT.

Prolactin – hormone released from the pituitary which can suppress GnRH and FSH leading to low T and sexual dysfunction.

Prostate specific antigen (PSA) – Released by prostate and can elevate in conditions that cause prostate inflammation, benign prostatic hypertrophy, and screen for prostate cancer.

Sex hormone binding globulin (SHBG) – glycoprotein that strongly binds most of the testosterone in your body 

Testosterone, total – total testosterone level including free, strongly bound (SHBG), and weakly bound (albumin)

Testosterone, free – level of testosterone that is not bound to carrier protein.  This represents only about 2% of the testosterone in your body.

At Primal we take a comprehensive and wholistic approach in developing an individualized plan to get you feeling great again.  Sometimes this may include medications in addition to testosterone.  If your provider believes you would benefit from additional medications then you will get low-cost pricing through our network of  compounding pharmacies across the US.  

There are no age restrictions for testosterone replacement therapy.  Androgen deficiency is typically associated with older men, but because of a variety of reasons testosterone deficiency is affecting men at younger ages.  Approximately 40% of men over age 45 have low testosterone and on average testosterone levels are decreasing at 1% per year.  The reasons are myriad, but all men suffering from the symptoms of low testosterone whose lab work is consistent with hypogonadism can benefit from testosterone supplementation.  Generally speaking, older men tend to have more chronic health issues and may require a primary doctor to help address their other health care issues before being cleared to participate in our program.

Low testosterone levels are typically the result of improper signaling from the brain or the inability to produce sufficient quantities of testosterone in the testicles.  In either case, men suffering from low testosterone levels, by definition, are producing inadequate levels of natural testosterone.  When a patient begins a TRT program they start introducing exogenous (external) testosterone into their system.  This brings their testosterone levels back to an optimal condition and they feel better.  This also interferes with the bodies signaling and production pathway so natural testosterone production is further decreased.  If the TRT program is stopped the brain with detect the low levels of testosterone in the system and begin signaling the testicles to produce natural testosterone again.  However, this production will most likely return to the patient’s natural baseline, which was originally inadequate, so all the of symptoms of low testosterone will return.

Every patient has a unique set of circumstances that effect how quickly they will experience a response from testosterone injections.  Severity of symptoms, underlying medical conditions and medications, body fat percentage, goals of therapy, etc. all play a role in how fast a patient will notice changes.  Most patients will notice changes within one month.  Some patients notice changes right away and some patients will have more gradual changes noticed over 2-3 months.  Typically, the first symptoms to improve are your sex drive and quality and frequency of erections with more subtle changes in mood, energy, and sense of well-being occurring after months of treatment.  During your follow up encounters we will review your response to therapy, recheck labs, and discussing alternative treatment options if needed.

This depends on why you are on therpay.  For members suffering the long-term effects of TBI our goal is to place your brain in a neuropermissive environment using a variety of supplements and hormone therapies that will allow you to heal over time and return to, or move towards, a pre-injury state.  As your body returns to a healthy homeostasis we are typically able to titrate your medications down and/or eliminate some.  This same strategy is often effective for men who come to us very overweight and do not exercise.  As you begin an exercise program, adjust your diet, and lose weight you will often find that your testosterone injections can be decreased or eliminated in favor of medications that work with your body to produce a healthy level of testosterone on your own.

However, androgen deficiency related to age and tesiticular hypofunctionis a chronic medical condition.  There are some temporary conditions such as short term physical or emotional stress, infection, or trauma that can cause decreases in natural testosterone production, but levels usually return to normal once the inciting event resolves.  Men who are experiencing the effects of low testosterone and are looking for a TRT program have typically been having symptoms for months, if not years, before they seek therapy.  In this case, on-going therapy will be required to reduce or relieve the symptoms.  Just as will other common medical conditions (diabetes, hypertension, hypothyroidism, etc.), a man suffering from chronic hypogonadism requiring testosterone supplementation can expect to be on therapy indefinitely if he wants to feel his best.

Injections have been the preferred delivery method for decades.  Intramuscular or subcutaneous testosterone cypionate provides a safe and effective delivery method that allows for easy titration of medication to keep you at optimal testosterone levels to alleviate your symptoms while mitigating side effects.  They work rapidly, provide easy and accurate dosing, and cause no accidental medication exposure to loved ones.  

Topical testosterone includes a variety of transdermal delivery systems including gels, creams, and patches.  The main benefit of these systems if that there are no needles involved.  For patients that just can’t get over the idea of regular injections this is clearly a benefit though it has been our experience that with proper education and training very rarely is this an insurmountable hurdle.  There are a number of significant drawbacks to topical therapies including skin irritation, difficulty making dosage adjustments, varying degrees of absorption, increased risk of hair loss, and expense.  Most importantly, there is the risk of accidently exposing loved ones through physical contact.  At Primal, we do offer a topical testosterone membership plan after careful consideration of the patient’s specific situation.

There are several different options for type and frequency of injection.  Your therapy will be tailored to you.  It is not uncommon for clinics to require you to come into the office for your injection.  In some cases, we have seen patients receiving injections for “TRT” up to every four weeks!  This is completely unacceptable.  At Primal you will be doing injections, at least once per week, in the comfort of your own home.  In our opinion, the best type of therapy is daily, superficial intramuscular injections of testosterone cypionate but we understand that isn’t an option for many patients, for one reason or another.  That is why our providers work with each patient individually to come up with a schedule that works for them.

Any medical therapy has both wanted and unwanted effects.  There is no difference with TRT.  The side effects that we see with TRT are related to the increased levels of testosterone and the natural metabolism of that testosterone in the body.  Some of these side effects include an increase in red blood cells, oiliness of the skin, stimulating non-cancerous prostate growth, decreased sperm production, fluid retention, mood swings, and breast sensitivity/gynecomastia.  The good news is that all of these symptoms can be anticipated, screened for, and treated.  

For more information see “TRT Fundamentals”

As often as is needed.  Regular laboratory evaluation is critical to any safe and successful TRT program.  At a minimum you will have an initial set of labs drawn before starting TRT with us.  You will have another set drawn 2-3 months after initiation to assess your response to therapy.  You will continue to have labs drawn at 2-3 month intervals until your lab work has stabilized at higher testosterone levels and your symptoms have resolved.  Once your labs and symptoms have stabilized you will be transitioned to a 6 month follow up schedule and if stable there over 18 months are eligible for a 12 month follow up schedule.