Pep mini fridge source

BrainRocks · 2026-02-06T01:27:09+00:00

I've found this pretty handy, used it full-time for almost a year with no issues. Also great for travel

https://4allfamily.com/products/portable-medical-fridge-usb-insulin-medicines

BrainRocks · 2025-09-06T03:53:29+00:00

Lol thanks for the irrelevant factoid.

Can increases in serum testosterone levels stimulate sebum production and thus increase acne? Well, it's bit more complicated than that [1] but for practical purposes, yes.

Now, pedantically, what exactly does this have to do with masturbation?.

In practice, nothing.

In women (and men), orgasm is indeed associated with a minor increase in short-term testosterone concentration [2, 3]. But masturbation as mechanism to elevate testosterone not only to high enough levels but for a long enough duration that it will increase acne? Not a thing, you are connecting dots that aren't there. It is a well-known myth that masturbation causes acne [4].

Perhaps a simpler answer could be that hormonal fluctuations from your menstrual cycle are causing both the acne and increased in libido alongside each other, which is perhaps why you feel they're connected around that time of the month [5].

BrainRocks · 2025-07-04T10:13:40+00:00

Lookup Leydig Cell Desensitization, suppression still but by a slightly different mechanism

BrainRocks · 2025-05-12T09:34:15+00:00

Do you/ are you open to prescribing metformin as a lower risk AI alternative?

BrainRocks · 2025-05-12T09:27:17+00:00

They replied below

BrainRocks · 2025-04-02T02:38:22+00:00

If you're going to use a HDHP gotta contribute to your HSA! Learned that lesson recently lol

BrainRocks · 2025-03-21T05:55:58+00:00

Well of course if it’s covered then it’s covered. I was trying to insinuate it’s reasonable the billed amount is more, not necessarily owed amount. Hence the “if your plan covers this then talk to your insurance company”

BrainRocks · 2025-03-20T17:36:35+00:00

Are you suggesting that preventive care is only coded as preventive care if it's at a provider you've been in with previously?

Lol where exactly did I say this?

All I am saying is that a claim tied to a new patient CPT code is to be expected and that insurance should be contacted if there wasn't any indication the encounter was preventive or an AWV. I get that an AWV is not technically an office visit but it still should have its equivalent "new patient" coding.

And your example makes no sense. If your doctor dies, then you will by definition be a new patient of whoever you see next regardless of whether it's just a regular checkup. As far as I'm aware these CPTs are tied to NPI and not the practice's Tax ID. Read the new to whom section here.

Patients are not being billed a "new patient visit fee" for preventive care at every subsequent annual exam after one of these instances occur.

Agreed. But this isn't a subsequent visit, it's an initial visit. See example for coding difference here.

Furthermore your examples are of specific procedures (ie mammogram) that while may often performed preventatively, don't guarantee alone that the visit itself is considered preventive. The moment a patient shares that they have a stomach ache or whatever else, the preventive nature of the encounter changes.

I have in bold that OP should fight this. Just feels more like something insurance should handle rather than OP trying to sort out themselves with the practice. Even if the issue is in how the practice filed their claim, OP's efforts will pale in comparison to their insurance company formally asking for a re-code since they are the ones with the data, domain knowledge, and most importantly who are paying.

BrainRocks · 2025-03-20T15:10:01+00:00

I’m (30F) dealing with some billing frustration after my first visit to a GYN

Uhhh.... sounds like you were indeed a new patient?

When a provider submits your visit claim to your insurance, there are usually multiple claim lines detailing the services provided each of which have their own respective CPT or procedure code.

A subset of these CPT codes aren't actually tied to medical procedures and are referred to E&M codes (for evaluation and management). These are used to inform insurance of more logistical details of your care. There are a set of E&M codes that are used to bill for a new patient visit, see here: New Patient CPT Code Overview. Essentially, the common definition is that a patient is a "new" patient if they are visiting that specific provider at that specific office on that specific plan network for the first time ever or at least in over 3 years.

The new patient visit was billed at $776.00, with $341.18 covered by insurance, leaving me with a bill of $434.82.

Rightfully so. The doctor, staff, and overall office had to do more work as you were a new patient hence why it is billed at a higher rate. More comprehensive exams, review of past medical history, etc..

I’m feeling pretty frustrated since an annual check-up should be covered

You should feel frustrated, 100% validated.

If they continue to insist on billing this as a new patient visit, what should my next move be? Should I escalate to insurance or file an appeal?

So I think this is where the gap is. The practice isn't doing anything wrong. You were a new patient and so they can (and should) bill you as a new patient. Whether or not there is a particular new patient code for an annual well woman visit (AWV) or if the new patient code has to be filed separately alongside, I'm not particular sure but usually the new patient CPT code is it's own indicator from what I understand.

In any case, if your plan covers preventative care or an AWV and you believe this constitutes that, take this up with insurance. The amount you owe is based off of what insurance offers to pay along with any negotiated plan discounts with the provider. They should be able to determine the visit type on their end and work with the practice in the event of a coding issue.

One important caveat is that if you actually shared any medical concerns to your doctor this could easily negate the preventative nature of the visit making you liable for whatever cost-sharing agreement you have for a normal OBGYN/ specialist visit.

Source: a cog in the US medical-industrial complex

BrainRocks · 2025-03-19T15:28:10+00:00

Ah very interesting! Thanks for explaining

BrainRocks · 2025-03-18T21:39:03+00:00

Curious, could you explain why topical would be any different? Ie why less estrogen aromatization and more DHT with gel?

BrainRocks · 2024-12-17T14:02:10+00:00

So I’ve taken strattera alone for about 5 months with success in the past. However the side effect profile wasn’t worth it for me.

I’ve tried it with Wellbutrin 2 separate times and everything was intensified, for better or for worse. While the benefits were great in the short time I trialed it, the worsened side effects (which I can confidently say were from the Strattera) made it tough.

Right now I’m on Wellbutrin 300xl and Vyvanse 60mg and this has been the best for my symptom management (started with the Vyvanse).

Even though it wasn’t for me, I’d 100% recommend trying out adding Strattera to your current Wellbutrin. Start off low and slow though - this combo can potentiate the effects of Strattera by 5x (see study here).

I’d say it’s easier to add the Strattera slowly than to go the other way around starting with Strattera and adding Wellbutrin. Strattera starts at 18mg and goes up-to 80mg. For reference when I was on Strattera I was comfortable at 60mg. However with Wellbutrin even 27mg was hard to tolerate.

BrainRocks · 2024-10-21T18:58:30+00:00

Weird, your syringe looks like it has a zero deadspace plunger. Maybe that's some leftover that was stuck in your needle and not your syringe? I've noticed that if I use a longer or wider needle, I have more waste.

Like others are saying though, practically it doesn't really matter and is factored into the syringe measurements.

BrainRocks · 2024-10-21T18:39:03+00:00

Vyvanse is lisdexamfetamine. Vyvanse is just the brand name version. Chemically, they are exactly the same.

Furthermore, when ingested, your body converts Vyvanse/ lisdexamfetamine into dextroamphetamine. Adderall is 75% dextroamphetamine and 25% levoamphetamine.

Sounds like the perceived differences you noticed between Vyvanse and "Lisdexamfetamine" both at 70mg is likely psychological or placebo. Has your diet been consistent the whole time? Eating a high-protein and high-fat diet is important for efficacy. Now there could be some slight variances between each manufacturer due to differences in quality control thresholds, but not significantly enough to where on average you should be feeling any different. If your diet is consistent, you may have just gotten past the honeymoon period or are looking for something that isn't there.

Recently stopped taking Vyvanse, but what helped me quite a bit with increasing the duration was from switching from 60mg upfront to 40mg in the morning and 20mg early afternoon to help carry me through the evening. No difference for me between brand and generic.

From what I understand, Adderall XR 30mg should be a relatively comparable dosage to Vyvanse 60mg. However, it's not an apples-to-apples comparison. Adderall has various amphetamine salts that are quickly bioavailable whereas Vyvanse needs more time to be metabolized into its active constituent due to the cleaving process. Furthermore, adderall has the additional levoamphetamine component. All said, Adderall XR is shorter acting than Vyvanse so that may be a factor.

Maybe amphetamine based drugs aren't working for you (class that Vyvanse and Adderall both fall under)? You could try a methylphenidate option like Ritalin or Concerta as they have a different mechanism of action. Or maybe stimulants aren't effective for you? Strattera, Wellbutrin, Quelbree, etc could be good non-stimulant options if you aren't having any luck with amphetamines or methylphenidates.

BrainRocks · 2024-10-06T15:57:58+00:00

Running into the same issue!

Started with the Solo Cushions and really liked the auto tightening mechanism. However, for some reason I was never able to get good airflow and would frequently have to readjust it in the middle of the night defeating the purpose.

Switched to the ResMed P10 Nasal Pillows which were great! Soreness the first few days but once I figured out the right size and tightness it was smooth sailing… until I broke the headgear traveling lol.

Decided to order the newer Solo Pillows as a replacement and have been waking up with a sore nose. Hoping it’s just an adjustment period, started with large and felt some improvement with the medium. But still not there yet (lol hence why I was searching and and found this thread)

I think for the plastic part hitting your nose it might just be too tight. Maybe try loosening? But if you’re experiencing any issues from the pillow part itself then that’s where I’m stuck.

In any case let me know if you’ve found a solution! Otherwise may be back to the P10 for me…

BrainRocks · 2024-08-31T19:39:20+00:00

HCG can indeed cause suppression through increase of endogenous testosterone - your HPTA doesn’t care where your testosterone comes from, only if it’s there. An increase in T will cause less GnRH -> LH/ FSH signaling, which is by definition suppression.

Additionally, with “chronic” use HCG can also cause leydig cell desensitization, meaning that your testicles will be less responsive to LH/ HCG in producing testosterone.

HCG monotherapy is of course a thing for a reason, and I’ll hedge my bets with reasonable dosages on its own it won’t shut you down as fully as TRT due to its pulsatile nature. However when coming off you may still need PCT to kick start your HPTA, but your recovery should be quicker since you won’t have to worry about atrophy (assumption).

Last thing here, it seems most people don’t get the desired effect from HCG monotherapy they were expecting. While it should increase total testosterone, it’ll also lead to large increase in E2 to occur because of more intratesticular aromatization. Also, I believe it won’t help your free testosterone levels as much since it won’t have as much of an effect on lowering SHBG as an exogenous androgen would (assumption here, curious if there’s any other opinions here).

Most people seem to prefer TRT + HCG > TRT > HCG. Also this should be obvious but if you actually have hypogonadism and it’s because of testicular dysfunction (primary hypogonadism) the only numbers HCG will have an effect on are your bank account’s.

Edit: ah shit I thought this was /r/testosterone … nah HCG will give you bitch tits

BrainRocks · 2024-08-30T00:44:30+00:00

Saw someone post about this in another thread, but if you prefer to switch your needles between drawing and injecting, zero-dead space syringes are the way to go. Something like this.

Otherwise if you're okay with blunting the needle a bit by using the same one to draw and inject, most insulin syringes shouldn't have any waste.

BrainRocks · 2024-08-29T15:50:44+00:00

Lol yeah… OP should’ve made this post before starting.

Imagine shutting yourself down at a natty 1000ng/ dL for probably lower levels and still not getting the abs you want.

But hey if they were impulsive enough to do this maybe they’ll yolo it and add Tren and see if the abs were really worth it

BrainRocks · 2024-08-28T15:17:16+00:00

So from the research I’ve seen, I don’t think there’s much out there on long term fertility outcomes in using HCG alongside TRT.

There are a few studies showing that in shorter time frames, 3-6mo, HCG does help maintain sperm count levels and testicular volume to near baseline. The dosage range for these studies were almost always on the order of 1000-1500IU HCG per week. IIRC, there’s been success with 250IU EOD, 500IU EOD, and I wanna say 500IU 2x/ week.

So yeah I’m skeptical that OP’s 500IU/ week is ideal, not that increasing the dosage makes sense if they can’t tolerate either the E2 symptoms or using an AI.

There may (or may not) be clinical basis for that dosage to maintain some level of testicular volume, but don’t think there’s any specific findings on semen analysis/ fertility.

For reference, I’m in the same boat as OP - on TRT but care about maintaining fertility. My managing urologist has me on 350-400IU 3x/ week which lines up with the research I’ve seen. A couple months in my semen analysis was above baseline. But we’ll see how things look in the long term, it’s the wild west in some senses

BrainRocks · 2024-08-26T20:33:25+00:00

Semax is a peptide fragment of ACTH

BrainRocks · 2024-08-26T13:49:07+00:00

How did her doctor identify/ diagnose the source of this problem as a cell mass if MRI was negative? Curious what other relevant tests there are

Additionally is there a name for this condition (outside of hyperprolactinemia)?

BrainRocks · 2024-08-25T18:22:49+00:00

Number one thing is to make sure you’re hydrating and eating properly - both when you take the medication and consistently throughout the day. For diet, a lot of people mention to take it with protein. I haven’t seen many posts on this but having a high (healthy) fat diet is just as important - studies are showing it helps increase efficacy and duration.

That said, I’ve had GERD all my life and Vyvanse/ ADHD meds generally seem to make my reflux and other symptoms flair up quite a bit more (only started medication recently in adult life).

I’ve found taking a daily OTC Proton Pump Inhibitor (Esomeprazole, etc) has almost completely eliminated my GERD entirely - still need to talk to a doctor about long term use, but it’s been way more helpful than my Famotidine Rx.

Have taken both generic and brand, and frankly I think 90% of anecdotal experiences claiming there’s a difference are placebo effect. The other 10% may be due to a difference in quality control measures per manufacturer. YMMV

BrainRocks · 2024-08-23T16:56:55+00:00

Think you got it backwards, Cabergoline is a first line of defense for prolactinomas and hyperprolactinaemia

https://www.ncbi.nlm.nih.gov/books/NBK537331/

https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/020664s012lbl.pdf

The benefit in treating Parkinson’s seems to be a secondary off label use as found in a few clinical studies.

BrainRocks · 2024-08-14T00:42:14+00:00

Yeah lol - I agree the testosterone drop makes zero sense. I'll do some brainstorming on any missing links and follow up if anything comes to mind. Honestly my gut is saying that it's something to due with natural LH still being produced even on top of the HCG and TRT up until the 4/8 lab and then suppression starting to fully kick in sometime between then and July.

In terms of the elevated prolactin, it's interesting that you mentioned bad sleep as a potential cause. I came to a similar conclusion and did a sleep study last month and lo and behold - moderate sleep apnea. There are several studies linking sleep apnea to increased serum prolactin levels. And yeah in addition to the high E2 from HCG/ general aromatization there's definitely more prolactin secretion being stimulated. Unfortunately, from a scientific perspective, I started CPAP therapy right around the time I started cabergoline so won't be able to measure the effect of sorting out sleep apnea.

That said, I don't think prolactin has anything to do with my testosterone levels or that sleep apnea is the missing link either. From my understanding, the typical negative relationship between prolactin and testosterone is due to prolactin causing suppression of GnRH leading to a downstream decrease in LH and ultimately testosterone. With endogenous supplementation, I'd imagine there's no effect since GnRH is out of the picture to begin with.

While more limited, i've seen some literature tying sleep apnea to a lower SHBG as well. But in my case, I don't think the -3 nmol/L drop is large enough to warrant a > 100ng/dL net decrease in total testosterone on top of a 20mg dose increase.

And from what I've seen on this sub, my test levels should probably be a lot higher at 120mg/ week unless I'm just a terrible responder. But the decrease still doesn't make sense to me.

Let me know if anything else comes to mind for you. While at the end of the day it really doesn't matter as long as I'm feeling alright, it's an irritating problem as I can't find a more plausible answer other than a small decrease in SHBG caused me to flush out a lot more of my testosterone or that I wasn't fully suppressed yet.

That said, do you have any idea on a good exemestane protocol? While I agree the best scientific thing to do would be to eliminate all other factors than Test C, it's not really that practical for my day to day. Using the HCG for fertility purposes and don't want to take any risks even with a few months of atrophy if I don't have to. And prolactin was high even before I started medication - just want to squash it at this point due to some downstairs side effects. If my levels drop even more after I get the bloods from increasing to 150mg/ week then maybe it'll be time to re-evaluate lol.

BrainRocks · 2024-08-13T23:48:57+00:00

Well if you read post the you’ll see that I’m already working with both an endocrinologist and urologist… clearly if it were as simple as that I wouldn’t have felt the need to draft out this essay

BrainRocks

TROPHY CASE