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"good enough" care at HMO
Apr 16, 2003

I've survived AIDS for 21 years. I now find myself at an HMO who believes "less is more" when it comes to treatment. My testosterone is just over the line by a few points - so no therapy is "authorized" - however, I'm down, depressed, fatigued and have 0 sex drive. (211 t-cells) What can I do to help get back to feeling good, with an HMO who goes by the rules? (when it suits them)

signed, tab

Response from Dr. Frascino

Hey Tab,

21 years!?! Yes, you are indeed a "survivor" and now is no time to be voted off the island due to HMO madness.

Are you seeing an HIV/AIDS specialist? If not, you should be. And Im not talking about some doctor the HMO designates (often magically) as a specialist. Check the American Academy of HIV Medicine (www.aahiv.org) for a list of specialists in your area. A second opinion might be all you need to encourage your HMO to be more reasonable. An outside AIDS specialist can also review your current medical management antiretrovirals, what tests to run, and how often they should be measured, etc.

Lets start with some brief facts about low testosterone. Its the most common hormonal energy-zapper for us HIVers. It affects 25-45 percent of all male positoids! Common symptoms include fatigue; depression; decreased appetite, weight, muscle mass, and bone mass; and lets not forget to mention decreased "boners" as well! That your total testosterone level is just squeaking into the very lowest end of the "normal" range does not mean you are not experiencing hypogonadism. That very low-normal range may be fine for Bob Dole (with or without Viagra) or Strom Thurmond, but not for a young stud muffin like you. First thing to do is insist that your HMO doctor check your "free" testosterone. Testosterone, as it turns out, is measured as a total of 2 components "free" and "protein-bound." Only the "free" testosterone is active to induce all the wonderful benefits of this marvelous hormone. If your "free" testosterone is low and Id be willing to bet my weight in HMO red-tape pre-approval forms it is then your HMO has no right to deny you testosterone replacement therapy. You can show them its "out of the normal range." If they still refuse, you could always mention something about your brother the medical malpractice lawyer (you do remember that long lost brother, dont you?).

HMOs can be difficult to work with, but Ive found that squeaky wheels (especially squeaky well informed wheels) will indeed get the grease in these settings. So Tab, start squeaking. And save the "grease," because youre going to need the extra lube when you get your mojo back up in working order! Good luck.

Dr. Bob


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