Gray RETA and your Doctor / PCP

Birdie said:

I didn't, and I won't. Trying things his way cost me a great deal of time—these days, we do it my way. The 2 liver enzymes that kicked off the whole discussion ([[Q1]]) aren't a problem anymore.

Perhaps someday I'll come clean with him. More probably, though, I'll let him know exactly how useless and draining some of the hurdles he put me through turned out to be. There's nothing quite like being instructed to put on weight so a surgery would approve you, or being herded into a room with a crowd of people to be weighed like livestock before everyone sits through the same video, or having your intake cut down to a constantly shifting allowance of "points"—a system that, for someone who cooks at home like me, turns almost algebraic.

For the first time since I was 8 years old, I'm not on a diet. I eat real food, in appropriate amounts without obsession. IMO this medication has done as much for my mental health as it has my waistline, and I am not debating it with anyone who has not physically experienced obesity or deeply loved and respected someone who has.

Sorry if that was a downer. I guess the idea hit a nerve.
Click to expand...
Amen to that! The System <tm> handles the “very” ill terribly, and when your condition isn't severe enough, all you get is a shrug.

Or they take one of my symptoms and call it the diagnosis, rather than wondering: what might be behind this?

Three states, 8+ physicians, and a handful of mental health providers later — every single one just repeats what the last one did.

“How about checking Vitamin D?”

“Oh, everyone around here runs low.” 🤦‍♀️

That single basic add-on test set things in motion toward feeling better… and it could have happened in 2011 or before. Infuriating.

.

I understand you completely. I followed the “proper” path and it brought me nothing but sadness and misery. I refuse to spend the rest of my life that way.
 
Besides my GP visit a few weeks back, I've got an appointment with my cardiologist coming up in April. Last year he chewed me out because my weight climbed from 190 up to 209. This time around I figure I'll be sitting somewhere between 185 and 190lbs, so he should be pleased. He's definitely going to want to know what I did, and I'll most likely just say low carb. The guy's pretty sharp, though, so he may put 2 and 2 together.
 
ambot88 said:

I skipped any lab tests and kept my doctor in the dark. Still, part of me wishes I had baseline bloodwork done, if only to compare before and after.
Click to expand...
I'm in the same situation. I regret not getting baseline labs first. Instead, I went ahead and got blood work 4 weeks after starting reta and nad.

The results came back with low iron and borderline anemia. I don't know whether peptides could be responsible for that. I did have aquablation prostate surgery on Dec 22, and there was significant blood clotting. We'll see—I'll keep getting labs done and check whether my iron levels improve.
 
A month back I went in for my annual visit with my PA. Reta never came up in conversation, and even though I'd dropped roughly 20lbs, it wasn't brought up either. The appointment followed the normal pattern — "Anything you want to discuss? How is everything going? Any concerns/issues? Any questions for me?...". Besides the standard panel we typically run, I handed him a list I'd put together and asked for several additional blood tests; he was completely fine with ordering them. The following day the results came back along with his note that all numbers looked great, that they were an improvement over the previous year's, and to keep doing what I'm doing.
 
I keep my doctor informed about every substance I use. His only requests are that I stay current with bloodwork and keep him updated.

Before beginning anything, absolutely have bloodwork done.
 
Vash_ said:

I keep my doctor informed about every substance I use. His only requests are that I stay current with bloodwork and keep him updated.

Before beginning anything, absolutely have bloodwork done.
Click to expand...
Here’s how I handle it: as long as what I’m doing looks sensible and they aren’t the prescriber—so they aren’t the ones on the hook—my doctors don’t make much of a fuss.
 
After 30 years of being an adult, the medical field has made 1 thing very obvious to me. For most patients, their Primary Care provider acts as a Pharmaceutical liaison. Big Pharma pays them to prescribe particular medications. Patients are never told about this. That means if your Doctor objects to patients using compounded or off-label drugs, the pushback comes from profit margin, not from personal care. Always follow the money....
 
chewonmysac said:

After 30 years of being an adult, the medical field has made 1 thing very obvious to me. For most patients, their Primary Care provider acts as a Pharmaceutical liaison. Big Pharma pays them to prescribe particular medications. Patients are never told about this. That means if your Doctor objects to patients using compounded or off-label drugs, the pushback comes from profit margin, not from personal care. Always follow the money....
Click to expand...
To be fair, while a lot of physicians do get swayed by BP, plenty of them don't. On one visit to a doctor I hadn't seen before, I noticed other patients hauling in actual backpacks and little cases stuffed with prescriptions. Seeing how many medications some of those folks were on really surprised me.

During my own appointment, after reviewing my labs and current meds, he straight away pushed 3 new brand-name drugs, and later I learned that 2 of those had generic versions available. When I brought up the price, he swung open a walk-in closet packed with what must have been 500 different medications and gave me both of them. That closet was about the size of a small pharmacy. After that, I switched to a different doctor, who started me on just 1 new medication, and it was generic. Live and learn.
 
chewonmysac said:

After 30 years of being an adult, the medical field has made 1 thing very obvious to me. For most patients, their Primary Care provider acts as a Pharmaceutical liaison. Big Pharma pays them to prescribe particular medications. Patients are never told about this. That means if your Doctor objects to patients using compounded or off-label drugs, the pushback comes from profit margin, not from personal care. Always follow the money....
Click to expand...
Sure, follow the money—but your reasoning is off. Speaking as a physician, I can say these medications don't come with kickbacks. Every payment a drug company makes to a doctor must appear on a government website, so it's simple to verify. Their real motive is usually self-protection: if a malpractice suit comes, they don't want money-hungry lawyers accusing them of failing to tell you to quit grey market. That said, they do need to be informed—mine had me halt the reta 2 weeks before my neurosurgery.
 
My approach will be to inform mine while not actually informing him.

He's a good physician — and the only kind I see — which to me means: "someone who gets that I'm hiring him as an expert on medicine and health, that the final call on my own health belongs to me and not to him, and that his job is to keep me fully informed and supported so I can choose what's right for me; someone who won't try to exercise some strange directorial authority over my choices or even assume he's entitled to scold or lecture me."

At the same time, I get that he's bound by our health system's insurance contracts. So I won't come right out and say I'm using tirzepatide — and maybe retatrutide down the road — that I didn't get a prescription for, since that would obligate him to put it in my chart, which could create problems later. Hypotheticals I raise with him, though, carry no such obligation. He'll know perfectly well they aren't hypothetical, because he isn't an idiot, and he'll know I don't expect him to treat them as hypothetical. I also doubt he'll wonder why I'm putting it that way, since I don't see doctors who are idiots.

In essence, the conversation will look like the one I'd have with him if I were regularly using cocaine or amphetamines and wasn't ready to quit. I figure he'll tell me how that might shift which considerations apply to managing my health, and we'll take it from there.
 
With my providers, I've taken a partially transparent approach. Tirzepatide use was something I did share with them — that part is accurate. What I held back was that Retatrutide is being stacked alongside it. My reasoning: a single GLP-1 admission should satisfy whatever they actually need to know.

What came of it: my electrophysiologist, cardiologist, rheumatologist and nephrologist were all Very Happy to learn that I was taking a GLP-1, since my Obstructive Sleep Apnea, AFib flares and joie de vivre have all measurably improved per the data. Regarding compounded sourcing, none of them object — the brand price is the reason. Whether I source Gray is something I have NOT told them. LOL.

More significant, though: my Chronic Kidney Disease markers have shifted from Stage 3 down to Stage 2 according to the data; and the bone-on-bone bilateral knee osteoarthritis pain is gone. A cane is no longer needed for walking, and I can climb stairs using both knees once more.

My GP and I haven't met since I began, but she will surely be shocked — I am down 70 pounds compared to when she last saw me last June. A Compounded GLP-1 is what I will tell her I'm on.
 
chewonmysac said:

After 30 years of being an adult, the medical field has made 1 thing very obvious to me. For most patients, their Primary Care provider acts as a Pharmaceutical liaison. Big Pharma pays them to prescribe particular medications. Patients are never told about this. That means if your Doctor objects to patients using compounded or off-label drugs, the pushback comes from profit margin, not from personal care. Always follow the money....
Click to expand...
I'd say you're leaning a bit toward cynicism, haha. Another explanation that isn't so sinister for their hesitancy around compounded drugs: they adhere closely to FDA rules, both because their licenses depend on it and because they lean on peer-reviewed, published human trial data. For most of the peptides we rely on, there simply isn't a sufficient body of human trials and solid evidence to meet those licensing standards.
 
Mc_ppka_tp said:

This Friday I've got a visit scheduled with my PA. My plan was to ask for a broad blood panel plus an ecg, since I'm on TRT and might experiment with a TRT+ down the road, so I want a snapshot of my current numbers. The issue of how I'd respond to her questions about my weight loss hadn't crossed my mind, and I'd rather keep my Chinese Reta use off the record. I figure I'll go with the zepbound telehealth "white lie."
Click to expand...
A brief update. During my visit, my PA reviewed both my chart and the dietician's report. She was so pleased by what she saw that she didn't ask what method I used. Her focus was on how my organs and metabolism were coping with the weight loss. As a result, she requested a large batch of blood work and added several tests I had proposed. In the end, I didn't need to use the little "white lie" I had practiced.
 
Legally, doctors are basically forced to cover themselves by saying they don't approve and that it could be risky, since the drug isn't approved — and if anything goes sideways, having that warning noted in your file works in their favor. That said, how each individual doctor actually reacts mostly comes down to how into the research they are and whether they've ever come across it at all.

When I brought up grey tirzepatide with my doctor, there was no problem. He'd already written scripts for ozempic and tirzepatide in the past. What surprised me was that hgh seemed to worry him more — not the medical side, but the safety and where it came from — when I mentioned it recently because I wanted my igf-1 levels tested. I can't really explain why the response differed. I never got the chance to bring up the reta with him either. One thing that helps: I'm not in the US. I live somewhere with government subsidised medical care that actually makes sense, so there's no dealing with insurance companies that sound like something pulled from a dystopian nightmare, and doctor patient confidentiality still exists.
 
I told my doctor about my grey reta use and explained my choice of it instead of Tirz. We went through the upsides, and my reasoning and thought process impressed her. I also requested that she keep it out of my records, and she did. I love my doctor.
 
Pinngo said:

I never brought it up with mine. For the past decade, my annual appointment has basically gone: "labs look good, you're healthy as a horse, but you're over weight. Work on that. Have a nice day, thanks for the $$$."

I get blood work done every 3 months, and it's more thorough than what they order, at 1/4 the cost. I also track heart rate, sleep, and other metrics with my watch, plus I check blood pressure on a regular basis. Them not knowing doesn't really bother me, and for my particular circumstances I doubt it would change anything.
Click to expand...
Which panels are you getting?
 
attcbf said:

Pinngo said:

I never brought it up with mine. For the past decade, my annual appointment has basically gone: "labs look good, you're healthy as a horse, but you're over weight. Work on that. Have a nice day, thanks for the $$$."

I get blood work done every 3 months, and it's more thorough than what they order, at 1/4 the cost. I also track heart rate, sleep, and other metrics with my watch, plus I check blood pressure on a regular basis. Them not knowing doesn't really bother me, and for my particular circumstances I doubt it would change anything.
Click to expand...
Which panels are you getting?
Click to expand...

Each round I get a CBC, CMP, HbA1c, lipids, TSH, and fasting insulin. If something catches my interest, I'll add other labs like testosterone or IGF-1.
 
Raidersilver said:

ambot88 said:

I skipped any lab tests and kept my doctor in the dark. Still, part of me wishes I had baseline bloodwork done, if only to compare before and after.
Click to expand...
I'm in the same situation. I regret not getting baseline labs first. Instead, I went ahead and got blood work 4 weeks after starting reta and nad.

The results came back with low iron and borderline anemia. I don't know whether peptides could be responsible for that. I did have aquablation prostate surgery on Dec 22, and there was significant blood clotting. We'll see—I'll keep getting labs done and check whether my iron levels improve.
Click to expand...

Also get ferritin checked — that shows how much iron your body has stored. Hope you're doing better.
 
Appreciate everyone's varied perspectives in this thread. My PCP and I have a strong rapport, and risking that is likely the main thing keeping me from beginning so far.

Still undecided on which path I'll take—plenty to weigh.
 
Pinngo said:

I never brought it up with mine. For the past decade, my annual appointment has basically gone: "labs look good, you're healthy as a horse, but you're over weight. Work on that. Have a nice day, thanks for the $$$."

I get blood work done every 3 months, and it's more thorough than what they order, at 1/4 the cost. I also track heart rate, sleep, and other metrics with my watch, plus I check blood pressure on a regular basis. Them not knowing doesn't really bother me, and for my particular circumstances I doubt it would change anything.
Click to expand...
When it comes to my PCP, the experience has not been great. I end up being the one teaching him, and fielding his questions. Anything that falls outside his insurance checklist or can't be filled at wallgreens leaves him completely lost. That's exactly why people say "The Practice of Medicine"
 
Back
Top