FAQ's

Asymmetric is a direct pay health and wellness medical practice that has completely removed insurance companies from the health care equation.  You may have heard of this healthcare delivery model referred to more commonly as “concierge medicine”.  In this model, patients pay their physicians directly for the medical services provided.  By eliminating insurance companies from the practice of medicine we can provide services outside of the insurer imposed “box”.  For example, a man in his 30s or 40s with “low-normal” testosterone levels and with symptoms of androgen deficiency would very likely benefit from testosterone replacement therapy.  However, in an insurance-based practice not only may this patient struggle to have their medical condition identified and treated by a practitioner who does not specialize is hormone optimization and testosterone replacement, but their medical insurance typically won’t cover the cost of ongoing therapy even if ordered.  To make matters worse, insurance-based practices don’t focus on negotiating rates and working with pharmacies and suppliers that adjust prices for cash pay patients, so the cost of therapy ends up being more expensive as well.

insurance-based practices don’t focus on negotiating rates and working with pharmacies and suppliers that adjust prices for cash pay patients, so the cost of therapy ends up being more expensive as well.

In addition, there is significant waste and inefficiency when dealing with insurance companies.  Coding, billing, and rebilling insurance companies takes extraordinary effort.  There are entire areas of specialization for medical coding alone.  There are third party business entities that exist to deal with billing and rebilling.   On top of that, there are the prior authorization requests, insurance rejections, and appeals that make up the typical daily practice of medicine now days.  Each of these unnecessary layers adds costs.  These costs get transferred to the patients through increased co-pays, medical office fees, and rising insurance premiums not to mention less and less time with your doctor if you can actually get in to see them.

Finally, in insurance-based practices the patient must typically have contact with their provider to generate a charge.  Have you ever wondered why you are required to make an appointment for a simple medication refill?  Why you must be seen to get some paperwork for your job filled out?  What about why you can’t just call or email your doctor a quick question and expect a timely and useful response.  Each of these things take time from the provider that doesn’t get reimbursed by the insurance company, but having you come into the office does.  No one wants to work for free and in an insurance-based practice that usually means less access and more hassle for patients.

At Asymmetric, we recognize that the current system is broken and doesn’t meet the needs of our patients.  Free from the cost constraints mandated by third party interference we can deliver high quality care at an affordable price that focuses exclusively on the best interests of our patients.

At Asymmetric we recognize that the current system is broken and doesn’t meet the needs of our patients.  Free from the cost constraints mandated by third party interference we can deliver high quality care at an affordable price that focuses exclusively on the best interests of our patients.  We believe that the doctor-patient partnership is the foundation of effective healthcare.  Extended video appointments and access to your provider through text, email, and phone allows us to develop a personalized approach to meeting your hormone optimization needs.  In doing so, we believe we can truly make a positive difference in our patient’s lives.

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

You can’t pay your membership fee with an HSA/FSA, but you can split some of the total cost burden of your program to your HSA/FSA. 

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 Asymmetric, as a form of “health plan”.  In the eyes of the IRS your HDHP would be your “primary” plan and your Asymmetric 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 Asymmetric membership fees. 

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

Yes.  HIPPA compliant telehealth capabilities are integrated directly into our patient communication and electronic health record platforms.

In addition, the DEA has temporarily extended the COVID era controlled substances prescribing guidelines through 2024 so you do not require an in-person appointment to begin therapy with controlled substances (testosterone, growth hormone, etc.).  That being said, in order to initiate therapy,  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 hormone therapy.  

Low testosterone levels are typically the result of improper signaling from the brain (secondary) or the inability to produce sufficient quantities of testosterone in the testicles (primary).  In either case, men suffering from low testosterone levels, by definition, are producing inadequate levels of natural testosterone. 

Depending on the reason for the low testosterone levels, therapeutic strategies involving non-testosterone based medications may be an option for treatment.  If these medications are used, then your natural testosterone production is enhanced.  However, if your TRT program requires introducing exogenous (external) testosterone into your system, then it will disrupt your bodies natural signaling and production pathway so natural testosterone production stops.  If the TRT program is stopped the brain will detect the low levels of testosterone in the system and begin signaling the testicles to produce natural testosterone again.  However, in the best case scenario, the production will 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.

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 Asymmetric, 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 Asymmetric 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.

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.