Now on TRT plus HCG to preserve fertility

[paco]

Hello, all. I am very excited to report that I started testosterone replacement therapy (TRT) on Saturday. After years of being tired and depressed with poor concentration and low libido, I was diagnosed as secondary hypogonadal about 15 months ago. Under the guidance of doctors, I have had intermittent success treating my symptoms with clomid or HCG or a combination of both over the past year. My wife and I are very eager to have more children, so I have been avoiding TRT as it may impact my fertility.

About six weeks ago my wife and I made the short drive to Houston to see Dr. Lipshultz. Dr. Lipshultz is a urologist and fertility specialist and was one of the researchers who published the often-cited study (the first study mentioned here) that showed that a group of patients undergoing TRT were able to maintain normal sperm production by using 500 IU HCG every other day. He really put us at ease that we are not putting our family at risk by my starting TRT, particularly since I have now "deposited" at the sperm bank three times, just in case my fertility is impacted. Dr. Lipshultz seems like a good and knowledgable doc.

He has started me on 5 g Testim (50 mg testosterone gel) every day plus 1,500 IU HCG once per week. I will follow his lead, of course, but I do want to ask him why we aren't dosing smaller amounts of HCG twice or three times a week, or 500 IU every other day as in his study. I want to ask because I am somewhat concerned that this may impact subjective benefit and even sperm production if the HCG is not "effective" during a portion of each week.

More than anything, I'm happy to be on a path to truly feeling better. However, I do want to ensure we are on the best HCG protocol possible for my goals. Does anyone have any thoughts on why HCG might be best (or might not be best) to administer once a week instead of more frequently when aiming to preserve sperm production?

 

[Bass]

first congratulations. second, you have the right attitude and concern. in my opinion and based on what I have read you will be fine doing smaller doses more frequent of hCG and still be fertile, the higher doses work too by based on what I have learned they are meant for short term use only, too much hCG can backfire, in other words you might become desensitized to it, and thus why the smaller doses is to mimic your natural level of LH. but seems like you have done your homework and have your questions ready for you doc. that is the key to a successful TRT.

BTW, Arnold Schwarzenegger was on roids most of his life and back then there was no hCG, and he still managed to have many kids, even one from his maid!

 

[paco]

Great comments, Bass. Thanks!

 

[Gene Devine]

Dr. Crisler is a big proponent of smaller doses more frequently (as am I) and also feels any single dose over 500 is too much as there are only so many receptors on the leydig cells (think over kill) and can potentially increase E2 as well.

 

[Nelson Vergel]

Dr Lipshultz is author of fertility textbooks. I had a meeting with him 2 days ago and will be brainstorming with his 4 fellows to come up with different studies using TRT+HCG with or without anastrozole.

I would follow his advise and not deviate from it. He starts guys on larger doses of HCG and then decreases them and increase the frequency.

Here are some of the studies he has done with his team: http://scholar.google.com/scholar?start=0&q=lipshultz+HCG&hl=en&as_sdt=0,44

I will be interviewing him during the next month and post the transcription on ExcelMale.com

 

[paco]

Thanks to you, Gene and Nelson. I will follow Dr. Lipshultz as I think I'm in good hands. : )

 

[Vettester Chris]

I agree that larger doses, probably exceeding the 500iu marker, starts becoming redundant. It will obviously vary from patient to patient ... I don't necessarily believe in the whole desensitization subject, but more so, as Gene mentioned, the amount of receptors associated with the Leydig cells will factor in the effectiveness of the LH analog (that's just my personal opinion, nothing concrete or scientific). However, as Nelson stated, stick with your physician's protocol. Your doctor can get you dialed in with labs and little time.

On a side note, I had doctor in the LA area that would pause the testosterone treatments, and just go HCG mono for a month. I won't go into the fine details, but just saying that's where some of my own personal experiences with seeing just how effective it was at different dosages with my serum levels.

 

[Nelson Vergel]

Lipshultz likes to give you a month break every 6 months with either HCG or Clomid

This field is full of so much diversity in views and protocols!

 

[Vettester Chris]

Lipshultz likes to give you a month break every 6 months with either HCG or Clomid

This field is full of so much diversity in views and protocols!

I know, it's crazy how many methods there are. The doctor in LA would do it every 3 months, the go 1 month HCG.

 

[GettingAnswers]

I know many folks say never to take a break but I swear the times I felt the best were those transition times... The week or two after stopping T, the first week or two of starting HCG and stopping T, the week or two after starting either T or HCG. Maybe a little variety is a good thing!!!

 

[EverettCD]

I also see one of the Urologists at Baylor College of Medicine. My Dr. started me on 500iu every 3.5 days & now I inject 300iu Mon, Wed & Fri. Prior to adding HCG to my protocol I had been on TRT for about 6 months, 2 months or so after starting HCG I came home to find my wife holding 3 positive pregnancy tests & now we have a newborn Needless to say I trust the Dr's at BCM & know that HCG works.

 

[Jerry Brainum]

first congratulations. second, you have the right attitude and concern. in my opinion and based on what I have read you will be fine doing smaller doses more frequent of hCG and still be fertile, the higher doses work too by based on what I have learned they are meant for short term use only, too much hCG can backfire, in other words you might become desensitized to it, and thus why the smaller doses is to mimic your natural level of LH. but seems like you have done your homework and have your questions ready for you doc. that is the key to a successful TRT.

BTW, Arnold Schwarzenegger was on roids most of his life and back then there was no hCG, and he still managed to have many kids, even one from his maid!

Arnold cycled his steroids, getting off them months at a time, and also used a conservative program. So there was no need for HCG in his case.

 

[Bass]

Arnold used steroids in his teens, these drugs were mostly experiments , and there was no such thing as conservative program in those days, but I could be wrong. using steroids at young age is almost certain he'll be shut down in his 30s, unless of course he's one of a million that has awesome genes

 

[Bass]

As for the different hCG doses shows that one size does not fit all, and TRT protocol needs to be bases on the individual.

 

[Jerry Brainum]

That would only be true if Arnold stayed on steroids consistently, which he did not.

 

[paco]

One more question... I'm almost 3 weeks in now. Nothing to report yet. However, I will see Dr. Lipshultz again in two weeks for a follow up. I will see him on a Monday afternoon, and I usually do my one weekly shot of 1,500 IUs of HCG Monday mornings. He draws blood for labs at his office.

Should I do my HCG that morning, and if so will that whopping dose just cause my testosterone to spike temporarily, thereby masking whatever impact (or lack thereof) the 5g daily of testosterone gel is having on my total and free testosterone? I want to make the most out of the visit, and I would hate to have the doctor look at relatively high total and free testosterone levels created solely by HCG and then determine there is no reason to increase the testosterone dosage, when it might actually actually warranted. Of course, I will ask the nurse what Dr. Lipshultz recommends, but I'd like to be educated on this issue before I talk to her.

 

[Nelson Vergel]

After several injection of HCG while on TRT, your "steady state" T levels tend to not fluctuate very much. So I would not worry about when your blood test is done. Say hi to Dr Lipshultz and his staff.

 

[paco]

Thank you, Nelson! Will do. : )

 

[paco]

Following is an update on my treatment. I had an appt. with Dr. Lipshultz yesterday after 5 ½ weeks on 1 tube Testim per day with 1,500 IUs HCG once per week. I told the doc that I was not feeling much improvement in energy, mood or libido. I had a few intermittent good days, but I was having more days where my mood and energy level was down or suddenly crashed. My low libido remained unchanged.


I was offered several options, including increasing the dosage of the gel and/or the HCG. However, Dr. Lipshultz strongly recommended that if I truly want to start feeling better – soon – that I go straight to injections. Also, he advised me to switch to 500 IUs of HCG three times a week rather than 1,500 IUs once per week. (Apparently, he believes there is little difference between those two dosing schedules.)


Yesterday I had my first shot (in my quad, lateral side of my leg) of 1cc testosterone cypionate at 200 mg/ml. I am prescribed the same dose once weekly together with HCG 500 IUs three times per week. In addition, I conceded to taking 12.5 mg clomid once daily, as Dr Lipshultz seems to believe that will help to preserve my fertility while on testosterone. (My experience with clomid tells me this dose has little positive or negative effect on me subjectively, but it does seem to help with natural production of testosterone.)


Dr. Lipshultz emphatically stated he “guaranteed” that on this regimen I will be feeling better in four weeks. For the first time in a long time since staring this journey to treat my low testosterone, I feel rightfully hopeful. I will keep the group posted.

 

[EverettCD]

Update Paco ?