6 weeks after starting, so 21 injections had gone by.
It's now clear that you do not respond to hCG monotherapy. Some men don't due to testicular failure. I doubt that switching to a brand name will be different. What was the goal? Fertility?
I just pulled this out of my book. His dose is lower, so keep that in mind.
Shippen’s Chorionic Gonadotrophin Stimulation Test (for males under 75 years of age)
Even though there seems not to be an accepted and clinically proven protocol to dose HCG, Dr. Eugene Shippen (author of the book “The Testosterone Syndrome”), has developed his own after his own experiences. Most doctors do not follow this protocol but I am showing it here since I get a lot of questions about it. I have never used this protocol myself since I have been on testosterone replacement for over 15 years.
Dr. Shippen has found that a typical treatment course for three weeks is best for determining those individuals who will respond well to HCG treatment. It is administered daily by injection 500 units subcutaneously, Monday through Friday for three weeks. The patient is taught to self administer with 50 Unit insulin syringes with 30 gauge needles in anterior thigh, seated with both hands-frees to perform the injection. Testosterone, total and free, plus E2 (estradiol) are measured before starting the protocol and on the third Saturday after 3 weeks of stimulation (he claims that salivary testing may be more accurate for adjusting doses). Studies have shown that subcutaneous injections are equal in efficacy to intramuscular administration.
By measuring the effect on his HCG protocol on total testosterone, he identifies candidates that require testosterone replacement versus those who just require having their testicles “awaken” with HCG to produce normal testosterone. I am yet to see any data that substantiates his approach, however.
Here is how he determines Leydig (testicular) cell function:
1. If the HCG protocol causes less than a 20% rise in total testosterone he suggests poor testicular reserve of Leydig cell function (primary hypogonadism or eugonadotrophic hypogonadism indicating combined central and peripheral factors).
2. 20-50% increase in total testosterone indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.
3. More than 50% increase in total testosterone suggests primarily centrally mediated depression of testicular function.
He then offers these options for treatment for patients depending on the response to HCG and patient determined choices.
1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.
2. The area in between 20-50% will usually require HCG boosting for a period of time, plus natural boosting or “partial” replacement options.
I am yet to see what he means with natural boosting! Dr. Shippen believes that full replacement with testosterone is always the last option in borderline cases since improvement over time may frequently occur as the testicles’ Leydig cell regeneration may actually happen. He claims that much of this is age-dependent. Up to age 60, boosting is almost always successful. In the age range, 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease-related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, obesity, alcohol, deficiency, etc.) He claims that this positive effect will not occur if suppressive therapy is instituted in the form of full testosterone replacement.
3. If there is an adequate response of more than 50% rise in testosterone, there is a very good Leydig cell reserve. HCG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response. But I am yet to see any data on long-term use of HCG used in this approach! (I invite researchers to do such studies)
4. Chorionic HCG can be self-administered and adjusted according to the response. In younger, high output responders (T > 1100ng/dl), HCG can be given every third or fourth day. This also minimizes estrogen conversion. In lower-level responders (600-800ng/dl), or those with a higher estradiol output associated with full dose HCG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full testosterone response.
Dr. Shippen believes in checking salivary levels of free testosterone on the day of the next injection, but before the next injection to determine the effectiveness and to adjust the dose accordingly. He claims that later as Leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.
5. He recommends monitoring both testosterone and estradiol levels to assess response to treatment after 2 - 3 weeks after a change in dose of HCG as well as periodic intervals during chronic administration. He claims that salivary testing will better reflect the true free levels of both estrogens and testosterone. (Pharmasan.com and others) Most insurance companies do not pay for salivary testing. Blood testing is the standard way to test for testosterone and estradiol.
6. Except for reports of antibodies developing against HCG (he mentions that he has never seen this problem), the claims that there are no adverse effects of chronic HCG administration.
Dr. Shippen’s book was published in the late 90’s. I know of no physician that uses his protocol. I have no opinion on its validity. The idea that testicular function can be improved with cycles of HCG in men with low testosterone caused by sluggish yet functioning Leydig cells is an interesting concept that needs to be studied. I guess that since this protocol requires very close monitoring, many doctors have avoided using it. The off-label nature of the protocol’s use of HCG can also make it expensive for patients who will have to pay cash for its use and monitoring.
