AI monotherapy

[Cataceous]

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They don’t offer the sensitive test in the uk, so this is the best I can get. What concerned me was that I’m c20% over the highest reference point, on both tests.

Have you got a conversion tool to get to the pg/ml values? I had a look online before but was unsure on the best one to use.

Could SHBG be causing this to be inflated? Or does it not work like that.
...

When SHBG is far from normal you need to look at the free hormones, which largely govern outcomes. As indicated, free estradiol is unremarkable.

I use this calculator to convert estradiol to the units we're used to.

High SHBG is naturally linked to higher testosterone and estradiol. The body is attempting maintain free hormone levels via testosterone production. As SHBG rises the free hormone levels will fall, but the body compensates by making more testosterone, some of which is naturally converted to estradiol. There's additional complexity, in that estradiol contributes to SHBG production in the liver. You'd think this positive feedback could lead to runaway levels, but apparently other limitations keep things under control.

 

[Bill0716]

When SHBG is far from normal you need to look at the free hormones, which largely govern outcomes. As indicated, free estradiol is unremarkable.

I use this calculator to convert estradiol to the units we're used to.

High SHBG is naturally linked to higher testosterone and estradiol. The body is attempting maintain free hormone levels via testosterone production. As SHBG rises the free hormone levels will fall, but the body compensates by making more testosterone, some of which is naturally converted to estradiol. There's additional complexity, in that estradiol contributes to SHBG production in the liver. You'd think this positive feedback could lead to runaway levels, but apparently other limitations keep things under control.

Thanks mate. How accurate is the free estrogen calculated? My free test was calculated too, I’m guessing it can’t be tested, only calculated?

That’s interesting what you say, as although my total t looks good, this could be a falsely reassuring number, as were my SHBG not so high then I suspect my total T would be lower, which gives me some reassurance that TRT could in fact be the way to go. Now I’ve just got to get my head around the fertility concerns on TRT!

 

[Bill0716]

Oh I tried literally everything. When I first got my labs back I researched for weeks. And then spent like $200 on supplements. I tried literally everything! Every supplement that you can think of to lower SHBG I’ve tried, no joke. I can’t remember the whole list, as it was 5 years ago, but I know for sure I’ve tried boron. I even had one of my TRT doctors prescribe me Danazol for a bit. I forget why I stopped taking it. I must of either had side effects, or maybe it didn’t work, or maybe it worked, but not good enough to justify the price. I honestly forget, but I’m sure if it worked well I would of stayed on it. So it most likely didn’t work as well as I wanted it to.

So the first few years I was on HCG monotherapy. Had a lot of E2 and gyno issues. Tried Clomid. Felt the worst I’ve ever felt in my entire life. Very depressed, almost suicidal. Just felt absolutely horrible. Then started Testosterone with HCG after that, and was on that up until around the beginning of this year. Stopped using an ai and HCG at the beginning of the year, to see how I felt on just testosterone alone. I currently feel pretty good, just have a lot of brain fog. But I’ve had brain fog the whole time on HRT, and am pretty sure it’s due to the black mold in the house I’ve been at the last 5 years. Coincidentally when I was 27 and started having low T. I’ll be 33 next month. Other than the brain fog I’m doing well in all categories.

As far as fertility, imo you have nothing to worry about. There’s a lot of stories of guys getting women pregnant on testosterone alone. Then you add in HCG, and you have a pretty good chance of being fertile, if you weren’t on testosterone alone. Then if that doesn’t work, there’s always FSH that should help do the trick. And if for some reason that doesn’t work, HMG should do it. Then there’s obv Clomid, but I’m scared shitless of that stuff. Luckily, there’s a ton of options out there for us. If I were you, I wouldn’t worry at all. If you are worried, I would just freeze your sperm, and then start TRT. That way you literally have nothing to worry about.

But honestly HCG can usually do the trick. I was on 1000iu’s of Empower’s HCG for months and months, along with my testosterone injections. I stopped the HCG around January of this year, and just kept doing testosterone by itself. In March I ended up knocking up my ex girlfriend by accident. That was two months completely off HCG, and just on testosterone propionate by itself. I actually had an appt for the baby yesterday. Here’s a couple of the ultrasound pics. So hopefully my story puts you at ease a bit. Other than the brain fog, I feel much better than I did when I had very low free T. And I literally got my ex pregnant by accident, without even trying, while off of HCG for two months. So I personally wouldn’t let fertility concerns prevent you from feeling better. But again, if you’re still worried about it for some reason, just freeze your sperm and hop on HRT. Starting HRT was the best decision I’ve ever made. Don’t regret it one bit.

Firstly, congrats on the little one!

Interesting to hear that you had no success with hcg and an AI. I was hoping that could work as another user suggested above, seemed like a good option for me but seeing as our issue is fairly similar, yours is the closest scenario I’ve found so hopefully I can avoid unnecessary trial and error based on your experiences.

Out of interest, can you remember your starting e2 numbers? And how are all of your numbers now? I’ve heard TrT helps lower SHBG so I’m guessing your free T is decent?

Really appreciate the response - the fertility stories give me confidence, id just hate to mess fertility up before I’ve had my first child. Me and the misses hope to start trying next year, but we are considering moving to oz so waiting for that to play out first. She wants me to wait until she’s up the duff before I start TRT and I’m not sure how well frozen sperm even works, but I will look into it for sure! Cheers, Bill

 

[Cataceous]

Thanks mate. How accurate is the free estrogen calculated? My free test was calculated too, I’m guessing it can’t be tested, only calculated?

That’s interesting what you say, as although my total t looks good, this could be a falsely reassuring number, as were my SHBG not so high then I suspect my total T would be lower, which gives me some reassurance that TRT could in fact be the way to go. Now I’ve just got to get my head around the fertility concerns on TRT!

Actually, testing free estradiol is probably the best thing, but it's expensive, and in this thread on the free estradiol calculator you'll see that @Gman86 has many measurements that line up quite nicely with the calculator.

Loss of fertility on TRT is a valid concern, even though the majority of guys can become fertile again. In the extreme this might mean stopping TRT and going on Clomid for awhile. If you want added insurance then you can bank sperm ahead of time.

 

[Gman86]

Firstly, congrats on the little one!

Interesting to hear that you had no success with hcg and an AI. I was hoping that could work as another user suggested above, seemed like a good option for me but seeing as our issue is fairly similar, yours is the closest scenario I’ve found so hopefully I can avoid unnecessary trial and error based on your experiences.

Out of interest, can you remember your starting e2 numbers? And how are all of your numbers now? I’ve heard TrT helps lower SHBG so I’m guessing your free T is decent?

Really appreciate the response - the fertility stories give me confidence, id just hate to mess fertility up before I’ve had my first child. Me and the misses hope to start trying next year, but we are considering moving to oz so waiting for that to play out first. She wants me to wait until she’s up the duff before I start TRT and I’m not sure how well frozen sperm even works, but I will look into it for sure! Cheers, Bill

Trust me, fertility is a HUGE concern of mine as well. This child is with my ex, who i’ll never have a relationship with. So if I can’t have more kids with someone in the future i’d be absolutely devastated. But I’ve done a ton of research on the subject, and i’m not concerned about HRT’s effects on fertility even in the slightest. There’s so many options for us to improve fertility, and that’s all while concurrently using testosterone. If you were to come off testosterone, and implement some, or all, of those options, I’d say it’s close to a 95% chance, or higher, that you’ll regain fertility, if lost at all. That 5% or less is going to mostly include guys that had an issue before HRT that caused fertility issues, or be just an extremely unlucky person. But the level of unluckiness would probably be the equivalent of being lucky enough to win the lottery. And most people aren’t that lucky, or that unlucky. So as long as you’re fertile now, you have almost 100% chance of regaining fertility either while on HRT, or while temporarily coming off HRT, imo. Again, that’s just my opinion. But it’s based off of years of research and studying anecdotal stories from many guys, and listening to many podcasts on hormone optimization and fertility.

And ya my SHBG was usually in the 50’s before HRT, and now runs low 40’s, sometimes high 30’s. My free T is pretty good right now. Mid range on quest’s lab range, top 3/4 of the range for labcorp, and top of the range for calculated free T. All those free T labs were while having 1002 total T at trough while on 42mg EOD of testosterone propionate. My E2 was around 20 before TRT. Those latest labs had my E2 around 50, not using any ai.

The move for you is to freeze sperm, hop on testosterone and HCG, and get your life back, while most likely remaining fertile just on the HCG alone. And from my understanding, as long as your sperm is healthy, and in high numbers when you freeze it, and your wife’s fertility is healthy, you should have absolutely no problems getting pregnant using frozen sperm, if you needed to even use the frozen sperm. I’d bet money that you won’t have to though.

 

[DragonBits]

cryopreserved and banking your sperm seems like the best safeguard, assuming the expense isn't a problem. It seems pretty reliable.

When you start TRT, you will still have sperm available for a period of time after, I got my fiancee pregnant 3 months after starting nebido.

But after 5 years, my sperm count was zero.

I went off of TRT for a couple of years to increase fertility, I had clomid mono for 3 months, my sperm counts returned to normal. Clomid was the only thing that really raised my E2, up from <5 to 27.6, it raised my total T, but not enough, 326 > 478.

Before TRT, 6 mg of boron increased my free T from 5.5 to 7.5 (6.6-18.1 range). It also increased my E2 from <5 > 11.1 (l 7.6-42.6 pg/ml). I never measured SHBG, but it must have lowered it.

Last 2 blood test for shbg it was measured 66.2 then 73.6. Pretty high, and up from a base of 40. Likely taking LEF ulbra prostate formula increased shbg, though I also quit HCG at the same time.

I am just guessing, but based on my last blood test for T/Ft/e2, my shbg has returned to normal for me, ~40.

I have never naturally had high E2, the only way my E2 gets high is to get my total T over 1100.

 

[Bill0716]

Trust me, fertility is a HUGE concern of mine as well. This child is with my ex, who i’ll never have a relationship with. So if I can’t have more kids with someone in the future i’d be absolutely devastated. But I’ve done a ton of research on the subject, and i’m not concerned about HRT’s effects on fertility even in the slightest. There’s so many options for us to improve fertility, and that’s all while concurrently using testosterone. If you were to come off testosterone, and implement some, or all, of those options, I’d say it’s close to a 95% chance, or higher, that you’ll regain fertility, if lost at all. That 5% or less is going to mostly include guys that had an issue before HRT that caused fertility issues, or be just an extremely unlucky person. But the level of unluckiness would probably be the equivalent of being lucky enough to win the lottery. And most people aren’t that lucky, or that unlucky. So as long as you’re fertile now, you have almost 100% chance of regaining fertility either while on HRT, or while temporarily coming off HRT, imo. Again, that’s just my opinion. But it’s based off of years of research and studying anecdotal stories from many guys, and listening to many podcasts on hormone optimization and fertility.

And ya my SHBG was usually in the 50’s before HRT, and now runs low 40’s, sometimes high 30’s. My free T is pretty good right now. Mid range on quest’s lab range, top 3/4 of the range for labcorp, and top of the range for calculated free T. All those free T labs were while having 1002 total T at trough while on 42mg EOD of testosterone propionate. My E2 was around 20 before TRT. Those latest labs had my E2 around 50, not using any ai.

The move for you is to freeze sperm, hop on testosterone and HCG, and get your life back, while most likely remaining fertile just on the HCG alone. And from my understanding, as long as your sperm is healthy, and in high numbers when you freeze it, and your wife’s fertility is healthy, you should have absolutely no problems getting pregnant using frozen sperm, if you needed to even use the frozen sperm. I’d bet money that you won’t have to though.

Thanks mate. That really helps put my mind at rest, I’ll speak it through with the misses and look into freezing my sperm, for peace of mind, if nothing else.

are there any podcasts you recommend that I can listen to on all things TRT? I recently bought jay Campbell’s TRT book, but find it quite “high-level” and would like to do some more detailed research.

Finally, I have no idea how to inject and the doctor really didn’t go over this, have you got any links on how to actually get the oil into the syringe etc. As a step by step guide for a beginner? Most of the videos I’ve found just skip to the injection itself, and I have no idea which sized needle to buy etc. Worries me that the doctor didn’t go over this at all with me but I’m limited for choice of doctors offering TRT privately in the UK.

Thanks for all your help. Bill

 

[Gman86]

Thanks mate. That really helps put my mind at rest, I’ll speak it through with the misses and look into freezing my sperm, for peace of mind, if nothing else.

are there any podcasts you recommend that I can listen to on all things TRT? I recently bought jay Campbell’s TRT book, but find it quite “high-level” and would like to do some more detailed research.

Finally, I have no idea how to inject and the doctor really didn’t go over this, have you got any links on how to actually get the oil into the syringe etc. As a step by step guide for a beginner? Most of the videos I’ve found just skip to the injection itself, and I have no idea which sized needle to buy etc. Worries me that the doctor didn’t go over this at all with me but I’m limited for choice of doctors offering TRT privately in the UK.

Thanks for all your help. Bill

Probably the best audio/ video resources right now on TRT are the “lifting dermatologist” on YouTube. Before that jay Campbell did the “TOT roundtable” on Youtube. All those videos must still be up. And then as far as podcasts go, a good resource is “superhuman radio”. He doesn’t always do TRT, but it’s probably the best podcast out there on overall optimization. Oh, and search “Lichten” in the podcast app. Check out the 3 different podcast series that Dr. Edward Lichten put out years back. Absolutely AMAZING info about TRT within those 3 podcast series. I’ve listened to them all multiple times. Will blow your mind how important hormones are. Not just for guys either. He goes over common things, like even headaches, and how to cure them through hormone optimization. He does quite a few episodes addressing female issues as well. Like cluster headaches and PMS. So it’s very informative for both men and women.

And as far as the needles go, I use these ones, and here’s the site I usually buy them off of. They work great. Good balance of not feeling the needle, and the oil drawing up quickly into the syringe.
EasyTouch Insulin Syringe 27 Gauge, 1cc, 1/2" - 100ct Healthwarehouse.com

And as far as needing to learn how to draw up the testosterone, just go to YouTube and watch nursing videos about drawing up insulin or something like that. There’s got to be hundreds of informative videos showing medical students how to draw up solutions and do injections.

 

[Bill0716]

Probably the best audio/ video resources right now on TRT are the “lifting dermatologist” on YouTube. Before that jay Campbell did the “TOT roundtable” on Youtube. All those videos must still be up. And then as far as podcasts go, a good resource is “superhuman radio”. He doesn’t always do TRT, but it’s probably the best podcast out there on overall optimization. Oh, and search “Lichten” in the podcast app. Check out the 3 different podcast series that Dr. Edward Lichten put out years back. Absolutely AMAZING info about TRT within those 3 podcast series. I’ve listened to them all multiple times. Will blow your mind how important hormones are. Not just for guys either. He goes over common things, like even headaches, and how to cure them through hormone optimization. He does quite a few episodes addressing female issues as well. Like cluster headaches and PMS. So it’s very informative for both men and women.

And as far as the needles go, I use these ones, and here’s the site I usually buy them off of. They work great. Good balance of not feeling the needle, and the oil drawing up quickly into the syringe.
EasyTouch Insulin Syringe 27 Gauge, 1cc, 1/2" - 100ct Healthwarehouse.com

And as far as needing to learn how to draw up the testosterone, just go to YouTube and watch nursing videos about drawing up insulin or something like that. There’s got to be hundreds of informative videos showing medical students how to draw up solutions and do injections.

Perfect, thanks a lot Gman! I’ll keep you posted on the results. Contacted a fertility centre about freezing sperm earlier as a first step. In the meantime, I’ll be sure to watch/ read as much as I can. All the best, Bill

 

[Bill0716]

cryopreserved and banking your sperm seems like the best safeguard, assuming the expense isn't a problem. It seems pretty reliable.

When you start TRT, you will still have sperm available for a period of time after, I got my fiancee pregnant 3 months after starting nebido.

But after 5 years, my sperm count was zero.

I went off of TRT for a couple of years to increase fertility, I had clomid mono for 3 months, my sperm counts returned to normal. Clomid was the only thing that really raised my E2, up from <5 to 27.6, it raised my total T, but not enough, 326 > 478.

Before TRT, 6 mg of boron increased my free T from 5.5 to 7.5 (6.6-18.1 range). It also increased my E2 from <5 > 11.1 (l 7.6-42.6 pg/ml). I never measured SHBG, but it must have lowered it.

Last 2 blood test for shbg it was measured 66.2 then 73.6. Pretty high, and up from a base of 40. Likely taking LEF ulbra prostate formula increased shbg, though I also quit HCG at the same time.

I am just guessing, but based on my last blood test for T/Ft/e2, my shbg has returned to normal for me, ~40.

I have never naturally had high E2, the only way my E2 gets high is to get my total T over 1100.

Thanks Dragonbits, I’ve taken yours and others advice and have contacted a centre about freezing sperm today, so I’ll keep you posted over the next few weeks. All the best, Bill

 

[Bill0716]

Actually, testing free estradiol is probably the best thing, but it's expensive, and in this thread on the free estradiol calculator you'll see that @Gman86 has many measurements that line up quite nicely with the calculator.

Loss of fertility on TRT is a valid concern, even though the majority of guys can become fertile again. In the extreme this might mean stopping TRT and going on Clomid for awhile. If you want added insurance then you can bank sperm ahead of time.

Thanks mate, much appreciated! I’ll be sure to check out the calculator.