HCG monotherapy: Good first option for a Secondary case?

[DHM]

Long story short, we've concluded that I have symptoms and lab results that correlate with secondary hypo (failing free T, high SHBG, 90% ADAM test).

Since I still have total T in the range of 380-600, I would like to try HCG monotherapy first either with/without an AI before T-Cyp.

Furthermore, my PCP has mentioned the treatment before and more likely to agree to HCG.

My main question is: If I go on HCG, is it possible to get my hormones to a balanced point and slowly get off the treatment without tanking?

Thanks.

 

[Nelson Vergel]

HCG will increase your testosterone while keeping your testicles working, but it really acts like testosterone therapy. Its use shuts down LH and FSH. When you stop HCG you may or may not return back to where you are now. I think it is not a bad idea to start it at 500 IU every other day or probably 1000 IU twice a week. Retest 6 weeks later for TT, FT and E2 by ultrasensitive test. https://www.excelmale.com/forum/sho...e-Testicular-Shrinkage-and-Preserve-Fertility

 

[DHM]

Thanks Nelson and sorry I didnt know which forum to put this in!

 

[paco]

If you are secondary, personally I think it's good to start with HCG and experiment with different dosages and schedules to see if you can resolve both low blood levels of testosterone as well as subjective complaints. Although HCG interferes with normal functioning of the HPT axis, it's arguably less augmentive than using testosterone or even testosterone plus HCG. Whereas testosterone stops any (any that might be remaining) signaling at the level of the testes and pituitary, HCG stops only the signaling at the level of the pituitary. So, you preserve the testes' ability to produce their own testosterone. And, given that it is an LH analog, using HCG also has the benefit of stimulating LH receptors throughout the brain and body, which is believed to have numerous benefits on mental and physical health. And, you more effectively preserve/promote fertility if that is a concern for you. Finally, using the minimum amount of intervention possible seems just like the wise thing to do.

That said, some people (including myself) who benefit from higher testosterone levels as a result of just HCG don't get all the subjective benefits associated with TRT. So, many will opt to use testosterone along with HCG to get the best of both worlds.

Regarding the use of AIs, that is not generally indicated unless you have an abnormally high estradiol level, according to a sensitive assay, or you are displaying clear symptoms of excessive estradiol such as water retention and/or gyno.

And on the subject of restarts, there is quite a bit of talk still lingering on that concept, but personally I haven't heard of many cases of it actually working long term. Maybe somebody will correct me on this point and the others above.

I hope that's helpful!

 

[Vettester Chris]

If I'm reading this right, you are looking at HCG as a bridge that will help get your "hormones balanced", then you can taper off treatment with hopes that you will sustain this balance? Unfortunately, it doesn't work that way. HCG will mimic the luteininzing hormone (LH), which is endogenously produced in the pituitary. Even at a 380 to 600ng/dl serum level, you are producing some LH. It would be good know what your LH/FSH values are going into this? In fact, if 600ng/dl is the serum score, I would suspect your LH has to be in the 4's or 5's (?), but I'm just speculating without any numbers. As noted above, introducing HCG will just suppress the HPTA with any natural LH production, and once you stop HCG you will indeed tank.

Also, regarding your free & bio test ... Address and treat this subject separately. SHBG and falling free T are not the variables to base a diagnosis of primary or secondary. I'm 'Secondary' through and through .. The initial checkup should be checking LH & FSH as discussed. My SHBG is low, I know plenty of secondary guys where their SHBG is high. That has more to do with E2, the liver, vitamin D, insulin, and even thyroxine (T4).

 

[DHM]

Thank you Paco and VC!

I see both of your points and just trying to take the minimal treatment route.

Even at a 380 to 600ng/dl serum level, you are producing some LH. It would be good know what your LH/FSH values are going into this?

Thats the highest capture Ive had for total-T (597), typically 380-490 for the previous test.

FSH/LH levels are typically between 3.5-4.3..... Post Clomid stim test 6-7.

I'd like to find the root cause for the dropoff and get to the bottom of the SHBG issue.

Has anyone heard any negative feedback (no pun..well maybe), axis shutdown from the Simeon dosage schedule? I ask because HCG injections via "the diet" are probably the most mainstream form and the backlash would definitely be there, I havent heard anything though.

 

[Nelson Vergel]

The Simeon diet dose what 125 IU per day. I am not sure what degree of HPTA effect that dose would have.

 

[NeedRelief]

At the levels Nelson suggested (2,000 IU a week) would you have to worry about desensitizing the testes? I'm considering upping my dosage from 600 3 times a week to 800 3 times a week as mentioned by my doc.

 

[Nelson Vergel]

I am posting three studies that explain this issue:

Can HCG Stop Working After Long Term Use in Men?
I have known men who have used doses over 5000 IU per week for over 5 years who have not had any slowdown and end of benefits.

I think what you really need to worry about at higher IU doses are increase in estradiol and DHT above upper limit of normal range.

 

[NeedRelief]

Good to hear! Man, your going to keep me busy, there is a ton of useful info in that link....thanks.

 

[DHM]

Therapy Update

Sent my labs to an HRT specialist. He was confident that my previous Clomid stim test was a good sign and we should continue.

25mg Clomid ED plus 25mg of DHEA (DHEA was mid range).

Results

TT= over 1330 ng/dl (Top Limit 1197)
LH= 10.5 mIU/ml (Top Limit 8.6)
DHEA= 506 ug/dl (Top Limit 475)
Free-T= 22.6pg/ml (Top Limit 25)

Consequently E2 was in the 90s, which was anticipated with Clomid. Free is in a good spot, however back calculating this means I have an SHBG in the 60s.

New regimen is 25mg of Clomid and DHEA EOD with 0.5mg Anastrazole to lower all concerning levels.

Output: Im not as tired at night (use to fall asleep at dinner), I feel pretty normal even though Ive got superphysiological levels. No change in Sex Drive, No AM wood.

Hopefully e2 will normalize and SHBG will lower with the decreased dosing and AI addition. Ill report back in 8 weeks or so.

 

[Nelson Vergel]

DHM

Was the LCM sensitive test used for your E2?

 

[DHM]

It was not, I've havent had the e2 sensitive assay yet and all the panels I average between 25-35. Doc uses both and wasn't concerned. E2 sensitive definitely for the next round with armidex.

 

[Nelson Vergel]

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility

 

[Specialk]

Hey Guys,

New here, but not new to TRT. I have to make a decision and I honestly don't know what to do.

Ok, history, former competitive bodybuilder / power lifter who definitely took too much in his 20's (heck any of you old time body builders remember Zack's gym on the east coast??-- before steroids were illegal, you could buy them mail order legally!)...

Anyway, I probably only did 10+ cycles my entire life, never had an issue coming off, didn't even know what PCT was back then (1980's)... Life moved on, I always lifted (still do) but had some very serious stress when I was about 35 yrs old (about 20 yrs ago) before than felt great, was big and strong and happy as a clam. But after the big time stress, I got depressed, not medicated, just normal human condition after/during stress... a buddy of mine was on TRT back then and suggested I try one of his gel packs... so I did and I felt like a million bucks in short order.

So I found a TRT doc and while they did all the testing, pituitary was ok, hypothalamus was ok, even my nards were ok, yet my total and free T was low... 320+- (I can't remember) so they put me on TRT and I have been on it for all this time... Almost 2 decades.

I had some hard core stress again (hey I'm blessed only two times in 51 years!)...but I guess my hormones take the brunt of stress, because I got hypER-thyroid (not hyp-O)... it was the most horrible experience I've even been through as I am a high adrenaline guy to begin with, I went to and endo and he said hyp-ER-thyroid makes you 10 times more sensitive to adrenaline, so it was like an anxiety attack on steroids, continually, until they got me on beta blockers (at the hospital... I tried to tuff it out on my own and wound up in the hospital, shaking violently, had lost 30 lbs in 2 weeks....etc.)

The endo said I didn't have Hashimoto's or Graves, just stress related inflammation of my thyroid, it ended, never came back and I've been good for almost 3 years with no re-occurance.

The endo also wanted to address my TRT since I was there (He's a cool guy) and after running a bunch of tests, he told me there is nothing wrong with my system and I should take Clomid to get everything up and running again.

So I was supposed to take 50mg daily and I could not handle it... I was light headed, sad - weepy...etc.. I have a family and can't be walking around feeling sorry for myself all day every day. So I went to 25mg daily and it was tolerable but I got tested and my Total T level was only 450 (I don't remember ng/dl, or pg/ml ) so I was not feeling like it was worth the side effects.

So I thought, well, if everything works, why not just suck it up and see if your body can fix itself. So I went off TRT completely for over a year... my labs were worse... 325+- with free T basically in the right proportion, E2 all in right proportions...

So I went back to my TRT doc (a friend of mine) and told him I wanted to try Dr. Schully's (sp?) protocol, but since I am real sensitive to all drugs, I went on 1000 iu HCG EOD for 10 shots while simultaneously taking 20mg/day Tamoxifen ( Nolvadex) and continued the Tamoxifen for an additional 2 weeks after the shots were done.

I've done the protocol twice and my labs just came in at 324 Total T, 4.2 Free T and I didn't need the tests as I knew I felt crummy.. However while on HCG I felt fantastic, even my family was excited for me.

I have read that HCG causes a negative feedback loop on LH and FSH so long term is no good and my doc feels that long term Tamoxifen is a bad idea. He also feels that aging Lydig cells just don't respond to "normal" physiological levels of LH (since I have normal levels)...

So now I am back at square one..

I hate TRT because I am a super active guy, and in my humble opinion testosterone is very much like insulin in that, a lot of variable effect it's levels. For example, stress, high physical work load, diet....etc... so same for testosterone, when I do jiu jitsu 4 days a week, plus lift weights, plus work on my acreage at home, I need MORE testosterone than when I am sitting behind the computer or lounging all day. I know this personally from experience over decades of TRT.

So I don't want to go on TRT where I am always behind the 8 ball when it comes to dosage and I obviously don't want to stay low T, as I am irritable (generally, not always) and moody (like a grumpy old man). I only feel great while I'm at the gym pumping iron and that only lasts for a few hours after.

So I guess, I'm opening up to some THOUGHTFUL input from all of you. I am not going to respond to any jokes or flames of any kind.

Thanks in advance for any well thought (hopefully research or experience based) input.