Here's a scary thought: Long term LH suppression on TRT- What are the effects?

[Charliebizz]

I hope I am one of these guys. My wife and I have sex 3-4 times per week. And, yes I do have ED. Cialis was being used before I got on TRT and the doctor told me is would not help with ED. That's not why I got on. I've been on two years and still everything is great.

I do believe it is different for me at age 64 and some of you young guys. There is something going on environmentally that is causing the low levels of guys under 40. I don't know how I'd respond if I was younger and had low testosterone. Being young with low test, ED, and no libido sounds horrible and I don't blame younger guys for seeking some kind of help. My T levels were low, but in range when I got on. I just felt that at age 62 I wanted more for my so called golden years. We have four adult kids, are empty nesters, so what the hell, right? For younger guys, it has to be carefully considered.

great post. I've asked that question countless times on other forums and it's always ignored. It seems as the men with age related hormone decline do so much better then us younger guys. My low t started at 26. I'm now going to be 36 next month.ive tried every aspect of hrt/restarts over the years and I always end up back at square one. At this point in my health journey I feel ok. My biggest complaint is body pain. Trt seemed to help me a good deal with it but at a cost. I was having tremendous anxiety. And way less consistent days. I'd have really good days and really bad energy and mood. Now being off I'm back even keel feel ok most days. I do not tolerate hcg well and the fear of being shut down for us younger guys long term is real. And most of the guys that feel good just shit all over that fear. But no one has a real answer to what we do when we can't backfill with things like hcg and what the long term effects could be. Most just point to how bad low t can be long term. Well I know that's not a good enough answer for me so I'm going to try and hold out as long as I can until maybe we get some better answers. Or better trt programs.

Also in my real world experience. I've met plenty of guys around my age that have low t and tried trt and it is the same story felt great at first then trt became more of a pain in the ass then it's worth. But a lot of the older men swear by it. And I'm talking a lot of people I have talked to in real life. So instead of us always arguing one side or the other wouldn't it be better to try and get to the bottom of this ?

 

[Deleted member 16042]

Why would HCG stop working? The premise of your hypothesis is that long-term LH deprivation results in deleterious sexual consequences, but there is no logical or scientific basis for the argument that HCG "stops working." If HCG is an analog to LH, then regular concomitant use should have the exact same effect, irrespective of duration. I think a more likely explanation is that androgens are only one component of sexual function, and later on in life many men encounter other issues that interfere with their libido/sexual performance, but instinctively blame trt. I do wonder what role FSH (HMG being the synthetic analog) plays outside of sperm production, and if there are any tangible benefit to using HMG alongside HCG.

While you are certainly correct that T levels and replacement therapy are not the only things responsible for ED and sexual function, there are MANY anecdotal accounts of HCG not working or ceasing to work for members of this forum, even in very short order, not over years of use. For me, its effect on the testicles has diminished considerably despite increasing dosage significantly. However I didn't have ED or sexual function issues initially before TRT, nor do I now, except testicular size and retraction problems after starting TRT. So, in my case, you are correct that there are other things at work, BUT, HCG's effectiveness has decreased in the course of a few months.

"no scientific evidence" doesn't mean something is not true when something has not been thoroughly studied. It just means we don't know yet.

 

[Nashtide]

While you are certainly correct that T levels and replacement therapy are not the only things responsible for ED and sexual function, there are MANY anecdotal accounts of HCG not working or ceasing to work for members of this forum, even in very short order, not over years of use. For me, its effect on the testicles has diminished considerably despite increasing dosage significantly. However I didn't have ED or sexual function issues initially before TRT, nor do I now, except testicular size and retraction problems after starting TRT. So, in my case, you are correct that there are other things at work, BUT, HCG's effectiveness has decreased in the course of a few months.

"no scientific evidence" doesn't mean something is not true when something has not been thoroughly studied. It just means we don't know yet.

Receptor cells of all types can become less sensitive to the substances that bind to those receptors for various reasons. The leydig cells are no exception. I believe the current thinking is that constant, steady supply of the substrate increases the likelihood that the receptors will become desensitized. Think of insulin resistance. Eating a diet which results in insulin spiking all day leads to resistance. I believe guys on TRT overuse hcg and or inject it too frequently.

 

[Charliebizz]

While you are certainly correct that T levels and replacement therapy are not the only things responsible for ED and sexual function, there are MANY anecdotal accounts of HCG not working or ceasing to work for members of this forum, even in very short order, not over years of use. For me, its effect on the testicles has diminished considerably despite increasing dosage significantly. However I didn't have ED or sexual function issues initially before TRT, nor do I now, except testicular size and retraction problems after starting TRT. So, in my case, you are correct that there are other things at work, BUT, HCG's effectiveness has decreased in the course of a few months.

"no scientific evidence" doesn't mean something is not true when something has not been thoroughly studied. It just means we don't know yet.

see that's the forward thinking we need more of on these boards. Just way to many things we do not know about yet. And to not wonder and speak about them is jut crazy imo. If this game we play was fool proof none of these boards would exist. We need to stick together and keep the discussions going.

 

[Maximos]

One of my best friends got on TRT 12 years ago. He was 30, he went to the doctor and his T was something like 400. He started doing weekly injections and never looked back. No dose micromanagment, no AI, no nothing. He feels awesome anf gets laid like a madman. He really knows very little about TRT too. He never got into any of these forums, he doesn't know what SHBG is or the what the "sweet spot" is or the T to E ratio. He injects once a week and goes on with his life.

This forum and many others are for people who haven't been dialed in yet or have several other problems or even maybe just like to talk about these things.

 

[Charliebizz]

One of my best friends got on TRT 12 years ago. He was 30, he went to the doctor and his T was something like 400. He started doing weekly injections and never looked back. No dose micromanagment, no AI, no nothing. He feels awesome anf gets laid like a madman. He really knows very little about TRT too. He never got into any of these forums, he doesn't know what SHBG is or the what the "sweet spot" is or the T to E ratio. He injects once a week and goes on with his life.

This forum and many others are for people who haven't been dialed in yet or have several other problems or even maybe just like to talk about these things.

thats awesome. Did he feel bad before trt or just took it based of a low normal reading.

 

[Nashtide]

I also think many other issues are at play with a lot of men. Thyroid issues. Adrenal issues. Psychological issues. Just to name a few.

 

[sh1973]

One of my best friends got on TRT 12 years ago. He was 30, he went to the doctor and his T was something like 400. He started doing weekly injections and never looked back. No dose micromanagment, no AI, no nothing. He feels awesome anf gets laid like a madman. He really knows very little about TRT too. He never got into any of these forums, he doesn't know what SHBG is or the what the "sweet spot" is or the T to E ratio. He injects once a week and goes on with his life.

This forum and many others are for people who haven't been dialed in yet or have several other problems or even maybe just like to talk about these things.

It’s interesting you mention this Maximos. If there’s one thing I’ve noticed over the last decade of reading and researching trt is, the men that seem to do the best are on once weekly injections. I realize there are guys the doing better by splitting the dose but some guys just don’t do well by doing that. I’ve personally know a couple guys around my age that do every two week dosing and say they wouldn’t change a thing.

 

[Maximos]

thats awesome. Did he feel bad before trt or just took it based of a low normal reading.

He had the usual symptoms, low energy and sex drive, low motivation e.t.c. I recall he had the symptoms for a couple of years before he checked his hormones.

 

[Maximos]

It’s interesting you mention this Maximos. If there’s one thing I’ve noticed over the last decade of reading and researching trt is, the men that seem to do the best are on once weekly injections. I realize there are guys the doing better by splitting the dose but some guys just don’t do well by doing that. I’ve personally know a couple guys around my age that do every two week dosing and say they wouldn’t change a thing.

Yes and I think its because, just like my friend, there are a lot of guys who just started doing TRT and never looked back. Why split the injections or do anything else if you are feeling great?
I also split my dose by the way.

 

[Maximos]

I also think many other issues are at play with a lot of men. Thyroid issues. Adrenal issues. Psychological issues. Just to name a few.

I had adrenal issues since before I started TRT and I spent almost 3 years wondering why I wasn't feeling 100% even on TRT. I was only looking at my Testosterone and E2 numbers and failed to see that my adrenals were not working propely. A month ago that I started supplementing with b vitamins, folic acid and pregnenolone and now I start to feel kinda like my old self. I have more energy, better erections and I feel much calmer.

I even believe that the b-vitamins and the pregnenolone helped me control me estrogen. I dont know my E2 levels yet but I haven't used any A.I. for the last month and so far I feel progressively better.

 

[Charliebizz]

I really wish we understood how that happens though. Are they primary or secondary the lucky ones ? Like I said above I did have other issues way before trt so that is a big factor. But what sucks for me is trt brings out worse symptoms then I ever had even though it helped with somethings. But negatives out weighed positives.

 

[Deleted member 16042]

I had adrenal issues since before I started TRT and I spent almost 3 years wondering why I wasn't feeling 100% even on TRT. I was only looking at my Testosterone and E2 numbers and failed to see that my adrenals were not working propely. A month ago that I started supplementing with b vitamins, folic acid and pregnenolone and now I start to feel kinda like my old self. I have more energy, better erections and I feel much calmer.

I even believe that the b-vitamins and the pregnenolone helped me control me estrogen. I dont know my E2 levels yet but I haven't used any A.I. for the last month and so far I feel progressively better.

This is a classic mistake which seems to dominate some people's thinking: to assume that all of their problems are T related, or T and E... blinders on to everything else that might cause such symptoms.

 

[AbsoluteZ3R0]

While you are certainly correct that T levels and replacement therapy are not the only things responsible for ED and sexual function, there are MANY anecdotal accounts of HCG not working or ceasing to work for members of this forum, even in very short order, not over years of use. For me, its effect on the testicles has diminished considerably despite increasing dosage significantly. However I didn't have ED or sexual function issues initially before TRT, nor do I now, except testicular size and retraction problems after starting TRT. So, in my case, you are correct that there are other things at work, BUT, HCG's effectiveness has decreased in the course of a few months.

"no scientific evidence" doesn't mean something is not true when something has not been thoroughly studied. It just means we don't know yet.

I am aware that just because something has not been studied does not mean that it isn't true, but I have not seen these anecdotal accounts either (although I'm sure they exist, as they do for about anything you can imagine). The HCG doses prescribed by clinicians have a relatively low physiological effect compared to the amount of LH a healthy body produces naturally, so it doesn't make sense that receptor down-regulation would occur unless high doses were taken. I remember Dr Saya's small study in which 500 iu of HCG taken twice weekly roughly had the effect of LH levels around 2miu/mL, which are borderline below range. LH receptor down-regulation makes more sense in the context of drugs like clomid, which shoot LH well over range for most men, and of course gnrh agonists which are intentionally used to shutdown gnrh receptors. Again, LH is not the only hormone that acts on the testes, so even with an adequate dose of HCG, you are likely to experience testicular atrophy over time unless the stimulating effects of FSH are also replicated.

Ironically, androgen usage up-regulates androgen receptor density, so obviously we can't blame AR down-regulation either. The problem with this sort of theory-crafting without evidence is that it leads to unneeded hysteria. Guys who've been doing fine might become unnecessarily concerned that they've made a mistake committing to trt, and guys who've been doing not so fine may be inclined to blame their trt without investigating other avenues. I'm sure you would agree that nothing in this post was meant to intentionally alarm anyone, but it could certainly have that effect, and unnecessarily so. While the idea that all the guys who feel great are out and about loving life and too busy to visit the forums might seem a bit alienating to those who are struggling, there may be some truth to that thought. This forum really only has appeal to three demographics: 1) People who need help, 2) people who are passionate about the subject and love the science of trt, or enjoy discussion in general 3) people who enjoy using their knowledge/experience to help others, or fall into some combination of the three categories. Beyond that, it's really easy to forget about this site and move on with life, especially if you're feeling pretty good. Of course, I have no evidence for these statements either, but it is something to consider.

 

[Nelson Vergel]

I talk about the issue of long-term LH suppression in these two videos.

Why is HCG Important for Men on Testosterone Replacement Therapy?
Can HCG replace LH?

 

[Dr Justin Saya MD]

I am aware that just because something has not been studied does not mean that it isn't true, but I have not seen these anecdotal accounts either (although I'm sure they exist, as they do for about anything you can imagine). The HCG doses prescribed by clinicians have a relatively low physiological effect compared to the amount of LH a healthy body produces naturally, so it doesn't make sense that receptor down-regulation would occur unless high doses were taken. I remember Dr Saya's small study in which 500 iu of HCG taken twice weekly roughly had the effect of LH levels around 2miu/mL, which are borderline below range. LH receptor down-regulation makes more sense in the context of drugs like clomid, which shoot LH well over range for most men, and of course gnrh agonists which are intentionally used to shutdown gnrh receptors. Again, LH is not the only hormone that acts on the testes, so even with an adequate dose of HCG, you are likely to experience testicular atrophy over time unless the stimulating effects of FSH are also replicated.

Ironically, androgen usage up-regulates androgen receptor density, so obviously we can't blame AR down-regulation either. The problem with this sort of theory-crafting without evidence is that it leads to unneeded hysteria. Guys who've been doing fine might become unnecessarily concerned that they've made a mistake committing to trt, and guys who've been doing not so fine may be inclined to blame their trt without investigating other avenues. I'm sure you would agree that nothing in this post was meant to intentionally alarm anyone, but it could certainly have that effect, and unnecessarily so. While the idea that all the guys who feel great are out and about loving life and too busy to visit the forums might seem a bit alienating to those who are struggling, there may be some truth to that thought. This forum really only has appeal to three demographics: 1) People who need help, 2) people who are passionate about the subject and love the science of trt, or enjoy discussion in general 3) people who enjoy using their knowledge/experience to help others, or fall into some combination of the three categories. Beyond that, it's really easy to forget about this site and move on with life, especially if you're feeling pretty good. Of course, I have no evidence for these statements either, but it is something to consider.

Some well-spoken points in this post.

Though we know there are some guys that struggle (even if only temporarily) with TRT (or any treatment for that matter), I can tell you WITHOUT A DOUBT that the forums disproportionately represent those that are actively having treatment issues. This is clearly due to the fact that said guys need help and are the ones most motivated to seek help via the forums.

I cannot even begin to estimate the number of times I’ve treated guys that are forum members, followed their case (both through direct treatment and through the forums) and then lose sight of them on the forums until a distant consult down the line...a year, two years, three years later, sparks my memory of their “forum case” and we have a nostalgic discussion. If I only had a dime for every time I’ve said “it’s been a really long time since I’ve seen you on the forums”...and by far the most common response is (in some variation) “well I’ve been doing great, staying busy, advancing career, growing family, etc, etc”...in other words they’re doing better and, indeed, out living their (improved) lives!

 

[CoastWatcher]

I am aware that just because something has not been studied does not mean that it isn't true, but I have not seen these anecdotal accounts either (although I'm sure they exist, as they do for about anything you can imagine). The HCG doses prescribed by clinicians have a relatively low physiological effect compared to the amount of LH a healthy body produces naturally, so it doesn't make sense that receptor down-regulation would occur unless high doses were taken. I remember Dr Saya's small study in which 500 iu of HCG taken twice weekly roughly had the effect of LH levels around 2miu/mL, which are borderline below range. LH receptor down-regulation makes more sense in the context of drugs like clomid, which shoot LH well over range for most men, and of course gnrh agonists which are intentionally used to shutdown gnrh receptors. Again, LH is not the only hormone that acts on the testes, so even with an adequate dose of HCG, you are likely to experience testicular atrophy over time unless the stimulating effects of FSH are also replicated.

Ironically, androgen usage up-regulates androgen receptor density, so obviously we can't blame AR down-regulation either. The problem with this sort of theory-crafting without evidence is that it leads to unneeded hysteria. Guys who've been doing fine might become unnecessarily concerned that they've made a mistake committing to trt, and guys who've been doing not so fine may be inclined to blame their trt without investigating other avenues. I'm sure you would agree that nothing in this post was meant to intentionally alarm anyone, but it could certainly have that effect, and unnecessarily so. While the idea that all the guys who feel great are out and about loving life and too busy to visit the forums might seem a bit alienating to those who are struggling, there may be some truth to that thought. This forum really only has appeal to three demographics: 1) People who need help, 2) people who are passionate about the subject and love the science of trt, or enjoy discussion in general 3) people who enjoy using their knowledge/experience to help others, or fall into some combination of the three categories. Beyond that, it's really easy to forget about this site and move on with life, especially if you're feeling pretty good. Of course, I have no evidence for these statements either, but it is something to consider.

In the years I've served as a moderator here at EM, the number of guys who stay consistently active, contributing on a regular basis and engaging with others in order to help them (and not necessarily seek to enhance their own TRT experience) is fairly small. Time and life certainly seems to pull them in other directions once they have overcome the challenges that brought them here. The circle keeps turning.

 

[Charliebizz]

I'm still very curious how men on trt only with no hcg are effected long term. It seems like that question is still kind of dodged on these forums. Some men can not tolerate hcg we see a decent amount of it on here. What is the solution. Is trt only safe long term?

 

[TestAdvocate]

Some well-spoken points in this post.

Though we know there are some guys that struggle (even if only temporarily) with TRT (or any treatment for that matter), I can tell you WITHOUT A DOUBT that the forums disproportionately represent those that are actively having treatment issues. This is clearly due to the fact that said guys need help and are the ones most motivated to seek help via the forums.

I cannot even begin to estimate the number of times I’ve treated guys that are forum members, followed their case (both through direct treatment and through the forums) and then lose sight of them on the forums until a distant consult down the line...a year, two years, three years later, sparks my memory of their “forum case” and we have a nostalgic discussion. If I only had a dime for every time I’ve said “it’s been a really long time since I’ve seen you on the forums”...and by far the most common response is (in some variation) “well I’ve been doing great, staying busy, advancing career, growing family, etc, etc”...in other words they’re doing better and, indeed, out living their (improved) lives!

Totally agree with this. I'm one of those guys, I'm one of your patients. I love this forum. This Forum served me so well in getting started, I occasionally check in now to see what's going on. TRT has been great for me. Staying on top of everything to keep "dialed in" takes effort, and then still things can go haywire. Then we check in again to get more specific info. I think when we choose this therapy, we are going in knowing that a lot of this is "pioneering" sort of speak. For me, I would rather Pioneer and live the benefits out, instead of waiting for 100% conclusive studies and finding out decades later that the therapy "absolutely" proves to be all it's touted to be. My wife and like to say...."Life is now! Life is in session!"

 

[JPB]

Bravo frankwhite !! You nailed it, it is just a matter of time. What has yet to be worked out is how to cycle off periodically without going totally through hell and back again before getting back on, restoring the original level of benefit.

The belief in TRT amongst people in the know is one should aim at keeping T levels steady, but there were older styles of cycling that were intended to allow some retention of natural function by letting levels drop off periodically. But for the most part over time these mini-bursts just lead to a roller-coaster affect. So it seems longer off periods are needed.

Regarding those thinking they are safeguarding against this problem simply with lower dosages, that is unlikely because your LH levels are still most likely next to zero.