HPTA Restart after Varicocele Surgery?

[stx358]

I have been on TRT for 10 months. Regimen is 80mg Test Cyp q 3.5 and 150IU HCG daily. Current labs are TT - 1091, FT - 23, Sensitive E - 32. Numbers are textbook and body comp really changed over last 10 months - went from 20% to 11% body fat - but the side effects - sleep, acne, weak orgasms - are awful.

In a post from a couple years ago on HPTA restart I remember Nelson saying that many men are misdiagnosed due to all the new TRT clinics and I think I am one of them. I started TRT after three tests that showed a Total T around 400 and symptoms - mainly low libido. I was later diagnosed with two large varicoceles which were subsequently removed. Shortly after that I started daily the HCG injections I take now and my testosterone went through the roof. That made me wonder if my testicles were working better after the varicocelectomy.

My issues are that I have read that HPTA startup is mainly for steroid users which is not me, and I am 48 years old and I've heard mixed results in guys my age. I did get my wife pregnant at 46 so I am not too far removed from that.

I am seriously considering this - the way I see it I can always go back to testosterone if it doesn't work. I'd be overjoyed with a total of 600 which would be an increase of 200 over my pre surgery numbers. I am just looking for someone to shoot some holes in my logic - I am sure there are some - and to share their experiences with varicoceles. There is precious little info on the board about it.

Finally, if I decide to come off is it better to lower the dose over the period of a couple months or just stop and initiate HPTA restart?

 

[lenny]

Wow, those are really good numbers. That sucks that you're having trouble with the side effects. I'm intrigued by the daily HCG protocol, though. Was that your doctor's recommendation? Never seen that prescribed before.

For your side effects though, certainly with the acne and possibly the sleep problems… it might be because your total T is a bit too high for you. You didn't mention it, so I take it you're not on an AI (aromatase inhibitor)? Weak orgasms is a curious problem to have with those numbers, so I feel your frustration. Your e2 is not particularly high, and your free T isn't bad.

I'm the same age as you, and also wound up with low T because of huge bilateral varicoceles, but didn't start TRT until about six months after the surgery. My pre-surgery total T was 308 ng/dL, and several months after surgery it had climbed up to 328. So not much of an improvement. Maybe if I'd been more patient, there might have been more long-term improvement, but probably not much.

That was five years ago now, and my doc is still encouraging me to take a month off T and do a restart protocol with high doses of HCG and clomid, just to get my sperm production back in full swing for awhile. I've been nervous to do that, since I'm pretty sure I'll feel like crap the whole time. But I'll probably take the plunge later this year… it's only for a month, after all.

Anyway, for you I would say screw it, it's worth a shot. Why not? Like you say, you can always go back on T if you don't like the results. I'm not sure what the odds are for a full HPTA restart after ten months of TRT, but I'm pretty sure it's been done. Just keep in mind that the chances of you ever getting back to where you were before the varicoceles did their damage are pretty much zero.

 

[stx358]

My doctor didn't know anything about HCG. I asked him to prescribe it based upon what I learned on here. 150 IU a day is Dr. Crisler's protocol. I felt horrible before HCG.

Correct I did not take an AI. I am with Nelson on this one. There is very little data to support the use of an AI and even less that indicates a "standard" estradiol level for men. That is a moving target. Most of the info on AI's is anecdotal or bro science and there seems to be a huge incidence of guys crashing their E on here. E is not a "female" hormone. Its a human hormone. I think that "female" label scares guys needlessly. I think a sensitive E of 32 is reasonable.

As for the surgery the thing is my balls hurt for 8 months after the surgery and I had the best surgeon in my area (Northern California). I think the recovery took that long. I finally feel great - that and the dramatic response to HCG makes me wonder is the surgery was successful.

I have scoured the boards and I have read a few incidences of guys our age having relatively painless restarts. The thing is when guys have a successful one they don't post it and probably fall off the boards. I think a lot of guys are probably going through this - 15-20% of men have varicoceles whether they know it or not. That's why I am talking about it. I want to help other guys like us. I plan to post my experience on here and to remain on the board even if I am successful. I am very thankful for everything I learned on here. If I was left in the hands of my incompetent TRT doctor I would have been ruined without Excel Male.

 

[Guided_by_Voices]

I too had a varicocele and used both clomid and hcg for some time afterward before going on TRT. The thing that stands out for me from what you posted is that your cyp dosage and T levels seem quite high. How did you arrive at that dosage? I have found through lots of experimentation that I do best at numbers around half of yours so your sides may be coming from the dosage, not from TRT itself. I would tinker with TRT before you try a restart.

 

[stx358]

My hope is that if my testicles are working well enough post recovery that I can hit half that Total T number without TRT. I was 400 before TRT.

 

[AdamYoung]

Did you notice any change in sperm count before and after surgery?

 

[Nelson Vergel]

Congratulations!

Varicolele Repair Surgery Improves Testosterone

Some other studies showed no effect, though. Objective: To investigate effect of microsurgical varicocele repair on sexual functions and serum total testosterone level in infertile hypogonadal men with varicocele, and also to determine factors that might predict improvement in total...

www.excelmale.com

 

[AdamYoung]

Thanks Nelson. Its a good study. Wish they did sperm analysis post surgery but i am sure it will increase as there are some literature online which mentioned increase in testicle size and sperm count as well.

 

[stx359]

Did you notice any change in sperm count before and after surgery?

I did not check sperm counts before or after as I was 48 at the time of the post and not interested in having more children. After this I consulted with Dr. Crisler (RIP) who advised that HPTA restarts are doomed to failure for most guys my age which makes sense. Now I am with Defy and using daily dosing which eliminated all the side effects I mentioned. I am on 16 mg/day tst cyp and 120 IU HCG per day with numbers right around where I reported them originally on this thread.

 

[AdamYoung]

So, Just curious what are the changes you found after surgery? How did you know that your testicles started working again? Did you see any changes in size? Or is it by increase in testosterone with low hcg dosage?

 

[stx359]

The main difference was that after I recovered, which took weeks, my testicles no longer hurt. I do a lot of weight lifting which caused blood to pool in my varicoceles and resulted in a constant dull ache. I chose to begin TRT right away despite the surgery because I was suffering from symptoms of low T and I did not know how much damage was done by the varicoceles and did not want to wait to find out. I had them on both sides not just one and they had been there for a couple of years before I was diagnosed, so the doctor said there was no telling how much damage was done or if my test would come back in my late 40's. It was only when I noticed months later that HCG had an effect on my testosterone that I learned there was still function down there, but I am a high SHBG guy so they would have to produce a lot to get my free T to an adequate level.

 

[Wolverine]

I did not check sperm counts before or after as I was 48 at the time of the post and not interested in having more children. After this I consulted with Dr. Crisler (RIP) who advised that HPTA restarts are doomed to failure for most guys my age which makes sense. Now I am with Defy and using daily dosing which eliminated all the side effects I mentioned. I am on 16 mg/day tst cyp and 120 IU HCG per day with numbers right around where I reported them originally on this thread.

Our paths are very similar. At age 50 had T in the low 300s and symptoms. Had grade 3 varicocele repair. Numbers did not come up so went on TRT at age 51. Now age 56. Been an up and down roller coaster and Ive tired most protocols, AIs, Hcg. Can't seem to be in that sweet spot consistently.

Interesting protocol. Usually I read low SHBG doing daily injections. I have symptoms similar to what you had but have never tried daily injections. Sleep issues and weak orgasms. I do 50mg twice a week T Cyp. No HCG currently. No AI. I've gone on and off with HCG. SHBG 16. What is your SHBG level? Do you use a 31 gauge insulin needle? Do you do two injections each day (T Cyp and the other HCG) seven days a week? Where do you inject? How are your EQ and libido? What are you labs on this protocol? Any AIs? Thanks.

 

[AdamYoung]

The main difference was that after I recovered, which took weeks, my testicles no longer hurt. I do a lot of weight lifting which caused blood to pool in my varicoceles and resulted in a constant dull ache. I chose to begin TRT right away despite the surgery because I was suffering from symptoms of low T and I did not know how much damage was done by the varicoceles and did not want to wait to find out. I had them on both sides not just one and they had been there for a couple of years before I was diagnosed, so the doctor said there was no telling how much damage was done or if my test would come back in my late 40's. It was only when I noticed months later that HCG had an effect on my testosterone that I learned there was still function down there, but I am a high SHBG guy so they would have to produce a lot to get my free T to an adequate level.

Thanks i am planning to get it repaired asap. I am only hoping to increase my sperm count. I am not worried about t levels as i can manage it by exogenous. Thanks

 

[stx359]

Our paths are very similar. At age 50 had T in the low 300s and symptoms. Had grade 3 varicocele repair. Numbers did not come up so went on TRT at age 51. Now age 56. Been an up and down roller coaster and Ive tired most protocols, AIs, Hcg. Can't seem to be in that sweet spot consistently.

Interesting protocol. Usually I read low SHBG doing daily injections. I have symptoms similar to what you had but have never tried daily injections. Sleep issues and weak orgasms. I do 50mg twice a week T Cyp. No HCG currently. No AI. I've gone on and off with HCG. SHBG 16. What is your SHBG level? Do you use a 31 gauge insulin needle? Do you do two injections each day (T Cyp and the other HCG) seven days a week? Where do you inject? How are your EQ and libido? What are you labs on this protocol? Any AIs? Thanks.

That was my understanding of daily dosing as well - that it was for low SBGH only. It was after consulting with Dr. Saya that I decided to go with dailies mainly because of side effects - in my case hematocrit, acne and sleep trouble. I was on that downward trend of high hematocrit, the need to give blood and ferritin close to zero (17). Also I was fabulously fit with great body comp but my back and chest looked like that a leper. Daily dosing solved all of it. My hematocrit is pegged at 48 and my skin is 100% clear. I am still dialing in my regimen though. I was on 140 mg a week doing twice weekly IM - went to 18 mg a day and now 16 mg a day sub Q but because absorption is different my total test shot to 1200 and my sensitive E2 to 73. Last labs were TT of 870 and E2 of 47 about a month ago. The high E2 drove down my SHBG to 37. Usually I am in my mid 40's. I don't take AI's because I have never experienced E2 symptoms.