Low T added T Gel, then Atrophy, added HCG ... now T Levels are dropping

[David House]

This is my first post to Excelmale.
I am a 58 yr old that has had ED issues for years but was just diagnosed about 7 months ago. No energy, no sex drive and weak erections at best. Penis shots were recommended but I opted out at this time. Urologist / Men's Wellness prescribed several meds the first was Sildenafil 1-5 (20mg) tablets then changed to
Tadalafil (20mg). Now changed to daily maintenance dose of 5mg Tadalafil and 100mg Sildenafil on sexual active days. TT levels on 2/28 was 229 ... TT levels on 3/30 was 189. Androgel prescribed 1 pump each arm ... recheck of TT on 6/17 was 342. Dr. increased Androgel to 2 pumps per arm. Improved energy, 25 lbs weight loss, improved libido and erections with stimulation. Have experienced about 50% testicular atrophy due to HRT. Told my Dr. of my atrophy concern and the feel that I have been chemically castrated. He said that he can prescribe self administered shots to stop additional testicle reduction and possibly return to a normal size. Will they return to their regular size? Can anyone provide information as I assume the shots will be HCG. This is all new for me so any information is welcomed.

 

[Cataceous]

Yes, it's quite common to add hCG to TRT in order to prevent or reverse testicular atrophy. Doses as low as 500 IU per week—in at least two injections—can do the job. Because of hCG's propensity to stimulate conversion of testosterone to estradiol, it is usually best to find the smallest dose that does the job. As an adjunct to TRT, hCG doses typically range from 500 to 1500 IU per week in at least two or three doses. There's no guarantee of complete size restoration of the testicles, but most guys have decent results.

If you're going to be doing injections anyway then you might consider taking your testosterone that way also. It is less expensive and more reliable.

 

[mooseman109]

HCG caused my estradiol to rise higher than I feel good with, so I have accepted small nuts. I could probably take an AI to help with HCG induced estradiol increase, but trying to keep meds limited.

 

[Vince]

I’m one who likes hCG. I inject 500 iu twice a week. This keeps my testicles nice and full. It would be tough for me to do trt without hCG.

 

[David House]

I’m one who likes hCG. I inject 500 iu twice a week. This keeps my testicles nice and full. It would be tough for me to do trt without hCG.

Not sure all the risk factors or side effects with HCG but will discuss with Dr. next week. It's like you take HRT for ED, low libido and lack of energy or other issues and then your testicles shrink because of testosterone replacement.
What concerns should I have with HCG ... as I am new to all of this ED stuff.

 

[Vince]

Not sure all the risk factors or side effects with HCG but will discuss with Dr. next week. It's like you take HRT for ED, low libido and lack of energy or other issues and then your testicles shrink because of testosterone replacement.
What concerns should I have with HCG ... as I am new to all of this ED stuff.

Personally I have no concerns with using hCG. Some members seem to have issues with E2 when using high doses of hcg. I’ve only had benefits from it.

 

[David House]

Yes, it's quite common to add hCG to TRT in order to prevent or reverse testicular atrophy. Doses as low as 500 IU per week—in at least two injections—can do the job. Because of hCG's propensity to stimulate conversion of testosterone to estradiol, it is usually best to find the smallest dose that does the job. As an adjunct to TRT, hCG doses typically range from 500 to 1500 IU per week in at least two or three doses. There's no guarantee of complete size restoration of the testicles, but most guys have decent results.

If you're going to be doing injections anyway then you might consider taking your testosterone that way also. It is less expensive and more reliable.

I currently can get a 90 supply of Androgel from my insurance mail order for $15.00. If gels are producing increased results my insurance may not cover injections.
When I first started Androgel, I began to feel better and had lots of energy but now it seems that my levels have decreased ... is that normal?
I'm having labs drawn this week so I will see what 80 mg per day gel produces in TT. I requested to have free T done but I assume it will be zero. Should I inquire about injections verses gel and if so what is the normal regimen and dosage. I have read about troughs of high and low when injecting so how to you combat that scenario. This low T, low libido and energy loss is a bite. Thanks for your feedback

 

[Cataceous]

Sounds like your insurance company is the one eating the high cost of Androgel. In any case, it's common to feel better when starting TRT only to have the effects fade. The presumption is that you're getting a boost from the exogenous testosterone before your natural production shuts down. Loss of natural testosterone production may contribute to substandard results down the road because you also lose production of other hormones that probably do some useful things. These include kisspeptin, GnRH, LH and FSH. HCG is often used as a passable replacement for LH.

Free T should not be zero. But if you didn't specifically request one of the accurate methods—equilibrium dialysis or ultrafiltration—then the result will not be as useful. Alternatively, it's good to simply order an SHBG test along with total testosterone and use the Tru-T calculator to get a decent estimate of free T—healthy normal range is 16-31 ng/dL.

If you like the gel and have good results then there's no reason to change as long as your cost is so low. I personally had a lot of problems with Androgel and gave up on it relatively quickly. I would have needed to apply it at least twice daily to keep levels high enough, and even then I may have had absorption problems. In contrast, injections have provided very consistent results.

Regarding highs and lows in serum testosterone: These may be bad when the excursions leave a normal physiological range. They may also be less good when the cycle takes place over many days. Normal physiology has most of the variation occurring in a daily cycle, with serum testosterone dropping from a morning peak to an evening trough. Increasing the injection frequency damps down the variations, which is preferable to having large excursions over multiple days. But having fairly constant hormones is not really a natural condition either.

 

[David House]

Sounds like your insurance company is the one eating the high cost of Androgel. In any case, it's common to feel better when starting TRT only to have the effects fade. The presumption is that you're getting a boost from the exogenous testosterone before your natural production shuts down. Loss of natural testosterone production may contribute to substandard results down the road because you also lose production of other hormones that probably do some useful things. These include kisspeptin, GnRH, LH and FSH. HCG is often used as a passable replacement for LH.

Free T should not be zero. But if you didn't specifically request one of the accurate methods—equilibrium dialysis or ultrafiltration—then the result will not be as useful. Alternatively, it's good to simply order an SHBG test along with total testosterone and use the Tru-T calculator to get a decent estimate of free T—healthy normal range is 16-31 ng/dL.

If you like the gel and have good results then there's no reason to change as long as your cost is so low. I personally had a lot of problems with Androgel and gave up on it relatively quickly. I would have needed to apply it at least twice daily to keep levels high enough, and even then I may have had absorption problems. In contrast, injections have provided very consistent results.

Regarding highs and lows in serum testosterone: These may be bad when the excursions leave a normal physiological range. They may also be less good when the cycle takes place over many days. Normal physiology has most of the variation occurring in a daily cycle, with serum testosterone dropping from a morning peak to an evening trough. Increasing the injection frequency damps down the variations, which is preferable to having large excursions over multiple days. But having fairly constant hormones is not really a natural condition either.

Thanks for the head up ... messaged my Dr. to request equilibrium dialysis or ultrafiltration test along with SHBG.

3/30/20 TEST RESULTS
Estradol, Sensitive 15.4 (8.0-35.0)
Prolactin 23.2 (4.0-15.2)
Retest on 6/17 10.5 (4.0-15.2)
LH 5.2 (1.7-8.6)
FSH 3.9 (1.5-12.4)
6/17 PSA 0.7 (0.0-4.0) prostrate size is small for last 2 exams.

 

[fifty]

You want equilibrium dialysis or ultrafiltration or SHBG. Probably easier to just ask for SHBG.

 

[David House]

You want equilibrium dialysis or ultrafiltration or SHBG. Probably easier to just ask for SHBG.

RESULTS FROM 8/6/20
Total T shows 707 (264-916) using 4 pumps of Androgel daily.
Free T shows 23.6 (7.2-24)
SHBG 17.8 (19.3-76.4)

 

[David House]

Sounds like your insurance company is the one eating the high cost of Androgel. In any case, it's common to feel better when starting TRT only to have the effects fade. The presumption is that you're getting a boost from the exogenous testosterone before your natural production shuts down. Loss of natural testosterone production may contribute to substandard results down the road because you also lose production of other hormones that probably do some useful things. These include kisspeptin, GnRH, LH and FSH. HCG is often used as a passable replacement for LH.

Free T should not be zero. But if you didn't specifically request one of the accurate methods—equilibrium dialysis or ultrafiltration—then the result will not be as useful. Alternatively, it's good to simply order an SHBG test along with total testosterone and use the Tru-T calculator to get a decent estimate of free T—healthy normal range is 16-31 ng/dL.

If you like the gel and have good results then there's no reason to change as long as your cost is so low. I personally had a lot of problems with Androgel and gave up on it relatively quickly. I would have needed to apply it at least twice daily to keep levels high enough, and even then I may have had absorption problems. In contrast, injections have provided very consistent results.

Regarding highs and lows in serum testosterone: These may be bad when the excursions leave a normal physiological range. They may also be less good when the cycle takes place over many days. Normal physiology has most of the variation occurring in a daily cycle, with serum testosterone dropping from a morning peak to an evening trough. Increasing the injection frequency damps down the variations, which is preferable to having large excursions over multiple days. But having fairly constant hormones is not really a natural condition either.

RESULTS FROM 8/6/20
Total T shows 707 (264-916) 4 pumps of Androgel daily.
Free T shows 23.6 (7.2-24)
SHBG 17.8 (19.3-76.4)

 

[Cataceous]

Good looking numbers, a little over mid-range for Tru-T. Was this approximately a peak reading, a few hours after gel application? It would be good if you're getting some diurnal variation without too low of a trough.

 

[David House]

Good looking numbers, a little over mid-range for Tru-T. Was this approximately a peak reading, a few hours after gel application? It would be good if you're getting some diurnal variation without too low of a trough.

Readings were 4-1/2 hours after application of gel. Had to look up diurnal variation as that was a new term to me. In relation to mood swings or depression ... they have never been an issue that affected me.

 

[Cataceous]

Readings were 4-1/2 hours after application of gel. Had to look up diurnal variation as that was a new term to me. In relation to mood swings or depression ... they have never been an issue that affected me.

Yes, "diurnal" is just a fancy work for "daily". It is commonly used in the literature when referring to daily variations in serum testosterone, which is what I meant. Normal men have peak testosterone around 8 am, with levels falling to a low point about 12 hours later. We can somewhat imitate this under TRT by using daily doses of testosterone formulations that have short enough half-lives. I've been speculating that there may be some benefits in having this rhythm, even if only subtle. Why else would it have evolved?

 

[David House]

Yes, "diurnal" is just a fancy work for "daily". It is commonly used in the literature when referring to daily variations in serum testosterone, which is what I meant. Normal men have peak testosterone around 8 am, with levels falling to a low point about 12 hours later. We can somewhat imitate this under TRT by using daily doses of testosterone formulations that have short enough half-lives. I've been speculating that there may be some benefits in having this rhythm, even if only subtle. Why else would it have evolved?

Thanks for the clarification and information. Just started Androgel in mid-April so all this is really new for me. Had low T issues for a couple years but did not realize what the systems actually were that I was experiencing.

 

[duramax]

I'm 56yo....started Androgel when I was 38yo. Initially was the best I've ever felt, but after 6 months my body quit absorbing like in the beginning. I've tried about every delivery method since and have never came close to the first 6 months on Androgel. I just have recently discovered that I'm low SHGB......I'm sure this has been my problem for many years. Now I do small injections daily.....not there yet, but remain hopeful on a good balance. Hope Androgel continues working for you.

 

[David House]

My Total T is now 707 but this is just after 4 months on Androgel and 2 pumps per arm each day. Seemed like superman for the 1st 2 months with lots of energy. You mentioned daily shots due to low SHGB ... can I ask what type since mine is also low but only by 2 pts. After 4 months testicular atrophy is very noticable so considering HCG but waiting to talk with dr. Had an apt for Thursday but it was cancelled and rescheduled to October ... not happy. So when you used Androgel did it raise your Total T.

 

[duramax]

My Total T is now 707 but this is just after 4 months on Androgel and 2 pumps per arm each day. Seemed like superman for the 1st 2 months with lots of energy. You mentioned daily shots due to low SHGB ... can I ask what type since mine is also low but only by 2 pts. After 4 months testicular atrophy is very noticable so considering HCG but waiting to talk with dr. Had an apt for Thursday but it was cancelled and rescheduled to October ... not happy. So when you used Androgel did it raise your Total T.

Sure it raised it for the first six months, but then I started having problems with absorption. This was way back when Androgel just came out. Most doctors never even tested other issues that are driven by TRT. Estrogen was never looked at, etc. I am using HCG now along with small doses of Arimidex. I use insulin syringes .15 daily...inject in shoulders. You will find most doctors out there will not prescribe HCG....your lucky if you have one that understands HRT. Maybe overtime testosterone will lower your SHGB? Lots of info on this site about it.

 

[David House]

Sounds like your insurance company is the one eating the high cost of Androgel. In any case, it's common to feel better when starting TRT only to have the effects fade. The presumption is that you're getting

Free T should not be zero. But if you didn't specifically request one of the accurate methods—equilibrium dialysis or ultrafiltration—then the result will not be as useful. Alternatively, it's good to simply order an SHBG test along with total testosterone and use the Tru-T calculator to get a decent estimate of free T—healthy normal range is 16-31 ng/dL.

If you like the gel and have good results then there's no reason to change as long as your cost is so low. I personally had a lot of problems with Androgel and gave up on it relatively quickly. I would have needed to apply it at least twice daily to keep levels high enough, and even then I may have had absorption problems. In contrast, injections have provided very consistent results.

Regarding highs and lows in serum testosterone: These may be bad when the excursions leave a normal physiological range. They may also be less good when the cycle takes place over many days. Normal physiology has most of the variation occurring in a daily cycle, with serum testosterone dropping from a morning peak to an evening trough. Increasing the injection frequency damps down the variations, which is preferable to having large excursions over multiple days. But having fairly constant hormones is not really a natural condition either.

Free T should not be zero.

Spoke with my Dr. about 1 wk ago and based on my original 229/189 TT numbers before TRT he calculated the my FT to be 4 ... so not zero but close!