Med student here. I have been on TRT since 21. Here is what I have learned about ED, libido and hormones.

[Cataceous]

@Cataceous can you explain your protocol in greater detail? I’m curious about the GnRH? I’ve never even heard of that. Is it something Defy prescribes? Also curious about your progesterone usage. Not sure if you are on a large dose or not? I’ve only ever seen the cream. Apologies if you’ve explained all this in a different thread.

The GnRH protocol is explained here. The only current difference is that the enclomiphene dose is reduced to 12.5 mg EOD. I don't yet have lab work on this lower amount to see if the gonadotropins are lower. The drug name for GnRH is gonadorelin. I'm not sure if Defy prescribes it, though I will be asking them. It is available from Hallandale Pharmacy.

I'm injecting 600 mcg of progesterone every night before bed. This puts serum levels near the middle of the range for LabCorp's test, so I wouldn't consider it a high dose. It has been good for mood and sleep. There may be less obvious benefits in correcting the deficiency ostensibly caused by TRT.

 

[MNguy]

The GnRH protocol is explained here. The only current difference is that the enclomiphene dose is reduced to 12.5 mg EOD. I don't yet have lab work on this lower amount to see if the gonadotropins are lower. The drug name for GnRH is gonadorelin. I'm not sure if Defy prescribes it, though I will be asking them. It is available from Hallandale Pharmacy.

I'm injecting 600 mcg of progesterone every night before bed. This puts serum levels near the middle of the range for LabCorp's test, so I wouldn't consider it a high dose. It has been good for mood and sleep. There may be less obvious benefits in correcting the deficiency ostensibly caused by TRT.

Thanks for the quick reply. Have you spoke to anyone else who is having success with a similar protocol?

 

[Cataceous]

Thanks for the quick reply. Have you spoke to anyone else who is having success with a similar protocol?

I'm not aware of anyone else attempting anything like it. It would be good to see if it works for others, but the protocol is demanding enough to deter all but the most highly motivated.

 

[Gingkohagane]

I wanted to comment you. This is really impressive work and I hope to see more of your posts.

 

[Hormetheus]

I'm not aware of anyone else attempting anything like it. It would be good to see if it works for others, but the protocol is demanding enough to deter all but the most highly motivated.

A very interesting protocol although seems very time/cost-intensive

 

[Cataceous]

A very interesting protocol although seems very time/cost-intensive

The financial cost is pretty trivial, maybe $2-3 a day. The time cost isn't negligible, but it's not excessive either. Possibly an extra 10-20 minutes a day. Each injection is less than a minute with a pre-filled syringe. It's a modest price to pay for the benefits.

 

[Hormetheus]

The financial cost is pretty trivial, maybe $2-3 a day. The time cost isn't negligible, but it's not excessive either. Possibly an extra 10-20 minutes a day. Each injection is less than a minute with a pre-filled syringe. It's a modest price to pay for the benefits.

If benefits are truly noticeable than I agree with your cost-effort-benefit analysis.

 

[gerardo]

The financial cost is pretty trivial, maybe $2-3 a day. The time cost isn't negligible, but it's not excessive either. Possibly an extra 10-20 minutes a day. Each injection is less than a minute with a pre-filled syringe. It's a modest price to pay for the benefits.

Interesting. Given your studies, what would your protocol look like today?

 

[Cataceous]

Interesting. Given your studies, what would your protocol look like today?

Referring to hormones only:
Daily subcutaneous: 3.2 mg TE, 2.4 mg TP, 20 mcg X5 + 5 mcg X1 GnRH, 10 mcg X5 KISS-10, 600 mcg PROG,
Daily oral: 12.5 mg DHEA
EOD oral: 12.5 mg enclomiphene

 

[gerardo]

Referring to hormones only:
Daily subcutaneous: 3.2 mg TE, 2.4 mg TP, 20 mcg X5 + 5 mcg X1 GnRH, 10 mcg X5 KISS-10, 600 mcg PROG,
Daily oral: 12.5 mg DHEA
EOD oral: 12.5 mg enclomiphene

It would be easier if you could apply gnrh only once a day and without enclomiphene. Is Gonadorelin the same one that people use in animals?

 

[Cataceous]

It would be easier if you could apply gnrh only once a day and without enclomiphene. Is Gonadorelin the same one that people use in animals?

Unfortunately, it seems unlikely that once-daily doses of GnRH would provide the full benefits. Gonadorelin is simply manufactured GnRH; it is identical to the natural version, and is used in people and animals.

 

[gerardo]

Unfortunately, it seems unlikely that once-daily doses of GnRH would provide the full benefits. Gonadorelin is simply manufactured GnRH; it is identical to the natural version, and is used in people and animals.

It is difficult to use GnRH due to the daily work environment. Have you tried to use only once a day and supplement with HCG?

 

[madman]

It is difficult to use GnRH due to the daily work environment. Have you tried to use only once a day and supplement with hCG?

You need to understand how it works let alone what would be involved for GnRH to be truly effective!

Injecting once daily is pointless.


post#45

Not tolerating Test Prop?

Thanks, very thorough response! I have put the attached plan together. Does this seem like a reasonable approach? Any thoughts would be appreciated. It is a pretty reasonable transition. One thing I'd note is that it does yield a nontrivial drop in peak testosterone over a relatively short time...

www.excelmale.com

Pulsatile GnRH Therapy

Treatment with GnRH requires subcutaneous pulsatile application using a portable pump and a butterfly needle placed in the abdominal wall and changed every 2 days. The dose ranges from 5 to 20 µg/ 120 min, or 100–400 ng/kg body weight per 120 min. Low-dose pulsatile GnRH therapy (2 µg/150 min) may not elicit a sufficient pituitary response, reflecting different degrees of central maturation [16]. In most cases, the induction of spermatogenesis is evidenced by the appearance of sperm in the ejaculate. Therapy lasts on average 4 months, as shown in six of seven GnRH therapy cycles in patients with idiopathic hypogonadotropic hypogonadism or Kallman syndrome [10]. Sperm counts were below the normal range of 1.2–15.3 mill/ml.


When pulsatile GnRH treatment fails, a mutation of the GnRH receptor gene can be the cause. These defects have been described and are probably transmitted as an autosomal recessive trait. A variable degree of hypogonadism in an affected kindred was seen: a male showed no response to pulsatile administration of GnRH, which was effective in his two sisters, all showing clinical patterns of hypogonadotropic hypogonadism [19].


Another cause for failure of pulsatile GnRH treatment was observed in a patient who formed anti-GnRH antibodies during intravenous administration. This was associated with deterioration of testosterone and gonadotropin levels [20].

Gonadotropin Treatment in Male Infertility​

Male hypogonadism is often associated with impaired fertility. In special cases, treatment with gonadotropins can induce, maintain, or augment spermatogenesis. Patients responsive to such regimens are men with secondary hypogonadism, lacking gonadotropin secretion due to pituitary disorders, or...


Table 1: Modern modalities of gonadotropin substitution therapy in men to achieve spermatogenesis and maintain androgenicity

 

[madman]

Alternatives for TRT in Men with Central Hypogonadism

Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy Abstract: Central hypogonadism is a clinical condition, characterized by sexual symptoms and low serum testosterone levels, due to an impaired function of the hypothalamus or pituitary gland...

www.excelmale.com

4. Pulsatile GnRH Therapy

Pulsatile GnRH treatment has been used to restore fertility in patients with central hypogonadism with intact pituitary function. [1]. As the physiological secretion of GnRH is episodic, continuous administration of GnRH leads to desensitization of the pituitary and suppression of gonadotropin secretion. GnRH therapy must thus be administered in a pulsatile manner by a subcutaneous pump [42,46]. Pulsatile GnRH therapy succeeds to induce spermatogenesis in 80% of men. This means the outcome of GnRH therapy and therapy with gonadotropins is similar [40]. Pulsatile GnRH therapy is expensive and requires experience and specific pump material [1,35,40] and it is no longer used in routine clinical practice.

 

[madman]

Take-home points for the uninformed:

*As the physiological secretion of GnRH is episodic, continuous administration of GnRH leads to desensitization of the pituitary and suppression of gonadotropin secretion.

* GnRH therapy must thus be administered in a pulsatile manner by a subcutaneous pump [42,46].

*Pulsatile GnRH is a less attractive option because of the cost and the need for expertise and specific pump material.

 

[Cataceous]

It is difficult to use GnRH due to the daily work environment. Have you tried to use only once a day and supplement with HCG?

I have not tried this. It would be a reasonable experiment. It's at least plausible that infrequent use of GnRH could still have value due to its stimulation of the various GnRH receptors, even if it failed to stimulate gonadotropin production.

 

[gerardo]

I have not tried this. It would be a reasonable experiment. It's at least plausible that infrequent use of GnRH could still have value due to its stimulation of the various GnRH receptors, even if it failed to stimulate gonadotropin production.

I will call you in private so as not to disturb the topic. Thanks

 

[gerardo]

You need to understand how it works let alone what would be involved for GnRH to be truly effective!

Injecting once daily is pointless.


post#45

Not tolerating Test Prop?

Thanks, very thorough response! I have put the attached plan together. Does this seem like a reasonable approach? Any thoughts would be appreciated. It is a pretty reasonable transition. One thing I'd note is that it does yield a nontrivial drop in peak testosterone over a relatively short time...

www.excelmale.com

 Pulsatile GnRH Therapy

Treatment with GnRH requires subcutaneous pulsatile application using a portable pump and a butterfly needle placed in the abdominal wall and changed every 2 days. The dose ranges from 5 to 20 µg/ 120 min, or 100–400 ng/kg body weight per 120 min. Low-dose pulsatile GnRH therapy (2 µg/150 min) may not elicit a sufficient pituitary response, reflecting different degrees of central maturation [16]. In most cases, the induction of spermatogenesis is evidenced by the appearance of sperm in the ejaculate. Therapy lasts on average 4 months, as shown in six of seven GnRH therapy cycles in patients with idiopathic hypogonadotropic hypogonadism or Kallman syndrome [10]. Sperm counts were below the normal range of 1.2–15.3 mill/ml.


When pulsatile GnRH treatment fails, a mutation of the GnRH receptor gene can be the cause. These defects have been described and are probably transmitted as an autosomal recessive trait. A variable degree of hypogonadism in an affected kindred was seen: a male showed no response to pulsatile administration of GnRH, which was effective in his two sisters, all showing clinical patterns of hypogonadotropic hypogonadism [19].

Ok Madman.I always thank you for your contributions. Know that I understand what you said, but there are many things to be studied completely. And the more we can see possibilities to achieve the best results, it would be very good. I see, for example, many doubts regarding the HPA and TRT axis and the effects of this over time. What will our body tell us that it does not need LH and FSH? Maybe he says we can live without him. Not to say that Even without wanting to have more children, testicular atrophy and sperm volume impair the quality of sex. It is still the issue of libido that many still do not get a good parameter. This forum is great because this exchange of information is important for all of us. When I bought Nelson's book on amazon and read it it was very good. A great experience of more than 30 years. Lots of story to tell.

 

[MNguy]

Has anyone else other than the OP had success with increasing cortisol levels? His section on cortisol replacement is really interesting. Seems very complex though.

 

[Gingkohagane]

Has anyone else other than the OP had success with increasing cortisol levels? His section on cortisol replacement is really interesting. Seems very complex though.

Caffeine is the best cortisol pusher. Shoots me through the roof when I'm not tolerant