Not responding well to compounded HCG?

[DahlinS]

Hi everyone,

I’ve been taking 1500IU of HCG EOD as a monotherapy for the past 6 weeks. But my total testosterone has only risen from 281 ng/dl to 345 ng/dl. The problem isn’t my testicles since my baseline LH was 1.8.

I’ve been using compounded HCG my doctor wants me to stay at the same dose and switch over to Pregnyl, retest in 6 weeks.

He says compounded HCG is well known for having potency issuess. Is this true? Pregnyl is expensive. Does anybody know where I can find it for less than $250 per 10,000IU?

thanks guys!

 

[captain]

Your LH level is not a test of your testicles. Using HCG is testing your testicles and they are not responding to your HCG. You would have used more than one vial at that dose and your not getting results. Your Doctor should have put you on Testosterone after 6 weeks.

 

[Nelson Vergel]

What compounding pharmacy are you using? Did you have to add bacteriostatic water to the hCG? How many IUs and how much water?

Several posts in the past discussed your issue: not responding to hcg excelmale.com site:www.excelmale.com - Google Search

 

[DahlinS]

What compounding pharmacy are you using? Did you have to add bacteriostatic water to the hCG? How many IUs and how much water?

Hey Nelson,

I use Empower pharmacy and I did have to add bacteriostatic water. 12,000 IUs, I add 6ml of H20 to the vial. 2,000 IU per ml. .75ml per injection=1,500 IU.

 

[Nelson Vergel]

Hey Nelson,

I use Empower pharmacy and I did have to add bacteriostatic water. 12,000 IUs, I add 6ml of H20 to the vial. 2,000 IU per ml. .75ml per injection=1,500 IU.

When did you get your T tested? How many injections had gone by?

 

[DahlinS]

When did you get your T tested? How many injections had gone by?

6 weeks after starting, so 21 injections had gone by.

 

[Nelson Vergel]

6 weeks after starting, so 21 injections had gone by.

It's now clear that you do not respond to hCG monotherapy. Some men don't due to testicular failure. I doubt that switching to a brand name will be different. What was the goal? Fertility?

I just pulled this out of my book. His dose is lower, so keep that in mind.

Shippen’s Chorionic Gonadotrophin Stimulation Test (for males under 75 years of age)


Even though there seems not to be an accepted and clinically proven protocol to dose HCG, Dr. Eugene Shippen (author of the book “The Testosterone Syndrome”), has developed his own after his own experiences. Most doctors do not follow this protocol but I am showing it here since I get a lot of questions about it. I have never used this protocol myself since I have been on testosterone replacement for over 15 years.

Dr. Shippen has found that a typical treatment course for three weeks is best for determining those individuals who will respond well to HCG treatment. It is administered daily by injection 500 units subcutaneously, Monday through Friday for three weeks. The patient is taught to self administer with 50 Unit insulin syringes with 30 gauge needles in anterior thigh, seated with both hands-frees to perform the injection. Testosterone, total and free, plus E2 (estradiol) are measured before starting the protocol and on the third Saturday after 3 weeks of stimulation (he claims that salivary testing may be more accurate for adjusting doses). Studies have shown that subcutaneous injections are equal in efficacy to intramuscular administration.

By measuring the effect on his HCG protocol on total testosterone, he identifies candidates that require testosterone replacement versus those who just require having their testicles “awaken” with HCG to produce normal testosterone. I am yet to see any data that substantiates his approach, however.

Here is how he determines Leydig (testicular) cell function:

1. If the HCG protocol causes less than a 20% rise in total testosterone he suggests poor testicular reserve of Leydig cell function (primary hypogonadism or eugonadotrophic hypogonadism indicating combined central and peripheral factors).

2. 20-50% increase in total testosterone indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.

3. More than 50% increase in total testosterone suggests primarily centrally mediated depression of testicular function.

He then offers these options for treatment for patients depending on the response to HCG and patient determined choices.

1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.

2. The area in between 20-50% will usually require HCG boosting for a period of time, plus natural boosting or “partial” replacement options.

I am yet to see what he means with natural boosting! Dr. Shippen believes that full replacement with testosterone is always the last option in borderline cases since improvement over time may frequently occur as the testicles’ Leydig cell regeneration may actually happen. He claims that much of this is age-dependent. Up to age 60, boosting is almost always successful. In the age range, 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease-related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, obesity, alcohol, deficiency, etc.) He claims that this positive effect will not occur if suppressive therapy is instituted in the form of full testosterone replacement.

3. If there is an adequate response of more than 50% rise in testosterone, there is a very good Leydig cell reserve. HCG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response. But I am yet to see any data on long-term use of HCG used in this approach! (I invite researchers to do such studies)

4. Chorionic HCG can be self-administered and adjusted according to the response. In younger, high output responders (T > 1100ng/dl), HCG can be given every third or fourth day. This also minimizes estrogen conversion. In lower-level responders (600-800ng/dl), or those with a higher estradiol output associated with full dose HCG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full testosterone response.

Dr. Shippen believes in checking salivary levels of free testosterone on the day of the next injection, but before the next injection to determine the effectiveness and to adjust the dose accordingly. He claims that later as Leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.

5. He recommends monitoring both testosterone and estradiol levels to assess response to treatment after 2 - 3 weeks after a change in dose of HCG as well as periodic intervals during chronic administration. He claims that salivary testing will better reflect the true free levels of both estrogens and testosterone. (Pharmasan.com and others) Most insurance companies do not pay for salivary testing. Blood testing is the standard way to test for testosterone and estradiol.

6. Except for reports of antibodies developing against HCG (he mentions that he has never seen this problem), the claims that there are no adverse effects of chronic HCG administration.

Dr. Shippen’s book was published in the late 90’s. I know of no physician that uses his protocol. I have no opinion on its validity. The idea that testicular function can be improved with cycles of HCG in men with low testosterone caused by sluggish yet functioning Leydig cells is an interesting concept that needs to be studied. I guess that since this protocol requires very close monitoring, many doctors have avoided using it. The off-label nature of the protocol’s use of HCG can also make it expensive for patients who will have to pay cash for its use and monitoring.

 

[Vince Carter]

LH isn't a baseline indicator...sounds like you're primary. Too we've had discussion of compounded HCG being less potent but its usually not something that can be proven. You might grab a cheap pregnancy test pee stick and put some of your HCG on it and see what you get in the result.

 

[captain]

I think I read that HCG will not change a Pregnancy test. I recall it saying it mimics LH but its not LH. I don't know if that's correct but remember reading or hearing that.

 

[BigBamBoo]

HCG WILL show a positive pregnancy test if it is good.

I stopped buying 12,000ml vials because after about 4-5 weeks it would not show positive so my thoughts say it has lost its potency.

The 6K vials would still show positive at the end.

 

[Nelson Vergel]

I stopped buying 12,000ml vials because after about 4-5 weeks it would not show positive so my thoughts say it has lost its potency.

Wow, really? Empower's?

 

[DahlinS]

It's now clear that you do not respond to hCG monotherapy. Some men don't due to testicular failure. I doubt that switching to a brand name will be different. What was the goal? Fertility?

I just pulled this out of my book. His dose is lower, so keep that in mind.

Shippen’s Chorionic Gonadotrophin Stimulation Test (for males under 75 years of age)


Even though there seems not to be an accepted and clinically proven protocol to dose HCG, Dr. Eugene Shippen (author of the book “The Testosterone Syndrome”), has developed his own after his own experiences. Most doctors do not follow this protocol but I am showing it here since I get a lot of questions about it. I have never used this protocol myself since I have been on testosterone replacement for over 15 years.

Dr. Shippen has found that a typical treatment course for three weeks is best for determining those individuals who will respond well to HCG treatment. It is administered daily by injection 500 units subcutaneously, Monday through Friday for three weeks. The patient is taught to self administer with 50 Unit insulin syringes with 30 gauge needles in anterior thigh, seated with both hands-frees to perform the injection. Testosterone, total and free, plus E2 (estradiol) are measured before starting the protocol and on the third Saturday after 3 weeks of stimulation (he claims that salivary testing may be more accurate for adjusting doses). Studies have shown that subcutaneous injections are equal in efficacy to intramuscular administration.

By measuring the effect on his HCG protocol on total testosterone, he identifies candidates that require testosterone replacement versus those who just require having their testicles “awaken” with HCG to produce normal testosterone. I am yet to see any data that substantiates his approach, however.

Here is how he determines Leydig (testicular) cell function:

1. If the HCG protocol causes less than a 20% rise in total testosterone he suggests poor testicular reserve of Leydig cell function (primary hypogonadism or eugonadotrophic hypogonadism indicating combined central and peripheral factors).

2. 20-50% increase in total testosterone indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.

3. More than 50% increase in total testosterone suggests primarily centrally mediated depression of testicular function.

He then offers these options for treatment for patients depending on the response to HCG and patient determined choices.

1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.

2. The area in between 20-50% will usually require HCG boosting for a period of time, plus natural boosting or “partial” replacement options.

I am yet to see what he means with natural boosting! Dr. Shippen believes that full replacement with testosterone is always the last option in borderline cases since improvement over time may frequently occur as the testicles’ Leydig cell regeneration may actually happen. He claims that much of this is age-dependent. Up to age 60, boosting is almost always successful. In the age range, 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease-related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, obesity, alcohol, deficiency, etc.) He claims that this positive effect will not occur if suppressive therapy is instituted in the form of full testosterone replacement.

3. If there is an adequate response of more than 50% rise in testosterone, there is a very good Leydig cell reserve. HCG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response. But I am yet to see any data on long-term use of HCG used in this approach! (I invite researchers to do such studies)

4. Chorionic HCG can be self-administered and adjusted according to the response. In younger, high output responders (T > 1100ng/dl), HCG can be given every third or fourth day. This also minimizes estrogen conversion. In lower-level responders (600-800ng/dl), or those with a higher estradiol output associated with full dose HCG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full testosterone response.

Dr. Shippen believes in checking salivary levels of free testosterone on the day of the next injection, but before the next injection to determine the effectiveness and to adjust the dose accordingly. He claims that later as Leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.

5. He recommends monitoring both testosterone and estradiol levels to assess response to treatment after 2 - 3 weeks after a change in dose of HCG as well as periodic intervals during chronic administration. He claims that salivary testing will better reflect the true free levels of both estrogens and testosterone. (Pharmasan.com and others) Most insurance companies do not pay for salivary testing. Blood testing is the standard way to test for testosterone and estradiol.

6. Except for reports of antibodies developing against HCG (he mentions that he has never seen this problem), the claims that there are no adverse effects of chronic HCG administration.

Dr. Shippen’s book was published in the late 90’s. I know of no physician that uses his protocol. I have no opinion on its validity. The idea that testicular function can be improved with cycles of HCG in men with low testosterone caused by sluggish yet functioning Leydig cells is an interesting concept that needs to be studied. I guess that since this protocol requires very close monitoring, many doctors have avoided using it. The off-label nature of the protocol’s use of HCG can also make it expensive for patients who will have to pay cash for its use and monitoring.

Thanks for the info Nelson. Yeah, the goal was fertility and to avoid Clomid. Clomid side effects scare me.

I guess if my balls aren’t going to behave, I need to start looking into a testosterone protocol.

 

[DahlinS]

HCG WILL show a positive pregnancy test if it is good.

I stopped buying 12,000ml vials because after about 4-5 weeks it would not show positive so my thoughts say it has lost its potency.

i read your comment and decided to stop and buy a pregnancy test on my way home from work. This is the result of a vial of Empower 12,000IU reconstituted 11 days ago.

Clearly HCG is present, but I don’t know what the faintness/darkness of the line means with regard to potency.

 

[DahlinS]

View attachment 8576i read your comment and decided to stop and buy a pregnancy test on my way home from work. This is the result of a vial of Empower 12,000IU reconstituted 11 days ago.

Clearly HCG is present, but I don’t know what the faintness/darkness of the line means with regard to potency.

 

[BigBamBoo]

Wow, really? Empower's?

Yes, Empower. I stopped buying the 12k vials because I felt it was useless about halfway through the vial.

Again....that was going off of how I felt and confirming with the pregnancy test.

But it could be still potent enough for our use but not strong enough to show positive on the pregnancy test. Who knows.....

 

[Nelson Vergel]

I contacted Empower Pharmacy about this thread. This is what they said:

Most pregnancy test brands claim an hCG detection threshold range anywhere from 6.3 – 50 mIU(million IU)/mL, with most tests falling between 20 – 35 mIU/mL. However, test manufacturers claims are not verified by independent testing. When independent studies have been carried out, the results are often quite different from what the test manufacturers claim. Some websites claim to list the sensitivity of various pregnancy test brands, but these sensitivity claims usually come directly from the test manufacturer rather from an independent testing agency.

A few independent studies have been done to test the sensitivity of various pregnancy test brands. Based on these studies, hCG threshold data for a few common pregnancy test brands are available:

Clearblue (manual and digital tests): 22 mIU/mL
e.p.t. (manual and digital tests): 22 mIU/mL
First Response Early Results: 6.3 mIU/mL

Since the sensitivity of these home pregnancy test kits is in the millions of IU the potency of a vial of injectable HCG which is not high enough to show up as positive on a pregnancy test strip.

Pregnancy hCG levels are in the million (mIU/mL)

Source: Early Pregnancy and Painless Spotting - Clinical Advisor

 

[Vince]

Yes, Empower. I stopped buying the 12k vials because I felt it was useless about halfway through the vial.

Again....that was going off of how I felt and confirming with the pregnancy test.

But it could be still potent enough for our use but not strong enough to show positive on the pregnancy test. Who knows.....

I always buy the largest vial of HCG. Which is now the 12,000 iu, I've never had any issues with it losing strength.

 

[he-man100]

I contacted Empower Pharmacy about this thread. This is what they said:

Most pregnancy test brands claim an hCG detection threshold range anywhere from 6.3 – 50 mIU(million IU)/mL, with most tests falling between 20 – 35 mIU/mL. However, test manufacturers claims are not verified by independent testing. When independent studies have been carried out, the results are often quite different from what the test manufacturers claim. Some websites claim to list the sensitivity of various pregnancy test brands, but these sensitivity claims usually come directly from the test manufacturer rather from an independent testing agency.

A few independent studies have been done to test the sensitivity of various pregnancy test brands. Based on these studies, hCG threshold data for a few common pregnancy test brands are available:

Clearblue (manual and digital tests): 22 mIU/mL
e.p.t. (manual and digital tests): 22 mIU/mL
First Response Early Results: 6.3 mIU/mL

Since the sensitivity of these home pregnancy test kits is in the millions of IU the potency of a vial of injectable HCG which is not high enough to show up as positive on a pregnancy test strip.

Pregnancy hCG levels are in the million (mIU/mL)

View attachment 8586

Source: Early Pregnancy and Painless Spotting - Clinical Advisor

They made a mistake here mIU/mL. stand for milli-international units per milliliter so 23 mIU/mL are 0.023 iu/ml and we usually have 5000 ie/ml with our hcg. So these pregnancy test are actually very sensetive.
mIU/mL to IU/mL Converter, Chart -- EndMemo

I suspect improper handling as the reason for negative pregnancy tests. You need to dip the test stripe into fluid for 3 to 5 sec. but most people are squirting their hcg on it

 

[HarryCat2]

They made a mistake here mIU/mL. stand for milli-international units per milliliter so 23 mIU/mL are 0.023 iu/ml and we usually have 5000 ie/ml with our hcg. So these pregnancy test are actually very sensetive.
mIU/mL to IU/mL Converter, Chart -- EndMemo

I suspect improper handling as the reason for negative pregnancy tests. You need to dip the test stripe into fluid for 3 to 5 sec. but most people are squirting their hcg on it

Well this is scary, the pharmacy I buy my HCG from doesn't even know the correct units that it is measure in.

 

[DahlinS]

Well this is scary, the pharmacy I buy my HCG from doesn't even know the correct units that it is measure in.

The more I learn about Empower, the sketchier they seem. Apparently they were slapped on the wrist by the FDA in 2017 for contamination issues and potency failures.