Optimum HCG dosage...

[Dr Justin Saya MD]

Vince...may eventually try that protocol! Since polycythemia is usually worse with injections I am hesitant to go there until I find reasonable control with TD Gel. Got so bad back in Sept that I had to terminate TRT, see a Hematologist to rule out Polycythemia Vera. 3 blood donations and one therapeutic phlebotomy later I was back down to manageable blood count levels. Eligible for another blood donation later this month, then another CBC lab to see how I am doing.

Roy - if not already, get checked for obstructive sleep apnea (talk to your PCP about a sleep study). I find it FAR too often that guys who continually struggle with elevations in hematocrit have MORE than one factor contributing (above and beyond TRT, as long as physiologically dosed).

Most common other factors, in this order: obstructive sleep apnea, smoking, live at high altitude, very high iron intake/levels, then some chronic respiratory diseases like COPD/emphysema.

Best of luck!

 

[olddawg]

Both Iron and Ferritin have stayed within range...thankfully! Initially my WBC was low but has since raised to ok level!? Just like any and every other part of the human anatomy...changing one thing usually alters other aspects...some positive and some negative!

 

[olddawg]

Thanks Dr Saya... Truly appreciate your input! Sleep apnea is not an issue, but chronic bronchitis is a possibility! Can almost max out a spirometer on a regular basis but get bronchitis with every cold!? Seem to expel abnormal amount mucus from lungs also. Daily usage of antihistamine seems to reduce lung mucus so Dr tends to think sinus drainage into lungs may be the culprit!? Seems that my normal blood count has been high even before TRT...was high normal on CBC Lab I was able to recover from 1990...I was 45 then and running 25+ miles per week.
Again...thank you so much for your concern and good advice....Roy

 

[Nelson Vergel]

What is the best dose of HCG? Dr Saya presents two case studies.

 

[olddawg]

Thanks Nelson...Vince had posted the connection for that study earlier today. Printed it out and have read it twice already! Just starting to browse through this website...you are EVERYWHERE! Thank you for taking the time to post info on this issue as I know you are a busy man. I have to extend cudos to you for doing a fine job here...thank you for sharing your wisdom with us! This site has proved itself to be a God Send for me! Hopefully by sharing my experience it will benefit others...for now I am just a sponge sucking up info =)
Hopefully life is good for you at this time...Roy

 

[olddawg]

Dr Saya... Just discovered that LabCorp has changed the methodology of E2 (Sensitive)Test #140244 from RIA to LC/MS-MS. According to some posts at All Things Male their results are coming in contrary to what we have seen in the past. Utilizing their current methodology the readings are coming in HIGHER than their standard E2 test, whereas most had just the opposite levels before this change. Several had similar readings to mine...standard test in mid to high 20's, sensitive test in high 30's to low 40's...with range of 8-35. Not sure what to trust at this point...could definitely impact HRT protocol for many...self included! Appreciate any and all of your input....Roy

 

[Dr Justin Saya MD]

Dr Saya... Just discovered that LabCorp has changed the methodology of E2 (Sensitive)Test #140244 from RIA to LC/MS-MS. According to some posts at All Things Male their results are coming in contrary to what we have seen in the past. Utilizing their current methodology the readings are coming in HIGHER than their standard E2 test, whereas most had just the opposite levels before this change. Several had similar readings to mine...standard test in mid to high 20's, sensitive test in high 30's to low 40's...with range of 8-35. Not sure what to trust at this point...could definitely impact HRT protocol for many...self included! Appreciate any and all of your input....Roy

Hi Roy, that test code (LabCorp# 140244) for the SENSITIVE estradiol has always been the LC/MS-MS methodology as far as I m aware (at least for the past few years). The other test code (LabCorp# 004515) for the STANDARD estradiol test is the RIA. In fact, it is the very fact that #140244 IS the LC/MS-MS methodology that makes it the sensitive test (if that makes sense...if it was the RIA methodology it wouldn't be the sensitive test to begin with). Unfortunately, it is an exercise in futility to attempt to compare the results of the RIA and LC/MS-MS head to head. It's simply not apples-to-apples. They have different ranges and different methodologies/sensitivities, so any direct comparison is pointless. Comparing or assuming truth in universal blanket statements like "the RIA always overestimates vs the LC/MS-MS" (or the opposite as you mention some guys on ATM are mentioning) - is equally as pointless. There simply can be no valid comparison made between the RIA and the LC/MS-MS tests. In other words, a value of 30pg/mL on the RIA is simply NOT the same or comparable to a value of 30pg/mL on the LC/MS-MS. It is recommended to only compare results within one single test methodology, if one gets stuck testing both the RIA and the LC/MS-MS and trying to interpret (impossible) or even worse make treatment changes relying on both results you will end up chasing your tail even more than if you weren't testing E2 levels at all. Further, as always, chasing numbers only should NOT be the goal regardless of if you utilize the RIA or LC/MS-MS - SYMPTOMS should be used as a "guide" as to whether your E2 levels may be low/normal/high as we are all different and all have different tolerances to varying E2 levels. An interesting point here is that LabCorp recently had an equipment failure affecting the equipment they use for the LC/MS-MS test, with the snowstorm there was a long delay in having the equipment repaired (although it is repaired now). Perhaps they temporarily funneled some of the backed up LC/MS-MS tests over to the standard RIA test due to this problem, thus explaining some of the recent "contrarian" results seen by the ATM guys?!? It's possible, but I don't think likely.

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[olddawg]

Thank you Dr Saya for the prompt reply and excellent explanation! I should have reread my post...then reworded it accordingly =( I wasn't trying to compare standard to sensitive results directly. Was trying to establish the validity of the current test #140244 as their assay seems to be indicating a higher level than what most have posted historically!? Your post pretty much cleared up the issue of methodology comparison. With consideration for personal symptoms/sensitivity, is the "target" range for E2 level(based on the LC/MS-MS Methodology) still in the 20-30 pg/ml range? Since I have not been at even a remotely stable level of hormones since starting TRT it is difficult to utilize symptoms in the equation. Hopefully my next set of labs(5-6 wks) will coincide with symptoms so we can make positive adjustments...if needed! Again, thank you for taking time, esp on Sunday, to reply...Roy

 

[Dr Justin Saya MD]

If you're seeking a "target" range, I can give you some general guidelines, however the guidelines will still be missing half of the equation in the absence of an accurate gauge on symptoms. Some guys may chime in with info on the T:E ratio theory, which I am a semi-proponent of in the sense as it relates to low or high estradiol symptoms. In other words, your ability to "tolerate" various estradiol levels with or without symptoms will often correlate with your concurrent testosterone level in relation to those estradiol levels. Having said that, if you are seeking generalized guidance, I would advise that an estradiol level GREATER than 20pg/mL would very rarely cause LOW estradiol symptoms and likewise an estradiol level of LESS THAN 40pg/mL will not often cause HIGH estradiol symptoms (partially dependent on the concurrent testosterone level as noted above). Hope that helps!

 

[olddawg]

EXACTLY what I was looking for! Based on those parameters I can proceed with a protocol that probably will keep me near the 40+ range for a while, as I am borderline osteoporosis and previous saliva tests indicated low E. Two previous standard E2 test came back at 6 and 11, not sure what the range was but both were near the bottom. If we can get TT and FT somewhat stabilized at a reasonable level without major E issues I will be happy. FT prior to TRT startup was a non-existent .29, SHBG at 78, TT had risen from around 200 to 370. Symptoms were pretty much in line with labs...no libido period, erections were almost never and worthless then, inability to orgasm, loss of muscle mass and pronounced weakness. Feeling fairly positive at this point! This site has helped me tremendously. Thank you so much! One day at a time...Roy