New Labs: HCG Monotherapy

Pharma / TRT Testosterone Replacement
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Hoping for some feedback here. I’ve been on HCG monotherapy for two years now. While things went well initially, my recent lab results are troubling and I am not sure where to turn (lower T & FSH).

For reference I am 39, 175 lbs, about 14% bf. No major physique changes, crashes, etc. lately, but I have not been feeling on my game, thatâ??s why I retested.

For some history, I discovered I had low T two years ago (I suspected I did) and immediately sought a doc who would prescribe what was needed. I started on HCG at 500iu 3x/wk and, once E2 went through the roof, convinced my doc to prescribe Adex (currently at 1mg/wk). Below is a history of my TT levels:

3/19/09: 284 (range 400 â?? 1080); started on 500iu 3x/wk
6/5/09: 640 (range 241 â?? 827)
7/24/09: 491 (dosage increased to 750iu 3x/wk)
10/21/09: 684
4/1/11: 293

My doc is out of state until early next month so I had an email exchange with him yesterday. He mentioned a dosage increase and I told him I am not comfortable doing that as it appears the HCG is no longer working. He is a big believer in HCG only and tells me he takes 3k iu/wk himself (he is mid-60s). Heâ??s been reluctant to prescribe me testosterone.

I will try to post a jpg of my lab work over the past couple of years. Random info: I had an MRI on my pituitary that came back negative, I have low cortisol, borderline high (untreated) BP, take 1 mg/day finasteride (when I remember), and my diet is high protein, mod carbs & fat (my cholesterol has always been mid-range/low; I eat plenty of red meat, eggs, etc). Supps: whey, ZMA, 4k Vit D/day, fishoil, melatonin, and LEFâ??s Two-per-Day (have 150mcg Iodine). Also two posts Iâ??ve made previously.

If anyone has recommendations on treatment options, what to tell my doc or needs more info, please let me know. I am trying to find another doc in my area but am not having much luck identifying a competent one.

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Does anyone have any ideas on this? Does it sound like adding test injections would help? Or is there potentially a bigger problem since it seems the HCG is no longer doing it for me?

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RWell I’ll chime in on this for a friend of mine is in a similar situation, I can’t read the blood work to well ( I do all my PC on my phone ).
Try HCG 3 weeks @500iu followed by 250ius for 3 weeks, followed up by 3 weeks of a serm nolvadex.
And tapper serm 20mg for 2 weeks, 10mg for 1 week introduction of an AI would be beneficial for estrodiol control in the androgen receptors and bumping up TT and FT, I prefer aromasin others choose arimidex.

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Thanks KY. I’m still looking for another doc, but if I am not able to find one I will schedule an appt with my current one when he returns and run this by him. I had thought about a SERM but wasn’t sure on a protocol. It seems like the options are that, increase HCG or add exogenous T.

I am doing a cortisol test today (AM/PM) and imagine I will be low. I’m also starting to monitor my body temp to see what that tells me (always been on the low side, but not sure how much it fluctuates throughout the day). Also going to pick up some iodine as I get minimal amounts currently.

And sorry for the poor quality image. I have been using anastrozole to combat high E2 as a result of the HCG. Getting that tested today too and will adjust dosage based on what I find.

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Hey no problem, I posted on a thread for a friend of mine thats clue less on HPTA reboot which is understandable, So I posted so he could see that not only I but others such as KSman are well versed in this ( let me state I’m still learning )sometimes HPTA just won’t refire if you will and with Mega doses of HCG/hmg can desensitize the leydigs hormone as seen in medical literature
http://jcem.endojournals.org/cgi/content/abstract/55/1/76?maxtoshow=&hits=10&RESULTFORMAT=1&andorexacttitle=and&titleabstract=HCG+in+males+&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=10&sortspec=relevance&resourcetype=HWCIT

DAA Has been reported as an alternative to HCG,though I’m not well versed in all chapters of DAA I do believe I read It can down regulate melatonin. Not good, can become a cancer issue. I don’t know at what doses it would be referred to to be harmful or yet beneficial.

I admire KSman’s views and approach on such topics and I’ll await his comments attaining to your situation, as stated I’m still learning

[quote]Tyler23 wrote:
Thanks KY. I’m still looking for another doc, but if I am not able to find one I will schedule an appt with my current one when he returns and run this by him. I had thought about a SERM but wasn’t sure on a protocol. It seems like the options are that, increase HCG or add exogenous T.

I am doing a cortisol test today (AM/PM) and imagine I will be low. I’m also starting to monitor my body temp to see what that tells me (always been on the low side, but not sure how much it fluctuates throughout the day). Also going to pick up some iodine as I get minimal amounts currently.

And sorry for the poor quality image. I have been using anastrozole to combat high E2 as a result of the HCG. Getting that tested today too and will adjust dosage based on what I find. [/quote]

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Be weary of high doses of hCG - as mentioned, they can desensitize the Leydigs. Then your’re F’d.

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500iu every day is insane and 250 to too much for some. As I have stated many times, too much hCG can increase intratesticular testosterone to very high levels. That makes a competitive AI ineffective when ITT levels are 8- to 100 times serum levels. 250iu - 300u EOD has been shown to be an effective LH replacement dose.

Many use to much hCG and docs can be the worst as they read stupid things that were published once and then do not become aware of the flaws.

Do not stack SERMs. Do not stack any SERM with hCG. Both lead to the above problems and LH receptor degradation, which is exactly what will make a HPTA restart attempt fail.

Note that one should control E2 as needed with anastrozole, then land on 0.5mg/week in EOD divided doses, if not an anastrozole over responder, then cruise on that for to avoid estrogen rebound, then cruise on that.

Always taper off of a SERM and do that on anastrozole, reducing to cruise levels.

If you are on program with that, great. Otherwise, adding this context for others passing by and reading.

Note that the above is not a full HPTA restart protocol, just aspect to keep in mind.

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Thanks KSman. Sorry for the late reply; I’ve been out of town for work.

Do you know where I could find information on a true/full HPTA restart protocol? Most of what I’ve run across is on forums, although I did see an update to Dr. Crisler’s protocol.

I figure my doc is going to need some convincing.

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[quote]KSman wrote:
500iu every day is insane and 250 to too much for some. As I have stated many times, too much hCG can increase intratesticular testosterone to very high levels. That makes a competitive AI ineffective when ITT levels are 8- to 100 times serum levels. 250iu - 300u EOD has been shown to be an effective LH replacement dose.[/quote]

Normal ITT levels in eugonadal men are 60-100 times greater than serum levels, and these are the levels that should be aimed for if maintaining fertility is desired. These ITT levels are what give hCG the indirect FSH-like activity that is sometimes quoted in the Physician’s Desk Reference. In terms of dosing, 250IU qod appears to raise ITT levels to approximately 80-95% of baseline. (~80-95x serum levels)

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Just got back some saliva tests.

Testosterone: 157.26 (30.1 - 142.5 pg/ml)
E2: 2.07 (range < 2.5 pg/ml)
Progesterone: 24.90 (range < 94 pg/ml)
Cortisol AM: 7.09 (5.1 - 40.2 nmol/L)
Cortisol PM: 1.66 (0.9 - 9.2 nmol/L)

So T is high on this test but serum levels were on the low side at 293 (241 - 827). More confused.

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I’ve seen a few people say that saliva tests are useless for testosterone (among other hormones)…we know serum levels are a good indicator, so this seems to prove the point…

Your cortisol is awful (which can accurately be tested via saliva)…you aren’t being treated at all for that right? You need to be!

Not sure if the hcg is screwing up your system, or its natural…but your treatment plan is not very good…you need to find a new doctor man…this one doesn’t seem to be doing you anything good…

Did you have pre-HCG cortisol baseline?

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Thanks for the feedback, VT.

I have one AM cortisol reading from right before starting HCG: 7.4 (5.1 - 40.2). Pretty much where it is now. It was lower 3 mos into HCG at 2.4 for AM and 0.3 for PM (0.9 - 9.2).

I know I need to find a new doc. Another poster on these forums who used to live in my area gave me a couple names but indicated that, while they are willing to do whatever, they’re both pretty much clueless about this stuff. I’m just not sure what to ask them to do at this point.

Clearly, I need to start Isocort of something like that. I have lowered my HCG dose to 500iu 3x/wk.

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500iu E3D is still pretty steep, it is at the borderline for leydig cell desensitization. most do 250iu, have you tried a lower dose?

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I want to start HCG mono-therapy with ED injections.

Is 100 units per day enough? I emphasize again - I want to do ED injections for sure.

Also is HCG suppressive for HPTA? I thought it is, but a doctor told me it IS NOT. Can you stop HCG mono cold turkey and have your previous testosterone levels?