Question for KSman & Others

Pharma TRT
1

This question is for KSman specifically, but anyone else too:

Have a bit of a riddle for you.

About a year and a half ago I noticed my hair was falling out like crazy, and I was not feeling well at all. I’d dealt with 15 years of low libido and T levels in the 400’s thanks to Propecia in my mid 20’s. I tested my numbers and they came back:

Testosterone tanked to 295
Estrogen tanked from 20’s to 8
DHT tanked to something like 5
However…
LH was showing at a sold upper range: 5.0
FSH was also slightly above mid-range.

I spent some time trying to figure out if this meant I was primary or secondary. I decided to try low dose Clomid to “kickstart” myself back into the 400’s. First 25mg. Felt great then horrible a few days later. Lowered to 12mg. Felt great for awhile, then tested my levels:

Testosterne went from 295 to 550 on only 12mg Clomid
But Estrogen tanked further to 3.
DHT tanked further as well, almost nothing.
BUT: Now LH and FSH were significantly “HIGH” out of range.

This left me scratching my head. LH and FSH too high from the Clomid no doubt. So should I even be on Clomid? I started out with almost “high” LH in the first place. Asking doctors resulted in zero advice. I should’ve come here. After some time, I began to feel terrible on 12mg clomid so I lowered my dose to 6mg, and added 5mg sublingual DHEA. This became my sweet spot for the next 10 months. Numbers leveled out at:

Testosterone - 450
Estrogen and DHT still too low
LH and FSH were now back in upper (but normal) range.

Later, in an effort to get my Estrogen back into the 20’s I decided to add Androgel, fully aware that this was a completely different can of worms I was opening. I made the leap from Clomid/DHEA to very low dose androgel. Barely the size of your thumbnail was sufficient to get me:

Testosterone 430’s
Estrogen back to 22
DHT back to normal

So now my question to you. Based on all of the above, do you feel I was primary or secondary? Notably my LH before all this began being at 5.0. I saw you say on the HTPA Restart thread: “If you have high FSH/LH, you are primary and there is nothing to restart.” I wasnt sure if a solid, healthy, slightly upper level LH qualified as “high” in this context.

Going forward:

I could bite the bullet and just suffer through the “proper” Clomid dose (100mg) with the hope that the onslaught would really kickstart my whole system once and for all. But this would no-doubt send my LH and FSH levels into the stratosphere. Im not sure if thats healthy/smart. That dose of Clomid would also suck. Bad headaches, night sweats, body odor, heavy body hair growth, terrifying nightmares, extreme mood swings, and bad hot flashes… but I could suck it up for a few weeks if I come out the other end “fixed”.

Your elaborate, detailed, insightful opinion are both welcome and hoped for. I’ve tried telling this story to doctors and its always too complex for them to maintain attention. Anyone else who wants to comment please do as well.

2

You and some others react badly to clomid. Get Nolvadex, it does not do that.
You would know that if you read the stickies.

High dose SERMs should never be used. The WWW is full of bad advice. More is not better.

You seemed to be mixed primary/secondary.

Your gene expression is messed up from the 5-aplha reductase inhibitor. So the mechanics of what should happen and why are not going to fully apply to you. Mainstream docs will be speechless or blowing smoke.

Your T–>DHT mechanics appear to have changed.

Your lab data without FT or SHBG leave too much unknown.

You might have a better mix with some androgel and nolvadex.

3

@KSman -

Thank you. Wanted to ask prior to digging into the stickies, so I know what mindset to go into them with. Helps me identify what advice applies to me versus the parts that don’t.

I’ll post the bloodwork. I’ve done it at every interval.

  • Pre-everything
  • After every Clomid dose change
  • After the switch to Androgel
  • After every modification to Androgel dose
  • And… prior to every phlebotomy every 3 months since.

Any suggestions on which would be most helpful?
Don’t think I ran SBGH for most of them.
Definitely did in the “Pre-everything” one.

In summary I was asking if you think I’d have a chance at a restart. And which methodology you think might work for me. Androgel/Novaldex sounds more like a continued TRT regimen.

K

4

FT is valuable and SHBG tells the same story.

If you need TRT, TRT will improve your quality of life, and that is paramount.

5

@KSman -

Its crazy. After 15 years of nearly no libido and T levels left at about 450 thanks to Propecia (was 850+ naturally, prior), I thought all of this would result in increased libido. It hasn’t. Nothing has. Clomid, DHEA, Androgel. None really have helped with libido at all. Granted, I have remained conservative and only pushed myself into the 500’s. Maybe that’s the reason. I’m not trying to hit 1,000. And I haven’t wanted to deal with AI’s or DHT inhibitors that might come with 600+ T levels. Not to mention Prostate/Heart/Stroke risks. Just wanted to play it all safe.

But Libido has been zilch. Im to the point of anger about that. I am 41 and haven’t felt that “push” to get out there and play the dating game for nearly 15 years. I strongly feel that strong libido is what allows guys to put up with the BS of the dating game, and pushes us to pursue women and find that special someone. But without that - as a result I am single at 41 and have no interest in dealing with first dates, etc. So Im done with it. I want my libido back. And I want it strong. And if I can have it back naturally by kickstarting everything, that would be best of all.

I’ll get the bloodwork posted soon. Thanks so much again for taking the time to reply. Your knowledge is more valuable than gold as doctors have shown themselves to be a completely useless bunch of condescending pricks.

6

I hear your pain!
Maybe labs will provide a path to improvement.

7

@KSman

Sorry for the delay. So backing up a bit.

Here were my numbers for most of the 15 years after Propecia:

Testosterone, Serum: 407 (348 - 1197)
Testosterone, Free: 10.13 (5 - 21)
% Free Testosterone: 2.49 (1.5 - 4.2)
Estradiol, Sensitive: 6 (3 - 70)
TSH: 1.7 (0.4 - 4.5)
Thyroxine: 10 (4.5 - 12)
T3 Uptake: 32 (24 - 39)

Year and a half ago prior to starting HRT:

Depression, No motivation, Bouts of extreme depression, go nowhere, do nothing, work from home, no vitality, no interest, no libido, terrible sleep quality, weak as hell in the gym, hair falling out. Emotions were unstable as hell. No control over my reaction to stress."

Test Results:

Testosterone Serum: 295 (348-1197) LOW
Testosterone Free: 7.61 (5 - 21)
% Free Testosterone: 2.5 (1.5 - 4.2)
DHT: 28 (30 - 85) LOW
DHEA Serum (i got the wrong one, should’ve gotten DHEA-S): 132 (31 - 701)
LH: 5.0 (1.7 - 8.6)
FSH: 3.9 (1.5 - 12.4)
Prolactin: 12.6 (4.0 - 15.2)
Estradiol, Sensitive: 8 (3 - 70)
SHBG: 33.8 (16.5 - 55.9)
Pregnenolone MS: 79 ( < 151)

After 2 weeks on Clomid 12mg:

Week 1 on Clomid - felt unbelievable. Depression literally dissolved within 24 hours of first administration. Sleep was deep and satisfying for a few days. Libido strong. Strength returned in Gym.
Week 2 on Clomid 12mg - Felt unwell. Body odor increased dramatically. Headaches. Hot flashes. Night sweats. Poor sleep. Feelings of aggression and easily irritated. Generally felt unwell.
Very strange afternoon bouts of severe depression. So depressed that I would lay in fetal position on couch every day at around 5pm for the rest of the evening. Worst emotional feeling ever. No motivation to go anywhere or do anything."

Test Results:

Testosterone Serum: 885 (348 - 1197)
Testosterone Free: 23.3 (5 - 21) HIGH
% Free Testosterone: 2.63 (1.5 - 4.2)
DHEA Sulfate: 210 (102 - 416)
DHEA Serum: 131 (31 - 701)
LH: 8.7 (1.7 - 8.6) HIGH
FSH: 6.3 (1.5 - 12.4)
Proactin: 7.9 (4 - 15)
Estradiol Sensitive: 18 (3 - 70)

Lowered dose to 6.5mg and added DHEA 5mg sublingual.
After 3 weeks:

Depression gone. Sleep acceptably normal. Energy Good. Productive workouts. Hair Loss finally stopped. Libido blah. Recovery time a solid 3-4 days before felt any slight interest again.

Test results:

Testosterone: 734
DHEA-Sulfate: 242
LH: 7.4
FSH: 5.2
Estradiol: 12
SHBG: 45.3 (16 - 56)

Kept with the regimen and tested again after 7 weeks of Clomid 6.5 and DHEA 5mg:

Everything still pretty great. This was my sweet spot for now. But libido still blah. Full 4 days for any interest to resurface after releasing.

Tested only my T:

Testosterone: 550

Decided at this point that 550 was insufficient for me, and that I needed to get my Estrogen and DHT back to where they should be. Clomid and DHEA were giving me a break from feeling miserable, but were keeping my E and DHT down. And I didn’t want to stay on the stuff forever. Goal at this point was to get my E2 up to about 25 again, and get my Testosterone to about 700 and maintain.

8 months Clomid 6.5 / DHEA 5mg:

Estradiol: 8.1 (7 - 42)

My notes regarding the 366 T levels below:

Switched to Androgel, half-postage-stamp size dose of gel. After 1 month: Was feeling really quite good. Libido actually improved a bit for the first time, so I was surprised to see that my testosterone was only 366. I can usually accurately guess my T levels, but that’s been in the setting of having Estrogen around 8 and DHT around 12 for many years. Apparently getting Estrogen up to where it should be, and getting DHT in a normal range again helped me feel a lot better even without the Testosterone. This teaches me (at least for my body) that its a worthwhile endeavor to get my T levels at around 650 and also get my Estrogen at 25-sh and DHT out of the teens. Not JUST get my testosterone levels up. However I should note that at 52 (below) DHT I started losing hair again. So maybe my goal should be 30’s or 40’s. I was unable to find any information online about average DHT levels by age, or recommended DHT levels."

Test Results:

Testosterone, Total: 366 (250 - 1100)
Testosterone, Free: 52 (35 - 155)
Estradiol: 29
DHT: 54 (16 - 79)

Here are my notes from the 448 Testosterone results below:

Half-postage-stamp size dose - one on each shoulder. After 2 months: Hair Loss seems to have plateaued a bit. No longer accelerating like it was. Libido is okay. I don’t feel any drastic improvement in this area. Unfortunately I did not write anything else after seeing the below test results, about how I was feeling. That typically means (for me) that all is well, and the remaining problem is getting my Hair Loss and Libido where I want them. So basically - an increase of Testosterone around 100 points, but no real change in libido. Coincidentally (?) the results also show now real change in DHT/Estrogen. So again I wonder if they are pretty influential in libido. More than Testosterone. Or maybe they’re right where they should be, and everyone’s waiting for my Testosterone levels to get where THEY should be (600’s).

Test results:

Testosterone, Total: 448
Testosterone, Free: 48
Estradiol: 26
DHT: 68

Notes prior to the below test results:

I decided to up my Androgel dose a bit, to try and get my Testosterone levels up. I tried putting it in a smaller skin-surface area to not increase DHT. Apparently didn’t work (on the DHT). And apparently my tiny bump in Testosterone dose didn’t do much either. Libido has been basically “nothing” according to my notes. Strange. Maybe DHT is too high now… although E2 has dropped a bit also. Confusing.

Test Results:

Testosterone, Total: 453
Testosterone, Free: 7.3
Estradiol: 17
DHT: 74

Like an idiot I started applying Androgel to legs and buttocks. Totally forgot about the skin-surface-area-DHT thing, and as you can see from below I just shot my DHT sky high by doing this. Had some pretty severe testicle aching during this period as well, including migraines, and dizziness, and nausea. Libido has been complete flatline the whole time. Been doing phlebotomy to keep my hematocrit down as well.

Testosterone, Total: 434
Estradiol: 18
DHT: 105 HIGH

Current: Added HCG Sublingual 500 IU. Switched to Androgel 1.62. Will test in several weeks.

So all of this to say - if I do a restart, how would you approach it if you were me?

My goal right now is libido. I can’t keep going through life without one.

Thanks

8

@KSman - I edited the post to be less wordy.

9

I just wanted to make sure that you’re aware hCG is not absorbed sublingually. hCG’s molecular weight is around 30,000 daltons. I believe the largest size that can be absorbed sublingually is around 1,200 daltons. This is why insulin is injected and not ingested. The hCG you’re consuming is being destroyed in your intestines and isnt making it to your blood as an FYI.

10

Restart might not work. SHBG seems oddly high at times relative to E2.

FT varys a lot hour by hour with transdermals, so your lab timing determines the result.
Transdermals have greatest E2 and DHT potential.

How did you feel here:
Testosterone, Total: 366 (250 - 1100)
Testosterone, Free: 52 (35 - 155)
_Estradiol: 29 _
DHT: 54 (16 - 79)

Half-postage-stamp size dose after 2 months:

_Testosterone, Total: 448 _
Testosterone, Free: 48
Estradiol: 26
DHT: 68

Did clomid make you feel down relative to transdermal T?

Please see the link to restart in the 2nd post of 1st topic in the forum.

11

@Hostile

Understood. Saw all those posts before I began on the sublingual HCG. But saw a bunch of posts alongside them saying it worked. Figured I’d test it myself and compare LH/FSH before and after. Of course, being a complete idiot, I forgot to run my LH/FSH numbers before starting the HCG. But I ran them at the 4 week mark and results are pending. I suppose if they’re completely normal we could assume its helping some. But I would have no problem dropping HCG and running a “before” test and starting the process over just to settle this hotly debated topic! How long would I have to go off HCG to know its gone back to “baseline”? Probably pretty quickly right? Doesn’t take long for Androgel to tank your LH levels. Max of 7 days?

@KSman - Actually had all of the “how I felts” typed out here but thought I had exhausted you with information overload so I removed it all!

Please scroll up and see the added notes (I was very thorough) prior to each test that I’ve re-added. (gimme about a half hour from this moment)

12

@KSman

Okay I entered everything above. Unfortunately despite having recorded every thought I had, looking back on a lot of the information I wrote down, its not very helpful. At least it doesn’t seem so to me right now. It can be assumed that if I didn’t mention it (headaches, aggression, weakness, poor sleep, depression) then those things were a non issue. I apparently was entirely focused on libido and stopping my hair from falling out again.

13

hCG’s mechanism of function isn’t through FSH or LH, it’s an analogue to LH. Its efficacy can only be tested through direct blood test or a pregnancy test if levels are high enough. I’ve tested sublingual hcg before and its ineffective. Anyone who claims otherwise is experiencing placebo.

14

I love this thread. Thanks for all the info.
I may be starting Clomid soon and seeing detailed first-hand accounts of its results are eye-opening.

15

@Hostile -

Sorry I thought it made LH numbers rise. I’m still willing to guinea-pig myself on this one though. Doesn’t sound like you’re open to me testing it though. I guess I have a hard time believing that the entire medical industry has gotten this one wrong, and continues to make a product that literally does nothing. That’s a huge claim to make, but its possible. I would say its worthy of testing, and retesting though. Plenty of extremely brilliant people are possibly wrong as they continue to prescribe it. Just let me know how long I have to be off the HCG for the numbers to bottom out. I’ll do a test now to see my levels while on it. If they go down after I drop it, then we will have proof it does something.

@gavinstevens - I would be careful with my numbers / records. I don’t think anyone responds as strongly as I do to the tiniest doses of things. I have never heard of anyone seeing results from such a micro-dose. Usually guys do 100mg or 50mg. I couldn’t even tolerate 12mg, and ended up happy at 6mg. I suppose its fun to see how it affects the numbers though.

@KSman - My new results came back today. Took the blood 5 days ago. Lackluster libido. Hair Loss seems to have stopped. 4 weeks on sublingual HCG and regular 1% androgel (postage stamp size dose):

Testosterone 330 :open_mouth: (348 - 1170)
Estradiol: 13
DHT: 40
LH: 3.6 (1.7 - 8.6)
FSH: 3.2 (1.5 - 12.4)

Shocked my T levels were so low. This much Androgel got me easily into the 500’s in the past.

So 4 days ago I switched to Androgel 1.62. Right now I am absolutely blown away by how I feel. I cut my gel volume dose in half for the 1.62 and yet I am still having extreme libido boosts right now. I just had sex with my girlfriend and it was like I was 17 again. Sensitivity sky high. Pleasure sky high. Erection as strong as a big dose of Viagra gives me. I was absolutely blown away by this.

I suppose the 1.62 is absorbing better. I assume my Testosterone is rising from 330’s significantly. But the bummer is this is ALWAYS short-lived. I am at about four days, so I expect in the next three days my libido will begin to tank and I’ll be right where I was before. I have noticed that I ALWAYS get a major libido boost when my hormones are in flux. Just like most guys when they first start TRT. That first week is always the best. People theorize that Estrogen or DHT get out of whack after that, and this is why the libido and well-being tanks. Im not so sure. I have a theory that its actually the rise and fall of hormone levels that (maybe) gives us this sensation.

I am actually going to retest my numbers tomorrow morning just to get a snapshot of how they look when I am feeling absolutely amazing, and horny for once. Then maybe re-test when this sensation stops in a few days. Im sure it will. I’ve been at 800’s testosterone and had zero libido.

16

I was simply attempting to prevent you from wasting your time and money. hCG must be injected. It’s ineffective via sublingual delivery and ingestion.

http://www.doctormason.com/index.php/articles/basic-principles-of-integrative-medicine/51-hcg-biology

17

Still haven’t answered my question, asked twice. If I chose to run a test, what would I need to do?

  1. Drop it for how long, then test?
  2. Start on it again for how long, then run comparison test?

You’ve got a link from 1 doctor. I’ve found that opinions are like *ssholes. Everyone’s got one. I have a difficult time dismissing that hundreds/thousands of people disagree with Doctor Mason, and prescribe a completely ineffective medication. Assuming the hundreds/thousands of medical professionals are 100% clueless and misinformed is hard for me. Lots of idiot doctors out there, but this misinformation spans doctors, pharmacists, and compounding pharmacies. That’s a lot of people. Its possible, but unlikely. Usually the truth is somewhere in between. So I want to run a test for myself.

18

Go ahead and test with whichever method you like. You seem of around average intelligence. You may figure it out. I’m not feeling very willing to assist you further. It’s not opinion that hcg does not absorb sublingually. It’s a fact that it does not. We know what size in dalton’s compounds can be absorbed sublingually. We know that hcg is significantly larger than that size. This isn’t an opinion.

20

@KSman

I’ve got an appt with my Hormone doc tomorrow (the useful kind, not the traditional kind). I am probably going to attempt the restart that I read about in the “sticky” thread.

Do you recommend any prep behavior prior to starting the HCG injections?

  • Should I taper off the androgel first?
  • If so, how many days completely off before I should begin?
  • Or just jump right into it and go cold turkey on the androgel?

Thanks

21

@KSman bumping post. Got my HCG.

Also just wanted to run a theory by you:

Don’t I already have proof my testes are working if 12mg Clomid got me to 885 Testosterone levels ?

I’m thinking that my T levels can easily be restored, but it’s my Estrogen and DHT which seem to tank.

Almost as if I’m not aromatizing T to E, and not binding with 5a Reductase enzyme to create DHT anymore.