T Nation

25 Yr Old Starting HCG Monotherapy for Secondary Hypogonadism


#1

I'll keep this as concise as possible. Bloodwork was done showing low T:

07/01/2014
TESTOSTERONE: 237 (292-1052 NG/DL)
CALC FREE TESTOSTERONE: 3.5 (4.8-25.0 NG/DL)
FOLLICLE STIM HORMONE: 6.0 (1.4-18.1)
LUTEINIZING HORMONE: 1.0 (1.5-9.3 mIU/mL)
PROLACTIN: 4.4 (3.0-30.0 NG/ML)
ESTRADIOL: 13 <=63 PG/ML

Given the low LH numbers and the fact that I was able to get my wife pregnant last September, we concluded the issue was likely in my pituitary glands. I will be getting an MRI next week to completely rule out the very minor chance of a tumor. Since I am young and don't want to threaten fertility the doctor did not want to prescribe Test. He suggested clomid but I requested HCG after comparing experiences users have had between the two.

Current prescription is 500 IU 3 times a week. The pharmacy gave me a 10ML vial of novarel...kind of annoying that 4ML will be wasted due to the 30 day expiration date. I'm asking my doctor if I can get pregnyl for a longer refrigeration life or if 5ML vials are available.

GOALS:
1. Increase libido, energy levels, and strength by normalizing T levels
2. Monitor estradiol levels to see if aromatase inhibitor is needed. I already have higher levels of chest fat and do not want to worsen gynecomastia

QUESTIONS:
1. Will HCG help promote natural LH production after the 6 week trail period or will I always need to continue to medicate with HCG?
2. How long have others experienced the benefits of HCG due to normal T levels?

Next bloodwork will be at the end of August. I will update this thread throughout treatment. Any comments or references are appreciated


#2

hCG does not promote LH production. hCG will increase T and your LH/FSH should shut down. It is odd that your FSH is as high as it is. Suggest that you test LH/FSH later when hCG is working. If FSH not near zero, that suggests a FSH secreting testicular tumor.

T response to hCG depends on ones age. Does not work as well for old guys. Might work well for you.

How long? Depends on how degraded your testes are now from prolonged low levels of LH. When you introduce hCG, your testes need to recover size as well as function and bulk tissue changes can take time to be fully realized.

There is a lot of very good info in the stickies. Please start with 'advice for new guys'. <<<<<<<<<<<<<<<<<<<<<

You can always do T+hCG if hCG alone is not enough.

Please note the cautions against long term high doses of hCG. 1500iu/week may be too much. You can desensitize the LH receptors and get high T-->E2 conversion inside the testes and anastrozole cannot control that.

Many here take 250iu hCG EOD and the vials last 80 days. There is no problem with the expiry date. Drug companies are required to come up with a date so they just make something up. Note that hCG originally was a product to stimulate release of eggs for artificial insemination or IVF. As such, the doses were 3000-5000 all at once and the life of a 10K vial was not an issue then. And those doses were IM. We know that SC works very well. Keep hCG refrigerated. When you get from pharmacy, get it dry and mix at home. We have seen pre-mix damaged in transit.


#3

Like KSMAN stated, HCG will only hurt your natural LH/FSH production. You should be on a SERM, Most docs use Clomid although it probably isn't the ideal one. Nolvadex is said to work as well or better than clomid without sides that clomid sometimes has.

At your age I would seriously look into a SERM vs HCG and shutting yourself down even further.


#4

Yes, SERM's can work. However, those chemicals are foreign to your body. hCG is not normally found in men, but all men were soaked in high levels of hCG in the womb for a few months. hCG and LH have two lobes. In each, the lobe that works in the LH receptor is identical. So in that regard, one can state that hCG is functionally bio-identical to LH.

You cannot say that about a SERM. Perhaps long term low dose SERM's would be a good choice - there simply is not any good data. Taking a pill every day or two is certainly more attractive than an refrigerated injectable that also does not travel well. From a fertility point of view, the FSH levels from a SERM are important. One might cycle from hCG-->SERM periodically to preserver fertility in a better fashion. Something more of interest to the young men here.

And you never want high hCG doses or high LH from SERM doses that are too high. There is risk of LH receptor desensitization and high amounts of T-->E2 aromatization that cannot be controlled with anastrozole. So one should not use hCG+SERM. However, one might use small doses of each, but there is no experience with that known here. But if one did that, there is still the burden of injections.


#5

Thank you both for such a fast reply. I am meeting with the doctor again tomorrow to go over everything again and will bring this for reference. Is there any literature on the effectiveness of SERM vs HCG in raising T levels? From what I've found both can work but HCG has less side effects.


#6

Effectiveness of each is the same in that you can get identical LH receptor activation either way. However, the result is determined with what your testes do with that. And dose dependent with limitations.

Note not much data re SERM sides in men. Most literature is centric to E2 depletion in female breast cancers where the [older] woman is already deeply menopausal *. Those as a group feel miserable by any measure. In any case, side effects are highly individual. We know that a lot of men will react badly to Clomid with estrogenic sides. However, for those that do not, there are no side effects for them. I have not researched SERM sides in general for many years, so can not add more.

  • If you give a SERM to a younger normal woman, her LH/FSH, E2 and T levels will increase. When the ovaries are non-functional, SERM's will not lead to E2 generated in the ovaries. SERM's can block the effects of the background E2 generation in the adrenals. An AI can reduce that.

The biggest issue really is the doctors. They are not dealing with issues at this level.


#7

Update - HCG Monotherapy seems working great! Prescription was 500 IU 3 times per week. Only concern is elevated estradiol levels. I'm meeting with an endocrinologist in a couple weeks to discuss therapy going forward.

Previous Labs:
07/01/2014
TESTOSTERONE: 237 (292-1052 NG/DL)
CALC FREE TESTOSTERONE: 3.5 (4.8-25.0 NG/DL)
FOLLICLE STIM HORMONE: 6.0 (1.4-18.1)
LUTEINIZING HORMONE: 1.0 (1.5-9.3 mIU/mL)
PROLACTIN: 4.4 (3.0-30.0 NG/ML)
ESTRADIOL: 13 <=63 PG/ML

Squat: 245 x 5
Bench: 175 x 5
Deadlift: 315 x 5

New Labs:
09/19/2014
TESTOSTERONE: 576 (292-1052 NG/DL)
CALC FREE TESTOSTERONE: 6.6 (4.8-25.0 NG/DL)
FOLLICLE STIM HORMONE: 0.3 (1.4-18.1)
LUTEINIZING HORMONE: 0.1 (1.5-9.3 mIU/mL)
PROLACTIN: 4.9 (3.0-30.0 NG/ML)
ESTRADIOL: 44 <=63 PG/ML

Squat: 290 x 5 (+45)
Bench: 200 x 5 (+25)
Deadlift: 350 x 5 (+35)

Thoughts?
Should I supplement something to reduce estradiol?
Is there a concern continuing HCG monotherapy long term?


#8

Going to try to bump once for any comments on test result update...


#9

Hi, I’m interested in hearing about your experience because I’ve just been prescribed hCG monotherapy for what I think is secondary hypogonadism (I’m 27 y.o.). You can check my posts here: http://tnation.T-Nation.com/hub/santiagom#myForums/thread/6100413/

I see you’ve had great gains re strength. How has been your libido and sexual desire? Mood? Any negative side effects?


#10

Your E2 made a considerable jump from baseline, 13 to 44, indicating your HCG dose might be a bit high. You may have tough time controlling that if majority of the conversion is in the testes. An AI can not control intra-testicular aromatization. I would go with a 250IU EOD dose and retest. If happy with the symptoms and the lab numbers, great, if not, add a small dose of T to your protocol.


#11

[quote]santiagom wrote:
Hi, I’m interested in hearing about your experience because I’ve just been prescribed hCG monotherapy for what I think is secondary hypogonadism (I’m 27 y.o.). You can check my posts here: http://tnation.T-Nation.com/hub/santiagom#myForums/thread/6100413/

I see you’ve had great gains re strength. How has been your libido and sexual desire? Mood? Any negative side effects?[/quote]

Libido and sex drive has been considerably higher. No negative side effects I can speak to as of yet.

[quote]Igs wrote:
Your E2 made a considerable jump from baseline, 13 to 44, indicating your HCG dose might be a bit high. You may have tough time controlling that if majority of the conversion is in the testes. An AI can not control intra-testicular aromatization. I would go with a 250IU EOD dose and retest. If happy with the symptoms and the lab numbers, great, if not, add a small dose of T to your protocol.[/quote]

Thanks Igs I noticed the same. I’m meeting with a specialist in a few weeks and will discuss this specifically. Is the alternate option of lower dose hcg supplemented with a small does of T an appropriate long term prescription? Given that I am young fertility is very important.


#12

It wouldn’t make any difference if you did HCG alone or HCG+T+AI for your testicular function. Both options will preserve it. You may have to switch from HCG to SERM temporarily if you are trying to conceive because HCG may not support enough spermategenosis.


#13

[quote]Igs wrote:
It wouldn’t make any difference if you did HCG alone or HCG+T+AI for your testicular function. Both options will preserve it. You may have to switch from HCG to SERM temporarily if you are trying to conceive because HCG may not support enough spermategenosis. [/quote]

In regards to your statement of switching to a SERM temporarily is that only if I add in T to the medications? It was my understanding that HCG alone did not threaten fertility and actually increases fertility…


#14

HCG maintains testicular function, fertility on the other hand seems to be individual, some guys can maintain enough sperm production and some don’t. You would need a sperm count to get a good idea. However HCG will maintain testicular size and function so that if you do have to go on a SERM, it’s an easy transition.

Taking T while on either will not matter as far as fertility goes.


#15

Ok - I’ve heard differently regarding T impacting fertility. My general practice doc told me T on its own (just cypionate or enanthate) is not a good idea as it may reduce fertility…the reason I chose hcg instead.


#16

Please read the stickies. Multiple times if you have to. Pieces will start to fall in place.


#17

[quote]Igs wrote:
Please read the stickies. Multiple times if you have to. Pieces will start to fall in place.[/quote]

Yes I have; below is an excerpt from the TRT protocol for injections

"hCG is a water based peptide hormone can be injected to replace the lost LH hormone that TRT shuts down. Without hCG, the LH receptors in the testes are no longer getting activated. The results are:

  • Fertility can be greatly reduced or eliminated. If making babies is important, you need to inject hCG. If hCG is not used, its use after a long time may or may not recover fertility."

Can you please be more specific and let me know where I am misunderstanding the relationship between T, hCG and fertility?


#18

Your testes are stimulated by LH to produce T, they are also stimulated by FSH to produce sperm. Exogenous T will shut down the production of both LH and FSH since it will detect enough T in the system. HCG will bypass this feedback system and will mimic LH and weakly mimic FSH, hence you will be able to keep the testicular function and size.

The ability to keep the sperm production will vary from person to person. So, how does the HCG help you with fertility then? IT KEEPS YOUR BALLS FROM ATROPHYING TO THE POINT OF NO RETURN. So, in case you do have to go on a SERM, you have a nice healthy pair of balls that can start producing T and sperm right out of the gate.


#19

Been a while since I’ve updated this. The past 3 months I’ve been on 500 IU HCG (novarel) every other day with one tablet of anastrozole. I’ve been very satisfied in general:

-Sex drive crazy high
-T up from 600 to 750
-Estradiol still high

Lifts
Squat: 320 x 5 (+30)
Bench: 215 x 5 (+15)
Deadlift: 375 x 5 (+25)

I’m decreasing dose of HCG to every 3 days but still taking anastrozole. Next appointment will be in June


#20

[quote]KSman wrote:
There is risk of LH receptor desensitization and high amounts of T–>E2 aromatization that cannot be controlled with anastrozole. [/quote]

I am interested in reading more about this. Can you provide a source for any information regarding this topic?