28, Bloodwork, Low T. Looking at TRT But Want More Info

Reposting because I’ve just started my HCG protocol and really want feedback to make sure I’m not messing anything up and to get an extra set of eyes on this stuff if possible.

Major apologies (Canadian and can’t help it) for the extra thread but this is a massive step in my life and I’m excited/terrified and want to make sure I get things right.

Symptoms: severe ED, brain fog, needing 12+ hours sleep, lack of focus, libido almost non-existant for a number of years. I’m in Canada (Toronto) GP just prescribed me viagra and basically told me to go screw myself on low ranges. Went to private anti-aging clinic and got prescribed HCG.

Bloodwork:

  1. Nov 2018

Total testosterone: 279.49 range = 250 - 835 ng/dl
FSH: 5.1 IU/L range = 1.5 - 12.4 IU/L
LH: 2.8 IU/L range = 1.7 - 8.6 IU/L
Free testosterone: 31.1 range = 15.6 - 146 pmol/L
TSH (ultra sensitive): 0.75 range = 0.27 - 4.20 mIU/L
T4 FREE: 20 range = 12 - 22 pmol/L
Hemaglobin: 161 range = 130 - 180 g/L
Hematocrit 0.48 range = 0.40 - 0.52 L/L
Cholesterol total: 3.77 <5.20 mmol/L
Triglycerides 0.97 <1.70 mmol/L
HDL - Cholesterol 2.00 > 1.00 mmol/L
LDL - Cholesterol 1.33 <3.5 mmol/L
Non-HDL-Cholesterol 1.77

  1. Dec 2018

E2: 84 <162 pmol/L
Progesterone: 1.2 <1.7 nmol/L
Total Testosterone: 554 242-831 ng/dl
Testosterone Free: 275 196-636 pmol/L
Testosterone Bioavailable: 6.4 3.6 - 11.2 nmol/L
SHBG: 59.2 10-70 nmol/L
Vitamin B12: 465 138-652 pmol/L
Ferritin: 115 22-275 ug/L

TSH: 0.97 0.32-4.00 mIU/L
Free T4: 16 9-19 pmol/L
Free T3: 4.1 2.6-5.8 pmol/L
PSA: 0.15 <4.0 ug/L
25-Hydroxy Vitamin D: 282 range 75 - 250 nmol/L
Reverse T3: 20 range 8 - 25 ng/dl
DHT: 38 range 16-79 ng/dl

C Reactive Protein: 0.38 <1.0 mg/L
WBC: 4.7 4-11 x E9/L
RBC: 5.46 4.5-6 x E12/L
Hemoglobin: 173 135-175 g/L
Hematocrit: 0.4999 .400-.500 L/L
MCV: 91 80-100 fL
MCH: 31.7 27.5 - 33.0 pg
MCHC: 347 305-360 g/L
RDW: 11.7 11.5 - 14.5 %
Platelet count: 206 150-400 x E9/L

Neurophilis: 2.9 2.0-7.5 xE9/L
Lymphocytes: 1.2 1.0-3.5 xE9/L
Monocytes: 0.5 0.2-1.0 xE9/L
Eosinophils: 0.1 0.0-0.5 xE9/L
Basophils: 0.0 0.0-0.2 xE9/L
Immature Granulocytes: 0.0 0.0-0.1 xE9/L
Nucleated RBC: 0 /100 WBC

Glucose Fasting: 4.7 3.6-6.0 nmol/L
Hemoglobin A1C/Total Hemoglobin: 5 <6.0%
Sodium: 145 135-145 mmol/L
Potassium: 4.0 3.5-5.2 mmol/L
Chloride: 105 98-108 mmol/L
Creatinine: 94 67-117 umol/L
eGFR: 95 90-173 m2

Urate: 456 230-480 umol/L
Albumin: 48 35-52 g/L
Bilirubin Total: 8 <20 umol/L
Alkaline Phosphatase: 66 40-129 U/L
Alanine Aminotransferase: 28 <50 U/L

Triglyceride: 0.32 mmol/L no range
Cholesterol: 3.68 mmol/L no range
HDL Cholesterol: 2.10 mmol/L no range
Non HDL Cholesterol: 1.58 mmol/L <2.6 mmol/L
LDL Cholesterol: 1.43 <2.0 mmol/L
Cholesterol/HDL Cholesterol: 1.8 no measurement given, no range given
Albumin (Urine) <5 mg/L no range given
Creatinine (urine) 16.1 3.25-24.5 mmol/L

  1. January 2018 (DUTCH Test)

Testosterone: 10 25-115
E2: 0.9 0.5 - 2.2
24hr free cortisol: 397 100-310
Total DHEA: 5152 1000-5500

Prescribed protocol: Anti-aging doctor currently has prescribed 500 IU HCG twice weekly with follow up bloodwork in 90 days. I’m choosing to divide up my HCG dose to 250 IU EOD based on what I have read on this forum.

Questions: (1) is it true that continued use of HCG is going to desensitize my leydig cells ala this article: https://medicinecoach.com/why-you-need-hcg-if-you-are-on-testosterone-therapy/

I’m planning to be on HCG alongside T (if I go that far) for many years so reading the above kind of worried me.

(2) Where do folks get their syringes from? Right now I’m using a pharmacy that is costing me $$

(3) Any input on my thyroid bloods would be much appreciated. I want to make sure I’m not missing anything here (I do get cold easily) - I have ordered some iodized salt to start using on everything.

(4) the DUTCH urine test revealed I have terrible T but also really high cortisol (especially at night). Anti-aging doctor ruled out adrenal fatigue but I’m really not so sure. I am taking ashwagandha and relora to try to curb this naturally but any other advice on this would be much appreciated.

(5) The HCG has felt really great so far but I am really wanting to go on T as well I think (in conjunction with HCG), I’d rather just be fully optimized than halfway. Any idea how to navigate that with my anti-aging doctor would be helpful.

If you inject large doses of HCG long term, then you could desensitize the leydig cells. You have nothing to worry about as your HCG dosage isn’t considered high. Looking at your SHBG, you will need TRT regardless as Free T isn’t good. You will need levels 1000+ to have optimal Free T levels which is at the top or slightly higher.

You will have to donate blood if you increase your dosage, you’re already at 50% Hematocrit and Hemoglobin is already at the top. Smaller frequent injections may lower all CBC labs whereas one large injection will drive it up.

This, plus your platelets are low, a good thing.

Possible, why are you using hCG?

Try eBay or Amazon.

You could make an argument for fT3 not being optimal and address based on symptoms.

For the most part, hCG monotherapy is not used for long term low T treatment.

Im from ontario canada, you need to go see Dr.Komer in burlington, get a referral to him. He is the leader in this stuff in canada. Only prob he is a one year wait list

Ok so I’ve been on HCG monotherapy since Feb 14. My results were pretty decent in the beginning - felt a decent ‘lift’ in the first week or so (focus a little better, sleep a little better etc.). Still had problems w/ ED and low libido.

Couple of bad side effects though - I think my estrogen is too high (my left nipple is really sensitive now and I’m worried about developing gyno). Still feeling brain fog/lack of focus during the day and my sex drive is still really low (still using ED meds too).

HCG protocol since Feb 14 has been 250 iu EOD:

Hemoglobin 163 130-180 g/L
Hematocrit .48 0.40 - 0.52 L/L
WBC Count 5.7 4.0 - 11.0 x10e9/L
RBC Count 5.04 4.40 - 5.90 x10e12/L
MCV 95 80 - 100 fl
MCHC 32 27-33 pg
RDW 11.5 11.5 - 14.5 %CV
Platlet Count 195 150 - 400 x10e9/L

HBA1C 0.5 <0.5 umol/L
Creatinine 102 62-110 umol/L
Cholesterol Total 3.58 <5.20 nmol/L
Triglycerides 0.43 <1.79 nmol/L
SGPT (ALT) 46 <41 U/L

TSH 1.39 0.27- 4.20 mIU/L
Free T4 18 12- 22 pmol/L
Free T3 5.7 4.0 - 6.8 pmol/L

E2: 155 <160 pmol/L
Total Testosterone: 756 251 - 836 ng/dl

My liver test (SPGT ALT) seems to be bad - kind of worried about my liver now so will take a look at that. My e2 nearly doubled which I’m not a fan of. Unfortunately they forgot to take LH, Free T, SHBG etc so I have to go back and get those (unbelievable). Kind of hard to say where I’m at without knowing those figures.

I am leaning towards going on Cypionate at this point but I’d like to keep doing HCG (really dont want to lose fertility + balls). Would like to keep doing 250 iu/EOD (maybe could lower that?).

Anyone have experience with running both (T protocol and HCG) where their estrogen went down as a result of using T in combination?

Any advice greatly appreciated @highpull @tontongg @KSman @systemlord

Usually E2 goes up when hCG is added to the mix.

Look at those thyroid labs, nice! HCG doesn’t activate all hormonal pathways, suppress the HPTA and half of the testicles, works for a select few.

Frequent T-Cyp injections should keep estrogen lower and more control. TRT+HCG is expected to cause estrogen sides if you’re having trouble with just HCG.

I’d think that 500iu twice weekly could get your intratesticular levels a bit high and you’d see e2 accumulating. This is confirmed with your bloods. T levels look great, and HCG is much more physiological than T already.

HCG yields a biphasic response with a first peak within a couple of hours post injection and another peak after 48/72hr. From there plus various studies trying out low doses it seems that spacing out injections to e4d will keep T and e2 where you’d want them.

Note that your e2 value in and of itself is absolutely fine. I think the issue with most “e2 symptoms” comes from a vicious circle engaging e2, Cortisol, prolactin, hypothyroidism… out of all of these, only Cortisol seems out of whack.

If I were you fixing Cortisol would be my absolute priority right now. No amount of TRT or HCG or anything will bring it down. Overstressed people tend to somehow get all sorts of side effects and pop tons of ancillaries because very few people ever mention glucocorticoid + mineralocorticoid receptors and electrolyte imbalances leading to BP issues and CVD. Looking at your Dutch Test and liver enzymes, you probably were/are overtrained, over stressed out, spend too much time in front of screens, the list goes on. You can’t keep the same lifestyle that triggered the extra Cortisol and use ashwagandha and HCG or T and hope it all goes away.

Hi all,

Still feeling the brain fog and honestly a bit down. Not sure what is up with me right now been training for a marathon so a lot of running involved so far and less heavy weight training so that probably has something to do with it. Worried now that it looks like my LH / FSH has shut down from HCG use. My prolactin was high (was developing a sensitive nipple on left side that has passed).

@tontongg thank you for the comments

My stress actually isn’t all that bad, able to work from home etc. Sleep has always been not great but I routinely get 7-8 hours per night (I just never feel fully rested which I kind of attributed to hormone imbalance). If you look at the DUTCH test it shows my T as extremely low. I agree my cortisol was very high, is there any other way to address this other than just reducing screen time and getting more sleep? Having better free T might help? Would love to do some reading on reducing cortisol.

Have the rest of my labs finally (still waiting on some numbers because its Canada):

SHBG 45 10-70 nmol/L
Vitamin D 132 75 - 250 nmol/L
IGF-1: 271 range coming
IGF-PB3 4.3 range coming
Free Testosterone 270 196-636 pmol/L
FSH 0.1 1.0-8.0 IU/L
LH <0.1 1.0-8.0 IU/L
Prolactin: High final numbers coming

Doctor is now recommending the following protocol per week:

100 mg testosterone enanthate
1000 IU HCG (for sperm/fertility/balls)

Doctor says the HCG isn’t working to stimulate my free T (still in lowest quartile even though total T is much higher) and that I need actual testosterone to help.

Current protocol has been HCG 250 IU EOD. Any suggestions on how to approach with the new prescription? Thinking both HCG and T EOD together or making T 50 mg twice per week.

Will fill in new numbers as they come in.

Actually I’ll correct myself as I just read about this study yielding very interesting AUCs: 1500iu e5d injection vs 300iu ED injection

Granted, ED injection could feel strenuous, but maybe 250iu eod isn’t enough for you.

https://www.steroidology.com/forum/anabolic-steroid-forum/135966-opinions-human-chorionic-gonadotropin-hcg-hrt.html

I suggest you print what Shippen (?) wrote here, and discuss it with your doc. 500iu M-F for 3 weeks might be too much and 250 M-F could do the job considering your history. I hope you guys get a good discussion.

Re: Cortisol. I don’t know. I’m trying everything myself, being happier and stress free can’t be forced /: giving ashwagandha and dhea a shot this month.

A very effective way to drop Cortisol that no lifter wants to hear about is training way less. I’d recommend following one of those Dan John routines or maybe Wendler’s 2-a-week AT MOST. I don’t even train legs hard anymore, or else I’m good for insomnia at worst or morning fog at best.

Walk around more, slow down, get massage therapies that kind of stuff. You might avoid a lifetime of TRT, which could be nothing but a band aid since you’re NOT primary, if you are willing to accept that your genetics don’t allow for hard training. Many (especially here in this forum) wanna act tough like there ain’t no overtraining and all that crap but if your sleep quality suffers then you’re overdoing it.

Edit - obviously had missed the part where you said you’re training for a marathon. Look no further.

Note that cortisol levels by themselves aren’t a super accurate indicator of what’s going on in every cell of your body, that’s why a Dutch Test is so valuable. Hopefully this message or the other above will lead to beneficial adjustments! Good luck

Hi all,

Have some updates from the last post. Most recent bloodwork below from November:

TSH: 0.82 0.32 - 4.0 mIU/L
Free T4: 15 9-19 pmol/L
Free T3: 4.7 2.6-5.8 pmol/L

Prolactin: 9.4 4.0-19.0 ug/L
E2: 130 <162 pmol/L
Total Testosterone: 1153.68 ng/dl
Free Testosterone: 805 196 - 636 pmol/L

Creatine Kinase: 545 44-275 U/L

Pics:

Thyoid folks out there, please do comment on my TSH etc levels. These were taken while I was still using HCG. For clarity, my protocol was testosterone enanthate 30 mg EOD and HCG 250 IU EOD.

As of the first of December I’ve stopped using HCG (protocol now just the 30 mg of test EOD) and I feel WAY better. I’ve found that my libido and ED have drastically improved by taking testosterone enanthate alone without HCG. I’m assuming this is because my estrogen was too high trying to do both?

Does anyone else have experience with this? I’d like to potentially go back on HCG because it keeps my fertility/testicular size etc. One option I’ve heard is just to reduce the doses of HCG and do them every day instead of EOD.

Maybe I could try something like 100 IU daily? Let me know thoughts - otherwise the move off of HCG has been great so far so I’m kind of reluctant to go back on it.

You could try something like 100 IU daily or maybe 200 IU’s 2x a week or something and see how you do.

This is pretty common and you’re choosing a full sack for decrease in libido and degrading in how you feel by choosing to be on HCG.

Some updates. I ended up struggling with insomnia after dropping the HCG - even though everything else felt great. My assumption based on reading this forum and some others is that dropping HCG has shut down my production of either progesterone or pregnenolone or both (progesterone mainly important for sleep). There is definitely a noticeable difference here re sleep - I can’t fall asleep as fast, can’t take naps, and I regularly wake up in the middle of the night.

I talked to my doctor about this and he is totally against me supplementing with progesterone, even if I am low on it without the HCG. I’m going to get bloodwork done tmrw morning that includes progesterone so I’ll find out one way or another. If it is progesterone that is low I’m going to find a way to try the progesterone cream and see if it helps.

Will be replying with my bloodwork as soon as I get it. I feel so close to being optimal here. Literally sleep is the last thing. Feel like if I get that figured out I’ll have a great protocol and will finally have this sorted.

In males progesterone synthesis is not unter the control of LH.
In females LH increases progesterone synthesis in the ovaries.

There is a good reason why you shouldnt supplement. Progesterone supplementation has been shown to increase the incidence of coronary arthery disease.

'In 1996, Hanke et al. demonstrated that in the rabbit model of atherosclerosis, progesterone therapy inhibited the beneficial effect of estrogen therapy on plaque size, likely by affecting arterial sex hormone receptors. Moreover, in the same study, therapy with progesterone alone was associated with considerably increased intimal thickening, compared with the castrated control rabbits [14]. Recently, Yang et al. demonstrated that progesterone induces the expression of macrophage CD36, a receptor for oxidized LDL that enhances foam cell formation.
In our study, progesterone levels were significantly correlated with WHR, fasting glucose and HbA1c, which are associated with insulin resistance. ’

Ok got the bloodwork back and looks like I was wrong on the progesterone anyway,

Highlights:

Hematocrit 0.512 0.4 - 0.5
Hemaglobin 176 135 - 175 g/L
TSH 0.76 0.32 - 4.00 mIU/L
Free T4: 16 9-19 pmol/L
Free T3: 5.2 2.6-5.8 pmol/L

E2: 99 <162 pmol/L
Progesterone: 1.1 <1.7 nmol/L
Total Testosterone: 911 242 - 838 ng/dl
Free Testosterone: 641 196 - 636 pmol/L
DHEA-S: Pending still

Pics:
CK etc

My crit is now high which would make sense on some of the fatigue I felt, still unsure re the insomnia but waiting for DHEA to come back. Really want some answer to this. My TSH has dropped but its still around where I was pre-TRT so I don’t think thyroid unless I’m missing something.

Is there anything else important for sleep that dropping HCG usually knocks down? My hematocrit is high but its not super high. I’m going to go donate blood in the next week or so to address that.

Your hematocrit is fine, normally doctors aren’t concerned until hematocrit is 54%>.