T Nation

A Prescription for Atrophy?


currently im rx testim gel 1% (50mg) a day so far it seems to work as test results have gone up. my question is is there someting otc for atrophy or do i need to talk to my doc for a rx to combat the dreaded shrinkage. Granted everythign else works great and im on a cycle of x-tren and epistane. just wondering what if anything i can use to help in the lower region.


yes there are things you can do - per the "TRT: Protocol for Injections" sticky and the "Estradiol: Why you should care sticky" among others.

I strongly advise reading through all of the stickies BEFORE you speak with your doctor - that way you will have a strong foundation and understanding of what you are asking for.

the short answer is that men can take HCG to mimic LH stimulation of the testicles to maintain size and health and produce other LH stimulated hormones like pregnenolone (but it can also over stimulate aromatase in the testicles.

A common suggestion is to take 250iu of HCG every three days - but everyone is different. For example, I am on 150iu EOD.


What's the benefit or reason behind smaller more frequent doses?


"my question is is there someting otc for atrophy or do i need to talk to my doc for a rx to combat the dreaded shrinkage."

Yeah, talk to your doctor about shrinkage and what he does for it.

If you're on the right dosage, you might experience little shrinkage. I have slight shrinkage--about 15 grams instead of the average 20 for adult male testicles--and use nothing but Androgel for my hypogonadism. LH and FSH are usually LOW NORMAL.


the doses are what are prescribed for me doc wants to do a check again in 6 months to see where im at. my doc doesent rx hcg so not wanting to cause any problems i guess a little shrinkage isnt too bad besides the g/f is still very happy and i guess thats what counts the most.


Urologists with fellowships in ANDROLOGY prescribe clomid and HCG--like mine.

What kind of doctor do you go to? If you're concerned with covering all bases, including fertility, then go to an ANDROLOGIST because that's what they deal with.


you don't have a rollcoaster of high T to start and then low T at the end of the week (or "shudder" biweekly)

freq injections give you a stable T dose that doesn't stress your body by going too high then too low. It also helps with reducing aromatase activity (since there are no spikes)


Yeah, I got that w/the T injections, I was referring to HCG shots. Or is the answer largely the same?


The half life of hCG really directs EOD injections. Then injecting T at the same time [EOD] makes a sensible routine... as one understands from the sticky.


How do you know if you need more, or less, Hcg? Blood test? By how you feel? Trial and error?


No testing. The tests would only show that you are pregnant.

We know the LH_replacement dose of hCG. Research showed that 250iu SC EOD is effective.

Just use that. The result will be that the testes maintain size and firmness and the scrotum will hang normally. We do not care about how much T production results. TRT T dose is adjusted to achieve target levels.

High doses of hCG, or high LH induced by SERMs, creates a high level of T-->E2 inside the testes. T levels in the testes are very high compared to serum T levels. Thus anastrozole, a competitive AI, is very ineffective at controlling E2 generation in the testes and serum E2 levels are then largely not controllable.

Doses smaller than 250iu EOD may be effective for maintenance.


I use 250iu eod. I was just curious how purechance came to the conclusion that he only needed 150iu eod......


I don't know that 150iu is enough. I am just doing trial and error.

but I did a blood test recently and it showed my 17-HydroxyPregnenolone was only 20 ng/mL. 17-HydroxyPregnenolone is linked directly to HCG and Intertesticular Testosterone levels - so I have recently bumped my dosage back up to 250iu and may try even higher if needed.


This is really something important. When will you be testing to see if pregnenolone levels respond positively?

When I got stared on T alone, I really got major shrinkage fast. My doc tested DHEA-S and pregnenolone before TRT. After 3 months pregnenolone levels dropped and as one would expect, DHEA followed. Unfortunately I am a very poor absorber of both as orals.

Repeating: Pregnenolone is created in mitochondria in cells throughout the body. There are supplements that support mitochondrial function, which declines with aging. So there is more that one can do beyond the issue of activating LH receptors in the testes.


my doc doesent rx hcg he is a general doc and wants to keep an eye on my levals for 6 months to see where im at. so either i live with some shrinkage or find something otc to help. or try and order hcg from an out of country pharmarcy and hope it doesent get taken by coustoms if anyone knows a good place to order from send me a message and i will email ya dont want to get into trouble here with sources. i called a hcg diet doc center here and all they wanted to do was charge me 1,000 right away and come in and get shots (didnt sound right)


sorry, I typed it wrong. I was talking about 17-hydroxyprogesterone not 17-hydroxypregnenolone

This link gives a pretty good run down on the 17-hydroxyprogesterone to hcg connection


basically HCG causes a rise in 17-hydroxyprogesterone AND intratesticular testosterone - so when you maximize 17-hydroxyprogesterone you are also maximizing intratesticular testosterone.

I wonder what happens if you take too much HCG and don't have sufficient Pregnenolone to start with?

I am going to go by how I feel, and hopefully get a couple of key tests in 3 months or so.


LH also creates high ITT, sometimes 80 times higher than serum T levels. The 250iu hCG dose EOD approximates those ITT ~80xserum levels. The paper that you link appears to be based somewhat on that research. Now when they want research subjects for such work, they do not have have their subjects limited by those willing to have syringes stuck into there testicles.

Obviously, there were no long term studies with fine needle aspiration to determine ITT. So now there can be long term studies of hCG response of ITT using progesterone as a proxy.