T Nation

Acne from HCG & Possibly Protocol Changes

Still dealing with random nodules/cysts and don’t know if I’m headed in the right direction or not. Here’s the basic timeline of my TRT journey.

February - start trt at 150mg per week. No sides

May - doctor increase to 200mg per week (EOD 57mg). Still no sides.

Sept 24th - add 250ui EOD hcg for possible benefits (sensitivity, libido, well being, etc). Skin oily, acne starting, extreme fatigue, low worth feeling. horrible experience.

Oct 1st - doctor has me quit hcg since it’s been extremely negative for me. So only used it for a week. Has me up dose of T instead to 225mg per week (64mg eod)

Oct 16th - 2 weeks gone by and still dealing with bad acne, doctor lowers dose to 210mg (60mg eod).

Well it’s been 5 weeks now at that dose and the acne is still bad. It’s not extreme but its enough to make me want to stay inside. Doesnt look good as a 31 year old with cysts on your neck and jawline. I say I have 1 or 2 cysts on my arm, back, and neck/jawline at a time. Ive been using 10% benzoyl peroxide wash since I started seeing acne show up and a couple days ago I added every vitamin that should help with acne. (Vit A, Vit E, B5, zinc, Vit C, etc).

At first I figured it was because of my hormones fluctuating but after being on this dose for 5 weeks I feel I should be pretty leveled out by now. Just kind of lost at what to do at this point. Do I keep riding it out and hope these vitamins help? Do I just go back to 200mg at this point? I just find it weird I went from 150mg to 200mg no problem but now after being on 210mg for a bit I’m still dealing with issues.

This is where your doctor—had they not gone to Hollywood Upstairs Medical College—would have stopped.

See how you answered your own question already?

Five weeks isn’t very long. Assuming you live to be 72 that’s ~0.13% of your life. Your skin is a massive organ and your hormones control pretty much everything regarding how your body functions. So yes, your levels are stabilized now after five weeks, but whatever you and Dr. Nick Riviera did to your system it’s going to take more than a few weeks to clear up.

If I was at 200mg with no negative side effects, then why is it an issue to see if I can increase dosage with more benefits and no side effects? I want to be optimal at the highest dose possible with the least sides. Why do you think 200mg is the magic number of why my doctor should have stopped there? Also not sure how I answered my own question already.

To make it clear, 150mg I didn’t feel much after 4 months but had no negative sides. Doctor upped to 200mg, after 4 months I felt a little better but no negative sides. Not sure how this means I shouldn’t try to tweak my protocol anymore.

So if my levels should be stable by now and I don’t feel any negative effects, except for acne, why are you saying my system is messed up and it’s going to take longer to clear up?

Turns out you can’t.

If the acne isn’t really worth mentioning then what is the purpose of this conversation? You’re the one asking why it happened and I’m telling you.

Because that’s pretty much the limit of the prescribing guidelines and it would be unusual for someone to need to push much further. At some point it ceases to be medicine and it becomes something else.

If the acne isn’t really worth mentioning then what is the purpose of this conversation? You’re the one asking why it happened and I’m telling you.

Except you haven’t told me any reason as to why… because I told you the reason why is started. I never asked why it happened. I asked why it’s still persisting and what the issue may be.

Like I said, it happened when I started HCG, and maybe changing T dosages didn’t help. So the purpose of this conversation is still what I asked in my original post. I’m wondering if after 5 weeks if my hormones should be leveled out and if so does that mean my dosage is too high or would the acne have subsided. Or is it because the HCG could have knocked me out of whack and it could take more than 7 or 8 weeks to stabilize. The acne did not start until I implemented HCG. When upping my test dosage AFTER discontinuing HCG the acne has not gotten better or worse. So it is hard to tell what the issue could be.

I don’t want to drop my dosage if the case is that I may not be stable yet and in a few weeks the acne could resolve… because if it is just from fluctuating hormones then lowering my dose will most likely make it WORSE and I will be back at step one. Having to wait 8+ weeks possibly to be acne free. But if it has been long enough and clearly it’s my dosage, then the answer is that I must drop my dosage anyway.

Because that’s pretty much the limit of the prescribing guidelines and it would be unusual for someone to need to push much further. At some point it ceases to be medicine and it becomes something else.

If you are pushing into supraphysiological levels then yes. 200mg per week gets me to the same spot that some people use 80mg to get to. So 200mg isn’t a one size fits all maximum dose. There are people who even need 250mg+ to feel optimal.

You added hcg and increased your dose. Your body reacted to this change with the acne. The change happened fast. Getting back to normal doesn’t necessarily work the same way. You can either be patient or not.

If it’s cystic acne—and that’s how you described it—the benzoyl peroxide isn’t going to do very much, unfortunately. Hit a tanning bed twice a week for maybe 5-7 minutes each time (longer if you’ve got darker skin, shorter if you’re fair) and give it some time. There’s a reason Accutane is sold at most decent underground labs. Steroid users frequently get acne, even seasoned veterans who think they know their body. The most commonly discussed acne issue that I’ve seen is when guys go from high test doses to low ones or when guys first start. It’s that initial change that throws people’s bodies off. And yes, it can take many weeks before it resolves.

My main problem is idk how long is long enough to know whether it’s the dose, or my body still adjusting/stabilizing. How long do you recommend I stay at this dose until I should know?

Maybe migrate down to your original dose of 200mg and see if things clear up within a few weeks? It’s tough to say. You’ve got some externalities that came on all at once. Have you ever used an AI? Maybe you’re in a weird place with persistently higher e2 (which some of us prefer) but while remaining in that state your body is still not cool with it and acne is your side effect. It’s entirely possible that a 10mg/w difference was enough to trigger all of this, though it would be a little unusual.

I think I’m also going to pay out of pocket and go get bloodwork done tomorrow just to see where my test and e2 are at. 5 weeks seems long enough to get a decent baseline. I know from previous labs I was usually anywhere between 75 to 85 e2 with absolutely no sides. If it looks like it’s closer to 100 I’ll probably drop dose

6Omg EOD, I won’t be surprised if your TT comes back 1500+. I did 70mg MWF and my TT was 1650 and I had no acne/sides…I know everyone is different, but more frequent shots will give you much higher levels which could lead to side affects.

I experienced the same thing with HCG. I was doing 250iu MWF and oily skin/acne break outs started immediately. I lowered my dose to 100iu MWF and there has been a noticeable reduction, but it’s still worse than before since I had no acne previously. I also use benzoyl peroxide and other body washes… I’m going to stick with this lower HCG dose for a while and see if it clears up. Otherwise acne seems like a common side affect for guys running HCG.

Honestly I think you made a lot of changes with the dose increase, adding/removing the HCG, and then reducing the dose. Your body is still adjusting. Get labs done and see where your levels are at. I lowered my dose from 210mg to 120mg (40mg MWF) and I’m at TT 1200 And I feel the same as on 210mg… I believe that the HCG is responsible for the break outs, but your dose also seems a bit high for a EOD protocol.

Give your body another 4 weeks and asses your acne, get labs done and see where your levels are at/ reduce your dose if you are to high and give yourself 8 weeks to see how you feel at the lower dose. See if your breakouts reduce with the lower dose after 8 weeks.

Good luck

I didn’t get side effects right away either. Sounds like you had a good long honeymoon phase and are now back to reality. Those of us that deal with shitty sides all wish we could live in that awesome initial part where it’s all sunshine. Trying to get back to that is what drew me to this forum, only to find out ya probably can’t.

Last I got tested from 57mg EOD my TT was around 1100 but free T was around 32ish. I’m just going to have to get tested soon and see since it’s been 3 months or so since my last labs

If you add hcg to test, it takes about 4 weeks for levels to stabilize?

Confused about my latest labs. Still dealing with acne (it has calmed down a good bit but is still a problem mainly on my back and shoulders) and loss of motivation and drive. Libido feels a little better though. I don’t think HCG should still be affecting me since its been 2 months since I quit it and was only on for a week. Got labs recently and they were definitely higher than my last labs.

Started TRT on 150mg per week, labs then were:
TT: 988
FT: 216
doctor didn’t test E2 or SHBG

my labs on 200mg were:
TT: 1135
E2: 85
FT: 328
SHBG: 15

210mg per week:
TT: 1389 ng/dl
FT: 414 pg/ml
E2: 110 pg/ml
SHBG: 14 nmol/L

Feel like the HCG shouldn’t be affecting me anymore and something wasn’t right. I don’t think my labs should have changed that much from a 10mg difference. I also changed brands of testosterone at the same time so now I’m wondering if my last brand happened to be somehow under dosed or something. Checked my current brand and it’s showing real with the UPIC code. My old brand I never checked.

How should I proceed? Assuming drop dose but to how much? Should I do it gradually over a couple of weeks or just do it at once? It’s the only thing I can think of doing to alleviate these sides.

This. The ester will help control the gradual decline in TT