I’m on HCG monotherapy 250IU EOD to increase my borderline abnormally low free test levels. I’m getting my bloodwork done every 2 weeks. I’m one month in now and my bloodwork is showing that my free test levels are going in the wrong direction - they are decreasing instead of increasing. All other hormones are within normal range - progesterone, estradiol, estrone, total test…
Any ideas?
Here are some of the things that have crossed my mind:
Is it possible that it just takes time and there is an initial lull?
I’ve been getting my bloodwork done just before my EOD shot. Could I be at the low end of the cycle? Like it’s peaking when I inject and then 2 days later it has dropped off?
Could I be somehow overstimulating the testes and having the opposite effect somehow?
I know that false results could always be a possibility but I don’t like the trend. Any thoughts would be appreciated.
This is probably what is going on. Before, you had low T and like many, that lead to low E2 and then SHBG would be lower. Now your testes creating more T, but E2 is increased and SHBG increased, binding to and reducing FT. You might have an exaggerated amount of T–>E2 inside your testes from the hCG, as some do. Anastrozole cannot do much to reduce E2 production in the testes.
One then needs to take enough anastrozole to reduce T–>E2 in peripheral tissues to create favorable serum level of E2. If hCG is dosed too high, E2 levels can be resistant to modulation with anastrozole.
We really need to see your lab numbers and ranges.
FT has a very short half life. So ones FT will have peaks and valleys following hCG injections. So, yes, ones lab timing could affect levels. Counteracting that effect is the long ~36 hour half life of hCG.
Note that low LH degrade the testes. hCG will recover the testes, but there is tissue remodeling that will occur and that takes time. If TT is up, you are responding. No need to test every two weeks.
Monitor and manage E2 and you can improve FT and the effects of FT on mood and libido.
[quote]KSman wrote:
This is probably what is going on. Before, you had low T and like many, that lead to low E2 and then SHBG would be lower. Now your testes creating more T, but E2 is increased and SHBG increased, binding to and reducing FT. You might have an exaggerated amount of T–>E2 inside your testes from the hCG, as some do. Anastrozole cannot do much to reduce E2 production in the testes.
One then needs to take enough anastrozole to reduce T–>E2 in peripheral tissues to create favorable serum level of E2. If hCG is dosed too high, E2 levels can be resistant to modulation with anastrozole.
We really need to see your lab numbers and ranges.
FT has a very short half life. So ones FT will have peaks and valleys following hCG injections. So, yes, ones lab timing could affect levels. Counteracting that effect is the long ~36 hour half life of hCG.
Note that low LH degrade the testes. hCG will recover the testes, but there is tissue remodeling that will occur and that takes time. If TT is up, you are responding. No need to test every two weeks.
Monitor and manage E2 and you can improve FT and the effects of FT on mood and libido.[/quote]
KSMan - sorry for the delay. Here are my lab results and ranges (I hope I don’t have to convert all the units and you can just analyze it based on the ranges):
I’m waiting for another set of lab results but it seems like 250IU HCG EOD isn’t increasing my free testosterone at all (if anything it seems to be decreasing it) and now my doctor is suggesting DHEA…should I just go in with your TRT protocol for injections? Is there something else that I should try before resorting to something that seems very serious and “final” for me - TRT injections for the rest of my life that will shut down my HTPA…I’m really nervous because my doctor will do what I ask but I don’t know what to ask. Please help.
In general, you fix causes, not symptoms. However, in this case, if the testes are not responding to HCG, then they will not work right if other systems are corrected and LH otherwise increases.
If DHEA was low enough to be rate limiting the testes, then there would be merit to what the doc suggests. However, you should take DHEA for other reasons as well. So no harm in trying, but the improvement would be an incremental improvement and based on where you are now, my expectation is that the result will not be sufficient.
Your T is low enough that the expected FSH/LH shutdown from the hCG has not occurred.
This outcome suggests a degree of primary hypogonadism. Short of a varicocele that could be surgically corrected, I don’t know of any out of this. FSH is not deeply low.
We very rarely see Estrone labs and really do not what to do with such.
The only flaw that I can see with the above thinking is if your hCG is not dosed correctly. If you diluted to 1000iu/ml, you would be injecting “25” on an insulin needle. You are keeping it refrigerated?
What changes did you notice in mood, size and firmness of your testes and how they hang?
Thanks KSMan…dosing is correct. I reconstitute 1000IU in 1mL and I inject 0.25mL (25 mark on insulin needle) EOD.
Mood is bad…I’m very emotional and not very happy most of the time. Testes seem small and they do not hang almost at all.
The reason I went in to see this doctor and had my blood tests in the first place was mainly because my hair was thinning. I just accepted everything else - small testes not hanging, storage of fat around midsection and breasts, low libido, and one problem that I have had for a while and it just keeps getting worse and I just accepted again as being not being very bright is problems with wordfinding. There are many times when I will test myself to find the word that I am picturing in my mind and it will take me a day - a simple word like “reeds”. Is it possible that I am suffering (not realizing it) from cognitive dysfunction (and even the hair loss???) from hypogonadism?
To simplify it for me - if the conclusion is hypogonadism - since none of the other hormones seem to be out of whack - is it safe to say that the only solution is exogenous T following your suggested protocol in the sticky?
I’m on HCG monotherapy 250IU EOD to increase my borderline abnormally low free test levels. I’m getting my bloodwork done every 2 weeks. I’m one month in now and my bloodwork is showing that my free test levels are going in the wrong direction - they are decreasing instead of increasing. All other hormones are within normal range - progesterone, estradiol, estrone, total test…
Any ideas?
Here are some of the things that have crossed my mind:
Is it possible that it just takes time and there is an initial lull?
I’ve been getting my bloodwork done just before my EOD shot. Could I be at the low end of the cycle? Like it’s peaking when I inject and then 2 days later it has dropped off?
Could I be somehow overstimulating the testes and having the opposite effect somehow?
I know that false results could always be a possibility but I don’t like the trend. Any thoughts would be appreciated.
[/quote]
We are finding that HCG is vulnrable to the natural hormone reactions which involves a stress response. If your adrenals are not in check then your testosterone is vulnerable to be depleted in a stress response where more then normal cortisol is needed. Cortisol is a hormone that is needed to live with out it you die there fore the body will compensate by diverting it from testosterone. I see alot of down regulation of HCG in just minor dosage. If a dr is just treating by free T he is a total moron. HCG may cause e2 to rise which may result in SHBG going up decreasing one free testosterone.
[quote]Hardasnails wrote:
We are finding that HCG is vulnrable to the natural hormone reactions which involves a stress response. If your adrenals are not in check then your testosterone is vulnerable to be depleted in a stress response where more then normal cortisol is needed. Cortisol is a hormone that is needed to live with out it you die there fore the body will compensate by diverting it from testosterone. I see alot of down regulation of HCG in just minor dosage. If a dr is just treating by free T he is a total moron. HCG may cause e2 to rise which may result in SHBG going up decreasing one free testosterone.[/quote]
Seems reasonable - do you have any suggestions (other than find a new doctor)? The thing is, my family doctor denies that there is any problem. This doctor is like gold because he has an open mind but I agree - knows very little.
If my body is draining my testosterone to supply cortisol production, what would indicate that and/or what would be the course of action?
hCG can lower LH, but I don’t see the cortisol connection other than your body can’t support the increased metabolism with low thyroid or cortisol as often stated here. However, if the testes are responding that will sink some DHEA and pregnenolone [indirectly]. And if the testes are working, they will create pregnenolone.
If the testes will not respond to hCG, they will not respond to LH.
“down regulation of HCG in just minor dosage” probably meant LH
It may be that you have decreased androgen receptor sensitivity which can be increased through proper nutritional intervention. Vitamin D, e, selenium has to be optimal for testes to respond to LH from the HCG.
One may want to up the dosage a bit. Its good you found a good dr because canada have crappy endocrine training.
In order to get the true picture I need to see all the testing results in order to even know where to begin. If adrenal and thyroid are imbalanced then this could be a huge factor.
[quote]Hardasnails wrote:
It may be that you have decreased androgen receptor sensitivity which can be increased through proper nutritional intervention. Vitamin D, e, selenium has to be optimal for testes to respond to LH from the HCG.
One may want to up the dosage a bit. Its good you found a good dr because canada have crappy endocrine training.
In order to get the true picture I need to see all the testing results in order to even know where to begin. If adrenal and thyroid are imbalanced then this could be a huge factor.[/quote]
Thanks Hardasnails: could you please tell me exactly which tests you would like to see?
Free Test 19.3 (31-94 pmol/L)!!!
Estrone 99 (52-240 pmol/L) I know that you said you didn’t know what to do with this analyte - I think it’s a precursor to estradiol.
Testosterone 13.5 (7.6 - 31.4 nmol/L)
Prolactin 9 (<18 ug/L)
Progesterone 0.8 (0.7-4.3 nmol/L)
Estradiol 74 (<157 pmol/L)
Here is my take on this - I had concluded hypogonadism thinking that the testes were being properly stimulated by LH with no reaction. Now I see that after 2 months of HCG my LH and FSH have gone WAY down and my free test is way down. However, upon further examination, it seems that my free test is a little bit higher than previous - marginally - not sure if it is just +/- error or an actual trend. Is the HCG expected to shut down (or decrease) my LH levels because my body is recognizing it as LH and reacting as if it doesn’t need to produce it anymore? In which case those 2 points taking together indicate that the HCG would actually be doing its job?
I’m going to read now to see if I can find out the effects of HCG on LH (and/or FSH)…
Hard to say. Your LH/FSH have been repressed, but with little change in T levels to explain that. Perhaps your set point for T+E is not quite low. I any case, we also have a strong indicator of some degree of primary hypogonadism as well.
Your T production might be rate limited by low DHEA.
How have your testes changed?
Overall, one can easily state that mono hCG is a failure. But what do we know about a varicocele?
[quote]KSman wrote:
Hard to say. Your LH/FSH have been repressed, but with little change in T levels to explain that. Perhaps your set point for T+E is not quite low. I any case, we also have a strong indicator of some degree of primary hypogonadism as well.
Your T production might be rate limited by low DHEA.
How have your testes changed?
Overall, one can easily state that mono hCG is a failure. But what do we know about a varicocele?
[/quote]
You said above “Perhaps your set point for T+E is not quite low.” - I think you meant IS quite low, right?
Maybe I could take DHEA as a supplement for a while as a building block for T and see what happens (in conjunction with continuing HCG).
Hard to say about Testes - I can’t really notice any change. Maybe they are somewhat more plump but not significant. I don’t think varicocele applies - I don’t feel any evidence of it…
I bought the book “Testosterone: A Man’s Guide” by Nelson Vergel. It really clarified a lot of things for me. At some point I think I’m just going to throw in the towel and supplement my T exogenously (TRT injections) and deal with the consequences. In the book one doctor mentions that when on TRT the patient should come off every 12-18 months to check that the HPTA axis can be restarted. I have such a low level of FT as it is, it seems like it could be very difficult to restart production after 12 months of negative feedback. My biggest fears of starting TRT are dependency (shutting down my HPTA) which is a sure thing and cancer. I know TRT doesn’t cause cancer, but in such an event, it could be throwing fuel on the fire if in a tissue that is sensitive to testosterone (like the testicles). That really scares me…