T Nation

Dr. Saw Labs After HCG And Said, "I Don't Understand"

Hi everyone. Thank you for taking the time to read my post, and for your consideration …

I landed on this board with the hope of educating myself, and better understanding what’s going on with my own body. Rather than continue to read posts, ad infinitum, learning more, but at the same time becoming more confused and frustrated, I’ve decided to share my labs and whatever information may be needed to find some answers. Answers which my doctor clearly does not have. A little about me:

Age: 48
Height: 74”
Weight: 195 lbs.
Body hair: Full, thick goatee, but sparse hair everywhere else on my body (I could not grow a beard if you paid me).
Exercise: Lived in the gym half of my life. Always strong, well-developed and built muscle easily. Always lean. Never taken PED’s. That said, have not worked out in 2+ years.
Diet: The cleanest of diets. I have Celiac Disease and am strictly gluten free, including no dairy. Prepare all of my own meals.
Health history: Non-Hodgkins lymphoma at age 36. Six months of chemotherapy; no radiation.
Alcohol: Far more than I should
Medications: None
Supplements: Cal/Mag, Zinc, B-12, Vitamin D (last few months only)

For the past 6-12 months I’ve been experiencing a few symptoms of low T (less overall drive; mental dullness; some aches and pains), but primarily diminished libido. I am normally very highly-sexed, but lately I haven’t had the desire. Though I have little problem with performance, my recovery/refractory period is much longer and ejaculate is noticeably reduced.

I attributed much of this to stress and being overworked, as 6 months ago I accepted a new position which is very demanding. I’m working 60+ hours/week and under a great deal of stress.

I decided to visit my GP for a checkup and asked him to run my labs. He is a progressive, forward-thinking doctor who understands the difference between “within range” and “ideal”, and has no reservations about using pharmaceuticals to improve a person’s well-being if he sees the need.

Following are the results of the first lab test, run in early June 2018. This is not all-inclusive, but select results based upon what I feel you may need from reading posts from others:

DHEA-S: 159.8 ug/dL (Ref: 80-560)
Estradiol: 44 pg/mL (Ref: 0-52)
Ferratin: 456 ng/mL (Ref: 22-322)
T4, total: 8.59 ug/dL (Ref: 4.87-11.72)
TSH3 (3rd Gen): 1.060 ulU/ml (Ref: 0.350-5.500)
T3, Free: 3.9 pg/mL (2.3-4.2)
DHT: 36 ng/dL (Ref: 30-85)
Testosterone, Total: 400 (Ref: 241-827)
Albumin: 4.67 g/dL (Ref: 3.50-5.50)
SHBG: 34.9 nmol/L (Ref: 13.3-89.5)
Testosterone, Free: 7.57 ng/dL (Ref: 4.26-16.4)
Bioavailable Testosterone %: 48 (No reference range given)
Hemocrit: 47.9% (Ref: 39-51)

Subsequent to seeing my results, and especially considering that my lab results from 2013 showed total testosterone closer to 600, he prescribed 0.4 mL units of HCG 2x/week for 6 weeks. He theorized the lower Test #’s could be stress-related and hopefully the HCG would jump start my Leydig cells and after one or two courses of HCG they would return to normal production.

I took the HCG for 8 weeks. During that time I felt a slight increase is testicle size, slight increase in recovery and generally felt better. However, I had no increase in libido and had terrible, terrible cystic acne on my back and shoulders. When I returned to the Dr. for a follow-up he said the acne was very rare and does not generally happen with HCG. He proceeded to run the labs again, but only the hormone panel. They are as follows:

DHEA-S: 203.1 ug/dL (Ref: 80-560)
Estradiol: 17 pg/mL (Ref: 0-52)
Ferratin: 402 ng/mL (Ref: 22-322)
DHT: 39 ng/dL (Ref: 30-85)
Testosterone, Total: 397 (Ref: 241-827)
Albumin: 4.69 g/dL (Ref: 3.50-5.50)
SHBG: 39.5 nmol/L (Ref: 13.3-89.5)
Testosterone, Free: 6.95 ng/dL (Ref: 4.26-16.4)
Bioavailable Testosterone %: 44.6 (No reference range given)
Hemocrit: 47.3% (Ref: 39-51)

After seeing the results I asked him how these numbers were possible. My bioavailable testosterone was actually lower! He literally said, “I don’t understand, maybe the HCG was bad”. You can imagine the faith I had in my doctor plummeted. Among others, my questions remain:

  • How is it possible for HCG to have NO effect on my testosterone levels (which could indicate primary Hypogonadism? “edited”) yet it changed my estrogen, DHT, SHBG, DHEA, etc.? Also, after reading this forum, I now understand that my doctor should have also tested for LH and FSH.
  • How could I have such terrible acne on my back with so little change in my Testosterone levels?
  • How could my estrogen levels have dropped so low without any other change in my testosterone levels?

Any pearls of wisdom are immensely appreciated.

HCG is suppressive, it stimulates the bottom half of the testicles and suppresses the other half. You need TRT, that stimulates all pathways. DHEA is low and needs supplementation, DHT will increase when you start TRT, DHT is converted from testosterone.

HCG can cause terrible acne is some men, HCG monotherapy isn’t for you.

Why do you think his E2 is so low? It was showing at 17. I would have assumed having decent T numbers he would of had a higher E2. I thought Hcg would have caused higher E2 also.

It could be your primary hypogonadism. Meaning your testicles not working well. So HCG is useless. You just getting the sides from it.

Also don’t you think the high ferritin should be investigated? Full iron panel? Complete metabolic panel too

I don’t fully understand it, and not really what I wanted to hear, but thank you for your reply. I have an insatiable wife I need to satisfy and, well, I need to do something.

After seeing my Ferratin levels I asked my Doc about Hemochromatosis, but he said I need to be 1000+ to be concerned. Even still, I told him I wanted to be proactive and he prescribed therapeutic phlebotomy. I know high levels of iron can wreak havoc on various systems and organs.

I have read that many people report a surge in E2 when taking HCG, which is why I thought it strange that mine plummeted.

I would not do this.

You need a CBC and many dont need a phlebotomy when on trt. It can do more harm than good.
Metabolic panel check liver enzymes ast and alt.

Iron panel that checks iron, tibc, uibc, iron saturation etc.
It could be nothing but worth additional labs.
Read this. Good info.

Pharmacist here, based on the first bloods, your high estradiol/testosterone ratio, your normal SHBG, you should have been trying clomid at a now-standard dose of 25mg MWF with an AI like arimidex or aromasin weekly/biweekly.

HCG mono didn’t make much sense, “just do T” isn’t reasonable at all since Clomid alone may very well get your T in the 700s. Which is very good. Find a better HRT Doctor, and keep T for a last resort solution only.

Also keep in mind that if you ever inject, 50 to 100 mg/wk are plenty. I’d start at the lower end of that range, see what are your peak and trough levels so that you can estimate your AUC = average T levels over a week. 100mg/wk already yielding the absolute top of the natural range. So realistically going above 60-80mg/wk is close to gaming the system.

The average serum testosterone concentrations after the last dose of each regimen were 1055 ng/dl during the week after the last 100-mg dose

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Also not a single comment about that ferritin? Get that down :slight_smile: probably a diet issue with a degree of chronic inflammation, which in and of itself may lower T. Or the high degree of stress you’re going through. Not sure.

https://www.bmj.com/content/351/bmj.h3692.full

Are you talking about Testosterone?

Ahem. Test E or C, yes. I left HCG out in this scenario.

So what would be the harm in starting someone off at say 100mg a week, see how they feel after 6 weeks, take bloods and go from there? Personally I went through hormonal hell when my doc started me at 50mg a week and my T crashed 100 points from my natural level of 325. It took me over 3 months of suffering to get up to a proper dosage of 125mg a week. Which, with all due respect, is hardly “gaming the system”.

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I understand that some people are pretty much genetically low responders, and nobody can predict what’s going to happen in each and every single individual based on dozens of studies. That said, some of the very well established TRT doctors nowadays start low. If you need to adjust, better to dose up and find the minimal effective dose. After a bit of tinkering you’re set for a good while.

It’s discussed here for example: https://www.excelmale.com/community/threads/how-is-it-possible-50-60-80mg-a-week.5670/

Many people are high responders. You don’t necessarily hear of them too much on forums. Interestingly, TC wrote a bit about Dr Crisler here:

It appears that due to a faster esterase metabolism (genetics) some people have lower responses to IM administration. This could get people to try injecting in fat depots to slow down the release = try subQ. Another alternative may be injecting more often. Lastly, I’d recommend discussing HCG with the doc, in case of a less-than-desired response. It usually increases T levels to where they should be, plus LH is very important for cholesterol metabolism.

http://www.pilarmartinescudero.com/bibliografia_dopaje/biovariabilidadde%20la%20testosterona%20segun%20la%20variacion%20genetica.pdf

The best dose is what gets your estradiol in the lower 20s at a trough. SHBG tends to go down on T injections so the T/E ratio could differ a bit. Free T is important. Would you raise the weekly dose if TT comes back in the 400s but E2 is 20 and free T is at the upper half of the range, all measured at a trough?

I was referring to people “gaming the system” when they want to see a trough of 600+ ng/dl or more, 800+ even. Meaning an average of 1000+, requiring AI and so on. Not reasonable.

Great post!

Well my question is why go through this suffering? There doesnt seem to be any harm in starting at a higher dose and easing your patients suffering. This just seems cruel.

This has been refuted quite a bit here as some guys feel awful at this level and some great. Personally I seem to feel much better in the 35-45 range. Isn’t this just number chasing? What if it takes me dumping my T to 380 in order to get E2 so low?

A testosterone level of 1000 is still in the normal range (which was lowered a couple of years ago). How can you say that isn’t reasonable? Physiologik recently posted labs with T over 6000 and an estradiol of 40 and he doesnt use an AI.

You don’t need to pay for a TP just go donate a pint of whole blood at you local blood bank or RedCross its free and only takes about 30 minutes.
your HCT is already at 47 so don’t do a second pint in two months which the blood bank will want you to do.

On your blood numbers remember a blood test is a snapshot in time. Your hormones fluctuate all day long and can swing a lot with stuff like stress, also having sex, strenuous exercise 24 hours before the blood draw. Even the time of day you drew blood esp T. T is the highest 7-8AM.
I also think you should try the clomid before going on TRT for the rest of your life. Believe me it looses its luster after sticking yourself 2-7 times a week for a couple years.
hth

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Please help me understand …

I took HCG for 8 weeks and my testosterone was unchanged. This is indicative of primary hypogonadism because my testes did not respond to LH, or HCG, which mimics LH. This means that no matter how much LH my body produces, my testes do not respond.

So my question is this: why would I take Clomid, which is responsible for tricking my body into producing more LH which my testes are not responding to?

My ferritin is definitely something I’m concerned about. It wasn’t even on my radar back in 2013 when my ferritin was 405. The Dr. made no mention of it. But now, after doing some reading and realizing the devastating effects it can have on the reproductive system, I am taking it seriously. My ferritin has been very high for at least 5 years, and perhaps longer, so I am going to be proactive.

I’ve had chemo, so they will not accept my blood.