T Nation

HCG and E2

Quick backstory, the last 2 years I’ve been dealing with brain fog, fatigue, no libido, and ED. I went to see a doc a few weeks ago (labs below) and his working theory is that by Free T levels are too low and prolactin is too high. Right now I am taking 500iu of HCG MWF and 5g of bromocriptine daily for three weeks. I’m coming into the 2nd week and have noticed very little, with the exception of the day after my first injection. I felt almost “normal” for a few hours and then back to how I’ve been lately. From what I’ve read here my starting E2 was probably too low, the hcg caused it to hit a better spot and then blew passed it. Does that seem reasonable or is there something else obvious? I thought DHEA-S may be a little low. I’m 26 years old, in decent shape, and work out moderately.

I wish I would have checked this forum before I went, it has been very informative, so thank you to everyone. When I go back in a couple of weeks I will attempt to ensure the tests we are doing better match the tests suggested here.

fT3 - 3.5 pg/mL (2.5-3.9)
fT4 - 1.4 ng/mL (0.6-1.5)
TSH - 1.87 mcIU/mL (0.50-5.00)
tpo - 1.7 IU/mL (<10.0)
tgab - 7.0 IU/mL (<100.0)
SHBG - 47 nmol/L (10-74)
TT -total testosterone - 470 ng/dL (285-950)
Free T - 72 pg/mL (50-247)
LH - 3.4 mIU/mL (1.5-9.3)
FSH - 4.8 mIU/mL (1.4-18.1)
cortisol random PM Test - 13.9 mcg/dL (3.1-16.7)
DHEA-S - 324 ug/dL (280-640)
prolactin - 9.0 ng/mL (2.1-17.7)
estradiol - 16.4 pg/mL (10-42)
Pregenolone - 220 ng/dl (23-173)
IGF-1 Somatomedin-C - 136 ng/mL (112-402)
Vitamin D25 OH - 43 ng/mL (30-100)
Chol_A - 168 mg/dl (0-200)
Trig_A - 54.00 no unit listed (48-352)
HDL_A - 58.4 mg/dl (23 - 92) md/dl
LDL_A - 98.80

Are labs pre medication or when?

Are you using iodized salt?
Check body temp when you first wake up. Pattern near or below 97F?

Describe your mood/depression, initiative/apathy etc.

You might be confusing hCG and Arimidex/anastrozole.

hCG first dose can create a elevated mood and energy. This seems to be a one time deal. Might be creating a transient increase in dopamine. Effects vary significantly.

hCG dose may be too high for long term but should create a good response at your age.

DHEA-S is not the cause of your problem. Pregnenolone is very good.

Give things time to happen, the testes need to physically change then you have to respond to increased T levels as gene expression changes.

I do not feel that prolactin is the root cause.

List your Rx and OTC meds.
Other health problems?
Stressful life?
Vehicle accident or blow to the head prior to two years ago?
Lost some peripheral vision?
Major illness 3 years ago?
testes ache?

Are labs pre medication or when?

     The labs were from 1 week before starting the medication.

Are you using iodized salt?

I don't really add salt to my food.  Is adding salt enough, or would an iodine supplement be necessary?

Check body temp when you first wake up. Pattern near or below 97F?

I will start monitoring this in the morning.

Describe your mood/depression, initiative/apathy etc.

I don't believe that I feel depressed.  Apathy and lack of motivation would be sot on.

You might be confusing hCG and Arimidex/anastrozole.

I thought HCG could/would cause E2 to rise along with testosterone.  Being that my returned value was 16.4 I thought it raised to near the 22 level when I felt better, and then kept rising past it.  
I was just attempting to rationalize why the day after the first shot I felt cured and then everything came back.  Your explanation makes more sense.

List your Rx and OTC meds.

I am not taking any medication outside of the HCG and bromocriptine.

Other health problems?

No

Stressful life?

It was during the time the issues started, but things have been much calmer for the last year.	

Vehicle accident or blow to the head prior to two years ago?

I've suffered a couple of blows to the head during high school sports.  One concussion that I know of when I was 16 or so.

Lost some peripheral vision?

No

Major illness 3 years ago?

No

testes ache?

They do now, slightly, since starting hcg.  They did not before.

You can use iodized salt and should take an iodine rich source for a while to build up your iodine stores.

After a couple of weeks I have not noticed any changes. I’ve been tracking my waking temp and it is consistently sitting between 96.8 and 97.2. I’ve started to use iodized salt, but is there anything else I should add in? What should normal waking temp be? Thanks.

I have seen 97.8F reported as a ‘normal’ waking temp. No guarantee that iodine will fix things, but at least you can take iodine deficiency off the table. It may take time to get results. If that does not work, you would start low dose T4 or dessicated thyroid extract.

Update - the iodized salt appears to be helping, as my morning temp is gradually eeking up. At least it is being more consistant.

We did blood work to see how well the 3 weeks of HCG (500iu MWF)was working. Results are -

SHBG - 45 nmol/L (10-74)
TT -total testosterone - 376 ng/dL (285-950)
Free T - 55 pg/mL (50-247)
estradiol - 21.1 pg/mL (10-42)

Free and total T have both dropped. The doctor would like to continue the protocol for 6 more weeks to see if there is an improved response before looking into other options.

Does it make sense to keep trying this protocol? Is it possible that the dose is just too high?

The blood was taken 24 hrs after a shot and at this point I have not noticed any changes in the symptoms I’ve stated previously.

seems to me your testicles aren’t responding, meaning you’re more on the primary side

So my doctor has decided to start TRT. He stated he would allow me to start injecting on my own after we tested injections every 2 weeks in the office. Partially he wants to ensure I know how to inject properly and to see if TRT causes me to feel better. He realized it could be a bit of a roller coaster, but it will only be 6-8 weeks and then I can control the injection frequency.

The plan is 300mg Test Cyp every 2 weeks. He wants me to remain on HCG 500 iu MWF. I asked about an AI and he stated that we would hold off to see how I responded and determine if it was necessary with blood work. I purchased arimidex just in case my doctor wouldn’t want to rx it. Should I use it during this trial time so I may feel better or hold off so the lab results are more accurate? If so with the wide injection time would you still do 1 mg a week or focused?

Thanks.

Your total testosteorne is low in reference to your SHBG. If you are on thyroid meds it can cause shbg to go up. HCG needs proper levels of vitamin D to work properly. I have several patietns that have been on HCG and once the vitamin D was between 65-90 there testosterone shot up. There where no other varaibles that had been change to alter this results. Vitamin D acts as a potential hormnone receptor that can some how affect the response to LH from HCG or clomid. The mechanism is not none but I have seen it in several cases of people. There also may be a genetic factor involved as well to this, but more exploration is needed.

When on TRT one needs to keep the plasma levels of testoteorne as steady as possible. 300 mgs once every 2 weeks will cause a response of 2500-2800 48 hours after the injection then by time you are due for your next shot you will be down to 200-300. So to go from 2800 to 300 mg/dl of testosteorne is huge emotional rollercoaster ride which can cause other hormones such as adrenals and thyroid to go out of balance. adding in 500 ius m,f,w is insane and will cause you even to go even higher.

It will be like doing a steroid cycle for the first 5 days and then rest of the time it will be like you being on nothing. It is very dangerous in many ways to your emotional and mental well being.

Majority of e2 can be managed with out an AI. It is really up to the skill of the practioner to properly adminsiter TRT to use less medication with best clincal results.

?!?!?!

starting at 300 biweekly when he acknowledges it will cause problems? what the hell?

500iu HCG EOD is also a massive starting dose of HCG. This is just crazy.

150mg weekly is a very large starting dose. Why not start off at 100mg which is what most men seem to need?

Hey, I have a great idea. I know that you have a broken leg and all, but why don’t we just try and set it here without x-rays or any type of cast. Now, I know that not using a cast MAY cause YOU problems, but why don’t WE see just how bad this treatment program is and how much it completely wrecks your system before I decide to treat you the right way.

you have got to be kidding. the sad thing is I know that you’re not.

also let’s start you a massive dose of Test with no aromatase control and you can just suffer through the spiking Estrogen. I mean it’s not like it is my body - I get to inflict this suffering (oh wait, I mean practical treatment plan) on others. And you don’t mind going through hell for 2 more months do you? No, good. I mean it’s not like you were feeling good to begin with, so why don’t we see how bad it can really get? Now that will be $150 and another $60-$90 for each shot visit (possibly not covered by insurance), you can bow down to me now and shower me with praise for allowing you to receive my amazing council.

sorry for my tangent. Doctors can get to me at times.

Thank you both for the input and concern. No need to apologize for the rant, I feel the same way. On the other hand this isnâ??t the first doc Iâ??ve seen and he is the only one who hasnâ??t told me it is all in my head. I view it as a situation where he is willing to run blood tests and write scripts, I just need to get it to the point where I can control the dose/frequency. At this point Iâ??m just hoping if I tell him that things are out of control he will listen and shorten this trial run.

On the Vitamin D side of things I am already taking 6000 IUs per day (and was at the time of blood work). How much more should I take?

Iâ??ll lower the hcg dose. Is there a better way to structure the timing of that to somewhat reduce the other fluctuations?

I take 10,000 ius vitamin D a day to keep levels at 70
Lower hcg dosage to 250 2 times a week plus lower weekly dosage to 50 mgs twice weekly will really help alleviate the potential need for AI. I tell guys to hold off on AI untill after first 5 weeks on TRT because it can just be your body reawakening the estrogen receptors from increase of testosteorne. If in the area I help run a clinic that specializes in HRT and hidden fatigue outside philadelphia PA

I’ll make the hcg and Vitamin D changes as noted. Unfortunately, I’m in Nebraska but thanks for the offer.

I take 12,000iu Pure Brand Liquid D3… and get D 25OH levels of 57 to 84.

Personally If you think that he is open minded and understands that Estrogen could be an issue I would do the protocol he wants and if you start to have issues with E2 symptoms at anytime notify him and demand to have your levels tested. If he wont well then you have to take matters into your own hands.

[quote]oscar31280 wrote:
Personally If you think that he is open minded and understands that Estrogen could be an issue I would do the protocol he wants and if you start to have issues with E2 symptoms at anytime notify him and demand to have your levels tested. If he wont well then you have to take matters into your own hands. [/quote]

No because then he will stop scripting T…everything else is easy to get. Keep the doc happy at least for the T script. Sounds crappy, but do what you have to do…look after yourself at all times

we would never advise someone with a broken leg that it is fine for a doc to set the leg without a cast - because hey he is a doc and you don’t want to upset him and we have to keep the doc happy.

we would say screw that. go find a doc who knows what they are doing - or you should sue him for being so stupid.

but for some reason we are willing to settle for dangerous less then optimal HRT treatment plans - which can have drastic implications for your physical and mental health.

it is just a sad state of affairs.

don’t compromise your health.

I agree with pure chance
You are opening the door to other hormonal imbalance namely thyroid and adrenals from this huge roller coaster ride of T and E

Well after a few days of playing phone tag with the doctor to discuss my issues with the protocol and my desire to change it, he made time for me yesterday. I was completely floored when he started talking about he believes smaller more frequent injections are ideal, and that he can’t talk guys into doing it themselves etc.

I had to do a double take based on my last appointment with him. It was very much like I was seeing a completely different person. So, I walked out of there with a script for the basic protocol in the stickies here. Kind of bizarre.