T Nation

hCG-Induced Hypogonadism, Update and Need Advice

Took a new bloodwork this Wednesday 28th of February and are still waiting for the results because the nurse managed to mix hematocrit with a hematomacrosis gene test (FDA test). FDA test is time consuming. In addition the lab had some IT issues so the results never came as promised before the weekend. So now, I am blind until tomorrow (Monday) regarding my E2 and hematocrit.

The reason I reach out for help is the simple reason I feel like CRAP!
Anxiety, depressed, insomnia, low energy etc.
I have done a lot if reading and ordered a new termometer to monitor my body temp.

So, in an attempt to get my life back I have an appointment with and endocrinologist in the middle of March. But I need to be alive until then, and hopefully also learn more about my condition, and what I need to do in order to get my life back. I have always been a calm, happy and highly driven person. Now I am just a train wreck. This situation is also hard on my family.

Recap (short story).
I was on Arimidex mono for two and a half years, then it stopped working, my test levels was again in the lower 300 range and I was feeling down, low energy, low libido, moody, bad sleep etc.

Due to low Test my andrologist gave me Testogel in April 2017 (Testogel) and because of testicular pain and atrophy 10 weeks later, in June 2017, my andrologist gave me hCG.
Everyone knows that I good doctor will figure out WHY the testosterone level is low, instead of just prescribing Arimidex or Testosterone etc. A good doctor will be MUCH more cautious and do some investigation before they put their patient on a potentially life long prescription.

The regimen I got was 1 sack of Testogel every morning and 500 IU hCG EOD for one week (four shots). Then three weeks pause from HCG. In addition I took 0.5 mg Arimidex e3d.

Motivation, drive, libido, mood etc. was back. I was feeling great until December 2018.
Everything crashed badly on the 10th of December 2018 with extreme insomnia and anxiety.

My doctor and Andrologist had no clue what the reason for my sudden crash was, my Test, E2, thyroid panel etc. looked good except high hematocrit (54%) and a little low E2. I therefore gave two medical blood donations in two weeks. But that didn’t help at all. Still high anxiety and no sleep at all.
In an attempt to feel better I did two things. Stopped Arimidex and took my hCG one week early, and this time I had done a lot of reading so I reduced the dose to 400 IU eod, four shots total. I now understood that the hCG regimen I was on was a receipt for disaster! My andrologist gave me WAY too high doses. I should have started at 250IU two times a week! If I had just done my homework instead of being so stupid, I would have avoided this devastating situation!

Well, after four shots on 400 UI hCG eod for one week I was back to normal…!

In the evening of the same day as the last (fourth) hCG shot:
I was eating dinner with my family feeling like crap, high anxiety, sleep deprived etc.
During the dinner the anxiety suddenly lifted, and just like that I was myself again, 100%.
My sleep was also back to normal, the calm, happy, highly driven me was back, 100%.

So for the next two weeks life was normal. I then started the arimidex again and after two days, BANG! Anxiety, insomnia back with a vengeance!

So, I quickly figured out that my sudden issues were due to low e2, but there was something that didn’t add up. I have driven my e2 down before I started on testogel (arimidex mono therapy), and all that happened was that my libido went through the roof and that I got dry and itchy skin. I just needed to stop taking arimidex and all the symptoms would disappear in one week.

To continue:
So after two more weeks in hell and unable to get my e2 back up, I took hCG again two weeks early. This time I reduced the dose to 300 IU, and reduced the number of shots from four to three. Well, nothing happened… anxiety, insomnia etc. persisted.

Then one week later my testicles started to hurt and shrink.
After a lot more reading I knew I was fucked, I had destroyed my own testicles!

I wanted to try a restart (I know, pretty stupid but I was a wreck).
In my search for hope if found several posts saying that Clomid would re-desensitize the Leydig cells in the testicles. I know… pretty stupid.

My andrologist gave me the following regimen:

  • Stop taking testogel, next day start with hCG.
  • 500 IU hCG e4d, four shots total.
  • 50 mg clomid for 4 weeks, the 25 mg for two weeks.

I know, too much Clomid.
Well, 3 days into the restart I was really a wreck, had to leave work.
4 days into the restart I was feeling better, and I was slowly coming back.
One week into the restart I reduced the Clomid dose to 25 mg eod.
My testicles were still hurting.
Bloodwork after one week showed that my HPTA was back online.
LH 5, after two weeks LH 10, and after four weeks LH 16…
Well my testicles are hardly producing any testosterone at all due to hCG induced Leydig cell desentization. I had fried my own testicles following the regimen of my andrologist!

Today I have admitted that I have become primary, my testicles produce Test in the 400 range with a LH of 16 and they are still hurting a little. I’m of course devastated; will I ever be myself again?
The last week I have admitted that a restart was stupid and started with Testogel every morning.
I must be able to work while I’m waiting for a full hormonal screening at the hospital.
But I still feel like crap and sleep is crap, no libido etc.
The Anxiety is not as bad as back in December, but I am far away from how I used to be before the crash.

So, my main question to you is:
I has always been a calm type, not afraid of anything. Doing skydiving etc.
Could one contributing factor for the anxiety and insomnia be low pregnenolone and DHEA?
The anxiety and insomnia disappeared after hCG, but the pregnenolone and DHEA can’t regulate that fast, can it? I believe that the main reason is low E2, but I still feel like crap even with an e2 of 0.12 (0.07 – 0.18). I will post my latest bloodwork when I get it tomorrow!

Thank you in advance!

Reading your story I thing you were going right through your sweet e2 spot. HCG brought your e2 back up, probably to much, then u took dex. Back down the e2 went and went down to much since you were not taking HCG anymore.
Post labs. Need e2 sensitive test.

Imo taking dhea and/or preg with further complicate things. Will need labs first anyway to check them. My dhea is low normal and I feel fine.

it seems you have brought yourself nice hormonal swing with all those changes with testogel, hCG, and AI. by the way, 0.5 mg arimidex e3d wasn’t too much?

I will try to get a sensitive e2 test. But I need a prescription from an endo first, and that’s almost two weeks away.
In an desperate attempt to feel better and get my e2 back up, I am using one of my wifes e2 patches. 1/2 a path. But I’m not feeling any better after one week. I think the reason is that the Clomid raised my SHBG from 37 to 78, now it’s down to 58, but that’s too high if my e2 is normal. The high SHBG is probably binding to all my e2… Bloodwork will show where I’m at.

Probably, I have stoppet using AI, and hope that I can do without it in the future. First I need to figure out why I feel like shit. I was on testogel for 8 months and felt great!
I hope that everything is due to low e2, I hope…

Last blodwork from 7th of March 2018:

  • B-Hemoglobin 15.5 g/100mL (13,4 - 17,0)

  • B-Hematokrit 0.46 (0.40 - 0.50)

  • S-Vitamin B12 1146 pmol/L (170 - 650)

  • S-Natrium 140 mmol/L (137 - 145)

  • S-Kalium 4.5 mmol/L (3.6 - 5,0)

  • S-Klorid 103 mmol/L (97 - 108)

  • S-Calsium 2.32 mmol/L (2.15 - 2.51)

  • S-Calsium, corr 2.34 mmol/L (2.17 - 2.53)

  • S-Magnesium 0.83 mmol/L (0.71 - 0.94)

  • S-Kreatinin 92 umol/L (60 - 105)

  • S-eGFR 82 mL/min/1.73m2 (>62)

  • S-ASAT 20 U/L (<45)

  • S-ALAT 30 U/L (<70)

  • S-CK 108 U/L (<280)

  • B-HbA1c 5.9% (<6,1)

  • S-Cholesterol 4.3 mmol/L (3.9 - 7.8)

  • S-HDL-cholesterol 1.1 mmol/L (0.8 - 2.1)

  • S-LDL-cholesterol 2.8 mmol/L (2.0 - 5.3)

  • S-Albumin 40 g/L (36 - 47)

  • S-PSA 0.57 ug/L (0 - 3.5)

  • S-CEA <0.6 ug/L (<5.0)

  • S-TSH 1.2 mU/L (0.20 - 4.0)

  • S-Free T4 18.5 pmol/L (11.0 - 23.0)

  • S-Free T3 5.0 pmol/L (3.5 - 6.5)

  • S-LH 9 U/L (1-10)

  • S-Prolactin 289 mU/L (<700)

  • S-Estradiol-17beta 0.15 nmol/L (<0.18)
    (E2 patch for one week!)

  • S-Testosteron 26 nmol/L (8 - 35)

  • S-SHBG 47 nmol/L (8 - 60)

  • Free Test index 5.6 (2.3 - 9.9)

  • S-Vitamin D 74 nmol/L (50 - 150)

  • Vitamin D3 74 nmol/L

The private laboratory are not able to test progesterone, pregnenelone, DHEA etc.

I’m back on testogel, 1/2 a pouch every morning, I’m a high absorber so one full pouch drives my testosterone above reference range for many hours.

I will probably get a full hormone panel next week at my local hospital.
I feel like crap, no sleep without strong sleep meds (sleep pressure gone). I can sort of fall asleep after 30 - 40 minutes, but always wakes up after 4 hours and are unable to fall back to sleep. Before the crash back in December I had extreme sleep pressure in the evening and could sleep all night in front of the television. If I woke up during the night, or used the snooze button on my alarm clock, I would fall back to sleep in one minute.

Estradiol patch is helping me regarding anxiety, it seems that my body doesn’t produce E2 anymore. So three days without the E2 patch and my skin is dry and itchy like hell again.

It also seems that the E2 patch REALLY brings me down, but it can also be from the Clomid cure I stopped two weeks ago. I now understand that it’s a lifelong mission for me to bring my hormone levels in balance…

I can get my hands on sublingual progesterone 25mg tablets and sublingual DHEA tablets.
But I have no idea if my progesterone or DHEA is low, and if that’s the reason for my sudden insomnia, anxiety, depression and total loss of interest in work, hobbies etc.
It could also be related to my adrenal glands? My doctor felt that free T3 of 5.0 was a little high, maybe my cortisol is high…?
Well, the full hormone panel will show all this…

I was finally called in to one of the best hormonal laboratories in this country today.
They gave me a 24 hour saliva cortisol sample kit (four vials with sponges for 7 am, 12 pm, 15 pm, and 21 pm), and bloodwork for the following hormones missing from the other blood work:
• Prolactin
• DHT (Dihydrotestosterone)
• 17-OH-Pregesterone
• 17-OH-Pregnenelone
• DHEA-Sulfate
• Aldesteron

Hopefully, the answers will explain my main problems: Insomnia, anxiety, depression, elevated resting pulse, no drive, no motivation, no libido, headache etc. Yesterday, just out of the blue at around noon my old self was back until late in the evening, a short relief from the misery.

If all levels are normal, I’m fucked, really fucked. I hope this hell is not the rest of my life.
But something must explain the sudden crash back in december…

If your doctor truly believes a fT3 of 5.0 is of concern leaves me very concerned! It’s not even out of range, these types of doctors are dangerous.

Well, my FT4 and FT3 is in the upper part of the scale.
But I don’t think this is the issue, even if my resting pulse is elevated and my sleep is crap.

I am still waiting for the blood work, will get it by the end of this week.
But today, I’m almost back to my old self, no anxiety, no depression and a solid 7 hours of sleep… I have a much more positive attitude… This is strange, because the only thing I use now is Testogel. It could of course be the Clomid side effects that are subsiding, and I start to feel much better because my E2 are in the middle of the reference range.

fT3=5 is perfect midrange and should support your body and oral body temperatures - see below. If oral body temperature is low with good fT3 we suspect elevated rT3 blocking fT3.

hCG is not the problem. hCG should never be combined with a SERM. The issue is over stimulation of LH receptors. Many find that hCG quickly improves mood which implicates a direct effect on the brain or neural transmitters.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab numbers and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Well, after a lot of problems at the hospital lab, my bloodwork finally came back!
Pregnenelone and progesterone LOW, DHEA LOW. Ferritin was very low after three blood donations.
Well, I started taking HCG again, 250 IU twice a week one week ago. Also take iron and vitamin D.
It doesn’t do anything for my balls, but MAN I feel good now!!!

Anxiety gone, depression gone.
Sleep much better (not perfect), therefore have much more energy, and in an almost too good mood.
My libido is back 100%, just like I was 16. Painful morning erections…
The morning after HCG shot is the worst when it comes to morning erection, have to wait like 10 minutes after waking up to be able to go to the bathroom, I am 52 years old… Before I crashed, I had soft morning erections without Cialis…???
I had to use 2.5 mg Cialis EOD to get decent erections, what is controlling this?
The test and E2 levels are the same as before. Well, I have one BIG issue with E2, it’s too low so I use and E2 patch two days a week to get my E2 in range. If I apply Testogel to my stomach and the fat above the hips my E2 also gets within range. I have low fat %, maybe that’s the reason?
Another thing, Testogel pouches are replaced with a pump bottle. Testogel 16.2 2% (twice as strong).
I will pick up 6 bottles this Saturday, anyone have experience with this? Will 2 pumps give the same amount as one pack of testogel?

Well, I have NO idea what’s happening now, my test is around 750 with an shbg of 42 (20 - 60).
My brain is also much clearer, and I work a lot faster with complex problems at work.

My balls have shrunk a lot, but that doesn’t bother me at all now.
Maybe they will respond a little bit to the low HCG dosage, hope so.

But, I have issues with Testogel. Maby use Testogel in the winter and shots during the summer.
It seems that how much I absorb fluctuates over time… Last summer I had to use 75 gram to get decent test level.

Now, I’m a super absorber so 1 pack (50 mg) of gel gives me over mid range test level THE NEXT MORNING!
If I apply one pack of Testogel to my shoulders after shower, my test level is around 1200 two hours later, and around 650 24 hours later… That’s too much for me, I’m horny as hell ALL DAY, have TONS of energy, talks fast etc.
So, if I apply it after shower I absorb WAY too much and must therefore use half a pack (25 mg) to get normal test levels.
My morning test level before application is now around 450, and I feel very good, so that seems to be enough for me.

So the main problem is unstable test levels. Some days I have to little test, and some days I’m horny, full of energy, singing in the shower etc. I’m really struggling to get a stable baseline.

So, I would like to start with shots with a short acting ester twice a week.
I will try 40 mg twice a week as a start, and try to get my stable test levels around 600 – 700. Above that and all I think about is pussy, very annoying. Also, when I crashed with high anxiety, depression etc. high Test levels made it worse.

Back to my low pregnenelone, progesterone and DHEA.
Should I start taking oral supplement (can get pills that melt under the tongue).
I will take new bloodwork in a couple of weeks to check my levels again.
I doubt that 250 IU HCG twice a week do much, but it does A LOT with how I feel…

Hey nibble…is it OK with you to have a private chat on this subject?

There are no PM’s on this forum.

And that first post was incredibly painful to read. The incompetence is simple mind boggling.

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Hi. I’m still here, but it was a close call.
Now I have my life back, and I got a son in the process :wink: Clomid is strong stuff.
I take 55 mg test enenthate e6d, 30 mg DHEA in the morning and 25 mg pregnenelone in the evening. That’s it.
Test levels is ca. 500 on day 6, 900 on day 2.
SHBG stable at 36 to 38, hematocrit stable at 48, E2 perfect. Use no AI, train hard and work a lot.
Feel great, calm, happy, sharp and focused.

Contacted the Metabolic Doc, he saved my life.
Fantastic doctor.
Started with Cyp, now use enenthate because Cyp is not available in Norway.

Have prescription for everything, and my primary care doctor is also fantastic that listened to me and “the doctor from USA” :wink:

Fuck! I read the first post and all I could think was, this poor bastard needs some basic TRT. Glad you got it all figured out. Those doctors were torturing you.

Hey nibble, you are lucky you have low E2, me I am super sensitive to E2 and is a challenge to keep it in range. Thank you for your detailed post which helped me a lot, I was in the same boat as you. Thanks so much!