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HCG Induced LH Receptor Desensitization?

Hi- New here, so I hope this is in the right place.

I’ve been in treatment for secondary hypogonadism for over a year. Wife and I are trying to have a second baby (had one naturally a few years ago) and I’ve been on HCG monotherapy for about 10 months now. I came across a T-Nation article while researching some current events and am hoping some of you can help as I’m not a lifter and testosterone replacement is relatively new to me.

We are working with an andrologist at the cleveland clinic who has me on 2000IU of HCG 3X/week. This was to help bring up my test levels (was 150 total a year ago). It did that; got me up to around 300 total. Not great, but somewhat better. For awhile, it made my sperm count go up (we are trying to have a final baby ASAP and it’s been quite a ride). In November it was over 25 million/ml, but my last SA showed it falling (13 million/ml). We keep track at home too and it’s been steadily falling for a few months now. My test levels are also slowly falling. Total T was 248 just a few weeks ago and I can feel it falling more.

Did some research and despite the fact that my doc thinks I’m crazy, I feel like my LH receptors are probably desensitized. The more I read about HCG the more I see that high doses really aren’t recommended because of this. She increased my HCG to 2500IU/3X a week but we’ve held off on it because I think it’s working backward now.

I hope this makes sense. I should also add that my LH/FSH levels back in September were both less than 1. At my most recent bloodwork, LH was 1.4 and FSH was 3.4. A friend I met in another forum suggested LH receptor sensitivity because of this and the more I hear about it, the more I think that’s what is going on.

So… is there a way to make my LH receptors sensitive again? We have access to clomiphene (which I have avoided) and FSH injections outside of the MD’s recommendation, but they’re pricy so I don’t want to drop big dollars if my receptors aren’t working now.

What can I do to help reset my leydigs? Any opinions are welcome. I don’t know what’s going on but we’ve been sinking mad money into treatment with little return and I’m done screwing around.

Am I reading that right? 6000 IU’s a week?

Have you tried adding FSH? It’s not cheap but should more directly stimulate sperm production from my understanding

I was following a guy in a different forum coming off of T + DECA and trying to regain fertility. He eventually had success with a combination of HCG and clomid. I seem to remember that his HCG was 500 IU 3X per week and a whopping 100mg clomid per day. It took him a while.

I poked around in the literature and the use of 6,000 IU per week is not unheard of, but most fertility protocols use a combination of HCG and clomid to enhance endogenous FSH production. You need FSH to initiate spermatogenisis and LH to finish the process. Actually, it’s intratesticular testosterone that is needed and that’s where HCG fits in. However, without an adequate FSH signal to initiate the process, there’s nothing to finish.

Here’s an excerpt from a 2014 publication on the subject. They reiterate that it takes time. You can download the article for free from PubMed with this link:https://www.ncbi.nlm.nih.gov/pubmed/26816749.

Initially, hCG is administrated alone. After several months of treatment, if no sperm is detected but adequate serum T levels are achieved, then treatment with FSH is introduced (13). Gonadotropins are self-administered subcutaneous injections with dosages ranging between 75-150 IU of FSH or human menopausal gonadotropin (hMG) two to three times weekly plus 1,500-2,500 IU of hCG twice weekly. The duration of treatment may vary from 6-24 months or more and typically continues until sperm appears in the ejaculate and/or when pregnancy is achieved. Most studies have shown that gonadotropins induce spermatogenesis in approximately 80% of treated men (14), with some demonstrating the use of hCG combined with hFSH, urine-hFSH, or hMG-inducing spermatogenesis in up to 94% of men (15). The time it takes for sperm to appear in the ejaculate varies, most study reporting an average time of seven months and average time of 28 months to achieve pregnancy (16). A multicenter, safety study demonstrated that the combination of hCG and rhFSH induces spermatogenesis in men with HH who failed to respond to treatment with hCG alone (17). The pregnancy rate also varies between studies, 38% to 51% of couple who seeks treatment obtain pregnancy (9,17). The gonadotropins also increased T levels and testicular volume with relatively few side-effects (13). Several factors correlate with the response to treatment. Cryptorchidism, small testicles, elevated BMI, and extreme gonadotropin insufficiency are generally considered a negative prognostic indicator for treatment with gonadotropins (13,18,19). Gonadotropins are generally well tolerated, and proper dose adjustments to optimize T levels will minimize side effects such as gynecomastia , acne, influenza-like symptoms, and weight gain.

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Yes, 6000IU a week. I suggested starting FSH too (wife and i keep tabs on swimmers with a home microscope: crazy but you can see A general idea of what’s going on that way—and my overall numbers have fallen drastically) but the andro says she “reserves that for dire situations where men are still azoospermic after stopping T” (i should have added that i was doing 100mg of fest cyp 2x per week along with 500 iu of hcg 3x a week from nov. ‘18-march ‘19 but even with the hcg i was still producing no sperm). Production did come back to
Some degree pretty fast after stopping this protocol and doing just HCG, but our numbers aren’t good enough for anything other than IVF at this point. Trying to avoid.

So she won’t give me FSH but i can source it from an overseas pharmacy if necessary.

Thanks man. I told this andro we should have been doing FSH song with the HCG but she is not buying it. At this point we can order it from overseas and i may need to resort to that.

I do have access to clomid right now and from the reading I’ve been doing it seems that would elevate my LH and FSH at least instead of LH only. My only concern is how do we proceed at this point?

I have clomid on hand now (quite a bit; couple months worth) and just got a new hcg shipment. I’m not sure if i should continue the hcg with the clomid or cut the hcg. I’m concerned about leydig desensitization but it seems even that isn’t a proven thing.

At this point I’m about to nix this andro and do this on my own. We can order our own blood tests and SAs. This doctor has done me no good and I’m tired of shelling out all this cash for something i can do without her help.

I stopped the HCG completely and have been taking 50mg of the clomid EOD in its place. I can restart the HCG; just trying to figure out the dose. I’m thinking 500 units 3x a week? Any thoughts on that?

We can (and will) order FSH within 60 days but it takes 4-6 weeks to get here from overseas. I’m feeling semi decent ATM on 50mg of clomid EOD.

Sorry for the long response; i appreciate the excerpt. That helps a lot. At this point i just don’t know if my leydigs are fried or what. This is all overwhelming and it seems the majority of docs have no idea wth they’re doing.

Should also add that after reading some posts here I am going to get my prolactin level tested. This all started with low libido, ED issues, and the lowered sperm count was only
Discovered after we tried to seek treatment for that. Going over all my labs and out of the three docs we have seen not one checked my prolactin.

I would go this route personally. It makes no sense to me that she’s withholding a potential treatment that, as far as I know, has no real downsides other than costs. I am going to trying for kids this year and am going to use fsh to hopefully speed things along as quickly as possible. I just don’t see any downside to using it but perhaps there’s something I don’t know about it that says otherwise

I would continue the HCG and 500 IU 3X per week sounds like a good plan. In a study of healthy young volunteers given high end doses of TRT (200mg T-eth per week), it was found that intratesticular testosterone (ITT) levels were brought back to pre-TRT levels with about 1000 IU in divided doses. It’s ITT that is important for sperm cell maturation. So your planned dose of 1500 IU per week sounds like a very good plan.

I don’t have a lot of experience with clomid, but the experience I had was not all that great. I felt like I had estrogen-like side-effects at 25mg per day. It was tolerable, but unpleasant. I was experimenting to see if I could replace HCG with clomid (in combination with 40mg T-cyp every 3 days (~93mg/week) when I was having difficulty sourcing HCG. I was not on the experiment long enough to perform any labs, so I don’t know if it actually worked. I was able to persuade my PCP to take over my medication management for my TRT protocol and she was willing to prescribe the HCG in quantities I needed.

Bottom line is that your proposed dose of 50mg EOD sounds like a good starting point. I’d follow that up in 2-3 weeks with LH/FSH labs to see where they are and whether or not you need to increase the dose. The guy I was following was using 100mg/day and he said he felt terrible, but he was able to eventually father a child, so you can’t argue with success.

Personally, I’d hold off on the HMG (pruified LH/FSH) because it is very expensive and you need a lot of it because it has a relatively short half-life in the body. It’s much less expensive if you can make your own and amplify the production with clomid.