T Nation

hCG, LH and Replacement Doses?

Here is a question mostly for KSMan, but anyone can weigh in.

In the TRT: Protocol for Injections sticky, the following is recommended as a starting point:

  • 100mg test cypionate or ethanate injected per week with two or more injections per week.
  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses.

Followed by adjustment of anastrozole and testosterone as needed according to bloodwork of improvement of symptoms.

Recently I have noticed KSMan referring to 250iu hCG SC EOD as a replacement dose for young healthy levels of LH. But if this is true, shouldn’t 250iu hCG SC EOD bring T levels back to youthful healthy values without needing any T cyp/enanth at all? Isn’t 100mg test per week (divided doses) also a replacement dose for healthy T levels? So we would be replacing healthy T levels twice in the recommended protocol.

Also if hCG is used alone, that would be hCG monotherapy, which is usually prescribed (perhaps incorrectly?) at higher doses than 250iu EOD.

My understanding was that the 250iu hCG SC EOD was added into the protocol for its preservative effect on Leydig cells in the testes during TRT and to have a minimal impact on testicular T production which is still being replaced by exogenous (injected) T. But if that’s true then 250iu is not a replacement dose for healthy T levels.

All of this is of course assuming that we are treating secondary hypogonadism and that testes are responsive to LH. In primary hypogonadism, hCG likely wouldn’t be helpful/preservative.

So what am I missing? Why is the suggested protocol not replacing healthy T levels twice?

There are two situations:

  • When young with healthy testes, hCG mono-therapy may produce adequate T levels.

  • When older, hCG simply often does not work well enough by itself.

With T+hCG, T provides the needed T levels and hCG supports the testes and make some T. In my case, adding hCG increased TT by 17%.

With primary hypogonadism, hCG will still probably prevent testicular atrophy.

Thanks for sharing your thoughts. I find this topic very interesting.

That makes sense to me.

But that would mean that for young men with healthy testes hCG+T may produce roughly twice the desired T levels?

In this case either T or hCG would need to come down. I take it that you would recommend lowering T dose until blood work looks good while keeping hCG constant. As opposed to lowering hCG and keeping T constant.

In older men, would you recommend lowering T dose to compensate for the increase caused by adding hCG? Or just not worry about the increase?

Either way, you always look at labs/symptoms and make dose adjustments as needed. Some young guys may not need T injections. Is there room for doctors to get this wrong? - absolutely!