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?