HCG Monotherapy for LowT/Low E2/High SHBG?

From the 8/6 lab, my provider had me start Boron and ZMA to lower SHBG. You can see it was lower in the recent labs. However, Free Testosterone and Estrogen still very low. I have concerns of Testosterone because I’m young 30s and may still want kids. I also would prefer not to be on something the rest of my life. My questions:

  • I’ve heard some (while not all) having success with HCG Monotherapy. Would this be a possibility to improve my Free Test & Estrogen?

  • Is HCG like TRT in the sense that it is forever? Or could this be a temporary thing to get my numbers up, then be discontinued?

I should mention that my provider previously had me on Clomid, which took my SHBG from slightly out of range to WAY out of range.

Also - LOW Reverse T3? Perhaps a separate issue, but after searching the forum and web, I’ve never seen a reverse t3 that is out of range by being TOO LOW. Curious what this mean of the state of my thyroid, since I was previously on NDT, but now just on T3.

Labs taken 11/12/19
Total Test - 623.6 (264-916 ng/dL)
Free Test - 7.5 (8.7-25.1pg/mL)
Estadiol sensitive 7.9(8.0 - 35.0)
SHBG 91.1 (16.5 - 55.9)**
Free T3 - 2.4 (2.2-4.4)
Reverse T3 6.7 (9.2 - 24.1)
IGF-1 142 (88-246 ng/mL)

Labs from 8/6/19
Total Test - 754 (264-916 ng/dL)
Free Test - 7.5 (8.7-25.1pg/mL)
Estadiol sensitive 10.7 (8.0 - 35.0)
SHBG 117.5 (16.5 - 55.9)
Reverse T3 15.6 (9.2 - 24.1)
IGF-1 142 (88-246 ng/mL)
Free T3 - 3.9 (2.2-4.4)

I am confused as to point of this approach, honestly. The HCG induces shutdown of the pituitary stimulation, so it would make no difference whatsoever to be on test at the same time, except that your chance of success would probably be a lot higher. If you stop the HCG, you will be right back where you were, you have only managed to prove that your tested respond to stimulation. It would be more appropriate to now move you to Clomid or Tamoxifen for at least 6 weeks without the HCG to see what happens. Was the liver ruled out as a problem? What is actually causing the high SHBG? You can take HCG at any time and have kids while on TRT, so , barring some sort of miracle, there wouldn’t be much point in doing HCG forever as monotherapy.

HCG monotherapy can work for some, but may not do much to lower crazy high SHBG, you may still fall short of healthy FT levels. As you age your testicles will become less efficient and therefore less response to stimulation.

I’m seeing a natural daily function in SHBG, no way to attribute the decrease to boron, but is easily explained by a reduction stopping NDT which cause your fT3 (and rT3) levels to decrease.

Your thyroid levels decreased, your T3 dosage is low, but if you increase T3 SHBG will increase.
There’s no way your FT levels are exactly the same seeing as SHBG decrease from 117.5->91.1, now you see how inaccurate directly measured FT testing really is.

This levels were optimal back in August and now levels are low again. Now you want to go on HCG monotherapy with low thyroid hormones. That’s not going to work and I’ll bet fertility is going to be a problem having a low normal thyroid hormones.

@systemlord Thank you for the input. Given everything, what protocol would be most fitting to address the low T, low E2, and high SHBG?

As far as thyroid - You say thyroid was good on 8/6. Before this I was taking 2grains NDT (Armour) and 30mcg Cytomel. After those labs, I was switched to 45mcg Cytomel, dropping the NDT. I thought the better Free T3 to Reverse T3 ratio indicated better thyroid? No?

The provider recommended TRT for the testosterone, and switching to just 20mcg Cytomel. But lowering the cytomel dose doesn’t seem to add up if the thyroid numbers came in the way it did?

You’ll probably do pretty well on once or twice weekly dosing, 150mg minimum once weekly or split it up twice weekly. We’ll have to see if 150mg weekly is enough overcome your SHBG issue.

You want fT3 50-80% of the ranges and rT3 <15 ng/dL, keeping fT3 low is never good.


You mean once or twice dosing of TRT? Pair with HCG? How concerned should I be with fertility or any other side effects? HCG monotherapy won’t do the trick?

For the thyroid - Given the labs on 8/6 were optimal when I was taking 1.5 grains Armour and 30mcg cytomel, and the labs taken 11/12 were only on 45mcg cytomel, should I return the armour in my protocol? I’m not sure why my provider suggested dropping Cytomel, but it seems they think that is what is disrupting my sleep. I’m not so sure this is the cause. I should mention that I did not take my morning 35mcg Cytomel the morning that I had my blood drawn.

I misunderstood, but the TRT protocol recommendation is ideal. HCG has a shorter half-life so twice weekly dosing is fine at 400-500iu. There is a male birth control in development and the reason it will not work is because even it cannot fully suppress sperm production to zero, TRT is no different even without HCG.

HCG keeps the testicles functioning and is used for fertility even for those not on TRT. FSH injections are another option since FSH is suppressed low on TRT, naturally it makes sense to use it while also being on HCG while on TRT attempting to have children.

I’ve seen some cases where men are on TRT and HCG which produces zero swimmers and FSH injections are added and the next thing you know the guy has 40 million swimmers and the wife is pregnant in a short amount of time.

You then are able to stop HCG and FSH and resume TRT until such time you are ready for another child.

@systemlord - Previously you were referring to HCG monotherapy? This treatment would be preferred to try first, particularly if it wouldn’t have to be forever. But if that is not going to tdo the trick and I must do TRT, I’ll discuss this option with my wife. Also - what would you recommend for the approach to the thyroid? I really appreciate your insight.

Your previous levels in August were great, fT3 almost at the top and rT3 15, perfection! I would have considered it as goal accomplished and you should have attempted HCG then and if it didn’t work, maybe TRT together with HCG.

I stopped TRT after two and a half years and four and a half weeks later…

@Stealthforce The only way you will be able to successfully optimize test levels is with TRT. This will most probably reduce your SHBG significantly.

If this will make you more comfortable I plan to start TRT in a few days being 31 and having no any children. I will attempt to freeze sperm in Thursday as an insurance, but I have not discovered a single case of guy who became permanently infertile from TRT. Most of the guys managed to return enough fertility just by adding HCG, very few needed to add FSH and in most cases when HCG alone did not work they increase HCG and drop the test for a few months(FSH is kinda expensive).

You can try HCG but most likely even if it improves your numbers it will not make you feel as good as testosterone. And isnt the main goal of testosterone optimization at the end to feel better?

Even if you are high SHBG I would encourage you in case of starting TRT to inject as often as possible. The most progressive TRT doctors nowadays do not justify injecting more rarely with high SHBG. No matter the SHBG rare injections like once per week or even twice per week cause peaks and troughs which cause very unpleasant hormonal swings in most men. I wouldnt put myself on that torture just to save a few injections weekly.