T Nation

HCG, Varicocele and E2 Confusion

After a battery of tests, both blood and urinalysis, I was diagnosed with secondary hypogonadism as well as a varicocele. Original reason for doctors visit were conditions symptomatic of low T, ongoing the last three years or so. I’m still in conference with my doc as to whether the varicocele is the cause of my low T and whether or not I need to worry about it. There seems to be a lot of literature out there that would indicate a varicocele is positively correlated with low T and testicular atrophy.
Before the varicocele diagnoses was made, my doc was unsure (still unsure) of the reason for the hypogonadism, but felt it warranted treatment regardless, and so we started HCG mono. Dosing was started at .7 ml every fourth day ( i.e. three days in between shot days)and was later reduced to .5 ml every fourth day after encouraging total testosterone numbers after my second blood lab. I welcomed this dose because it is roughly in line with numbers represented on here for hcg mono to avoid Leydig cell desensitization.

Discouraging was my FT numbers. I know from the stickies that TT = FT + weakly bound T + SHBG-T.

Given my numbers below, I’m curious whether I should try putting arimidex into the mix in order to increase FT and lowering SHBG (I’ve heard that E2 manipulation can lower SHBG. However others have stated there is no efficient way to manipulate SHBG at all (confused on this)). If I were to do that, at what dose should I start the arimidex? 22 is the sweet spot for E2; how much would I need to drop it from 31.5? Any other suggestions? I’ve increased iodine intake (iodized salt) as per suggestion by KSman.

Generally speaking my symptoms associated with E2 are not cause for huge concern. I can get an erection, I have nocturnal erections some nights. However, it is sometimes difficult to keep it up without constant stimulation. So things aren’t horrible, but could be better.

My symptoms have gotten better (more energy, better libido, ect.) but not as good as they could be, in my opinion.

BEFORE HCG:

Estradiol 2.2 ug/24hrs (normal 0.8-4.6)
Total testosterone 29.4 ug/24hrs (normal 20-200 ug/24hrs)
FT 7.2 pg/mL (8.7-25.1)
DHEA-S 300.3 ug/dL (88.9-427.0)
SHBG 43.2 nmol/L (16.5-55.9)
Insulin 11.3 uIU/mL (2.6-24.9)
Cortisol 12.7 ug/dL (2.3-19.4 (AM 6.2 -19.4, PM 2.3 - 11.9) Test taken at 5:00 p.m.)

4 weeks AFTER HCG:

DHEA-S â?? 278 ug/dl (normal 80-560 ug/dl)
Estradiol â?? 31.5 pg/mL (normal 11-80 pg/mL)
SHBG â?? 55.1 nmol/L (normal 11-80 nmol/L)
FT â?? 1.62 ng/dL (normal 0.95 â?? 4.30 ng/dL)
Total Testosterone - 722 ng/dL (normal 241-827 ng/dL).

Thank you very much for taking the time! Look forward to responses.

Well definitely get a few opinions on that varicocele. I myself have one about 4mm in size also had low T. Urologist did not seem to think the Varicocele is the culprit maybe for fertility issues but I had no problem with fertility.

She was probably right because I went on a SERM and Testosterone went through the roof. So it makes me think the varicocele is not playing a part in my low T. I don’t know maybe every case is different maybe a lot of low T guys also have varicoceles. Maybe a lot of guys with high Test also have varicoceles.

It seems to me that you are also having a positive result from your HCG and your boys are responding. Unless you are in pain or have fertility issues that you need sorted I would probably leave the varicocele alone, that’s what the Urologist said to me.

If you are aiming for 22 for E2 then you will not need to take much since you are only at 31 at the moment. As for dosage start small and monitor if you will be staying on HCG then you could add in Arimidex say at .25mg E3D, or maybe .125mg E3d. Even that might be too much but you will probably notice if it is with joint pain and constipation being the symptoms of too low E2.

If you need to take .125mg of A-dex cutting that small pill into 8 parts is going to be hard. So maybe dissolve that pill in alcohol (Vodka) and use a dropper to dose after you work out what 1 drop is worth in mg.

You will need to take a dosage and then get blood work done and then calculate your new dosage if aiming for 22. Otherwise predicting how your body will respond to Adex is just a guess.

Varicocele could cause low T based on what I have read as well, but no doc would confirm. I was on tamox at the same time as I had my varicocelectomy so I can’t confirm which one increased my T, likely more contribution from the tamox. And you are pretty low in the Total T so fixing the varicocele wouldn’t put you up into the numbers people around here like to see.

As for consulting with your doc about it, if it bothers you or is painful see another doctor don’t just take one doctor’s opinion on it. I went to 3 docs and 2 said no surgery was required and it wouldn’t even fix the pain if I did have surgery, I was grade 3+, finally 3rd doc specialized in microsurgery and operated and 2 years later I am feeling much better and pain is gone.

As for long term HCG monotherapy my doc wouldn’t go for it because of potential desensitization issues then you’d be stuck with full TRT as the only option. Other folks on T-Nation here have been on it and it works for them so if it’s working and no issues that’s great. If you saw that level of change you are definately secondary and iroczinoz is right, get the E2 down in 20s and you should be good.

Thanks for the responses.
After an appointment with the surgeon, he was not only open, but suggested that the surgery for the varicocele would be a good option for me. He did say that he had no way of guaranteeing that T would increase with the surgery, but that it would certainly mitigate complications in the future and MAY have the added benefit of increased T. Whether the increase would allow for cessation of the HcG mono + AI or not can only be known by doing the surgery. I’m still on the fence and need further research before jumping in.
As for the arimidex, I decided to start with two weekly doses of .125 mg. I started with one dose of .25 mg and found that put me on somewhat of a roller coaster ride, feeling great after taking it, and somewhat anxious and achy by the end of the week. I’ve read somewhere that the half life it roughly three days, so it would make sense that a minimum of two doses per week would be necessary.

Thanks again and I’ll post results when I get my next labs, after adding the AI into the mix.

Tamox and the surgery got your levels up?