T Nation


Ive read a lot of the different threads…and just curious who is on any new formulat with HMG that also has HCG inb it, prescribed by their doctor? Im doing the HCG 250iu M/W/F with my HRT, but running out and my doc doesnt think I need it unless Im trying to have kids…and when I do want to have kids can hop on it…but I do not want to risk it, and I do feel better on HCG…so next week Im going to talk to him about it again, to avoid paying out of pocket and waiting a month for HCG to arrive…wondering if I can talk him into HMG+HCG if anyone on here is taking it from their doctor, and what kind of persuasive argument I can give…

Im 36, and do plan on having kids down the road. As well since I feel better with the HCG, and know it seems to be the standard protocol on here and elsewhere, I do not want to stop…but now I gotta outsource it, and know if my doc approves my insurance will cover it so want to do my best to get him talked into HCG at the least, and if HMG+HCG is “better” than might as well go for that.


HMG is expensive. If you use both, you need less of each.

HMG contains some hCG.

Wow so no one is chiming in that is trying HMG with their TRT?

This is an area that I am actually studying right now with several colleages. The IRB approval is still pending and we are in the early recruitment phase of the study but I am interested in the combination as it pertains to fertility while on TRT. The short answer would be that, due to cost I would not recommend adding it to your regimen if you are not actively trying to have kids. There would be very little tangential benefit from its inclusion outside of improved sperm production.

Thank you…any sources I can point my doctor to?

There is some data that the size of the testicles prior to attempting to reestablish fertility with gonadotrophs in hypogonadal men is a strong predictor of successful reinstitution. This may or may not apply to idiopathic hypogonadism in all cases but it is the only predictor identified. Therefore, it MAY be that keeping the testis viable with consistent hCG therapy is a good plan if fertility could be desired down the road. This is speculation. Bottom line is that there is not much evidence to stand on in terms of convincing him to keep you on hCG other than keeping testicular tissue in tact. That and the positive subjective feelings you attribute to the drug.

And HMG is not new. In fact it is the old standard which is being replaced with recombinant human FSH.

The only sources of info to point him to at this point is primary literature i.e. actually study evidence, since no one has codified a protocol which has infiltrated the tertiary literature at the point…I’m working on it.

A decent review published in 2000 that would at least catch you up with the current paradigm (which I don’t agree with necessarily) and mentions the testicular size issue is:

Mol Cell Endocrinol. 2000 Mar 30;161(1-2):73-88.

Hormone substitution in male hypogonadism.
Zitzmann M, Nieschlag E.

Institute of Reproductive Medicine of the University, Domagkstr. 11, D-48149, Münster, Germany.

Look it up in pubmed.

Get on hCG and once a month, stop the hCG and use nolvadex for a week to create LH+FSH. That will help keep the testes spermy over the years. Get a sperm count and see what you really need. You can get on nolvadex only when trying to make babies if needed. That is all basic and cheap.

Do not do hCG and nolvadex at the same time. When starting nolvadex, take two days after the last dose of hCG. Ditto for transition SERM–>hCG.

Many do not have fertility issues on T+hCG, but most of that group do not want more kids.

You do not need HMG. New does not mean needed.

Thanks KSman!

Well this week I see my doc…been out of HCG for a week…

Yea I was fine with HCG, but last time I asked the doc said he didnt think I needed it…but I mentioned HMG and it was new, so he said he would look into it…so I figured getting HMG would be better than nothing, because I have to order my HCG through another source that costs an arm and a leg, HRT clinic that charges yearly fee, and all I use them for is HCG…so if my doc would give me either HCG or HMG with my insurance having to cover it Id be golden…

Ive never used it…

Oh…Im gonna read through some of your old threads to find the answer if its hidden somewhere…but if I did do Nolvadex for week once every month, do I stop Arimidex while on Nolvadex for the week, then hop back on?

My doc asked McGuffs pharmacists about HMG to see if they know anyone using it…he is open to it if I could find any papers on established protocol…good thing is before he didnt think I needed hcg unless I was trying to have kids, but I do feel better on and dont want my testes shrunken, so I gotta do my homework before next visit and find some papers on standard protocol from doctors using it (which Ill print out the stickies again), and any research or just articles by any TRT/HRT doctors using HCG and Arimidex protocols in their patients…

You would stay on AI when on the SERM.

Gave the doc the sticky, and a few other articles from HRT sites.

If you are getting bloodwork, go ahead and get a full panel.

yes I always get full panels…dont know all thats on it, but every single time I go the labs are always like “wow you are getting tons of tests done”…my doc usually does all the hormones, metabolic, vitamins, the works…

I am curious where my E2 is, last time it was way over 100, I had stopped using an AI for a while just to see…and it blew up and my nipples were sore…so for the past 3 months or so been back on Arimidex 1.5mg week (200mg T a week), and curious to see where it will be.

[quote]KSman wrote:
You would stay on AI when on the SERM.[/quote]


I think you meant “you would NOT stay on AI when on the SERM”


Im kicking it off next Tues, so I was gonna stay on the AI, Test, and Nolvadex for a week, and by then should have my HCg and resume 250iu 3x week of that…been a few months off HCG and I can tell the difference in feeling, not ball size…just dont feel as good

Also, no matter what its been years, even before I started HRT…my creatinine levels are always out of range, and my liver values are slightly elevated always…and I am on mega dose ALA, NAC, IV glutathione, and tons of other liver support supplements…so curious what they will be this time…also RBC has been high in past, but Ill donate blood every two months and it comes down, but when I forget it can be a little higher…

Depending on how far out of range these values are, there can be an explanation for these particular values if you are training hard and consistently. Both ALT and AST are non-specific markers for liver damage (not function, even though they are referred to as liver function tests (LFT’s)). They are also present in skeletal muscle and will be slightly elevated due to muscle damage. They should be less than 1 time the upper limit of normal however. Similarly, creatinine values can be elevated due to increased muscle mass and muscle damage due to increased production and this does not necessarily indicate poor renal function. Increased protein load from an excess intake can also increase the value. Supplemental creatine due to conversion to creatinine will also potentially cause a rise in SCr. However, if the value is very high (>1.5) for instance or increases suddenly from baseline then you should be concerned.

Finally, the RBC/HCT elevation is a very common side effect of testosterone therapy and seeing as how your dose is higher than most TRT regimens it isn’t surprising at all that you would have this issue. Two options lower the dose or keep giving the gift of life.

Thank you doc! Well, Ill keep donating blood for now, and over time will be decreasing all my dosages of HRT stuff…I was in very bad shape a year to two years ago, like dead immune system and hormones, so Im enjoying getting back to being myself…when I feel as close to normal as possible, Ive already discussed with my doc tapering some of the doses…

As for training, I am training 5-9 times a week…so that could explain it…Im doing double sessions, AM and PM, and a 3 hour walk each night practically…not intense walk, but its physical activity…I also take low dose creatine and beta alanine…

But yea, Ive always been training super hard, and for a while I was deathly ill and not training for 3 years, but I cant remember what my liver values were at the time because there were other more important things totally out of whack!

Labs back, as usual my creatinine, AST/ALT a little high, HDL a tad low…all things that have been consistent…I can type them up later if anyone is interested…

My neutrophils were low and lymphs high, but Ive had some kind of sinus infection/wicked cold for 3 weeks, and just started anti biotics this week for it got so bad…

Of note, for a while I was off Arimidex just to stick to doctors plan, E2 went over 100 on last labs…so been on Arimidex 1.5mg week per 200mg Test, brought it down to 26.6…so that works for sure if anyone is wondering…I was on for a while, got off, my E2 climbed over time, back on and its back under control…

Frequency of injections, ive done labs the 2nd or 3rd day after a once a week 200mg dose, and my levels came in over 1000…I did my labs this time (due to travel) like the 8th day after injection (held off a day because knew I had labs to do), came in 600s…I normally do two times a week Sun/Thurs or Mon/Thurs…seeing that it spikes super high in my labs right after a shot, and comes down to half of that a week later, whether its mood, energy, zits, whatever to keep levels stable Im all about 2x week injections for sure and see why with labs…