T Nation

HRT - Progress and Questions

Editing original post.

In December of 2011, we discovered I was azoospermatic after 18 months of T+HCG+AI.

I ceased all TRT and after about 6 months, recovered to about 2 million sperm per mL.

Most recent semen analysis was this past Monday, still at around 2 million per mL. Roughly 10% of a “normal” male. Thankfully, enough for IVF, and also thankfully, motility and morphology are good. So, this 8 month ride I’ve been on was a victory in that it achieved what I set out to achieve.

I paid a steep price in suffering, so I am glad I got what I was after.

I wish that HCG maintained my fertility even slightly while on that regimen, but it did not, and should be taken into consideration by anyone going down a similar path.

Now then, the sperm are banked, and it’s time for me to return to treatment. I am now primary, as my testicles are now clearly dysfunctional. In spite of ample LH and FSH (confirmed by lab work), my testosterone level remains next to zero.

I am considering TRT without the use of HCG for a couple of reasons and welcome discussion on same.

When I began treatment on HCG alone, my e2 rocketed (70 or so). When I added androgel to the HCG, e2 remained at 70 ie no increase from the androgel.

When I switched to injections and hCG, it again remained around 70.

I needed 0.0625mg (you read that right) of arimidex to lower my estrogen levels.

It’s my belief that I was chasing E2 levels with an AI due to HCG.

I’m sure HCG offers some benefit from a mood perspective etc, but if it means I don’t have to chase E2 all over the map if I don’t take it, I’ll deal with that easily. I have no need to keep my testicles full now, and my wife is fine with it from an aesthetic point.

In any event, I’ll add labwork and such and post progress as I move along.

Hope you all are well.

Forgot to mention one last question - slight ache in my testicles, right mainly. With hcG, at this dose, shouldn’t that prevent atrophy? Could I need more?

Feeling good on Androgel and then crashing is a pretty common occurence. Get your doc to put you on testosterone cypionate injections. 100mg/wk. keep up with the hCG, add 1mg Arimidex/wk. Look at KSman’s TRT protocol at the top of the forum.

Numbers as of Feb 4/2010:

Testosterone: 317 ng/dL
Bioavailable testosterone: 6.8 (measured in nmol/L range 2.5-18.7)
LH: 3 IU/L
Estradiol: 25.3 pg/mL
Prolactin: 7 ug/L
DHEA: 7.6 (measured in umol/L range 3.3-14.0)
TSH: 1.81 mIU/L
Hematocrit: 0.42
HS-CRP: 2.2

Having same tests drawn tomorrow, about 4 months later. At the 2 month mark, as I say, he only tested for total testosterone, which was around 600 ng/dL - if I hadnt plateaued at that level, I’d stick with hcG monotherapy.

Use the [edit] button on your post and add lab ranges and HS-CRP units.

Do you have inflamed gums, injury or infection at the time of the Feb lab work?

E2 is not high, but compared to T levels this makes you estrogen dominant.

Cholesterol numbers?

You seem to be describing typical issues that are caused by TRT induced increases in E2.

[quote]KSman wrote:
Use the [edit] button on your post and add lab ranges and HS-CRP units.[/quote]

I’ll do so when I get the latest numbers back to give a clearer picture, hopefully.

Do you have inflamed gums, injury or infection at the time of the Feb lab work?[/quote]

Inflamed gums are a possibility, nothing drastic, though.

E2 is not high, but compared to T levels this makes you estrogen dominant.[/quote]

…meaning estrogen is even more critical in my case?

Cholesterol numbers?[/quote]

My GP told me last time I had bloodword that they are “borderline high” in terms of “bad” cholesterol.

That sucks. I mean, that’s good to know, if that is the case, but unless my doc is willing to be a little more open minded re: estrogen control, I don’t know what I’ll do being in Ontario. He seems rather offended if you even mention something that isn’t the protocol he suggested. Finding him was hard enough. Finding another might be even more challenging. I’ll know more Tuesday when I see him.

Thanks folks.

Tell him that you want to use anastrozole to get near E2=22pg/ml and that he will be able to see the results.

Since you asked, I dug up my cholesterol numbers from last summer:

total cholesterol - 250 mg/dL
triglycerides - 138 mg/dL
HDL - 54 mg/dL
LDL - 168 mg/dL

I’ve been on Androgel for 8 years straight. Never hit a wall.

[quote]Bricknyce wrote:
I’ve been on Androgel for 8 years straight. Never hit a wall. [/quote]

I wish that were the case for me too, and I’m not even really pegging the androgel as the cause, because this happened when my T went up from hcg mono as well, just to a lesser degree.

My gut says estrogen control too.

We’re well aware you’re a proponent of androgel big guy :slight_smile:

Ok, I have my appointment on Tuesday. By the way, the appointment is with Dr. Larry Komer, in Burlington, Ontario - he’s apparently schooled by Dr. Crisler himself, per a post I saw over at the all things male forums. He seems like a great guy, tho some of his protocols haven’t exactly been in line with the literature I read here. I can assume at this point perhaps because I’m a new patient that he is making changes to my protocol as he sees fit, which, more or less, I am ok with. That being said, I am fed up with feeling like a truck ran me over 3 weeks after a new adjustment (the adjustment being so far to increase external T without any other changes/additions)

SOOOO…that wordy preface out of the way:

I’m going in there intimidated by a man who is well known for his TRT. He’s sort of a pioneer in these parts, there are no other docs around that do what he does.

Is my best approach to insist we try some sort of estrogen control to see where it takes me? I will have lab results to share with all of you on Tuesday, but unfortunately, my appointment with him will take place first.

I am about halfway through the Estriadol thread - it’s a lot to take in, but the more I read about it, the more it seems to fit my pattern of feeling great for a few weeks and then feeling like I could fall asleep at the dinner table lol.

I have a GREAT doctor (http://www.impotencespecialists.com/dbfls/cvs/mellinger.htm) who has done a shit load of work in urology and andrology. I just follow his word.

I see no point in schooling, trying to school, or warring with docs who know what they’re doing. If the fixed up hundreds or thousands of other patients, what’s the point? I do what my doc says, and I’ve NEVER had a problem. When I was a new patient of his and I tried that “I heard that…” or “I read that…” or “someone told me that…” lines of shit, he ALWAYS replied with, “What does that have to do with our situation here?”

I don’t necessarily disagree. I also have a primary objective of feeling better for a longer period than a few weeks. Obviously I am in no position to go toe-to-toe with an expert, but I do want to equip myself with enough knowledge to ask the right questions, you know?

Well, I am one angry individual.

I (and those who have guided me) were bang on. My estrogen has skyrocketed, and Androgel actually made my testosterone levels go DOWN.

The doctor more or less rushed me out of the office, ignored my questions, and I was back on the street with nothing to show except an injectable script rather than Androgel.

The numbers (these are the tests he requested):

Testosterone: 553 ng/dL (19.2 nmol/L range 8.4-28.7)
DHEA: 7.3 umol/L range 3.3-14.0
Estradiol: 191 pmol/L range 43-151 (52 pg/mL)

It’s no wonder I’m not feeling the benefits, as to me, if my estrogen increased at the same rate as my t levels, it seems like it would be a wash to me.

I don’t know what to do at this point. Anyone have any leads on TRT doctors in the Greater Toronto Area?

It’s becoming obvious this doctor is not going to be sufficient, in spite of his claims to be a champion of men’s health.

Any advice welcome.

Sounds to me like you have thyroid issues from high choleseterol and triglycerides. I would like to see full thyroid panel ft3 ft4 tsh, tpo, tgab rt3. You need to have adrenal cortisol saliva to assess the adrenals. One needs to look at factors that may causing low testosterone. First thing on mind is vitamin D 25 oh which 99% of canadians are low on. The average dosages for people in that region should be about 10,000 ius a day then monitored by dr’s to achieve levels of 60-90 levels 20-100 range. Some times giving vitamin D has stimiulated a person testosterone to get back to optimal range oon its own.

I have seen this alot in clients and patients when TRT was not implied, but just correcting the nutritional imbalnaces the body will in many cases rebalance it self, but not to many Dr’s look into this and start people on TRT way to early. depending on you age may be a clomid restart could be tried, but only if you are under 30 would be worth trying. I would alos look at your diary intake and also your eating patterns, as well as alcohol intake, again many other factors need to be investigated before conclusion can be made.

Interesting note: my testicles, right specifically, ached consistently while on Androgel. Since receiving the 200mg injection Tuesday, that has alleviated entirely. Any thoughts?

Aching testes often occurs with depressed LH levels. This often occurs with TRT that does not include hCG. When one does not respond to transdermal T, LH can be repressed. With your injected T, I expect that the aching will show up.

Remember, TRT without hCG [TRT-hCG] most often leads to testicular atrophy and the the tissue can undergo destructive irreversible changes* that are fundamentally organ failure. Most docs think that this is OK unless you have a need to make babies.

  • this takes time, most on TRT-hCG for a few months can recover when hCG is introduced

I get a few reports that some TRT guys do not need hCG to maintain fullness of the testes and normal scrotum form. My BS meter goes off.

That’s what I found odd, because I’ve been on plenty of hCG from day one. In fact, hCG by itself to begin with, then Androgel added. 400IU three times a week.

With any TRT Lh needs to be replaced because it is found althrough out the body on differenct receptors sites such as brain and muscle just not your testicles. When people start HCG they feel a sense of well being and back to normal in many cases. After putting patients on this one guy after one shot…saw light at the end of the tunnnel for being on TRT for many years still not feeling right and now he is living life and much more pleasant to be around. His wife came back to us and was like I do not know what you did but I have my old husband back… Do remind that every one system is different so people reaction will be varied.

Don’t want to hijack the thread, but are you saying that ALL men should take hCG when they start TRT, KSman? And can you provide a link to an article(s) explaining the E2 sweet spot of 22pg/ml. I need to be able to explain to my own doc, because he thinks there is no “too low” for men when it comes to e2.