T Nation

HRT - Progress and Questions

[quote]mobiuskoan wrote:
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.[/quote]

If you’re not concerned with maintaining some degree of fertility and/or the cosmetics of having your balls shrivel up I suppose you don’t have to take it.

[quote]NeelyDan wrote:

[quote]mobiuskoan wrote:
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.[/quote]

If you’re not concerned with maintaining some degree of fertility and/or the cosmetics of having your balls shrivel up I suppose you don’t have to take it.[/quote]

I definitely do not want my balls to shrivel up. Or ache. I’ve been on TRT for almost 2 weeks now and have noticed any problems. What I’m asking is is hCG always indicated? I’m hoping the answer is no. Obviously, Bricknyce gets along fine with only Androgel. No hCG and no Arimidex/anastrozole.

[quote]mobiuskoan wrote:

[quote]NeelyDan wrote:

[quote]mobiuskoan wrote:
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.[/quote]

If you’re not concerned with maintaining some degree of fertility and/or the cosmetics of having your balls shrivel up I suppose you don’t have to take it.[/quote]

I definitely do not want my balls to shrivel up. Or ache. I’ve been on TRT for almost 2 weeks now and have noticed any problems. What I’m asking is is hCG always indicated? I’m hoping the answer is no. Obviously, Bricknyce gets along fine with only Androgel. No hCG and no Arimidex/anastrozole.[/quote]

Correct. And now I find this surprising considering it seems like everyone else who does what I do has a problem.

I’ve also never had aching testicles despite having some atrophy - approximately 15 grams instead of the normal 20.

Hey Bricknyce, should I go to www.testiclescales.com?

[quote]mobiuskoan wrote:
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.[/quote]

Ksman can you pull up the study that identifed that >30 estrodial is when men expreince unpleasant symptoms. I know its out there. When doing over several hundreds blood test for younger patients the average for health male was TT 500-700 , e2 18-25, shbg 15-20 I use that as a model for trying to target but every one is different so symptoms over rule this in some cases.

Bricknyce has been all over this forum telling guys NOT to take the advise of other people on the internet while at the same time telling everyone they don’t need hcg or an ai because he dosen’t use them. Now he says he finds it “surprising” that “everyone else who does what I do has a problem”(ie doenn’t use hcg)

Either you COMPLETELY misinterpreted my writings OR I didn’t express myself clearly.

I meant I was surprised that I do so well on ONLY Androgel while others have experienced problems with it (eg, aching testicles, over-aromatization, severely depressed gonadotropins, whatever).

And thank god I do good on only this drug.

When did I say EVERYONE–you do know the difference between everyone and some–doesn’t need an AI or HCG? My doc himself prescribes these for those who need it.

Anyway, the fact that someone needs HCG, Androgel, an AI, or whatever, IS indicative of problems - medical conditions.

My mistake, sorry man. I went back and checked it was someone else who started the thread "You Don’t Need AN AI.

It’s OK.

[quote]mobiuskoan wrote:
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.[/quote]

You doctor really has no idea about the role of estrogens.

I think that I first saw this E2=22pg/ml recommendation somewhere at lef.org, but it has been a long time and many others about the net have repeated this. From my own experience and the shared experiences of many other guys on this site and others and by PMs, I know that landing there from higher levels makes guys feel a lot better and really improves libido. E2=22pg/ml seems to be libido optimal. Low levels of E2 can kill libido, create ED, one feels like crap, joints ache, mood problems or depression. Would some feel better at E2=15? Perhaps, but most might not feel as good.

Tell your doc to take 1mg Arimidex per day for a month and then he can make up his own mind. Estrogens are essential for proper brain function.

We know that anastrozole over-responders find out that status when there E2 crashes into single digits or undetectable levels. They feel horrible!

We need E2 for emotional integrity. Many might feel emotionally dry at E2=22pg/ml. One can be detached and analytical, which are classic normal male traits. As males develop in the womb and as infants, then again in adolescence, levels of testosterone create sexual pursuit regions in the brain that are 2.5 times larger than females, and the parts of the brain that are involved in communication, verbal expression, emotions and social connection are significantly killed off by testosterone. Your life is run by hormones. The male brain is a modification of the female brain. Estrogens are absolutely essential for proper brain function. There is aromatase in the brain to make essential estrogens locally there as well. Aromatase inhibitors can affect that as well.

[quote]Hardasnails wrote:
Ksman can you pull up the study that identifed that >30 estrodial is when men expreince unpleasant symptoms. I know its out there. When doing over several hundreds blood test for younger patients the average for health male was TT 500-700 , e2 18-25, shbg 15-20 I use that as a model for trying to target but every one is different so symptoms over rule this in some cases.[/quote]

I do not recall a specific study, but I have read so much material over the years and it is all a blur, not compartmentalized by paper.

I have worked with many who had E2>30pg/ml who all felt great benefit when getting down near E2=22pg/ml. My needs shifted, getting older, and my lab showed E2=28pg/ml and I really was not feeling right. So I increased my anastrozole dose by a factor or 28/22 and I felt better with that.

Time to repeat: One can be on TRT-AI and have TT and FT at the upper range limits or higher. If E2 in the mid 30’s or higher, one can have most of the symptoms of untreated hypogonadism. When guys are on TRT with elevated E2 levels and feeling like garbage on a hot summer day, introducing anastrozole, TRT+AI, can be like a complete rebirth and personality transformation.

Estradiol control is the most important success factor and most doctors are clueless. We have had endo’s say “I [I as in god] do not test for that”. We have had a report of doc say “why do you want to test for estradiol? -you are not a woman.”

Thanks for the insights, guys – really helpful. The good thing is, regardless of my doctor’s opinion on estradiol, I’m in charge of it anyway. With the anastrozole and testing, I can dial in the perfect level. Thanks again, guys.

To steer this bugger back onto topic, tried speaking with my GP today about possibly prescribing directly to me, and she responded by saying she wasn’t comfortable and would need to refer me to an endo.

Which, in Canada, can take up to 6 months.

Back to the drawing board.

If person balls are aching its from the lack of LH that is most likely causing this…

[quote]Hardasnails wrote:
If person balls are aching its from the lack of LH that is most likely causing this…[/quote]

If that were the case, this would be remedied how?

[quote]NeelyDan wrote:

[quote]Hardasnails wrote:
If person balls are aching its from the lack of LH that is most likely causing this…[/quote]

If that were the case, this would be remedied how?[/quote]

By restoring LH levels [typically impossible] or injecting hCG. This aching is not an absolute and there is variability in terms of how guys experience this. In most cases, the testes are probably shrinking and getting softer with the scrotum pulling up closer to the body.

LH is not available as a therapeutic peptide.

In some cases, a SERM might lead to higher LH levels, but SERMs have side effects that make them unsuitable for a long term solution. If a cause of deep HPTA repression was found and could be corrected, one’s LH levels might recover.

This issue is primarily one of secondary hypogonadism that is characterized by low LH/FSH levels. Note that primary hypogonadism is a failure of the testes to produce adequate amounts of T when LH levels are adequate. The rest of the HPTA can then sometimes high levels of LH/FSH trying to get the testes to produce. In many cases, one has a mix of primary and secondary hypogonadism; especially with age related cases. [I have not seen a lab report myself that involved high LH/FSH levels.]

A HRT dose of hCG that replaces LH levels is 250iu SC EOD. This can maintain the testes when one is in a state of TRT induced HPTA shutdown. This dose prevents atrophy and permanent changes to the testes that can accurately be characterized as TRT induced organ failure. There are also issues of one’s sexual self image and how one is regarded by one’s wife or GF. HRT doses of hCG can increase ones T levels above what their TRT yields to some extent. In some cases of secondary hypogonadism in younger males, hCG monotherapy can restore useful T levels; this is not seen very often and frequently does not work.

There is always the hope that a broken HPTA with low LH can be restarted. This often does not work and is otherwise often very difficult for various reasons.

I was told that excessive hcG can actually cause this ache. Ever hear of cases similar to this? I’m just wondering if I even NEED 400IU of hcG or if it’s causing more harm than good.

hcG monotherapy brought me from sub-300 to over 600 total test, which if i understand correctly, confirms I’m secondary.

400iu how often?

Mon/Wed/Fri/Repeat