I’ve been lurking here for about 8 Months ( since I started TRT), and I really have found it quite informative. I’m retired, so I have plenty of time to spend reading and I think I’ve learned quite a bit. A little background on me might be helpful. I’ve been an avid cyclist since my late teens (I’m 56 now, so almost 40 years), as well as running, although I’m not physically capable of that anymore and I’ll explain why. When I was 43 I was t-boned twice while cycling. The first accident was caused by a women driving a Ford Expedition who decided that waiting two seconds for me to pass before making her left turn was just a little too much for her to bear, so while I was traveling on a slight downhill with a strong tailwind (hence going almost 30mph), I was suddenly presented with what was essentially a brick wall directly in front of me. I was unable to stop. I hit the bar that is between the front and rear passenger seats, bounced back and landed on my tail bone which cracked and my l5-s1 disk was smashed totally. As a result, I had to have fusion surgery. Since then, the extra stress put on the disks above that level has caused both the l4-l5 and l3-l4 disks to herniate and necessitated two more surgeries. I’m still cycling (I’m at about 3500 miles so far this year), but I’m also on pain management which consists at this point of a Fentanyl patch at 50mcg an hour and 4mg Hydromorphone (Dilauded) for breakthrough pain. All of this has resulted in a condition known as OPIAD (opioid induced androgen deficiency), hence my need for TRT. I started on TRT back in April, but the first Dr. was a total disaster. He started me on 100mg bi-weekly which obviously just made me much worse. If I had known then what I know now, I never would have allowed that. I found a new Endo who is trying, but she is still a little in over her head with this. Treating OPIAD is a little more complicated than treating age related decline because the opioids actually catabolize testosterone which makes achieving normal levels a challenge. I’m now doing 40mg EOD. I started that in July and after a month, I was able to get to 802 ng/dl. My e2 at that point wasn’t too bad (29 pg/ml), but as time went on, I began to feel that it was going high. I went to quest and had it tested on my own using the Ultrasensitive lc/ms/ms test and it came back at 50 pg/ml which is obviously high. My Endo is unfamiliar with both exemestane ( Aromasin my preferred AI) and hcg, so I bought the exemestane as a research chemical and the hcg (Pregnyl) from another source. So I went for bloodwork as follow up last week and my tt and ft were just over the top. Bloodwork is as follows:
Triglyceride 93 mg/dL 30 - 149 mg/dL
Cholesterol 219 mg/dL 100 - 199 mg/dL H
HDL Cholesterol 80 mg/dL >45 mg/dL
VLDL Cholesterol 19 mg/dL 6 - 40 mg/dL
LDL Cholesterol 120 mg/dL 60 - 129 mg/dL
Fasting Time 12 hrs
TC:HDL Ratio 2.74 1.00 - 5.00
LDL:HDL Ratio 1.50 0.50 - 3.55
Non HDL Cholesterol 139 mg/dL 90 - 159 mg/dL Protein, Total 7.1 g/dL 6.0 - 8.4 g/dL
Albumin 4.2 g/dL 3.5 - 5.0 g/dL
Calcium 9.5 mg/dL 8.5 - 10.5 mg/dL
Bilirubin, Total 0.7 mg/dL 0.0 - 1.5 mg/dL
Alkaline Phosphatase 52 U/L 40 - 150 U/L
AST 38 U/L 7 - 40 U/L
Glucose 108 mg/dL 65 - 100 mg/dL H
BUN 7 mg/dL 10 - 25 mg/dL L
Creatinine 0.90 mg/dL 0.70 - 1.40 mg/dL
Sodium 136 mmol/L 135 - 146 mmol/L
Potassium 4.7 mmol/L 3.5 - 5.0 mmol/L
Chloride 93 mmol/L 97 - 105 mmol/L L
CO2 24 mmol/L 23 - 32 mmol/L
Anion Gap 19 mmol/L 9 - 18 mmol/L H
ALT 15 U/L 5 - 50 U/L
Hemoglobin 15.1 g/dL 13.0 - 17.0 g/dL
Hematocrit 43.5 % 39.0 - 51.0 %
Estradiol 17B 45 pg/mL 0 - 60 pg/mL
Testosterone 1703 ng/dL 220 - 1000 ng/dL H
Testosterone Free % 2.7 % 1.4 - 3.2 %
Testosterone Free 458.9 pg/mL 41.7 - 180.2 pg/mL H
I actually reduced the Test dose to 30mg EOD for a month before my bloodwork as insurance that my levels wouldn’t be too high, but apparently something went wrong, I’m not prescribed the hcg at this point, but I wasn’t feeling good two days before the test, so I injected 250iu of hcg. I also skipped my normal 12.5mg EOD dose of exemestane, because, again I’m not prescribed that and I’m trying to get my Endo to prescribe it, so I thought I’de let the E2 go a little high.
My main question is can hcg actually boost testosterone levels that much?
Something that may be confounding all of this is I remember reading that supplemental biotin can skew a number of test results because biotin is actually used in the assay. I take a 2500 mcg biotin capsule every day, but I stopped four days before bloodwork. However, my multivitamin contains 100mcg and the b-complex I take also has 300mcg. I didn’t think that would be enough to throw things off so I continued taking them both until the day before bloodwork. Right now, my Endo is saying my Testosterone level is too high and instead of giving me the Aromasin, she just wants to reduce my Testosterone dose. I brought up the biotin as a possible confounding factor and have asked if I can have the free and total testosterone test redone, but I haven’t heard back from her yet.
So is it really possible for hcg to boost Testosterone levels that much, or is the biotin the culprit, or maybe a combination of the two. I can stop the hcg for a week or ten days, but I’m worried that the test ( if she orders it) will still come back high.
Thanks and sorry for being so long winded. Actually, I’ll be surprised if anyone takes the time to read it all.
Unlikely IMO that it was the biotin. What was the timing of blood draw to injections on both occassions?
I’ve never seen someone’s T jump that much from hcg. If your testicles began their normal production of T as if there was no external source of T, I could see those numbers being attainable.
I’m wondering if the first T data point was taken on a trough and the second at a peak, which is why I asked about lab and injection timing.
When I had the test done in July, I was injecting twice a week. Now I’m injecting EOD. Both tests were done on injection days, but I hadn’t done it yet. But with EOD injections, there shouldn’t be any appreciable troughs and peaks.[quote=“Hostile, post:2, topic:223027”]
If your testicles began their normal production of T as if there was no external source of T, I could see those numbers being attainable.
I guess that is really my question. If the HCG is enough to get my normal production going, I’m wandering if I even need TRT. The main reason testosterone falls on pain management is because of an interruption in the HPTA that results in reduced LH. The HCG mimics LH, so maybe that’s all I need.
I’ve also been taking 1mg of Menatetranone (mk4) which is a form of vitamin k2 for about four years now. See a study on that here: https://www.researchgate.net/publication/51634166_Menaquinone-4_enhances_testosterone_production_in_rats_and_testis-derived_tumor_cells.
So maybe my testicles are healthy enough for normal testosterone production and all they need is LH or in it’s stead, HCG?
Good hypothesis. Try it and see what the results are.
Thanks for your reply ( I think ). Now I’m in a bit of a quandary. I’ve spent 9 months trying to get the TRT protocol ironed out and I’m finally feeling pretty good most of the time. I still have days when things get out of whack, but pretty good for the most part. I’m reluctant to throw a monkey wrench into the whole thing at this point by trying just the HCG alone. But TRT is such a PITA it would be nice if I could just inject HCG alone and be okay. I wish I could find an Endo who knew what they were doing to help, but as with most of us, I’m pretty much on my own.
I’ll have to do some more research and think about it.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- advice for new guys
- things that damage your hormones
- protocol for injections
- finding a TRT doc
Suggest that you purchase lab work on your own and do the fine tuning yourself.
hCG typically has lesser effects, you are on your own finding whats going on. The hCG is branded?
If hCG dose is too high, T–>E2 inside the testes can be very high
Hematocrit [HTC] is low VS your T levels. Any digestive issues that might be causing a low level of GI bleed blood loss? An occult blood test would be useful. Was RBC checked?
Glucose=108 was fasting? !!! Fasting Time 12 hrs !!! If so, test A1C for a better measure of average glucose levels.
Are you using a statin drug to manage cholesterol?
Where are you located?
I’ve already done that. Did I post something that made you think I didn’t?
Yes, I know. That’s one of the things that make me think the test is faulty. It’s also possible that because of all bicycling I do, there is a high turnover of blood. RBC wasn’t checked this time, but it was 6 months ago and although I can’t remember the exact values, there were no flags.
Yes, the HCG is Pregnyl. It comes in two 5000iu of unreconstituted powder. I mix it with 5ml of bacteriostatic water to make a 1000iu per ml solution. I’ve been injecting 250iu twice a week. Which is actually less than the 250iu EOD recommended in the stickie. I’m just trying to figure out how I could have levels that high from injecting 30mg of Testosterone EOD. The HCG is the only thing I could think of other than the test being thrown off by biotin. I know it might sound silly, but if you google biotin and thyroid tests, you will find that it isn’t. The same caution also applies to Testosterone tests depending on how they’re done.
As for the high Glucose, even though I had fasted for more than 12 hours, I was drinking Gatoraid just before the blood draw. I drink it a lot of it and didn’t even think about it until after the fact.[quote=“KSman, post:6, topic:223027”]
Are you using a statin drug to manage cholesterol?
Absolutely not, nor will I ever. My cholesterol is just fine the way it is, and even if it weren’t, I wouldn’t take a statin.
I live in N.E. Ohio.
You can order your own labs in that state, on internet sites and show up at a labcorp draw station. LEF.com is one source, others that you can google may be cheaper for your selected labs.
Your hCG reaction is very strong. E2 seems to confirm this. You will need to use less hCG and save some $$$.
I am guessing that your energy levels are very strong. So maybe I do not need to do my thing re thyroid/iodine etc. With your history, I could easily see problems from stress and high output training can then burn down the bridges. Your story seems very impressive, in terms of what you manage to do. You make Vit-D3 on your bike, should supplement in Ohio winters.
Doing your own labs, you can see if you can fly on hCG or hCG+AI.
Any inflammatory processes from your injuries? I found that Rx meloxicam 15mg reduced pain and swelling in my knuckles and arrested the inflammatory progression that I had. Very inexpensive, $40 per year at Walmart - cash price.
HCG definitely spikes T but as stated by others you seem to be having a very strong reaction.
For comparison purposes, a buddy of mine was on Androgel and his test was 500-700. Adding 500 IU of HCG 3x week jacked it to 1800 in three weeks. I hit 960 on just HCG myself.
A few unrelated points : watch the LDL bro and get that to < 100 even if you take a low dose statin. Incidentally statins work at low doses and are literally a life saver as we get older. You are actually healthier on the meds than without (if you need it).
Lastly, As an avid cyclist myself, I cringed when I read your description because I’ve seen that happen and have had many injuries as well (including chipping a vertebra in my neck (although that was in a race). all I can say is I wish you well in your recovery. I’ve seen too many injuries from asholes on the road. Thank god it didn’t cost you your life.
You know, the strange thing is, I used to ride helmetless. Dumb, I know, but I did it that way for 20 plus years without an issue. My father bought me a helmet at the beginning of that season. If I hadn’t been wearing it that day, I most definitely would not be typing this now. I would have been lucky to die, otherwise I’de be a useless vegetable. Scary stuff that, and I try not to think about it. As the song says, “we’re just one phone call from our knees”.
Thanks for the well wishes. The helpfulness and support this community to provides is a godsend to everyone on this path.
I may try going without the HCG completely for now. I’m seeing a new Endo next visit at the advice of the one I’m seeing now, and she says he prescribes HCG, so he may be able to guide me in that regard. I’m actually weening down the Fentanyl at this point, mostly because since I started on TRT, my pain level has decreased dramatically. I know this isn’t about pain management, but pain is what brought me to this point. We’ll see how it all plays out. Things are in flux right now, and I’m not sure I want to make any more changes at this point.
Thanks for your help and input.
With HDL=80, I do not see any risk factors at all.
With older guys, T increases with hCG are quite mild. Mine was 17% - 10 years ago.
Part of that may be mediated by inflammatory processes, you should trial meloxicam to see if that has any effect*. Fish oil and antioxidants are also useful. Nerves can be trapped by inflamed tissues or tight muscles. If T has improved things itself, perhaps the result of going from catabolic to anabolic.
- I was taking 6 naproxen a day for my hands and that had little effect. That was a lot of drugs and showed up on my labs as kidney stress, 15mg/day naproxen solved the problem and reduced joint/bone swelling and some remodeling has occurred. So there may be some joint/bone specific benefits that could apply to you.
T will also improve your bone health and density, something that may be significant for you.
OMG, someone who finally gets it. Yes, that is it in a nutshell. How to get Doctors to understand this is the question for the ages.
Re the meloxicam, I’m trying to reduce my drug load as much as possible at this point. I know at some point, sometimes we have to admit that we need to add something we may not want to, but right now, I’m going to try and rely on good nutrition, TRT and cycling. The bike got me into this, it will get me out again.
But I will keep the meloxicam in mind as something to try.
Thanks for the heads up.
With all of that joint damage, there can be inflammatory problems that diet cannot address.
I know what you mean. My joints never felt better being on T. Now that I’m coming off - I ache every day.