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Hypogonadotrophic Hypergonadism/HCG/Fertility

Hello there,

Im 27 y. old, 75kg, 10% bf

I had very low testosterone in 02/2019 and was on Nebido (2 applications). First one in 03/19 and the last one was in 05/19.
Since I want to have children, I stopped with Nebido.

Now my testorone is lower than before and my balls are smaller. Feeling like shit every day with bad sleep:

13.11.19 FSH mIU/ml 0,2-10,0 0,2
13.11.19 LH mIU/ml 0,5-6,0 0,1
13.11.19 Prolaktin ng/ml 0,00-20,00 7,44
13.11.19 SHBG nmol/l 9,0-55,0 32,9
13.11.19 Testosteron nmol/l 6,2-26,2 3,1

My doctor has now prescribed me HcG. 1500 ie. twice a week. Feeling a little bit better now.

When did Nebido completely leave my body?
Do you think this is a good way? Do you have any advice for me?

I can also give you more information if you need it.

HCG suppress the HPTA, I would have gone with clomid which increases LH and testosterone and is the go to drug for fertility in men previously on TRT. Clomid reboots the HPTA and isn’t suppressive, strange your doctor went with HCG when clomid is the better option.

Here in Germany Clomid is not available for mens healt and I think there is still Nebido left so there will be no effect?

Not necessarily, there are men on TRT microdosing clomid with good results. More often than not, the drug makers don’t really have optimal dosing recommendations, it takes a doctor thinking outside the box and a little bit of tinkering to find what’s good for a particular individual.

What was your initial T before starting Nebido? Did you get the necessary diagnostics done? Thyroid ok? Prolactin ok?

Nebido has a looong half life and Clomiphene (Clomid) wont be able to restart HTP axis and override the Nebido for a long time (months). So from this perspective it makes sense to go with hCG for the next 3 to 6 months (however i would switch to 3xper week 500 IU as hCG has a short half life of only about 2 days). Your testicles will regain in size and you will be good to go with either of 2 options, depending on how low T was initially

  • stay on hCG monotherapy if you do fine or combine with T (T enanthate is available in Germany, eg Eifelfango T Depot)
  • or switch to low dose clomiphene (Clomid is also available in Germany but its used off label and wont be taken over by the insurance, but its cheap anyway)
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Thanks for your answer.

Yes, I think i have every diagnostics done:
Thyroid little small, fT3&fT4 in the lower reference -> started with 25 mmc Thyroxin, TSH ok
Prolactin is ok in the last 6 bloodworks :wink:

T before Nebido: 3,0 nmol/l
LH: 0,3
FSH: 0,2

Thanks for your advices! Is it possible to know when I can start with Clomid? On my last LHRH-Test 2 weeks ago there was no respond…
I´m not really sure when to stop hcg and try clomid…

(however i would switch to 3xper week 500 IU as hCG has a short half life of only about 2 days) -> I will discuess with my doc

Ok, with these LH and FSH values there is something atypical going on.

Did you get the necessary genetic screening? MRI of the brain done?

I dont think that clomiphene will work in your case, especially when the LHRH test was negative.

I guess then also your testicles are underdeveloped? Google Tanner stage. In this special case superphysiological hCG dose do make sense. Discuss this with your doc, in your situation thats the best approach to move forward.

I thought the LHRH test is negative due the nebido depot in my body. I think anyway that the test with LH and FSH <0.1 is ineffective or am I wrong?

I had a normal puberty, beard growth is present, also belly and chest hair. Pubic hair normal. Muscles are present, deep voice. Libido was great until end of 2018 after a diet -> Nebido

MRT is done -> nothing found on my brain

No, my testicles had a normal size before nebido

Thats interesting.

The LHRH (GnRH) test should override the negative feedback from the Nebido (or actually the estrogen) to the hypothalamus. You should have seen an elevation of LH and FSH as a response to the LHRH (and consequently an increase in T). So your pituitary is relly sensitive to the feedback from the remaining Nebido (or actually the estrogen - minor feedback loop directly to the pituitary)

The LH and FSH values that you posted were pre-Nebido or are these the test results from the LHRH test?
LH: 0,3, FSH: 0,2

1500 iu 2X a week is not optimal. I would do 500 iu EOD, or go possibly up to 300 ED. HCG has a short half life, and it converts to E2. 1500 iu will likely cause big spikes in E2. I would do 500 iu EOD (1750 iu a week). I think you will get just as much out of that as the original protocol, but with less side effects.

Just my 2 cent.

I thought there was a refractory period with HCG that makes taking it daily pretty much useless?

I am not quite sure what that means, TBH?

The theory goes that once you’ve used HCG to stimulate Leydig cells, they need a day or two recovery before they can be successfully stimulated again. Trying to stimulate them in the meantime is a total waste. I’m assuming (but have no evidence to back this up) that that probably applies more to larger doses of HCG than your body produces naturally (I know it actually produces LH, you know what I mean) as obviously in “normal” people the body releases testosterone every day.

It may or may not be true, I don’t honestly know without doing some research. Perhaps someone else knows.

Okay, I understand. I think at 300 iu ED would be okay. Probably just extra shots that don’t give benefit over 500 iu EOD.

500 iu EOD does not give me any worry about damaging the Leydig cells.

Here is a study that says constant stimulation with HCG has no benefit. From what I got out of it anything less than 48hrs post initial injection will not stimulate the leydig cells.

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I had no increase in LH & FSH because they were under the measuring accuracy. Testosterone increased a little bit
28.08.19 Testosteron nmol/l 10,0
28.08.19 Testosteron after 30 min nmol/l 10,7

28.10.19 Testosteron nmol/l 3,0
28.10.19 Testosteron after 30 min nmol/l 3,2

I can’t really imagine the signal path being blocked.

BEFORE NEBIDO:
13.02.19 FSH mIU/ml 0,2 ( 0,2-10,0 )
13.02.19 LH mIU/ml 0,3 ( 0,5-6,0 )
13.02.19 Testosteron nmol/l 3,0

I will stay on 1500 I.E. HcG 2x per week until the next bloodwork in 4 weeks.

Intersting fact:
I checked my blood work and found out that on the last one (November) my LH und FSH were measurable and before (until Oct) they were not (April,July,August, Sept). Do you think HPTA was online again?

I would guess that no benefit happened because the test subject (the rat) was completely saturated with HCG. 100 iu in a rat is a lot. That would be like saying that I did not get further benefit from my second 20,000 iu injection two days after my first 20,000 iu injection (used 20,000 iu, because that would be how much a 200 lb adult would take if it were scaled on weight).

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Exactly

Very well could be.

A lot of doctors in the hormone field do seem to believe that it has no benefit at all though.

Well in practice, I do 3X a week with HCG. I only dose 150 iu per shot.