T Nation

Letrozole vs. HCG to Raise Testosterone

Hi everyone! I’m a 40+ male and I’ve had low testosterone (around the low limit of the range) for at least a decade. Years ago I had a month long testosterone gel trial, but it dropped my testosterone value very low. Then I tried HCG, which almost doubled my testosterone value and basically I should’ve continuted the treatment. I wanted to see if my body could start to work on its own so I quit it, but after a while the test value dropped back down.

I live in Scandinavia and almost every doctor here offers gel or injections, but as HCG worked years ago I’d rather try that again. I just visited a highly respected endocrinologist and he offered me letrozole instead, saying that it’s better and has worked well for this purpose. Right after the appointment I googled it and found out that obviously letro often drops estradiol really low and kills libido. I read it does get testosterone up, but often without the positive effects obviously due to the lower estrogen.

I actually contacted my doctor immediately afterwards and I don’t think he was too happy about it. The good news is I’ll obiously get it changed to HCG, but before doing so I’d like to ask if I’m correct with what I’ve read? Any thoughts or experiences are welcome. Was it worth getting the doctor slightly pissed at me?

I’ll also try to do my part to share what I’ve learned and experienced so far. It’s actually been quite a path with not just testosterone issues but things like mercury chelation and anti-candida protocols. A lot of incredible results, but not really on the hormone side.

I shouldn’t bump this myself, but I realized maybe use of letrozole is quite uncommon so I suppose I could ask the same question by putting anastrozole (Arimidex) there instead. I believe the mechanism is similar.

So does anyone have knowledge about using anastrozole or other estrogen blockers to raise testosterone and libido? AFAIK the libido tends to go down, which would be the opposite from what I was told by the doctor. Is this correct? Thank you!

Someone please correct me if I am wrong, but from what I know HCG over the long term may cause desensitisation of the leydig cells.

SERMs could be beneficial but it is a hit or a miss, If I remember correctly some studies did not note an increase of libido despite testosterone getting higher from the use of SERMs. But there are many anecdotal experiences with having higher libido while using SERMs.

With anastrozole and other AIs you run the risk of crashing your estrogen so you need to be very careful.

Do you have any recent bloodwork?

Thank you very much andoc96! Yes I’ve had plenty of bloodwork done. The units are different here in Scandinavia, but I made some conversions:

Testosterone 274 ng/dL (a few months earlier 317)
Free testosterone 163pmol/l (155-800)
Prolactin 26 ng/mL (a bit high)
S- E2 0.06nmol/l, which I think is 16 pg/mL
LH 2.3
PSA 1.1
FSH 6.2
Aldosterone 175 pmol/l (60-980)
Thyroid, liver, active B12, D3, ferritin fine (but cortisol not always optimal)
Kalium lowish 3.6
DHEA-S 3.6 (2-16)
Creatinine 70 (60-100), P-CK low
Candida positive (three different tests)

After posting the messages I researched this topic a bit more and it really seems letro is a known libido killer. It was the main side effect in one trial (54%) and I didn’t find anything to say that it would’ve increased libido, instead I found descriptions like these:

  • as horny as a dead castrated rat
  • side effects more than just sex drive loss and joint pain
  • will most likely crush your libido
  • just like being castrated
  • sex drive to go down the drain

But you said there are many anecdotal experiences with having higher libido while using SERMs. I wonder if some SERMs are better in this one because I couldn’t find anything positive about letro in that regard. Thank you again for your info and thoughts!

I just checked the dosage of letrozole, I was prescribed 1.25-2.5mg three times a week. I wonder if it’s possible that a small dosage could raise testosterone and libido or is that enough to have negative effects on the libido side?

Yeah, not likely. Did the doc offer any ideas as to the cause of your low test? All of the values are low, the E2 is low now. So it follow logically that you simpy do not make enough testosteone, and for that reason your E2 (which is derived from testosterone in men) and free T are low. Is it a pituitary problem? Is it simply that your testicals don’t function properly? Clomid would be the more obvious first line of attack. hCG definitely downregulates over time and will stop working at some point. Most likely you will end up on injections, as the gels clearly does not work for you (which is a common problem)

Thank you hardartery! No the doc didn’t really say anything about the cause, just that it seems pituitary related which I though is quite obvious. I’ve tried hCG before and it worked so I know the testicles are able to produce more testo. I’d like to ask a few more questions based on your reply:

  1. What did you mean by “yeah, not likely”? That the dosage I mentioned likely wouldn’t affect libido negatively? So you think it could actually work, raise the test (as I’ve read it does) but not have the side effect of crashing E2?

  2. Then again, I hadn’t thought I may have low E2 too, so the risk with letro would be higher to start with?

  3. You said hCG definitely downregulates over time and will stop working at some point? Do you mean that the body stops producing as much testo and basically you’d need more and more hCG to get the same effect?

  4. How certain are you about that? I thought quite a few have positive experiences with hCG, with some preferring it over Clomid. Would cycling help, maybe something like 6 weeks on, 2 weeks off?

I’ve had a small Clomid trial, but didn’t take labs then. It seemed to work for a couple of weeks, but then the effect lessened. The dosage was small, 25mg every other day. When I visited the doctor Clomid was an alternative, but like I said some seem to prefer hCG so that’s the prescription I have now. Thank you so much again!

Okay. Letrozole will not do what you want. HCG will require a larger dosage eventually or stop working altogether if you don’t cycle off of it. Lots of people love Clomid short term, they also frequently love HCG. The fact is, when you stop taking it you go back to how you were, so they do not fix anything. If you are not trying to have kids, TRT is cheaper and easier and does basically the same thing, but better.

Thank you again for taking the time to share your knowledge, I appreciate this! Yeah I guess it’ll go to TRT eventually, but I think I’ll give HCG another go before that. HCG is actually pretty cheap here and my private insurance covers the costs anyway. It’s more difficult to get Clomid here, not impossible, but it requires a special application from the doctor. I’ll have a better chance at getting that after the summer.

AFAIK the only injectable testosterone options over here are Sustanon and Nebido. Out of these Sustanon with frequent injections would obviously be better. I also wonder if Tostran with a larger amount could work better than the Androgel I tried years ago (it lowered my test value to 6.5 in a month).

Do you (or anyone else over here) happen to have thoughts about cycling HCG, maybe 6 weeks on/2 weeks off? Thanks again!

The gel has a bad absorption rate. You were not getting even what that pump of it was supposed to give you. You got just enough to shut down natural production which is the worst possible thing. You would need at least two or three times that dose to work.

Thank you again! It’s funny how little most doctors know about these things. A highly respected endocrinologist said the gel couldn’t shut down my own production in one month, but yeah that’s exactly what happened. If there’s no difference in absorption (I thought Tostran would be stronger) there’s no way to have a dose that’s 2-3 times higher. That would mean I’d need to spread it all over my body.