T Nation

My Prolactinoma Recovery Story and Questions about HCG/TRT


Hey everyone,
I wanted to create this post for a couple of different reasons: #1: to get feedback and opinions from men that have gone through something similar to myself and #2: to hopefully help other men that are just starting to go down the road that I have been down over the last several years. I’ll structure this post with my experience first and my questions at the end. I originally posted on this forum in March 2016, nearly 2 years ago. So much has changed since then.

My original post is here:

Here is my information from that time frame:

age- 31
height- 6’2"
weight- 210
waist- 34
describe body and facial hair- normal facial hair, little to no chest hair, hair on legs, underarms, and stomach
did to grow fast or slow and steady as a teen- I grew to about my current height around 9th grade, was about 130lbs at the time and then gradually filled into my current weight
testes ache or hurt? ever?- testes don’t hurt of ache now but when I was in late teens early twenties, they did some (always thought it was because I went to long without sex)
mood-high highs and then sudden deep lows
depression-yes often
libido-as of now, pretty much non-existent
get cold easily? a change?-yes, hands and feet are always cold
dry skin, brittle nails?-extremely dry skin, have to apply lotion on entire body after and shower and to hands every time after I wash my hands. skin gets very white and scaly feeling
use iodized salt?-sometimes
eat much sea food?-sometimes
exposure to chemicals? -not that I’m aware of
ever used hair loss drugs?- no
Rx and OTC drugs-none except a multivitamin

I had just gone to my primary care doctor about issues that I had developed over the previous 5 or so years that had gotten progressively worse. My symptoms were: extreme fatigue, zero libido, crippling anxiety and depression, concentration and drive issues, a constant feeling of brain fog and dissociation from reality, terrible joint pain specifically in my hips, and severe gastro issues to point that my body seemed to have issue digesting almost anything.

During that time frame, I was working full time, going to college part time, and just eating anything when I had the time to. I thought that my symptoms were related to just having an overly busy life. I thought these issues would clear up after college when I settled into my new career and had a little more free time and could clean up my diet a bit, but unfortunately this was not the case. I worked at what I would call a get-your-feet wet company for a couple of years after I graduated college at age 28 before jumping into a new job that paid better and had better benefits.

I am an embedded software engineer by trade. At my new job, I still had issues concentrating and focusing enough to get any of my daily tasks done at work. My anxiety was so bad, I didn’t even want to leave my cubicle at work to go to the bathroom. Everyday after I ate lunch, my stomach would cramp and churn. I would get so tired that I would literally nod off sometimes at my desk which made me look like a lazy worker which has never been the case in my life. Along with all of that, my new job is with an international company that sometimes required trips to Germany. Being that I had such bad anxiety and had never even been on an airplane, the thoughts of this terrified me. I had gotten to the point that I thought that I was no longer mentally or socially capable to perform the work necessary in my career.

I have a fairly long drive to work and had also noticed that I started having a lot of pain in hips. The best way that I can describe the pain is that it felt like a constant uncomfortable pressure in my left hip and I felt like I was literally going to split in half at my ass crack. At one point, the pain became so difficult that I had issues wearing underwear with waistbands that were even a little tight. I had injured my back when I was around 21 due to an incorrect lift in the gym so I thought that it was related to that issue catching up with me since I wasn’t in the same great shape now that I’m in my 30’s. In addition to this, my knees popped and cracked constantly. It was becoming difficult to go up and down that stairs as a 31 year old man!

In terms of my libido, if I tried really hard, I could get about a half-wood but could not maintain it through sexual intercourse with my wife. During sexual intercourse, I would best describe my genitals as just being numb. This frustrated my wife on several different levels. She felt that I was no longer sexually attracted to her and that our relationship was in jeopardy. She had also recently stopped taking birth control and we were trying to get pregnant with our first child. She was also going through something similar. Since stopping her birth control, she was struggling with anxiety and depression and had recently been diagnosed with hashimoto’s thyroiditis.

So at this point, it felt like my life was in shambles. My personal relationships were suffering, my career was failing, and I felt like I was sure to die before I saw 35 years old. To be completely honest, before I went to the doctor, I was sure that I had something extremely wrong with me like some sort of cancer.

I did a little research about low testosterone before initially going to the doctor because of my libido issues. I told the doctor my problems and asked her to check my testosterone. She agreed to do so and was actually even keen enough to test my prolactin as well. Below are those test results and as you can see, my total T and Free T were beyond terrible. My TSH was also high (according to the information that I’ve read on this site, not the labs ranges :slight_smile: ) and my vitamin D was low. My prolactin was also way out of range.

TESTOSTERONE, TOTAL 12/28/2015 122.00 300-1080 ng/dL
TESTOSTERONE FREE 12/28/2015 20.00 47-244 pg/mL
PROLACTIN, SERUM 12/28/2015 52.40 2.64-13.13 NG/ML
TSH 12/28/2015 2.250 34-5.60 uIU/ml
Free T4 (Thyroxine) 12/28/2015 0.80 0.6-1.1 ng/dL
Vitamin D (25 Hydroxy) 12/28/2015 29.00 30-100 ng/ml

My PCP was going to prescribe TRT to me at this point but my prolactin levels made her worry that I had an issue outside of her scope of knowledge so she referred me to an endocrinologist.

The endocrinologist ran the following tests on me to confirm my issue. Please note that my total T is at 202 when he tested. This is actually relevant to one of points/questions. The PCP tested my testosterone at around 1pm and the endo tested it at about 8am. I think this accounts for the difference in levels even though I had not started any sort of treatment at this point because testosterone is the highest in the morning in younger men. You can also see that with my LH and FSH levels why my wife and I could not conceive a child during our seldom sexual interactions.

FREE TESTOSTERONE EQUILIBRIUM 3/18/2016 28.30 PG/ML 35.0-155.0
Z-SCORE MALE 3/18/2016 -0.20 -2.0 - +2.0
IGF1 3/18/2016 138.00 53-331
ACTH 3/18/2016 42.00 PG/ML 6-50
PROLACTIN, SERUM 3/18/2016 54.90 NG/ML 2.64-13.13
LH (LUTEINIZING HORMONE) 3/18/2016 1.14 MIU/ML 1.24-8.62
FSH 3/18/2016 1.90 MIU/ML 1.27-19.26
IRON 3/18/2016 102.00 UG/DL 42-165
TOTAL IRON BINDING 3/18/2016 344.00 UG/DL 255-512
IRON % SAT 3/18/2016 30.00% 15-50
T4, FREE 3/18/2016 0.85 0.50-1.40
TSH 3/18/2016 2.05 UIU/ML 0.34-5.60
CORTISOL TOTAL AM 3/18/2016 8.30 6.7-22.6

The endo next ordered an MRI to confirm his suspicions that I had a prolactinoma. The MRI did, of course, confirm that I had one. A 5-6 mm tumor was present on the right side of my pituitary gland. The doctor immediately prescribed cabergoline at a dosage of 0.25mg twice a week. He told me that the cabergoline should suppress the tumor and allow my male hormones to return to the appropriate levels.

I spoke to him about testosterone replacement theory but he felt the cabergoline would be sufficient. He said, as next step, he would try clomid to attempt to jump start my pituitary if my testosterone levels did not recover enough. This encouraged me that he knew what he was doing since I had read about the HPTA restart on this site. I gave him the benefit of the doubt and agreed to just try the cabergoline and see where it takes me.

I also told him about my hip and joint issues. He said that there was no way that had anything to do with my hormone levels and I would need to go back to my PCP to discuss it with her.

I returned to my PCP about the joint and hip issues and she ran bone scan on me (think super X-ray). The bone scan showed that I had degenerative disc disease in my spine and osteopenia (essentially pre-osteoperosis). She up-ed my vitamin D supplementation and sent me back to the endo because she believed it was due to my hormone issues :(. At the same time, she diagnosed my hip issue as bursitis and gave me a cortisone shot to try to help the issue.

I then returned to the endo to discuss my bone density issue. At this point, it had been a couple of months since my initial visit with him. He actually acknowledged that the issue with my bone density may be related to my hormone deficiency this time and to give the cabergoline time to work on the issue and he would re-check my bone density after 1 year. He acknowledged that I likely had an E2 issue since E follows T. It certainly would have been nice if he had checked my E2 in the first place. From here, he re-tested my blood for my original issue. Below are the results.

TESTOSTERONE TOTAL - SERUM 5/13/2016 295.00 ng/dl 175-781
PROLACTIN, SERUM 5/13/2016 9.88 NG/ML 2.64-13.13

As you can see, the testing that he performed this time was a little sparse. The TT test that he had performed this time paid no attention to free T and was a serum test rather than an equilibrium panel. The good news was that my prolactin was now down in the appropriate range and my total T had went up quite a bit.

I could definitely feel the effects of this too. All of my symptoms were still there but they had greatly improved. The cabergoline also had revived my sex drive so that I felt like having sex about once per week and it actually felt good again! I inquired about TRT again and he said that he felt that things would continue to improve for me but he was willing to let me try it to see if it would help my symptoms. He did, however, warn me that it could harm my ability to have children. I brought up the fact that HCG could help with this issue. He agreed with that fact, but expressed that insurance may not be willing to pay for. I thought about it for a moment and thought about how my wife and I were trying to have a child. I didn’t want to compromise this in any way. This caused me to get cold feet on the subject. I agreed to give it more time as he had suggested. He wanted to see me again in about a month.

The next visit about a month later was similar. I still noticed that I was improving but the same symptoms though improved continued to nag me. This time the endo decided take a look at my cholesterol. I requested that he take a look at my free T also. As you can see from the results below Total T was up quite a bit and free T had tripled since the first time it was checked at the beginning of this process before I began receiving treatment. The tests also revealed that overall cholesterol was a bit high, HDL was on the lower end and LDL was trending high. I wonder if my hormone deficiency had affected my metabolism. TSH and T4 was also measured with TSH being a bit higher than I would like. From what I have read on this site, near 1.0 is ideal. The endo wasn’t worried about most of this and wanted to see me back in 6 months.

FREE TESTOSTERONE EQUILIBRIUM 6/17/2016 64.80 PG/ML 35.0-155.0
PROLACTIN, SERUM 6/17/2016 7.18 NG/ML 2.64-13.13

TSH 6/17/2016 2.20 UIU/ML 0.34-5.60
T4, FREE 6/17/2016 0.84 0.50-1.40

HDL 6/17/2016 43.00 MG/DL >= 40
TRIGLYCERIDES 6/17/2016 154.00 MG/DL Adult Reference Ranges for Triglycerides**:
<150 mg/dL (Normal)
150-199 mg/dL (Borderline High)
200-499 mg/dL (High)

=500 mg/dL (Very High)

LDL 6/17/2016 147.00 MG/DL Reference Range:
130-159 (BORDERLINE)

=160 (HIGH)

Non-HDL 6/17/2016 178.00 MG/DL
Target for non-HDL cholesterol is 30 mg/dL
higher than LDL cholesterol target

CRP (C-REACTIVE PROTEIN) 6/17/2016 0.50
For Ages > 17 Years:
hs-CRP mg/L Risk According to AHA/CDC Guidelines

<1.0 Lower Relative Cardiovascular Risk.
1.0-3.0 Average Relative Cardiovascular Risk
3.1-10.0 Higher Relative Cardiovascular Risk.
Consider retesting in 1 to 2 weeks to
exclude a benign transient elevation
in the baseline CRP value secondary to
infection or inflammation.

10.0 Persistent elevations upon retesting,
may be associated with infection and

Lp (a) 6/17/2016 26.00 NMOL/L <75
Optimal < 75 nmol/L; Moderate 75-125 nmol/L; High > 125 nmol/L
Cardiovascular event risk category cut points (optimal, moderate,
high) are based on Marcovina et al. Clin Chem. 2003;49:1785 and
Nordestgaard et al. European Heart J. 2010;31:2844 (results of
meta-analysis and expert panel recommendations).

CHOLESTEROL 6/17/2016 221.00 MG/DL 125-200
Adult Reference Ranges for Cholesterol, Total:*

or = 20 Years: 125-200 mg/dL
<200 (Desirable)
200-239 (Borderline)
=240 (Higher Risk)

Apolipoprotein B 6/17/2016 109.00 MG/DL 52-109
Optimal < 80 mg/dL; Moderate 80-119 mg/dL; High > or = 120 mg/dL
Cardiovascular event risk category cut points (optimal, moderate,
high) are based on National Lipid Association recommendations

PLAC 6/17/2016 148.00 NG/ML 81-259 Holston Medical Group (HMG)
Optimal < 200 ng/mL; Moderate 200-235 ng/mL; High > 235 ng/mL
Cardiovascular event risk category cut points (optimal, moderate,
high) are based on Lanman et al. Prev Cardiol. 2006;9:138

LDL Peak Size 6/17/2016 216.80 Angstrom >= 218.2
Optimal >222.5; Moderate 222.5-218.2; High <218.2
Adult cardiovascular event risk category cut points (optimal,
moderate, high) are based on adult U.S. reference population.
Association between lipoprotein subfractions and cardiovascular events
is based on Musunuru et al. ATVB. 2009;29:1975.

LDL Pattern 6/17/2016 B A
Optimal Pattern A; High Pattern B
HDL Large 6/17/2016 5724.00 NMOL/L 4334-10815
Optimal >9386; Moderate 9386-6996; High <6996
LDL Medium 6/17/2016 419.00 NMOL/L 167-465
Optimal <201; Moderate 201-271; High >271

LDL Small 6/17/2016 327.00 NMOL/L 123-441
Optimal <162; Moderate 162-217; High >217

LDL Particle Number 6/17/2016 1575.00 NMOL/L 1016-2185
Optimal <1260; Moderate 1260-1538; High >1538

In the following months, a lot of things began to change in my life. I felt myself to continue to improve. I noticed that my facial hair began to grow faster and coarser. I developed a patch of chest hair in the middle of my chest. Previously, I only had a couple of hairs there. I would wake up every morning with an erection and typically felt like having sex at least twice a week but could normally muster up enough for a sexual encounter on pretty much any given day.

From a professional perspective, my career also began to improve. I was getting my work done faster and my creativity and critical thinking had improved immensely. I no longer felt the same anxiety that made me fear to leave my desk at work. I began developing a better working relationship with my colleagues. I had improved so much since the beginning of treatment that I was entrusted with a large scale project on my own.

The biggest change happened about a month after this visit. My wife and I had found out that she was pregnant with our first child. It was something that both her and I didn’t think was going to happen. After seeing my LH and FSH in my initial visit to the endo, I wasn’t sure that I was capable of it. It really made me feel like a man for the first time in a long time. Things weren’t perfect from a symptomatic perspective but it felt like my once derailed life was back on the rails again.

By the time that I saw the endo again, my symptoms had improved further. I still fought fatigue but no more nodding off at my desk, concentration and drive had improved but still not optimal, brain fog had probably cleared up by about 60%, the reality dissociation was gone, joint pain was still there but probably improved by about 50%, gastro issues probably improved by about 50% too.

This time I asked the endo to once again check my total T, free T, and estradiol. He agreed to do this and also checked my vitamin D levels, TSH, prolactin, and cholesterol again.

FREE TESTOSTERONE EQUILIBRIUM 12/16/2016 92.30 PG/ML 35.0-155.0 TOTAL TESTOSTERONE EQUILIBRIUM 12/16/2016 483.00 NG/DL 250-1100
ESTRADIOL, SERUM 12/16/2016 24.00 PG/ML 20-75 pg/ml
PROLACTIN, SERUM 12/16/2016 4.27 NG/ML 2.64-13.13
TSH 12/16/2016 1.60 uIU/ml 0.34-5.60
Vitamin D (25 Hydroxy) 12/16/2016 42.00 ng/ml 30-100
LDL Cholesterol (Calc) 12/16/2016 147.00
HDL Cholesterol 12/16/2016 43.00
Triglycerides 12/16/2016 154.00
Cholesterol 12/16/2016 221.00

After getting these results back, I spoke to the endo again and he felt that my cholesterol would continue to improve as my hormone levels stabilized. I was pretty happy with my numbers. My prolactin was maintaining a healthy level. My vitamin D was up. My estradiol was almost ideal (I had read on this site that around 22 was about perfect). TSH was down to 1.6 also. I still couldn’t completely shake my symptoms though and the thought that I could reach near 100% if I continued to go in this direction.

I spoke to the endocrinologist again about TRT and he told me that I had no medical need for it and it would not help me feel any better than I felt. I felt this wasn’t true because every time I was tested and these levels improved, I felt better. However, maybe I was being impatient about my recovery. Maybe my body wasn’t done healing itself yet. I mean, every time I had been retested, it had improved, right?

I once again backed off the subject. The endo didn’t want to see me again for 1 year. After 1 year, he was going to check my levels again and have another bone density scan done to check my bone mass for a second time. I decided that I would spend the next year trying to expand my knowledge on this subject and just living my life and paying attention to how my physical, emotional, and mental state was changing.

Over the next year, the symptoms that I had previously described stayed close to the same. I had some significant changes in my life and did some things that I could never have done before I was treated. My baby girl was born happy and healthy. I finished the large project at work that I had started and was successful in doing so. I even traveled out of the country for the first time for work.

I feel like these things are important to mention because I don’t want to just focus on the negative about how I’m still not 100% better. If there is another guy that is starting a similar journey to the one that I am on and reads this post, I want them to know that things get better and there are milestones that I’ve reached since first finding out that I had this issue that I did not think I was capable of before being treated. I went from a 31 year old that had no quality of life and basically didn’t really care if I lived or died because of it to an almost 34 year old man that has gotten my life back. I don’t feel like my healing journey is over yet which is the primary reason for this post.

Sure everything is not roses but it has gotten better. There have still been issues on the last year. After giving birth, my has suffered immensely from post-partum depression and post-partum thyroiditis. I won’t go in depth on her story here but the negligence that her endocrinologist (she see a different endo than I do) has display has made my lose a lot of faith in the general medical community. She is still struggling with her issues and it was made us both question whether or not to have another child unfortunately.

So I know that was a lot of information but I really felt that it was necessary to describe all of it to explain where I was and where I’m at now. I think this a good point to describe myself again and my symptoms to truly get the appropriate feedback that I’m looking for, so here it is

age- 33
height- 6’2"
weight- 197
waist- 34
morning temp: 97.5
describe body and facial hair- coarse facial hair, strip of chair hair down the center, hair on legs, underarms, and stomach
did to grow fast or slow and steady as a teen- I grew to about my current height around 9th grade, was about 130lbs at the time and then gradually filled into my current weight
testes ache or hurt? ever?- testes don’t hurt of ache now but when I was in late teens early twenties, they did some (always thought it was because I went to long without sex)
mood-mostly positive, but depression and disinterest in everything occasionally
depression-yes, maybe one day per week
libido-feel like sex a couple times per week
get cold easily? a change?-yes, hands and feet are always cold
dry skin, brittle nails?-skin still dry but improved, nails seemed to also improved some as well
use iodized salt?-sometimes
eat much sea food?-sometimes
exposure to chemicals? -not that I’m aware of
ever used hair loss drugs?- no
Rx and OTC drugs-multivitamin, 3800 units of vitamin D per day
other symptoms: osteopenia, degenerative disc disease, fatigue in the afternoon and evening, slightly low libido, social anxiety, depression but fairly minimal, concentration and drive issues, short term memory issues, trouble finding words, brain fog in the afternoon and evening, joint pain in hips

Something key that I want to point out here is that I typically feel the best in the morning and by afternoon/evening, my symptoms such as the fatigue, concentration, brain fog, joint pain seem to get significantly worse. I know that it is common practice to test hormones in the morning and I’ve expressed to my endo before that I feel like my testosterone is dropping after the morning and this is exacerbating my symptoms but he kind of blew that theory off.

Anyways, on to the last visit with the endo in December. I told him about my symptoms again. He felt it could have something to do with IGF1 levels so he added that to the blood tests. This time I talked to him about HCG and/or TRT and he said that there is no medical reason for further treatment. Here are the results of the tests that he performed.

VITAMIN D (25-HYDROXY), SERUM 12/8/2017 58.00 30-100
TESTOSTERONE TOTAL - SERUM 12/8/2017 342.00NG/DL 175-781
PROLACTIN, SERUM 12/8/2017 4.54NG/ML 2.64-13.13
IGF1 12/8/2017 198.00 53-331
Z-SCORE MALE 12/8/2017 0.70 -2.0 - +2.0

Notice that he used total T serum test rather than an equilibrium test. If I calculate where I am in the range, I am in the bottom 28%. This is the same for the Total T equilibrium test that he had checked the year before at the same time so it doesn’t seem to have changed much in the last year. He had actually checked my IGF1 prior to beginning the cabergoline and it was 138 so it has actually jumped up 60 points.

My latest bone scan also indicated that I still have osteopenia but it has improved. Below is the original scan and the newest one

-score in the lumbar spine is -1.5
-total mean T-score in the femurs is -1.6.

LUMBAR SPINE: BMD=(g/cm2) 1.144; T-Score = -0.6
TOTAL HIP left: BMD=(g/cm2) 0.925; T-score = -1.3
FEMORAL NECK left: BMD=(g/cm2) 0.933; T-Score -1.1

So that’s basically where I’m at. I think it is fair to say that if my levels haven’t progressed after 1 year, they have stabilized. I feel like TRT/HCG would help me since increasing my levels has gotten me this far. I also feel like it could help with my bone health even though the endo disagrees. I’m in the bottom 28% for total T and the bottom 48% for Free T. I mean, seriously, if I go to the gas station, I don’t put 1/4 tank of gas in my vehicle, I fill the damn thing up!

I am open to any and all feedback from anyone on these forums, especially those who have had a micro/macroprolactinoma. It has been difficult to find guys on here that have taken TRT/HCG after cabergoline. I would love to hear results. I would also love to hear from experts on the subject like KSman. If you don’t think I should take it at all, I’d still like to hear your feedback.

My fear is that I am turning TRT/HCG into a magical elixir that will help all of my problems and then I will start taking it and nothing will change and I will be stuck injecting test cyp and/or hcg for the rest of my life with no noticeable further benefits. I’m not a bodybuilder trying to prep for competition. I’m a computer professional and a new father that wants to have a quality life so I can provide for my family and have the energy to give my daughter the father that she deserves.

I know that testosterone decreases naturally in men after 30 and since I’m already closer to the bottom of the range, I don’t want things to get worse. As a next step I am going to try to get a full picture of where I’m at through further blood work including:

total T
bioavailable T
free T
and a further look at my cholesterol since the endo just let that one go

My questions:

  1. Is a HPTA with nolva or clomid even worth a shot since I’ve likely had my hormones suppressed for some time now due to the prolactinoma? Could there be any benefit that could drive my free T and total T up further?

  2. Recently I’ve been leaning more towards hcg monotherapy than any other option. I know that my original problem was with my pituitary gland. I’m not sure how/if the prolactinoma damaged it but I find it reasonable to think hcg monotherapy may help me quite a bit since I know my testes are working and hence my GPCR receptors as well. At 34, it would be nice to hang onto my fertility just in case my wife and I decide to have another baby. Any thoughts?

  3. If the answer to the previous two questions are no and test cyp or a test/hcg/ai combo are the way to go. I’d like to get thoughts on my next move. My endo doesn’t seem to be listening to my case for treatment anymore since the numbers are in range. My thoughts are: I have a very understanding and open minded PCP. I am afraid that she will defer to the endo though since I’ve had the pituitary tumor and the bone mass issues that the endo is now managing. This makes me hesitant to go to her and pursue treatment. But honestly, I think she is a good doctor and she originally found that I had elevated prolactin and bone mass issues in the first place.

My second option is an anti-aging clinic here that is local. The doctor that operates it is a osteopathic doctor that specializes in the male/female bio-identical hormone replacement. I’ve already emailed her to get here pricing and it was fairly reasonable ($195 for the first two visits, $75 for each visit after that, blood draws can be ran through insurance). I believe that she works with a local compounding pharmacy. I kind of like the idea of getting the perspective of a doctor that operates outside of our ridiculous medical system here in the US but I’m also afraid that such a person may just try to sell me something without my best interest at heart. Does anyone have any experience with this approach? If so, have you been able to get insurance to cover your test cyp and ai? I know for a fact that my insurance does not cover hcg unfortunately (as a side note, I find it funny that insurance will pay for TRT which will make a man sterile but a fertility drug like hcg is not covered). I guess my only other fear with this approach is that I may have to start the search for another endo to continue my cabergoline prescription since I did not adhere to his narrow-minded advice that I don’t need TRT. The endo tried discontinuing the cabergoline twice already and it did not go well. My anxiety and depression went through the roof when even halving the dosage.

  1. How about my thyroid? The recommendation on this site is a TSH of 1.0. Admittedly, I have not done as much research on this subject as I should have. I was encouraged to see that after treating my pituitary tumor, my TSH dropped from 2.25 to 1.6. Is worth looking further into since my morning temp is a bit low at 97.5?

Anyways, thanks for reading my story and considering my questions. I really appreciate it.

KSman is Here
Pituitary Tumor - HCG Script Questions (Dosage, Gyno)

Hi, I can’t give you advice but I had to tell you that the improvement you made are really inspiring ! Hope you can reach 100% soon !


Thanks tuckerleonie! I really appreciate the well wishes! I wish you the same. I think that we all share a common goal on this forum to improve our quality of life. That’s what it is all about. When I read my original forum topic from a couple of years ago, I barely recognize that guy and that is definitely a good thing.


You seem to be iodine deficient so I expect that mom and baby are too. However, pre-natal vitamins fill that gap and should have been used when trying to conceive, during pregnancy and breast feeding.

Your best measure of thyroid function for you and family is waking and mid-afternoon body temperatures and those temperatures can be a thyroid med dosing guide for your wife.

Iodine deficiency, with inadequate selenium can lead to thyroid auto-immune diseases. While TSH was up, fT4 was a bit low then OK at mid-range. fT3 is the only active thyroid hormone and never tested. There is no T4 receptor. T4 is a reservoir for T4–>T3.

Please carefully read the [newly enhanced!] thyroid basics sticky.

Before cabergoline shrank your adinoma, did you have any sense that your width of peripheral vision was reduced? Should be ~180 degrees.

AM cortisol at 8AM or 1 hour after waking

Serum iron is less that useful, better to have CBC and ferritin.
Your lower T levels will make your blood a bit thinner.
AN cortisol=8.3 is well below where action is required. Perhaps this has evolved.

Good to see that IGF-1 has improved. That will help with joints and general well-being.

Bones need calcium, magnesium, Vit-D, trace elements including boron that you would get from vitamins. Milk is good. Many are magnesium deficient and a sign of that is leg/foot cramps or ability to tighten up a muscle and have it lock up. See “ZMA” sold in this site’s Biotest store. You cannot get enough magnesium in a vitamin pill because the bulk of needed magnesium is relatively huge.

Both Bio-T and FT are redundant.
SHBG is a good idea
No point in DHT, it will be unremarkable.
PSA at age 31 is odd, but you have had an odd hormone backdrop and would be good to see that, then if OK, test when near 40.

TRT is indicated for your bone issues.

Find 5000iu Vit-D3 tiny gel caps and then save cost of testing Vit-D25.

I missed your thread in 2016, sorry, I could have fast tracked this process.

TRT will increase/restore collagen that you were loosing for a few years. Your skin will be looking better now. The collagen matrix in your bones is the platform for mineralization. More FT will support bone local FT–>E2 for local E2 utilization. While materializing your bodes, your mineral intake must of course be higher than maintenance amounts.

You should read the HPTA restart sticky, might help, might not. SERMs used inappropriately could make things worse.

hCG mono might work if your testes are up to the task. We do not have sufficient labs to talk this further.

Your E2 was OK, but with lower T levels. On TRT with higher FT, FT–>E2 will increase and you would need anastrozole to be near E2=22pg/ml.

I always ask for prolactin with young guys who are secondary with low LH/FSH.

Prolactin and dopamine oppose each other. When prolactin was high, dopamine was depressed eroding your ability to feel reward and joy. So that has changes and you have a positive attitude.


Thank you for your reply, KSman. I was really hoping to hear from you. It’s no problem that you missed the initial thread. I know that there are a ton of guys that posts on here. I find it amazing that you are able to keep up with what you do.

I just finished reading your sticky on thyroid issues and it really clarifies a lot. I will be taking morning and evening temps this week and will re-post at the end of the week with more detailed results. I have a question regarding selenium but I will post it at the bottom of the reply to consolidate my questions.

In terms of my wife during her pregnancy, we were extremely strict about her sticking to her prenatal vitamin and daily DHA.

My wife has gone through hell with her hasimoto’s disease and it really made me realize just how negligent endocrinologist can be. At one point after her pregnancy, her TSH was over 9 and at another point, it was 0 because he wasn’t checking it frequently enough. It took a OB doctor to give him a kick in the ass about it! With her most recent tests, her TSH = 2.9 and fT4=1.1. Still very bad numbers but she is more trusting of the medical community than I am. I will try to get her to check temps as well and help her see the light.

I will readjust the labs the I will have to the following:

total T
free T
Prolactin (caber seems to keep this in check though)
Cardio IQ for choloesterol

Hopefully I can get an appointment with my PCP this friday to have labs done. She is a nurse practitioner and honestly I think she is better than any doctor that I’ve ever seen. I’m still a bit afraid that she will defer to the endo. But at the very least, this will get a clearer picture of where I’m at to work with.

I will also add a ZMA supplement to my daily intake.

In terms of my adinoma prior to the caber, I really did not have issues with my peripheral vision but vision would blur intermittently. I haven’t had this issue since be treated. I even saw the eye doctor in may and was told that I had near 20/20 vision.

Since the IGF increased, well-being and joint pain has definitely improved but still problematic.


  1. My multivitamin does contain selenium at 200 mcg per pill. Thoughts on this? Too little or ok? I did not find an dosage recommendation in the thyroid basics. No iodine in my multi-vitamin also.

  2. The endo seemed to think that with my total T = 483 and free T = 92.3 that my bone density problems will continue to resolve. His exact quote when I asked him about using T replacement to help further was: “Super-charging your testosterone is not going to expedite your bone density recovery”. What are your thoughts higher T ranges (800 to 1200) to help with bone density?

3.What are your thoughts about my symptoms getting worse after the morning? I have read some about diurnal variation and I really feel that I may be having a significant enough fluctuation to be feeling a difference.

I would say that in terms of your observation about collagen, you are right on the money. I still have issues with my skin being very dry and having to use lotion over my whole body on a daily basis but I did notice that it improved since my total T = 122.

Thanks again for your help!


A bit of an update on this. I would like to hear your take on this and the above 3 questions. @KSman

I’ve been monitoring my waking and mid-afternoon temperature to get an idea of my thyroid function and below are the results. It seems that there is a bit of an issue there.

Thoughts on this?

I may purchase some lodoral for IR. Any thoughts on dosage?

Also, is the 200mcg of selenium in my multivitamin sufficient for free radical cleanup?

6:30am 97.0
1:30pm 98.3

6:30am 96.9
1:30pm 97.9

6:30am 97.2
1:30pm 98.1

6:30am 97.2
1:30pm 97.3 (I was stopped by a co-worker before taking this one and chatted for a minute so I don’t think this is accurate)

I had a really erratic sleep last night. Feel asleep about 11pm, work up at 3am, and feel back to sleep at 5am so I was afraid that would affect my temperature readings so I’ve skipped today.

Aside from this, I saw my primary care doctor today and explained to her my desire to start TRT and my reasoning behind it. She was impressed by the amount of research that I had done on the subject and agreed that I would be a good candidate for it even though my total T number was in the “reference range”. We spoke for about an hour on the subject. She agreed to do the following blood tests that I requested with no fight.

total T
free T
free T4
free T3

I’m have another appointment with her in two weeks to go over the blood work and develop a treatment plan. She inquired about why I was not going through my endocrinologist for this process. I described the difficulty that I’ve had getting him to understand my desire to have “optimal” hormone levels so I feel like a healthy 33 year old male. She essentially told me that she has often found that endo’s can have their “head up their asses” a lot of time. She offered to help me find a new endo that is more aligned with my goals. I agreed that would be a good idea. She said she could manage my TRT for the time being.

So, anyways here are the good points of our conversation
-She said she would give me the option between the gel or the test cypionate shot and would allow me to self inject. Big plus there!
-She understood that hemacrit and RBC must be monitored to avoid heart attack/stroke risk
-She understood my desire for a PSA before beginning and the need to monitor prostate health during this process.

Now, here are the bad points of our conversation

  • I expressed my desire to use a protocol of 100mg-200mg test cyp in divided doses twice per week, 250iu of hcg EOD, and 1mg of anastrozole in divided doses twice per week. Her response to this is that she never prescribes HCG and is not comfortable with it because she doesn’t know enough about it. She would only prescribe the anastrozole if necessary. And last…she would prescribe the test cyp with only one injection every 2 weeks. This is concerning.

I think I can change her mind on the every 2 weeks if I bring her an article on the half life of test cyp. I tried to explain this to her but it didn’t seem to sink in. I think she thought I was asking for full doses twice per week instead of divided doses.

In terms of the anastrozole, I can probably change her mind by a follow up E2 blood test after beginning treatment. Thoughts on the safety of starting this process with the anastrozole starting staggered since she is being a bit stubborn on this point?

In terms of the HCG, I don’t think I will be able to move her at all on this point because she admittedly did not have knowledge on the subject, even though I explained to her that it will mimic LH production and prevent testicular shutdown. I think I may be able to find a different source for this. Maybe if she helps me find an open minded endo. Thoughts?

So, that is where I’m at.

Should I start the process since I have my foot in the door with a somewhat “open minded” doctor and work on the rest as I go? Or should I start over and try to make the stars line up elsewhere with starting the test/hcg/adex all at once?

I’m tempted to just go ahead and start since the doctor is actually willing to work with me on even 1/3 of this equation partially worked out. I know that even getting a doctor to hear you out and work with you just on TRT is a struggle from first hand experience and stories other guys have posted on this site.


@KSman, another update.

I received all of my test results from seeing my PCP and had a another visit with her to discuss the results. The results from the test are at the bottom of the page.

@KSman, I would love to get your feedback on my results, questions, and starting TRT protocol. I’ve also carried over some outstanding questions that I had as well. Even with my elementary knowledge on this subject, I can see that my Total T, Free T, LH, and FSH were not good. SHBG looks to be a bit below mid-range which I guess is ok. PSA was only 0.6 which seems good. RBC, Hematocrit, Hemaglobin seemed near the higher end of normal which concerned me a bit with starting TRT. I upped my water intake to 70 to 90 ounces per day to try to offset this. I admit that my fluid intake is not always optimal. I also love to see what you think about my thyroid levels in my results. I will re-post my temps below also.

-multivitamin (screenshot of my multi below)

-Vitamin D (4000 units + what is in multivitamin) (upped it to this since our last conversation)

-magnesium malate(screenshot of below)(added this since our last conversation. I picked malate because I read it was good for the gut and I have IBS with constipation)

As a reminder, these results are after taking cabergoline for about 2 years to suppress my prolactinoma. I think this resulted in my joint issues (bursitis in the hips) and bone issues (osteopenia). I honestly think by this point, this is going to be the best that my system can produce on its own. You can note that prolactin was tested again here and came back at 5.0 so it seems to pretty well be in check if I compare this blood draw to previous blood draws. It has been pretty steady between 4 to 6 in the last year and half or so. Also my calcium seems pretty good so I can only assume that lower E2 due to lower FT, resulted in bone loss.

Anyways, my doctor agreed that my TT and FT were near the lower end of the “normal range” and should be higher for a 33 year old man. She agreed to prescribe testosterone cypionate. She is letting me self inject. Initially she wanted me to do the injection IM one every two weeks. I informed her that the half life of testosterone cypionate is ~8 days and I would like to inject 1 to 2 times each week. She agreed to .5mL/100mg 1X per week IM. She gave me a prescription for 200mg/mL of testosterone cypionate and enough needles(25 gauge 1.5 inch, not ideal, I know) to cover injections 1X per week.

I spoke to her again about using anastrozole for E2 conversion. Apparently, there was a miscommunication in our last conversation. I thought she was familiar with AI’s but she was not, so no AI prescription. She actually googled anastrozole on her laptop while we were in the room together to read a little about it.

She told me that she understood what I was trying to do with my hormone replacement protocol and why I was trying to do it but some of the topics that I was interested in such as HCG and AI’s were a bit “advanced” for how she has treated here patients with TRT in the past.

She recommended a particular integrative medical doctor in our area that specialized in male hormone replacement. Unfortunately, this doctor operates outside of the health insurance spectrum. She did, however, say that she would continue to prescribe my testosterone cypionate and monitor my blood work and that she would work with this integrative medical doctor and take suggestions from him on my protocol so that I could have things covered by insurance through her. I thought this sounded like a great option!

I haven’t seen this new doctor yet but he had a lot videos on his web site of him speaking about the type of care that he administers and he sounds like a very promising option to fill in any gaps that my current doctor has left.

So I have already picked up my first prescription of test cyp and the pharmacist actually mentioned that he took test cyp shots himself. I thought this was great! I picked his brain some about his protocol and subq injections. He said the he took all of his injections IM 1X per week and did not recommend and hadn’t heard of doing the injections subq so I didn’t really get any further with him either unfortunately. He was, however, familiar with anastrozole as an AI but said he did not use one himself.

Since I had all of this resistance from my doctor and pharmacist, I decided to try to start out with an 100mg/.5mL intjection IM every Monday (I take my caber on Mondays and Thursdays). I gave myself my first shot this past Monday in the upper, outer quadrant of my right glute. I feel like I did a good job with the injection, only minor discomfort after it was done that went away by the next morning.

I’ve felt positives and negatives this week after my first injection. On the positive side, I have been waking up in the morning with much more energy and a more positive outlook on the day ahead. I have already noticed a big turn-around with my joint health. My knees have been popping less and the bursitis in my hips seems to have almost disappeared already! I couldn’t believe it! Also a big increase in appetite. I feel hungry like a teenager again! I usually eat once every six hours and sometimes that is forced. This week I’ve been hungry about every 3 hours. I have also began taking magnesium malate each night before bed which has seemed to help a lot with my IBS symptoms since it has helped me go to the bathroom every morning. This was something I’ve had problems with for years.

On the negative side, my nipples have been extremely sensitive and I have been getting this extremely anxious/jittery feeling every afternoon. It’s really bothered me to even have my shirt rubbing against my nipples with the increased sensitivity. Both of these symptoms seemed to have improved after Thursday of this week. I will be interested to see if they return after my second shot. I spoke to the pharmacist again about these symptoms and if an AI would be in order since I’m pretty much positive the nipple issue is related to E2 conversion. He seemed to think that these issues would subside as my body got used to the change in hormone levels. He said not to worry about it unless these issues persisted for longer than 1 month.


  1. Thoughts on my beginner TRT protocol until I see the new doctor? If I switch to 50mg twice each week, is 50mg/.25mL a large enough volume to inject twice per week? Also my test cyp is suspended in cottonseed oil and the directions that come with it say for IM use only, is this still ok to use subq? The brand name of the test cyp is Westward. Cottonseed oil seems to be a fairly standard oil to suspend test cyp in but I’ve read about a lot guys getting site reactions from it which concerns me since I’ve had hive related responses from medications in the past. Ive also read that if your shbg falls on the high side, once per week injections are better to drive FT higher. I’m not sure if I fall on the high or low side based on my level in the blood test.Thoughts?

  2. What are your thoughts about the anxiety/jittery reaction and sensitive nipple response in the afternoons? Do I need to pursue an AI immediately or take the pharmacist’s advice and give it some time? Since I have had joint/bone issues (osteopenia), I have really been concerned about driving E2 too low. I’ve had no bloating this week even with the upped water intake. Actually I’ve felt less bloated and weight has been steady. I’m sure that my E2 was super low when my total T was 122 and free T was 20 before being treated for the prolactinoma. I’ve worried about adrenal fatigue since my cortisol always seems a bit low. BTW, the cortisol test below my not be accurate since I talked to the doc so long before my blood test and blood wasn’t tested since about 10:30am. (UPDATE 3/21, Nipples have calmed down after this week’s shot and jittery feeling is gone. Still big improvement in joint pain. Not sure what E2 is at the moment but joints feels better than when when I had the blood test. E2 was almost ideal level in test.)

  3. Thyroid questions (blood test include TSH, free T4, Total T3 (not sure if this is the same as free T3 like I asked the doc to check), and TPO): Below is a temp sample (I can definitely get more if needed):

I read your sticky on thyroid basics (great read but still unclear about how much IR if needed). Thoughts?

Is the 55 mcg of selenium in my multivitamin sufficient? It was 200 mcg but they’ve lower it in the new bottle I bought :frowning:

6:30am 97.0
1:30pm 98.3

6:30am 96.9
1:30pm 97.9

6:30am 97.2
1:30pm 98.1

6:30am 97.2
1:30pm 97.3 (I was stopped by a co-worker before taking this one and chatted for a minute so I don’t think this is accurate)

  1. Last, this is more of an observation than anyways. I’ve noticed that my ALT is always a little low in every blood test that I get. I’ve read that high ALT can indicate liver issues but docs always gloss over my low ALT and tell me nothing to worry about. I found this article linking low ALT to frailty and early mortality. Perhaps this could be another indicator of insufficient hormones.

Thanks in advance as always.

TESTOSTERONE, TOTAL 2/23/2018 381.00 300-1080 ng/dL

TESTOSTERONE FREE 2/23/2018 65.00 47-244 pg/mL

TESTOSTERON %FREE 2/23/2018 1.70 1.6-2.9 %

SEX HORMONE BINDING GLOBULIN 2/23/2018 38 11-80nmol/L

LUTEINIZING HORMONE (LH) 2/23/2018 2.5 MALE 1.2-8.6mIU/mL

Follicle-stimulating hormone (FSH) 2/23/2018 2.9 MALE 1.3-20.0mIU/mL

ESTRADIOL by Tandem Mass Spectrometry(E2) 2/23/2018 22.8 MALE 10.0-42.0pg/mL

PROLACTIN 2/23/2018 5.0 MALE 3.0-14.7ng/mL

0 -49 0.0-2.5ng/mL
50-59 0.0-3.5ng/mL
60-69 0.0-4.5ng/mL

70 0.0-5.5ng/mL
The percentage of Free PSA can be used to enhance the differentiation of prostate cancer from benign prostatic disease in patients whose PSA levels are between 4.1 and 10.0ng/ml.

TSH 2/23/2018 1.80 0.34-5.60 uIU/ml

Free T4 (Thyroxine) 2/23/2018 0.80 0.6-1.1 ng/dL

Total T3 2/23/2018 125 70-204ng/dL

THYROID PEROXIDASE (TPO) 2/23/2018 0.7 0.0-0.9IU/mL

Cortisol 2/23/2018 5.90 ug/dL
Normal diurnal variation of cortisol results in peak levels at 6-8 am (6.7-22.6 ug/dL)and nadir by 11 pm (0-9.9 ug/dL). Correlation of result with time of collection is required.

Ferritin 2/23/2018 108.00 24-336 ng/mL

WBC 2/23/2018 6.90 3.5-10.5 K/uL

RBC 2/23/2018 5.43 4.20-5.60 M/uL

HGB 2/23/2018 16.00 g/DL 13.5-17.5 g/dL

HCT 2/23/2018 47.50 38.0-50.0 %

MCV 2/23/2018 87.40 80.0-100.0 fL

MCH 2/23/2018 29.40 26.0-34.0 pg

MCHC 2/23/2018 33.60 31.0-37.0 g/dL

RDW 2/23/2018 13.00 12.0-15.0 %

Platelet Count 2/23/2018 241.00 150-450 K/uL

Neutrophils 2/23/2018 58.00 45-75 %

Lymphocytes 2/23/2018 33.00 20-50 %

Monocytes 2/23/2018 8.00 0-8 %

Eosinophils 2/23/2018 1.00 0-5 %

Basophils 2/23/2018 1.00 0-2 %

Absolute Neutrophils (including precursors) 2/23/2018 4.00 1.5-7.0 K/uL

Absolute Lymphocytes 2/23/2018 2.30 0.8-4.0 K/uL

Absolute Monocytes 2/23/2018 0.50 0.0-0.9 K/uL

Absolute Eosinophils 2/23/2018 0.10 0.0-0.6 K/uL

Absolute Basophils 2/23/2018 0.00 0.0-0.2 K/uL

Cholesterol 2/23/2018 194.00 see below mg/dL
<200 mg/dL desirable 200-239 mg/dL borderline high >239 mg/dL high risk
Triglycerides 2/23/2018 109.00 see below mg/dL
<150 mg/dL normal 150 - 199 mg/dL borderline high 200 - 499 mg/dL high >499 mg/dL very high

HDL Cholesterol 2/23/2018 43.00 see below mg/dL
<40 mg/dL low >59 mg/dL high

LDL Cholesterol (Calc) 2/23/2018 129.00 see below mg/dL
<100 mg/dL optimal 100-129 mg/dL near or above optimal 130-159 mg/dL borderline high 160-189 mg/dL high >189 mg/dL very high Note: result calculated using Friedenwald equation: LDL = Tot Chol-(HDL+(Trig/5)). Marked aberrations of cholesterol or triglycerides may result in unreliable calculated LDL values.

Non-HDL Cholesterol 2/23/2018 151.00 see below mg/dL
Non-HDL cholesterol (total cholesterol - HDL cholesterol) is a secondary target of therapy in persons with high triglycerides (>199 g/dL), with the goal set at 30 mg/dL higher than that for LDL cholesterol.

Glucose 2/23/2018 85.00 70-99 mg/dL

BUN 2/23/2018 12.00 6-20 mg/dL

Creatinine 2/23/2018 0.92 0.90-1.30 mg/dL

Calcium 2/23/2018 9.80 8.6-10.0 mg/dL

Sodium 2/23/2018 138.00 136-145 mmol/L

Potassium 2/23/2018 3.90 3.5-5.1 mmol/L

CO2 2/23/2018 27.00 22-32 mmol/L

Anion Gap 2/23/2018 7.00 5.0-15.0 mmol/L

Albumin 2/23/2018 4.80 3.5-5.2 g/dL

Bilirubin, Total 2/23/2018 0.70 0.3-1.2 mg/dL

Alkaline Phosphatase 2/23/2018 58.00 34-104 IU/L

Total Protein 2/23/2018 7.70 6.4-8.3 g/dL

ALT 2/23/2018 16.00 17-63 IU/L

AST 2/23/2018 21.00 15-41 IU/L

Calcium (corrected for albumin) 2/23/2018 9.20 8.6-10.0 mg/dL

BUN/Creatinine Ratio 2/23/2018 13.00 RATIO

Phosphorus 2/23/2018 3.10 2.4-4.7 mg/dL

Total Protein 2/23/2018 7.30 6.4-8.3 g/dL

Vitamin B12 2/23/2018 590.00 211-911 pg/mL