T Nation

On TRT 8 Years, Testicular Atrophy, hCG

I am a new member and arrived with many questions. But knowing how irritating it is to have someone post a question that has been already answered in the forums, often several times, I’ve researched this site for over a week before posting and will be doing so for a long time.

I have found answers here to much of what I needed to know and can’t say how much I appreciate it. So I’ll just focus on what I’ve learned for now and ask a question or two, which may well provide me with all I need, as the data base here is so full of info. I’m posting here because my problem is specifically with TRT and the only negative symptom I have that I’m aware of, which is testicular atrophy. As for high E levels, I know from reading here that I need to get that blood work done before I can get feedback on that. But since I’ve been on TRT for so long (over 8 years, never missed a day) I’m concerned and I definitely want to check everything out.

I guess this has been said by countless guys newly posting here, but I’m just baffled (and damn pissed to be frank) that I’ve been on TRT for 8 years and only now am learning about the full protocol and how important it is, in many cases, to supplement the T with an AI and hCG, at least. And I did not go into it lightly, I did a lot of research, or should say I spent a great deal of time and effort to learn about TRT. The problem is, when your sources are deficient then you can cover them 100% and still be ignorant of the whole picture. I guess this is what gets me. Never, not once, anywhere did I read or hear anything about testicular atrophy, and very little about the problems of increased E with TRT. I knew what these things are and would have certainly taken steps had I known they could be a real problem. Of course this was over 8 years ago but I have tried to keep informed since, clearly not well enough. I think because I’ve done so well overall I didn’t remain as diligent as I should have. But all I read about TRT, even at Vanderbilt Med Library (a top research university in my home town), was the possible (and erroneous we know now) risks of prostate cancer, and possible gynecomastia. So, excuse this rant … I know I’m preaching to the choir (or to the bishops, so to speak) but it pisses me off. So I’m just grateful for you guys and the huge data-base you have spawned here.

So I guess for now I just want to get some confirmation about what I need to do for the testes problem, which is, I feel certain, to get on hCG. I will give further info in future but for this purpose I’ll give basics (but will gladly provide more stats now if that’s better).

I’m 57, 6ft., 160lbs, very low body fat (don’t know numbers), have done resistance training for much of my life, off for some years but steady again for last 10 years. Good diet and blood sugar levels. A major change came when I began TRT about 8 years ago. I began with transdermal gel, Testim, since my insurance totally covers it. I know it’s not the best form but I suppose I must be a good absorber and all, as I got great results very fast. Before that I had seen little results from my weight training, although I was using good form and have experience. With T I quickly gained more muscle mass, lost more body fat, great rise in libido, etc… the expected stuff with good T replacement. One of the most intense benefits was not physical but rather mental. I had been having depression, sometimes severe, for a few years and T not only helped, it dispelled the depression entirely. This was unexpected but greatly appreciated! In fact I am still having good results. My numbers have always been between 800 and 1345 TT (Quest, 241-827mg/dl), and it was 1335 on my last test a month ago. I’m on what I assume is the standard dosage: 1% gel, 50mg daily. But always wanting to learn more and I took note when I saw this site on a Google search. Also I think I had suspicions by now about a few issues, like the smaller testes and tight scrotum.

I couldn’t believe when I first saw the info here about shrinking testes, I like did a double take (is that possible when reading?). I noticed it a few years ago, slowly but surely, and it’s become a real drag. But my libido is great, even in overdrive at times, which I don’t mind at all, and my erections are good, plenty of semen and strong ejaculations. But the descriptions on here about the smaller testes and especially the tight sack, could have been taken from my own profile. Truly it’s like before I went through puberty. My cock is fine, and I’m very sensitive, have great orgasms, so I was not as concerned until recently. Also my testes are pulled up so high, almost into my body. No pain, just a tendency to pull down constantly on them, they don’t feel right and don’t hang at all, as they always did before. I just never knew what the hell it was, nor did my doc. I never had any illusions about the range of a doctor’s knowledge (or lack thereof). Having a couple in the family., well, 'nuff said. But it shouldn’t have taken 8 years to even hear about this. Thank you all here for providing much, much needed info!

So am I correct in my thinking that I need to get on hCG? I can get all the protocol info (dosage, injection info, etc) from the stickies and links. I just wanted to run this by you all and get right to work on it. Then I can return with full blood-work numbers and get your take on a possible AI if my E is high, plus anything else. I have the suggested blood-work I need to get from a couple of posts and stickies here, so can take care of that. But it may take some time to get my docs to put out for full bloodwork; damn, I thought my days of conning the croakers were over… (sorry, I’m an ex-addict, proudly 20 years clean now, but the lingo dies hard). Also, I think (hope) I found a decent site for ‘research chemicals’ as I suspect a problem with a script for hCG.

If I can get this first problem handled it will be a great start. I’ve learned so much here in a weeks research and am putting it to use already, and will continue to read and learn. I take it very seriously; I haven’t made it to 57 by screwing around (well, maybe some) but you take my meaning, which I guess is simply that I seldom do things in half-measures. At this age you realize more than ever how very important your health is, every second. Well, I’ll sign off for now. Thanks for any help. Stevie


You are on the right track with your hcg need…get it through pharmas if you can–UGL’s are hit or miss, and a lot of them are scamming now with the popularity of the hcg diet…

Also, its great you did your research, but come on man, you don’t have to write War and Peace for your introductory post…took me about 5 minutes to get through it! Bullet points!

Thanks VTBalla34, Point taken. Sorry about the length of post. That’s what happens when you’re a writer, hell and that was with a major edit. I gave even more personal info in the Beginners forum and guess that was where it belongs. In future will stick to stats and most relevant stuff. Yeah, I’ll definitely try my best to get a script for hCG. Thanks for the confirmation, that’s what I was looking for. Will return with results and update, etc. Thanks again man.

welcome on board… (yes, it was a long read, but unlike other long posts, at least it flowed and kept my attention).

yes, HCG might be able to help, but you need to be careful.

you seem to be doing fine with your current treatment plan, and if you are not planning on having kids, then it is an aesthic concern mainly - I am not saying it is not a serious concern or downplaying it all, but you need to weigh that against the possible disruption it could cause to your system.

IF you start HCG, you may want to start out very slowly (100iu every three days) and gauge your reaction for two weeks, then maybe increase another 50iu, then on up to the 250iu E3D standard.

please post test results when available. have you been monitoring your other systems as well? TSH, Cortisol, etc.

Thanks Pure Chance! That info is very helpful. I’ve gotten different info on beginning doses and definitely want to be careful, so will follow your advice. What is my main concern with the HCG, higher E levels?

I’m past having kids and it’s not important to me anyway so it’s just for my health. The testes problem really is uncomfortable, sometimes to distraction. You know, it’s a total thing I guess, in addition to the aesthetics of it. I don’t relish the idea of any organ failure.

Yeah, I need to get full blood work. This is a problem as it takes forever to see my doc and I don’t know yet how cooperative he will be. I can get 1,000iu of HCG now from a reliable source, so I’m thinking I’ll try your suggested dosing (I have experience with injections) for, as you said 2 weeks and assess.

I will get all the blood work suggested in the stickies, as much as possible, and post soon as I can. I had it done a bit over a month ago but they did very basic stuff, no TSH or fee T4, cortisol, etc, but I’m going to request a full panel of all I can get, especially E. What I have now isn’t really worth posting, so much is missing. Mainly did TT: 1335 and PSA: 0.4, both good (all are Quest ranges). So I need to get some numbers and will report. Thanks so much for taking time, both you guys. Guess I need to sign off before I write a sequel (ha). Stevie

If you’re looking for complications, there’s a thread here about the possibility of prions in HCG that hasn’t been discussed enough to my liking.

Thanks dooright… will check it out. The more info the better.

I’m not an expert on HCG, I just know some are more sensitive to it than others so that is why I was recommending a slower than normal start.

If you were jumping in without prior treatment, you probably could just start at 250iu, but since you have a treatment plan that is working (best to confirm with test results that nothing is too far out of whack), you want to make slow incremental adjustments so that you can go back if new symptoms/issues come up.

HCG is a great start but if it does not give you the result you want, I would suggest doing some research on Clomid. I used it for 3 weeks during the summer with good results. I think Shippen uses it to try to restart guys who are shut down.

Thanks guys! I have a doc appointment next week so hope to get full panel done. Also will see what my insurance will cover. Good news is I looked at the formulary (Blue Cross RX) and it covers anastrozole, in case I need that but don’t think it covers HCG, so will check on Clomid. Damn, it’s not the protocols that are so difficult but all the issues of doctors’ compliance, insurance coverage, etc. So I want to try to get all the info I can, post it here and look at my options. I really appreciate everyone’s help.

I got an appointment with my doc, finally. I’m requesting the more comprehensive male panel and other blood work suggested here and will get as much done as I can. I require no blood work to know that I need a script for HCG, as a brief physical exam of testes will reveal. But will need to get results of E2 levels before he will know about prescribing an AI.

I’m fairly sure he has never written for HCG nor for an AI, in case my blood work shows high E2. So I wanted to ask if anyone could give me some info on how the scripts are usually written.

I will give him the info I know, and I’m printing out some of the excellent info posted here, and a couple of papers by Dr. Crisler, etc. So he will know the standard dosage for HCG is 250 iu E3D, sub Q. But is this usually written for a month supply with refills?

Same with an AI. From the research I’ve done I feel that anastrozole would be best for me, plus my insurance does cover it (generic, but not Arimidex). Again, is this usually written as a monthly rx with refills?

I simply want to cover all bases so he will have all info on this visit, as it’s very difficult to get in to see him. I think I have most else covered, hopefully. This appointment is very important so I really appreciate any help. thanks, Stevie

A lot of insurance companies require a predetermination for HCG nowadays–be sure to square that away or you will have a long wait…it is also very difficult to find places that carry it. Costco ordered it for me.

The doc should write the script in a way that helps your insurance pay for it–most likely for a “one month supply” that you just go and refill every 2-3 months or so (a lot of people throw it out after 60 days as its shelf life is limited).

Same with adex–one month supply. But if your doc writes the script for, say, 3-4 mg/week, you will take only a portion of that and have it available for months from the single script.

Thanks man, that’s exactly the info I needed. My doc is usually good about writing to meet requirements of my insurance company, so that was a big concern for me, thanks for addressing that too. I’ll post here as I make progress, and give blood work results as well. Thanks again!

I finally got my lab results back. My doc sends them by mail so I haven’t had a chance to discuss it with him. He gave me no scripts yet and I will give more info on the appointment in a follow-up post. For now I want to get these stats posted. I gave a lot of personal info at beginning of this thread, but here will give basic info requested in stickies, etc, along with my recent labs.

On TRT for approx 8 years: Testim 1% gel, 50mg daily
Age: 58
Weight: 160
Waist: 34" (was always approx 30-32 until around age 50)
Height: 6 ft.
Where you carry fat: Stomach (very front only, around navel) and obliques (love handles). These are the only places. Very little anywhere else. Strangely, after starting TRT I lost some fat everywhere, but actually gained it here.

What supplements do you take: Multi vitamin/mineral supps, whey protein, flax oil, digestive enzymes.
What meds to you take, Rx and OTC: Testim 1% gel, 50mg daily.

What other illnesses, history of infections or surgeries [not in detail] has implications for adrenals: The only thing I’m aware of that may be a factor is exposure to insecticides. A long story so will just say that it resulted in severe sensitivity to many substances: bleach, ammonia, gasoline, certain plastics, etc. Diagnosed as MCS (multiple chemical sensitivity). Fortunately over the last several years I’m much less sensitive.

Do you feel cold easily: No
Do you use iodized salt or have iodine in your vitamins: Yes
How do you react to major stress: Fairly well.
Any extremes of diet: I eat about a pound of cottage cheese (fat free) every day, and about 2 oz of raw, unsalted almonds. Otherwise a fairly moderate balanced diet. I eat about 5 very small meals daily.

Fasting cholesterol levels: Total cholesterol 112 mg/dL (Q 125-200 mg/dL). Doc says my levels have been consistent for years, very low, the best I could have. Don’t know if he’s right about it being the best.

Fasting serum glucose: 78 (on 11/24/2011); 94 (on 2/29/2012) Quest range 65-99 mg/dL

I have a few specific questions/comments concerning the labs but will put them at end of lab results, as footnotes*.
Blood drawn on 2/24/12, approx 2 p.m.

Chemistry Panel (Metabolic panel with lipids): All in normal ranges. Can give specifics if needed.

Complete Blood Count (CBC): All in normal ranges. Doc often writes notes next to my results, and for most of my CBC he wrote ‘perfect’, including Hematocrit (for what it’s worth).

Prolactin: 15.1 (2.0-18.0 ng/mL)

Free Testosterone: 77.6 (35.0-155.0 pg/mL) see footnote*

Total Testosterone: 619 (250-1100 ng/dL) see*

Prostate-Speci�c Antigen (PSA): 0.4 (0-4.0 ng/mL)

Estradiol: 33 (0-39 pg/mL) see*

TSH (Thyroid Stimulating Hormone) and T4 (?): my lab says:
TSH W/REFLEX TO FT4: 3.02 (0.40-4.50 mIU/L) Doc wrote ‘good’.

I requested everything suggested in stickies, etc, but obviously I didn’t get it all, mostly because insurance would not cover it. I would definitely pay out-of-pocket if possible, it is not.

  • Footnotes/questions:
    My main problem regarding my labs is with the ranges. Many are different this time from those I’ve had for years, making it difficult to observe any changes and make comparisons. Also, from reading the stickies and many posts, I at least knew what numbers to look for, especially for E2 and TT/FT. But now I find the ranges are all different. For E2 I know that 22 pg/mL is optimal in the former range but what about this new range (0-39 pg/mL)? VTBalla34 wrote that his Quest district has also changed to this reference range for their Estradiol test, but I cannot find any data for optimal levels. Same thing basically on the TT and FT numbers. I suppose I should be able to translate the numbers but I’m really not sure, so any help is appreciated.

I have a few more details & questions but don’t want to go overlong here so will address them in follow-ups. Thanks!

Since you are doing very well on TRT, I would not even think of using an AI at all. The fact that your libido is so good means that your estrogen is pretty much optimal for you.

I also wouldn’t bother with HCG if I were you, given that you are doing well and have been for years. HCG is notorious for throwing estrogen levels out of whack, which can then cause loss of libido, ED, fat gain, etc., among other symptoms.

I wouldn’t mess with success.

(This is from the point of view of someone who has lost all libido on TRT despite good blood levels of hormones. I wish I could have had your response.)

Thanks seekonk… yeah, overall I’ve done very well, especially for using a transdermal. But I’m having serious problem with my testes, I mean it’s not just cosmetic, much of the time they are retracted almost totally into my body. I didn’t get into the physical part of this recent exam yet, so that may not have been clear. I covered this problem at very beginning of this thread but not since, so I doubt you read that part. This is why I’m considering HCG. I’m in pain, not from within the testicles themselves but from the pressure (?) or tightness from them being so drawn up. My doc was shocked, literally. They have atrophied a great deal too, which he noted, but it’s the retraction that he was really surprised by, I would say alarmed.

I took my doc several good papers, excerpts from here, Dr. Crisler, etc. and he is open to it I think. Anyway, he is sending me to a urologist to get more info. I let him know that I didn’t have much expectation that a regular uro would be knowledgeable on this, but he knows of one that deals with many men on TRT, and I was able to get an appt on March 7. One thing for sure, I have to do something about this. I’m constantly pulling, trying to pull them down, often without realizing it , and that is causing it’s own problems (rawness, irritation).

So I guess I’ll see how the uro appt goes. If anyone has any ideas on my labs… mainly the E2 and TT and FT, I would appreciate it. I mean, do my E2 levels appear too high? I don’t know because the ranges are not the same as referenced here or anywhere I’ve seen. I think my TT is ok but have no idea about FT, once again, these ranges are different from those I’ve learned about here and elsewhere. Thanks!

Can anyone take a look at my labs? Mainly just need some help with the E2, TT and FT results. As I explain above, these Quest lab ranges are all different from what I’ve always had, or any I’ve seen discussed, so I don’t know how to interpret them. Actually this is the first time I’ve ever had E2 and FT tested. I know optimal levels for all these, as stated here in stickies and posts, but not with these lab ranges. I’m posting these 3 here again for convenience. I welcome feedback on all my lab results, but these 3 are most important:

E2 - 33 pg/mL (0-39 pg/mL)
TT - 619 ng/mL (250-1100 ng/dL)
FT - 77.6 pg/mL (35.0-155.0 pg/mL)

I really appreciate any feedback. Thanks!

[quote]StevieA wrote:
Can anyone take a look at my labs? Mainly just need some help with the E2, TT and FT results. As I explain above, these Quest lab ranges are all different from what I’ve always had, or any I’ve seen discussed, so I don’t know how to interpret them. Actually this is the first time I’ve ever had E2 and FT tested. I know optimal levels for all these, as stated here in stickies and posts, but not with these lab ranges. I’m posting these 3 here again for convenience. I welcome feedback on all my lab results, but these 3 are most important:

E2 - 33 pg/mL (0-39 pg/mL)
TT - 619 ng/mL (250-1100 ng/dL)
FT - 77.6 pg/mL (35.0-155.0 pg/mL)

TT and FT are excellent, and you feel good at those values, which is the best indication that you are where you need to be. There is no correct or optimal estradiol level. This is what the famous Dr. Mariano has to say about estradiol:

“What estradiol level is best for any individual often needs to be determined by trial and error. It is unique for each individual. Most do best around 30 pg/ml. But some do best at lower and higher levels. For example, I have a 65 y.o. patient with a total testosterone of 840 ng/dl and an estradiol of 47 pg/ml. He’s having the time of his life - able to make love numerous times each night - after more than a decade of having no sex. The estradiol level works for him without side effects. Some may do better with much loser levels of estradiol - the response is highly individualistic.”

I think the fact that your libido and sexual performance are good are a strong indication that you are where you should be with E2.

Thanks so much seekonk. Yeah, what you said makes sense. I think that it has just been frustrating to finally get the appointment and blood work only to find I cannot evaluate it due to all new ranges. But you are right, the most important thing is how I feel, which is good except for the testes problem, but blood work doesn’t address that anyway. I have an appointment with a urologist and am going just because my doc wants it. Maybe I’ll get that sorted out. As for the blood work, what would be nice would be a kind of conversion chart, I mean just for anyone dealing with changing lab ranges. I appreciate your input on my current labs, it helps a lot to get some feedback on it. Yeah, I felt like my TT and FT is good, just wasn’t sure. Thanks again!

your E2 test doesn’t seem like the right test. so it could be estrogen, but a TSH of 3 is the biggest warning sign I see.

3 is not GOOD as indicated by your doc.

you really need to check FT4, FT3, RT3, and 8am cortisol.
vitamin D25-OH and ferritin can also be helpful.
please check out stopthethyroidmadness.com