T Nation

Restart: Help Understanding LH/FSH - HCG Correlation

Been on TRT for 1.5years, varying doses (all within 80-160mg/week), on/off HCG and AI, trying to find my optimal dose (T caused me severe back acne). Finally decided to come off to see what would happen.

Pre TRT labs:
-Total T 350-400 (300-900)
-Free T 6-7 (8-25)
-Estradiol 14-18 (8-42, not sensitive)
-Diet wasn’t optimal at the time and I was on calorie deficiency + didn’t get all the fats I should have -> may have jumped on TRT path too fast after all

Protocol I used to stop:

  • HCG 400 IU EOD on parallel with T for 2months
    -dropped T, only HCG 450 IU EOD for 4weeks
    -felt like shut from week 2 onwards, all low T and high E symptoms
    -acne totally cleared up though…

Labs after 4weeks
-total T 190 (300-900)
-Free 6 (8-25)
-FSH 1.6 (1.5-12.4)
-LH 1.8 (1.7-8.6)
-no HCG for 3days prior labs

I know I should have used SERM and followed one of the many protocols on this site. My question is however if these labs indicate anything to you? Shouldn’t the HCG have simulated some natural Test production? Should LH be higher, stimulated my HCG (or is HCG just acting like LH but doesn’t actually effect LH levels itself?)?

  1. hCG only mimicks LH at the androgen receptor. It does not stimulate natural LH secretion by the pituitary, on the contrary it shuts down the natural LH secretion if injected at high enough levels
  2. hCG has a half life of about 2 days, so 3 days after the last hCG injection you still had some of the hCG in your system

-> what most likely happened: The LH and T levels of your last blood test are quite meaningless as you most likely have just been in a transition state between LH secretion surpressed by the hCG but partly LH secretion recovered due to the low systemic concentration 3 days after the last injection

You need to stay off the hCG for a minimum of a week (ideally 2 weeks) before the next blood draw to get any meaningful results regarding your natural T levels.


Thank you johann, very much appreciate the quick reply.

  1. What is high enough levels? Was 450iu high enough to do that? I know for sure my LH was <0.1 some months back.

  2. Yes I did. The original thinking was to see if HCG could have boosted my T to acceptable levels+if LH/FSH were working/giving even weak signals for the body’s own system to do what it’s supposed to do, is yes, drop HCG completely and retest in x months. Did not know of point 1 you made.

What’s the conclusion here? Are there any chances that my mean my natural T could actually be significantly higher than the measured 190? Just trying to think “what now”.

Give it some time. You’ll likely go back to your pre TRT levels but it isn’t going to happen overnight.

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Johann covered pretty well. The HCG will stimulate the boys, the Clomid or Nolvadex is to stimulate the pituitary to produce LH. Whether or not it will work depends on why you were low to begin with.

Thanks all. I spoke with my doctor and here’s what he suggested:
-HCG 3x4000IU/week
-Clomid 3x50mg/week
T, E, FSH, LH monitored on 4w periods and protocol runs as long as needed.

In my understanding - on this forum HCG and Clomid are not recommended to be taken at the same time, right?

Also something he said I’d like to get your input on: it’s okay to use Testosterone while doing this recovery cycle, as long as amounts are less than 75mg/week as HCG/Clomid will offset any ‘harm’.

That is correct.

No. He’s delusional. Any quantity of exogynous T induces shutdown making the Clomid irrelevant and making this not a restart in any way.

I’ll do 4weeks just HCG, then labs followed by 4+weeks Clomid if they look okay. No test.

Any feedback on the dosage?


Furthermore- I’m reading AIs don’t work on HCG caused Estrogen issues and the only way is to adjust the dosage if such occur.

Question: should AI still be used with HCG in this protocol? I personally do easily convert to E and have had issues with it in the past.

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There are 2 ways for your body to “make” E2

1.) Testosterone is converted to E2 via aromatase enzyme
2.) A small amount can be created directly in the testicles

The amount of E2 being made via #2 increases when you put your balls into overdrive via HCG, so that’s the piece you can’t control with an AI

However, you can still regulate the amount of T being converted to E2 via aromatase with AI’s

I don’t know what the ratio is or how effective an AI will be while on HCG, but obviously it’s clear it will be less effective than it would be if none were being made in your balls.

But… this is all temporary if you’re ultimately trying to get back to working “naturally” and stopping T/HCG/Clomid, etc., yes?

This is actually via aromatase as well, last thing I read said that anyway. The problem is there is a barrier like the Blood/Brain barrier that keeps the AI out of the testes and that zone. That means that you suppress the enzyme everywhere except where the HCG is actually doing it’s magic.

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Thank you for the clarification. The purpose is to see what levels of natural T and E my body would settle after a correctly done restart and how I’ll feel. Im in my mid-30s and don’t want to spend rest of my life wondering if I really should be pinning T.

Here’s where we are after this protocol: HCG 2000iu/EOD for two weeks, followed by Clomid 25mg ED ~ 3 weeks, AI taken occasionally.

T total: 474 (264-916)
T free: 10.1 (8.7-25.1)
E: 8.9 (non-sensitive)
LH: 7.8 (1.7-8.6)
FSH: 4.4 (1.5-12.4)
IGF-1: 169 (88-246) not sure why doc included this

I’m not sure how to feel about the results. I’ve gained fat in the past few months with my restart efforts, workouts aren’t like they used to be, not as strong anymore. I don’t feel as strong and confident otherwise either, if you know what i mean. Libido has diminished (literally nothing can arose me right now) but that may just be the Clomid.

I think I was hoping for low results and justification to go back to Test now that I’ve remembered how it is without… How do you guys read the results? What should I do next?

I was thinking of waiting for four weeks to have the Clomid clear out from the system and re-take the labs just to be sure at least.

Honestly the results are terrible given that your E2 is very low, I have seen men diagnosed with osteoporosis with E2 levels in the mid teens. Unless you can attain supraphysiological LH levels, TRT is in your not so distant future.

Thank you for the input @systemlord - please know that the low E2 can likely be explained with the 0.25mg Anastrozole I took maybe 5days prior the labs as I felt slight breast tenderness and I’m very cautious of gyno due to previous problems with it. I should have stated this in the post more clearly, sorry.

Given the LH/FSH levels where they are, should I expect T levels be higher?

I don’t expect levels to increase, you have regressed and gain fat and I think it will continue. If a clomid restart works usually levels hold and patients don’t backslide.

Thanks. I’ll report back in four weeks after one more set of labs before making the final call.

Results came back with Total in Low 400s, Free ~9 and I’m back on the Testosterone now…

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