T Nation

Restarting TRT/HCG: My Protocol

Hey everyone, if you have checked my past threads you will see that I was on TRT for 6 months but decided to stop in order to have my sperm frozen. I stopped TRT on March 1st 2020 and yesterday I managed to freeze a decent sperm sample ( 21M/ml ) and now am ready to get back on TRT.

I couldn’t nail the exact protocol last time due to adding HCG +HMG + Proviron + DHEAs at the same time as TRT which shot my E2 through the roof.

It didn’t help recover my fertility nor resolved my symptoms ( even though it improved a bit ) so that’s why I stopped.

My main symptoms before TRT and right now are low libido and ED. Ah, I am a 34 year old male, fit and workout 5 days a week.

On the protocol that I am going to start now and that I discussed with my doctor, we are going to add HCG in order to preserve fertility.

What he suggested to me was:

25mg T Enanthate EOD ( 100mg / week )
150 IU HCG EOD ( 600 IU / week )

To be mentioned that naturally I am a low SHBG / low E2 guy.
I am attaching here my blood tests I did 2 days ago.

Thoughts on the protocol overall and if you think TRT is the solution to my ED problems?

25mg EOD is only 87.5mg not 100mg. 150IU HCG EOD is 525IU not 600IU.

I would be surprised if that was enough T to get you into the upper level. HCG will help with T levels but can also push E2 levels. I wouldn’t add the HCG now, there is enough literature out there showing you can add it in at a later stage to address fertility.

Rather do the Dr suggested T, get tests again around 6 weeks, assess how you’re feeling and see bloods. Then increase or decrease dose to arrive at a good spot. Add HCG when needed.

Agree with the prior post. Check your math.
(25/2) X 7 = 87.5mg/week T-eth
(150/2) X 7 = 525 IU/week HCG

Regarding the starting protocol, you will probably find this will boost your T, but you will probably be happier with a higher dose. Assuming your doc buys into upping the dose, I recommend increasing it to at least 30mg EOD (105mg/week) and then retest in 6 weeks. I recommend you shoot for getting Free T in the upper 75th percentile of a 20-30 year old man. You may have to do one or two 20mg/week dose adjustment after that. Always give your system at least 6 weeks to stabilize and then retest and make adjustments based on the labs.

Regarding HCG, given that your goal is maintaining fertility, I recommend increasing the dose to about 1000 IU/week. There are 2 good studies that show this is about the right amount to overcome testicular suppression as measured by intratesticular testosterone levels (ITT). See the graph below.

I would not worry about E2. My experience with 1000 IU per weeks indicates that it will not affect E2 levels. I believe this has been repeated over and over in the forums to the point where it’s taken as the “truth”? but where’s the evidence? My experience is to the contrary. E2 is a difficult hormone to measure, it bounces around a lot, and too many guys get their undies in a bundle over it. It’s not the evil hormone it’s made out to be. Guys need E2 too for normal libido and erections.

Sorry for the confusion, my protocol is 100mg T / week and 600 IU HCG / week. I thought EOD meant 4 times per week.

I also think I should go for 1000 IU HCG per week but don’t know how to split it to minimize E2 spikes. Each HCG vial is 1500 IU. In the past injecting 1500IU in one shot gave me bad sides so I dont want to go in big one shot doses.

Also my doc was fine to give me up to 200mg / week but I told him I want to start low ( since Im low SHBG ) and increase it needed later on.

This is not 100mg, it’s 87.5mg, just FYI [quote=“rimseb, post:5, topic:268206”]
I thought EOD meant 4 times per week.
[/quote]

30mg EOD is 105mg, prolly as close as you can get. 4 shots one week, 3 shots the next

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I suggest that the HCg be broken up into at least 3 injections per week. The studies that were the subject of the graph used and E2D (every 2 days) protocol. My standard protocol is 450 Iu E3D. This works well with E3D T-cyp injection protocol. Injections are always on the same day, so it just makes administration easier.

I support your approach on starting low and increasing the dose until there is complete symptom abatement. In my case that occurs around 125mg/week, but everyone is different. I’m at the opposite end of the SHBG spectrum. My SHBG is typically in the 80+ nmol/L range. With low SHBG, you will probably do better on a more frequent injection cycle than longer intervals, or at least that what a number of guys with low SHBG I’ve communicated with have said.

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Thanks for the detailed reply, very useful.

I am thinking of going with HCG 150IU every day for a month (1050 IU / week ) and do a sperm analysis to see if it’s working as it should.

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The way I figure out EOD dosing:

30mg EOD would be:

30x15 divided by 4. 112.5mg per week.

15 is the number of times per month you inject. Then divide by 4 weeks per month.

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30mg EOD -> 30x7 (7 shots every 2 weeks) 210 / 2 weeks = 105mg weekly. It won’t line up right if you go off monthly shots, since some months will have more days than others

Quick update, talked with my doctor and in fact it’s 25mg T EOD ( so one week 100mg the next 75 ) and the same for HCG , 150IU EOD.

Thoughts on this protocol?

It’s basically 87.5 per week since you are doing every other day. I mean… you are not going to notice a difference from week to week. Lower than most but if you are doing EOD shots you won’t have troughs so your levels could still be pretty good.

Seems like a pretty low dose to me. Any particular reason to start that low?

Regarding sperm analysis, it takes at least 3 months for the sperm cells you produce today to reach your ejaculate. It’s a very slow process of production and maturation as they migrate through your reproductive system. So, you should wait probably 4-6 months before doing any sort of analysis of the success (or failure) of HCG. Between 3 and 4 months, there will be a mix of old and new (since treatment) sperm cells, so waiting at least 4 months is advisable.

Regarding your protocol of 25mg E2D (EOD), I’ve already given my advice there. It’s an OK place to start and with such a low dosage, frequent injections are a good idea. My experience is that with more frequent injections, you can get by with lower doses because it the naidr (low point) where you feel your worse. With frequent injections, you raise the low point and lower the high point, so an overall more stable blood levels of T. I do thing though, that in about 6 weeks you should evaluate bumping that up about 20 mg per week for 6 weeks, retest and evaluate if another bump is needed.

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I’m curious about this process. Say I’m on HCG today, it’s a high enough dose to produce sperm… all is going well, then I stop taking it next week and start back the following week (i.e. skipped 1 week). Will the sperm I made today still eventually end up being viable a few months from now, or will stopping HCG at any point along the way stop all sperm from going through whatever process, resetting the ~3 month clock.

I’m mainly asking because I’ve been on it for about 3 months now and we are trying to conceive. I’ve missed a week or so of injections probably twice in the last 3 months and I’m curious whether each of those is basically a total reset to the 3 month clock or if I’ll just have less sperm at certain points along the way as those missed weeks reach the ~3 month mark.

To be honest, I have no idea. My gut says that’s it’s not an all or nothing response. The week break probably just means that there may be a gap in the count at a certain point downstream.

Keep in mind too that it’s not just the FSH component of HCG that is important in stimulating spermatogenisis. The LH component is equally important. Sperm cells need much higher Testosterone levels than are present in the blood for final maturation. When testicular T production is low, the sperm cells do not mature fully or normally. This is why Intratesticular Testosterone (ITT) is used as a marker for fertility. When it is low, morphology and motility of the sperm cells are abnormal.

If you are trying to conceive, my best advice is to maintain weekly doses of about 1000 IU split into an E2D or E3D protocol. This level has been shown in 2 studies to bring ITT levels back to normal in healthy males given 200mg of T-eth/week to suppress T production. See the graph below I made from these studies.

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Thanks, makes sense. I’ve been doing 500 IU’s 3x a week (1500 total a week). Looks like that should be enough to get my levels up… the wife wants me to get a semen analysis done and I’m not looking forward to it

A semen analysis at some point beyond 4 months of HCG therapy sounds like a good idea. It will tell you whether HCG alone is enough to bring fertility up to sufficiently for conception. However, HCG has only weak FSH activity, so you may need to add in clomid or enclomiphene if you can get it to bring FSH up. You need sufficient FSH to initiate spermatogenisis. LH finishes the job with high ITT so that they mature properly.

A second semen analysis 4-6 months after adding in clomid will also give you information on whether or not you have to come off of TRT. Some guys find it necessary, while others do not. I’ve read mixed stories in the forums.

Keep in mind too that I’m not a doctor and a fertility expert’s advice is probably warranted. I have an advanced degree in reproductive endocrinology and my thesis involved GnRH control of LH/FSH production, and I read a lot, so I happen to know a little about this subject.

Thanks. I was considering HMG/FSH as a backup option if I have to use something else to increase fertility. The downside is the cost of going that route. That stuff is like $600 a month or something like that.

I was a crazy person on Clomid (tried it before going down the TRT path) and really, really don’t want to do that again. Perhaps enclomiphene will go over better, if necessary. Hopefully she’ll be pregnant before 4-6 months but I guess we’ll see. I’d really rather not come off TRT but if I have to then that just may be what I have to do.

I’m going to go ahead with the semen test now and just get some idea of what is happening and then go from there