T Nation

What to Expect from HCG Mono/TRT?


#1

I am 34 years old, lean muscle, fit, and collapsed six months ago with persistent ED, low libido, general apathy with life, no motivation, and insomnia. I've had a few lab tests, am working with a very good doctor, and am looking for guidance based on all of your experiences.

My history: Suffered a physical/mental breakdown ten years ago at age 23 where I couldn't sleep, couldn't get an erection, and had extreme depression/anxiety. It was as though my body was being consumed by uncontrollable adrenaline. Went to numerous docs, had tons of labs done with a consistency each time: total T between 270-360, free T below range, low LH, and low FSH. Each doctor told me I was in range and normal and told me to talk to a psychiatrist and take Viagra. I realized I was on my own and started a regimen of vitamins, herbs, fish oil, 5htp, etc and was able to partially recover. I was able to sleep, erections got better but were still very lacking, depression/gloominess got better but still came and went, and I was able to have a sex life with Viagra.

Five years later at age 29, I eliminated the vitamins but kept the other supps and was able to have sex without Viagra with probably 70% erections and mood became much better. I started eating a lot healthier and exercising well and felt overall good and consistent and got married to an incredible woman.

Recent collapse: My wife and I want to start a family so I started taking an OTC fertility supplement with carnitine, ginseng, and maca in it. My libido skyrocketed and my erections (while still somewhat weak) became more frequent. Ten weeks later, I crashed with almost all of the symptoms I had ten years ago: insomnia, waking up in the middle of the night with heart pounding, ED, no morning erections, zero libido, no motivation, and anxiety.

Most recent labs:

Total T: 355 (348-1197)
Free T: 10.6 (8.7-25.1)
LH: 1.5 (1.7-8.6)
FSH: 2.0 (1.5-12.4)
SHBG 43.8 (16.5-55.9)
Estradiol 10 (8-35)
Progesterone 0.8 (0.2-1.4)
Pregnenelone 65
DHEA-S 366 (138-475)
Cortisol 18.1 (6.2-19.4)
TSH 2.3 (.45-4.5)
RT3 15.2 (9.2-24.1)
T3 113 (71-180)
T4 8.1 (4.5-12.0)

My doc is suggesting HCG 500iu ED and judging from the labs I'm secondary so that makes sense. My question is if anyone has been in this situation, what would you expect? If I'm having some kind of adrenaline/stress reaction causing all of these issues, would the optimal hormones likely ease this? Is the main benefit usually libido or does ease of erection/erection strength usually get better? I read of many guys getting on TRT and having their sex lives ruined and I've been hanging by a thread all of this time. I see it as a go for broke move, either a home run or it'll overstimulate my body further. Also, would you worry about the 500iu HCG every morning leading to primary hypogonadism? Lastly, have any of you found any beneficial changes to vision from HCG/TRT?

Sorry for all the questions but I'd love to hear first hand from other guys who have gone through this before. Thanks a lot!


#2

TRT really improves quality of life, when done right.
Your high SHBG is a big problem and can’t be explained by E2 levels.

I am wondering if your OTC fertility drug is the problem. Maybe something bogus in it.

TSH should be nearer to 1.0, yours is way to high. The ranges are misleading!
need fT3 and fT4 labs!

Check your overall thyroid function by taking oral body temperatures:

  • when you first wake up, should be 97.7-98.8, higher is OK, 97.3 is a problem
  • ALSO check for 98.6 mid-afternoon
    THIS REQUEST IS NOT TRIVIAL !!!

Your thyroid function could be a mess from not using iodized salt.
Sea salt, Celtic salt, Himalayan Salt messes up peoples lives.

Thyroid and/or low T can really mess up your life.

hCG can work, but works better the younger you are.
But doing that may increase SHBG more and limit gains, so looking for cause of increased SHBG is very important.
Injecting T has the same concerns.

Please read these stickies - carefully:

  • advice for new guys — then you might know more than your doc
  • things that damage your hormones

Provide a lot more info about you as per the first sticky.
Describe all medical concerns, digestive issues etc
List all medications, Rx and OTC as well as supplements and anything applied to your skin or wife’s skin.
Do you or have you consumed drinks with bromated vege oils?
Are you exposed to chemicals or fumes at work?
Any loss of width of peripheral vision?

Provide these labs if available:
CBC
AST/ALT
hematocrit
IGF-1
fasting glucose
fasting cholesterol
prolactin !!!


#3

Thanks so much for the reply KSman.

Information:

34 years old
6’0"
180
35i. Waist

Usually takes 2 days for facial hair to fill in, full head of hair, chest and belly hair, arm and leg hair

I used to carry weight on my belly with some love handles. Weighed 212 in 2012, then did 2 rounds of P90x and switched to a low carb diet, lots of meat and veggies, got down to 180. Now no matter how much I eat and don’t exercise, the current weight remains. No belly fat, no love handles, but muscles have def weakened over past year.

For ten years after last adrenal meltdown at 23 years old, supplement regimen has been: Aceytl Carnitine, DMAE, MoodMax (sexual health herbal/amino supp), 3 grams fish oil, 3 grams borage oil, calcium, magnesium, Vit D, 5htp. After adding in FertilAid supp and crashing, current doc has me on new regimen: methylB12, methylfolate, SAM-E, DHEA 25mg, Travacor, Aceytl Carnitine, DMAE, Life Guard B vitamin complex, fish oil, borage oil, copper, iron, vit A, vit D, vit K2, buffered C, calcium, magnesium, cayenne pepper, garlic, 5htp.

Rx: no history of propecia, 2mg of Prazosin alpha blocker at night for insomnia, 50 mg of Viagra as needed. On 10 day antibiotic currently to clear sinus infection - taking 300 billion, 14 strain probiotic 3 hours after antibiotic to prevent damage and continue to do so afterwards daily.

Labs see attached. These are from May 2015 right after I crashed but before the October 2015 results I posted above on docs treatment plan. What has changed since changing supp regimen? Cortisol has risen from 12 to 18, total T about the same, free T has plummeted, SHBG has risen from 32 to 44, TSH went up, LH has gone from 3 to 1.5, homocysteine is up too. As I noted above, I eliminated multivitamins five years ago and my free T improved nicely, I didn’t need Viagra at that point. I wonder if multivitamins are causing this and I do better on less. Interestingly, Dr Crysler on his forum said the best way to lower SHBG is to raise total T. I’ve also heard low SHBG guys do terrible on TRT. I could be mistaken but I thought the fact my SHBG levels were rising was good assuming I was going on HCG/TRT. If not, I need to keep it lower to do the best I can with what little total T I have naturally.

Diet is good, breakfast usually a protein bar or poached eggs, salads with white chicken meat, occasional cheeseburger, lamb, fish, broccoli, spinach, Brussels sprouts, pistachio nuts, turkey jerkey, Mexican food, some sushi. Used to drink one cup of coffee each morning but stopped after issues started. Same with occasional alcohol.

I wasn’t working out for about 8 months before I collapsed, so no overtraining.

Testes felt dead and got smaller, achey the second I stopped MoodMax. My LH dropped in half when I stopped that supplement and balls started hurting. If I take a MoodMax tablet, balls tingle again and firm up.

Morning erections lacking. Had them everyday until I crashed, now never in the morning. Occasionally, I open my eyes in the middle of the night and feel an erection but its a lot weaker than before.


#4

Labs


#5

Labs


#6

Labs


#7

Labs


#8

Labs


#9

Labs


#10

Anxiety, agitation, nervousness, and insomnia are among the first side effects that come up when googling ginseng. Carnitine is also infamous for causing anxiety in people who are prone to it. You seem to have a prior history of anxiety disorder which would make you more vulnerable to these kinds of side effects.

I don’t think you need to look any further than this for reasons for your crash.

Hopefully you stopped the supplements already. You may need to give things a few weeks to a couple of months to settle down again. A short-term rescue anti-anxiety or insomnia medication may be helpful in the meantime, but try not to make a habit of using them.

I wouldn’t trust lab results taken during your crash. Retest when things have settled down and are sleeping well again.


#11


You might consider trazodone 150mg for sleep. Start at 50mg fragments.
Also 5-6mg time release melatonin. Must be time release.
For me, vit-C at bed time seems to help too.

Hard to read the labs. But I did see mid-range SHBG/
Cholesterol is a bit low. Try eating differently.
HDL also improved, keep taking that B-complex multi-vit

Thyroid ideal levels:
TSH near 1.0, yours is a bit high
fT3 and fT3 should be mid range or a bit better, both are higher.

Check your overall thyroid function by taking oral body temperatures:

  • when you first wake up, should be 97.7-98.8, higher is OK, 97.3 is a problem
  • ALSO check for 98.6 mid-afternoon
    THIS REQUEST IS NOT TRIVIAL !!!
    ==============

Please respond:
Your thyroid function could be a mess from not using iodized salt.
Sea salt, Celtic salt, Himalayan Salt messes up peoples lives.
What do you use for salt and history of that…

Vit-D25 low. Take 5,000iu/day
find small oil based caps
take with a meal that has more oils/fats and less fiber
take DHEA the same way

Most males do not need to take iron and some need to avoid iron in supplements and iron fortified foods.
Is there a story here?


#12

Thanks for the replies.

I stopped that fertility supplement in early May and things haven’t gone back to normal yet. Getting to reset is going to take time and seems easier said than done. My doc thinks those ingredients basically jacked up my norepinepherine levels which caused imbalances/adrenal issues because I didn’t have the hormone levels protect and repair. He says T is calming mechanism that protects from stress. I just need more time to heal.

I actually have been grinding up pink sea salt in water 3x a day to raise my blood pressure and give my adrenals a breather. Maybe that’s what’s pushing my TSH higher, not sure. My wife cooks with sea salt but I eat out often too and am probably getting regular salt that way.

I’ll have to look into the Trazodone. Did you find that higher T helps you sleep better? Maybe cortisol would have more to do with that than T but would love to hear about your experience.

I pushed my Vitamin D from low 20s to 53 last reading a few weeks ago. Still felt no difference with D3 supplementation and T still in the gutter. I’m still taking NOW D3 5000iu daily.

Its funny you mention iron. My ferritin levels are apparently good but it isn’t available to me - my iron is below range. I currently have too much zinc and low ceruplasmin so I’m now supplementing 10mg of copper daily to try and pick this iron availability up. I wake up with my arms and hands asleep every morning and my legs get pins and needles during the day. I wonder if the iron has something to do with that.

Thanks again for all your suggestions.


#13

I’m curious about your mental breakdown. I’ve had panic attacks but they weren’t a constant thing. I understand how panic can lead to adrenal fatigue though with the dumping of high amounts of stress chemicals in your brain.

I have anxiety issues and TRT both helped and hurt my anxiety situation. It overall has made me more resilient to stress and on average a more stable mood. BUT, mood swings are way more intense and I am more of an intense person overall. And as this goes towards panic/anxiety/OCD for me it’s made panic situations more intense, and made me a lot more obsessive of a person.

But I’m a lot more willing to face things head on. Slowly increasing the ability to think for myself and decide for myself. Though I have very little confidence in my brain.


#14

Are you getting iodine from iodized salt or from vitamins that list iodine?
And for how long?

Check your overall thyroid function by taking oral body temperatures:

  • when you first wake up, should be 97.7-98.8, higher is OK, 97.3 is a problem
  • ALSO check for 98.6 mid-afternoon
    THIS REQUEST IS NOT TRIVIAL !!!

#15

TRT and sleep IME:

  • Transdermal testosterone gives me terrible insomnia that even Xanax doesn’t fix. Maybe too much stimulation from DHT conversion in skin? For many guys, TRT is stimulating, which is fine if you want to fix low energy, but not fine if you are more of a wound up person.
  • Injected testosterone is neutral on sleep for me.

TRT and mood IME:

  • I am more prone to mood swings and depression on TRT than off TRT. This is independent of whether E2 levels are high, average, or low.

Many guys do report significant improvements in mood, but you won’t know until you try it. As far as I can tell from anecdotal reports online, TRT doesn’t normally make a lot of difference to sleep either way, although some guys report needing less sleep (as a good thing) - which could be a problem if you are already prone to insomnia. I haven’t seen reports of increased sleep from TRT.


#16

Thanks again for all the color. It is really helpful for me. Another question. If HCG mono is a disaster for me and I need to get off of it, is LH permanently suppressed at that point or can it come back with time? Also, does HCG suppress FSH too or only LH?

KSman, I’m not supplementing iodine currently. I also don’t know my body temperature because I don’t currently have a thermometer at home. My doc is considered a thyroid expert and sees no issues with my thyroid even though my TSH has gone up. My latest free T3 reading was 4.2 on a scale of 2.2-4.4. Do you think that compensates for the TSH?

Thanks again


#17

Check your body temperatures.
You and wife and ?others?

Remove pink salt and sea salt from your house and use iodized salt.
Everyone in the house is affected.

You may have progressed from hypo to hyper thyroidism with rT3 part of the pattern.

Read the thyroid basics sticky.

hCG does not repress LH or FSH.
hCG increases T and E2 and those repress LH/FSH

My latest free T3 reading was 4.2 on a scale of 2.2-4.4. Do you think that compensates for the TSH?
Question is wrong.

Please stop bypassing my thyroid points and questions.

Your doc may not be the expert that you think he is.
TSH should be closer to 1.0 and doc never asks about iodine - idiot
T3, T4, fT3, fT3 should be near mid-range
The lab ranges are misleading and docs are included.

Please post the rest of the thyroid labs that go with rT3=4.2


#18

Hi KSman,

My thyroid panel:

TSH 2.3
Reverse T3 15.2
T4 8.1
T3 113
Free T3 4.2

My TSH used to be 1.3 but that was when my T was under 300 and free T was also below range.

Not trying to bypass your questions. Thank you for the help! I’ll give you an update once I get my temperatures checked. Sea salt getting tossed.


#19

So I started injecting HCG per my docs prescription three days ago. I noticed the end of day 1 and yesterday libido and partial erections were coming back frequently. I also had a great night of sleep last night.

However, about 25 minutes after my shot today, my heart started pounding, started getting nausea, diarrea, felt like I was going to fall over. My heart is still pounding 11 hours after my shot. Not sure if the HCG is crushing my cortisol.

I injected 500iu each morning the past three mornings.


#20

250iu hCG SC EOD was demonstrated to be a good replacement dose for youthful LH levels.
You are injecting 4 times that amount.

Your body may be struggling to adjust. You can inject less and see if that helps.

We know that high hCG [or SERM] dosing can lead to high T–>E2 production rates inside the testes and high serum E2 levels. E2 can mess you up. High hCG or SERM dosing may also desensitize your testes. High hCG dosing is also expensive.

Read the thyroid basics sticky too. You probably need supplemental iodine and should have selenium and iodine in your multi-vits.