Working HCG Mono Therapy but No Libido or Sex Drive?!

Your testes are the problem, you have got this wrong.

Total T doesn’t mean anything, it’s the free or bio-T that is useful and a good predictor of T production. Your blood work is like mine, high shbg doesn’t “eat up” your free T. It inflates total T to higher ranges than it would have been with low free T. Your FT not rising on hCG, that means your testes aren’t particularly responsive to the LH. Normal high LH/FSH also suggest that your testes are the problem.

You are not hypothyroid. Don’t get into the madness. Your thyroid labs are good. Look for 98.6 in the evening/afternoon with the oral themometer.

Thanks equalo212,

I do not understand that however. What about this:

Bioavailable Testosterone - 219 ng/dL -
% Bioavailable Testosterone - 36% of Total -

Above is my labs, and I tested in this range twice now.

< or =19 years: not established
20-29 years: 83-257 ng/dL
30-39 years: 72-235 ng/dL
40-49 years: 61-213 ng/dL
50-59 years: 50-190 ng/dL
60-69 years: 40-168 ng/dL

This puts me in the upper range on bioavailable T for my age. In that case it means I am a high producer. How would that mean my testes are the problem?

Non-specific ranges are useless and your lab could be testing using another methodology. If this range was true, then no one would be hypogonadal. Take this for an example:

A person who has TT : 350, SHBG: 20. Now this guy is your or my age which is in 20s. Do you think his T is low? Most would think so especially if symptoms are as bad as yours and mine.

BUT, BIO-T of this person would be : 213 ng/dl, very similar to yours and mine! and fT of 9 ng/dl.

In RANGE! No ones hypogonadal or suffering.

Your FT like mine is low, yours is 8.5 in range of 9-30. Mine goes 7-10 in the same range. Does that indicate low T or no? Since one of the most agreed upon concepts in the whole easily misunderstood lingo of hormones is that fT is the biologically active hormone and the body does not give two hoots about biologically inactive hormone even if you believe that you are producing it and SHBG is taking it away.

But in terms of how test results can come out, yes, the way that one can have good or high total T while having low free T is from having high SHBG.

"It’s not that the high SHBG causes the low free T though. Rather it’s completely the other way around: the low free T is the direct outcome of the HPTA function, and would be the same regardless of SHBG amount, but as the amount of T bound to SHBG is a product, so to speak, of both free T and amount of SHBG, high SHBG causes a given free T amount to yield a higher total T value.

If one makes the mistake of taking total T as a valid predictor in its own right, and ignores that free T is what should be looked at, then the high SHBG combined with the wrong assumption leads to the wrong conclusion that things are OK.

Whereas looking at the free T alone and ignoring the other values, as they are only consequences of free T and levels of other things, avoids coming to wrong conclusions."

This is a quote from Bill Roberts who’s a AAS specialist and his opinions are very well respected. You can decide for yourself now.

By the same analogy, A young 25 year old guy with TT: 700, SHBG: 24; will have a Bio-T of 434 ng/dl, way over your bio T range. Would this guy be considered a normally functioning male or an overproducer of T? I am sure you would say that these numbers are ideally minimum what a healthy guy of 25 should be producing, no?

I see what you mean, thanks a lot for that explanation.

Since we are both in a similar situation then, what are your views on correcting this problem?

I have no idea how I ended up with this issue but it seems like less then a year back my free T was in range and better then now.

12/10/2015 - Free testosterone (saliva): 94 pg/mL - ref: 60-135 pg/mL (18-30 years)

I would like to find a solution that does not involve TRT. I have stopped HCG since a week back since I feel I did not benefit much for it towards the end and it caused other issues.

When hCG doesn’t lead to very high T, testes are usually at fault. When you felt better it was still low, maybe i’m wrong with that as i’m not well versed with saliva testing. Look, don’t go by the ranges only. If you were used to higher T levels prior to problems, just being in range won’t work, so TRT is the only option for when Testes are not doing their job. As you will see, fT/Bio-T ranges are all over the place. You will see 3-15 pg/ml, 3-31, 9-45, 9-20. All different ranges. You want to focus extravagantly to ranges or fix yourself?
I just read you replying above as to that your bio T is already high. You have been mislead my friend. Bio-T and fT is low, which are the only factors that matter when determining hypogonadism.

If you don’t mind me asking, Why the resistance to TRT? I would bite anyone’s hand off for offering if it means i’ll not feel like an 80 year old grandpa and actually have the energy to do what i want to do at 25.

For me, i have a bilateral varicocele in my testes which seems to be messing with testicular function. My e2 was high from a restart i did previously which didn’t do anything for me, so i’m on anastrozole 0.5mg/week to reduce. My SHBG has dropped from highest of 67 to now 53.3 and TT has also gone up but that’s expected from the AI and not likely to last but i don’t feel any better. I’m planning on going for TRT for a trial period of 3 months first or maybe more time if i feel good. In the mean time, i am planning for a varicocele repair to be done and once that’s done and recovered from, i will try to come off TRT with a Restart and see how the testes respond.

Also consider the aforementioned range that you quoted, High point of 257 ng/dl. We know that approx. 50-60% of Total Testosterone measured is ideally bio-available, i.e, fT + T bound to serum Albumin. Consider the range for TT in the same article, for their particular methodology to determine T is 240-950 ng/dL, half of which should be bio available, i.e, Bio-T : 120- 475 ng/dl. So you can see how inaccurate that range is.

Quest Diagnostic ranges are: 110-575 ng/dl which matches their TT range( 220-1150 ng/dl).

You and i are closer to the bottom than to the high in both these with <250 ng/dl Bio-T. It must be noted that it’s unclear in studies still as to how much of the Albumin bound T actually gets free. We know that fT is what is biologically relevant for receptor binding.

For reference, if you see threads on here with symptomatic people looking for advice, you’ll often see a TT of less than 300 ng/dl with more fT than you and me.

Have you had your testes examined or had an ultrasound? Look for potential varicoceles, doctors are ignorant on these issues. It’s getting more attention these days of how varicoceles can affect Leydig cell function in the testes. It needs common sense to understand that if something can affect one half of testicular function (Spermatogenesis) due to overall poor environment for the the testes to work, it will also affect to a good degree the other half of testicular function. Depending on the damage that they have caused and duration that they have been affecting the testes, a varicocele repair may restart normal function.

The term that I use is low thyroid function. Hypo is more severe. We have many here who have had low thyroid function who were not getting enough iodine who restored temperatures and felt better after fixing their iodine deficiency. Has that worked for everyone? -No. There can be complications from rT3 that will stop iodine replenishment from working, even when it has helped a particular individual in the past. That rT3 blocking can stop T4 or T4+T3 meds from working. Given the complexities that can occur, I suggest that you not go with absolutist statements from others. You will need to experiment to see what works for you. The best first step is to eliminate a [suspected] iodine deficiency and see how your body and mind respond. Sometimes things cannot be easily fixed and medications are needed and one’s labs mean that most doctors will state that you are normal and do nothing.

Avoid running with implications of what you read for full blown hypothyroidism as this may be misleading with low thyroid function [sub clinical]. I do stress that low thyroid function slows down every cell in the body and can compromise many functional systems. All the more reason to make sure that your thyroid function is good.

Early stages of adrenal fatigue can involve higher levels of cortisol as a maladaptive stress response. But the adrenals start to fail and and things go down hill from there. Given the complexities, I suggest that people read Wilson’s book on adrenal fatigue.

Really great again equalo212, thanks for helping me gain an understanding of this. It all makes sense now. It is madness then that many doctors only diagnose these issues judging on total T.

This would for sure be interesting to know.

I have not but should I not notice any other issues with my testes if varicoceles was the case? I never had any issues with my balls other then they go small when E is high or when I have not gotten enough sleep. Never had pain or anything and sperm production seems fine, always been same since I was young.

Really I feel like it would be the last resort. I travel a lot in many foreign countries for work and I currently live in Thailand. It’s hard to find a qualified doctor for this that you can feel confident with and also hard to do labs on the road.

Generally I am also more inclined to natural solutions and I want to try everything else before resorting to TRT which might have to be a choice for life.

What disturbs me in my case is that my free T used to be good just like a year ago and there must be a reason for this happening. I want to find it before deciding about TRT.

Thanks KSman,

I bought a book about iodine on Amazon, seems like I need to educate myself in this further.

Do you think I should get tested for rT3 and the antibodies?

I definitely think adrenal fatigue is part of my case. See following cortisol labs:

September 2015:
Cortisol (Saliva, 06:00-08:00 am) 14 nM 41 nM - HIGH 13-24 nM
Cortisol (Saliva, 11:00-01:00 pm) 6 nM 9 nM 5-10 nM
Cortisol (Saliva, 04:00-05:00 pm) 4 nM 6 nM 3-8 nM
Cortisol (Saliva, 10:00-Midnight) 1 nM 4 nM 1-4 nM
Cortisol Load (Saliva) 25 nM 60 nM - HIGH

12 Jan 16 10:18AM
Cortisol (Serum, Morning-Noon) 8.1 ug/dL (10:18am) ref: 6.24-18 ug/dL

23 Apr 16 10:18AM
Cortisol (Serum, Morning-Noon) 6.6 ug/dL (10:18am) - LOW ref: 6.24-18 ug/dL Morning

I’ve for sure been suffering from a lot of stress the last few years.

I will do a few weeks of Fadogia agrestis and see how that affect my labs. Should also be good to rebalance from HCG.

It’s a case of ignorance. Even the guidelines by the endocrine society, a group notorious for downplaying testosterone problems suggest evaluation of FT levels if patient is symptomatic with normal TT to rule out shbg alteration. Doctors who are ignorant or who are bound by insurance companies are likely to tell you are okay. Doctors have to answer to committees on prescriptions. And doctors typically are trained in disease and not health management.

I would rather treat my symptoms now rather than wait for it to drop one or two points on the blood test for the doctor to act. At our age group, If something is bad enough to give bad symptoms, what are the odds of getting better naturally with age? Close to zero.

What were your FT levels a year ago you mention? Were you symptomatic?

I understand the perceived inconvenience of TRT, I have been really anxious and scared to commit to something which will be for life. But if it is required to make me not waste my younger years by not having an ounce of energy or desire, I would happily take the inconvenience of 2 shots a week rather than wasting my life just because of reluctance to the shots.

98.6F = 37C

I do not understand this. 14 or 41?
Other cortisol samples are near bottom of range.
If was 41, I would for 8AM.

Low iodine may be causing low body temperatures.
What is your history of using iodized salt?

Sorry typo from copying:

14 nM was from lab 19 May 2014.
41 nM was from lab 12 October 2015.

Here is a labs screenshot to clarify:

And now 2016:

January: 8.1 ug/dL (10:18am)
April: 6.6 ug/dL (10:18am) - LOW

So it looks like I had normal labs 2014 and then cortisol went up and now it’s almost below reference ranges. Sure looks like typical adrenal fatigue progression no?

I’ve started iodine supplement. I have been using sea salt many years and nothing else, I probably caused myself this deficency.

I thinks that you have a good reading of the situation. You should read Wilson’s book on adrenal fatigue.

Make sure that you are getting selenium to go with the iodine.

Are there others living with you who have been using sea salt?

Yeah I will start on 50mg Iodoral per day with selenium in a week or two, currently doing 13mg day in drops.

Yes but not long term, I travel a lot for the last 6 years.

Just to follow up a bit on this.

I have successfully improved several of my test parameters and is in a better shape now then before. Maybe this can help some people with similar issues.

I switched to a more “primal” diet, removing all grains and starchy carbs and emphasis on meats, eggs, nuts, fruits and veggies. I already had dairy and artificial sugars out of my diet before. I also started drinking tea 5 cups a day. Supplement iodine 50mg a day.

This has started normalising my Cholesterol now, improvements on all points since last time:

Cholesterol Total: 167 mg/dL (before: 202)
Triglyceride: 36 mg/dL (before: 54)
HDL: 44 mg/dL (before: 46)
LDL: 108 mg/dL (before: 134)

My PSA is halved now which is cool considering they usually recommend low fat for this and I have been eating lots of fats:

PSA: 0.663 ng/mL (before: 1.2)

I’ve been taking notoginseng, iron protein plus from LE, Lactoferrin:

This has bumped my RBC, Ferritin, Hemoglobin, Hematocrit up and I am no longer anemic (within normal range now). I think within the end of the year I will be back in mid normal range.

I started Fadogia Agrestis supplementation and after 40 days, my total T and free T has increased. Unfortunately my SHBG has also but I think this also has to do with my increased tea intake and progesterone cream I have been taking help my low cortisol and progesterone.

I think I overdid the progesterone because my E2 is low now, doesn’t show up on the normal test (this is not sensitive test). I think I screwed my E2 test up also because I took progesterone before bed day before test in morning. I also took more then usual because leak from bottle.

However I do not feel any symptoms of low E and I have felt good. I had low E from AI use before and this is not same feeling. Anyhow I will be dropping the Progesterone now.

Total T: 9.898 ng/mL (before: 6.10)
Free T: 134 pg/mL (before: 88)
SHBG: 74.5 nmol/L (before: 58.2)
E2: < 10 pg/mL (before: 25)

That’s something like a 50% increase in Free T which I am quite happy about and I am now within normal range even if it could go up a bit more.

I have seen more progress in my health from all natural treatments then anything the doctor could give me. I am happy that I stopped HCG, AI and that I did not try T gels or injections.

Worth to notice is that I have been working out only once a week and not very intense training during the last two months, so this is improvements only from diet and supplements alone. Now I am off work and adding exercise 3 times weekly minimum.

How is your libido? Has it recovered much and is it at all like it was a few years ago?

My libido has improved, however I am not how I was back around start of my 20s (28 now). But I am starting to think that might actually also be because I am approaching middle age.

I think my libido is highly correlated to stress and estrogen levels, and I just have not been able to dial my E2 in perfectly yet.

However, during these two months on changing my regimen, I have lost 2kg body fat. My weight was 73ish kg before, I am now 70kg and less abdominal fat.

My balls hang much lower now most of the time which I have noticed a big difference in. It’s better then what it was on HCG.

I do get that horny urge now maybe once a week which I have not had much before, yet far from what it was around 20. However my sexual function is MUCH improved and sex is amazing with my girlfriend and she is loving it. I have no problem to perform when needed and I have much stamina and harder then I have been in a long time.

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All men have some pregnenolone–>progesterone in their adrenals

These small levels of progesterone are not HPTA repressive.
If you are using small amounts of progesterone to get normal male levels, there should not be a problem.

You will get some added progesterone–>cortisol.
Is your AM cortisol low? YES, but 10:18 introduces a lot of doubt
Do you take at night?
Helps you sleep or wakes you up or neutral? - sleep better

The concerns re thyroid and transdermal T absorption probably apply to absorbing any steroid hormone.

As for E2
SHBG: 74.5 nmol/L (before: 58.2)
E2: < 10 pg/mL (before: 25)

You made many changes to your diet, nutrients and activity. Hard to make conclusions.
Your FT increases and SHBG increased too. Very odd. Progesterone is doing something unexpected.
Try reducing progesterone.

With women taking larger amounts of progesterone to correct abnormal bleeding and thickening of the endometrium, large doses will affect their HPOA and reduce LH/FSH. At some levels, the same will happen to men. E2 is the largest lever on the HPOA.

Thanks KSman for checking in again, I’ve stopped posted about this because generally people don’t really know a lot in depth about hormones here. I appreciate your expertise though.

It’s been 6 months and I have been experimenting with many things.

I have not done another blood test yet because my symptoms has been good and I have judged that as I am improving, I am heading in the right direction. I will however do another hormone panel very soon.

I made one really substantial change that have made a ton of difference in my wellbeing which is eliminating close to all carbohydrates, I’ve been doing a ketogenic diet staying under 50g net carbs per day most of the time. Been on this for 4-5 months.

Keto eliminated all the anxiety and mood problems I’ve been having for a long time. I suspect I am one of those males who have issues with carboydrates like Dr Adam Nally talks about in this video on Ketosis and testosterone:

I am also of Scandinavian heritage and traditional diets here are very much low carb, high fat, so it makes sense.

My mood, energy levels and overall wellbeing has all been excellent last few months since being fat adapted and I no longer take any hormonal related supplements.

I did detailed research about carbs and testosterone and many websites such as argues that carbs are essential for T production, and this is bullshit to be honest. The research studies say that total T is higher yes on diets higher in carbs, but so is SHBG. Low carb decreases total T and SHBG. When I ran the numbers in the research studies through a free T calculator, the difference was only 7% in favour of higher carb diet. Same with cortisol, with an increase in cortisol on low carb diet also comes with an increase of cortisol binding protein, which equals no big change in free cortisol. It’s obvious people are drawing the wrong conclusions.

I suspect that at the start when my totalt T was lower (6.10) I was really deficient in Iodine and Selenium and supplementing these help bring my T levels up.

My high SHBG is difficult to figure out because all labs I’ve taken show it in the high normal range at least. I did to a 23andMe DNA test and it came up with unusually many COMT mutations. Basically I break down dopamine and other catecholamines a lot slower than most people, and it also makes me break downs estrogens slower. I suspect because of my first saliva test of estrogen back in 2015 was insanely high, that my main problem is excess estrogen accumulation. I’ve been on DIM or cruciferous vegetable supplements for 2-3 months, not sure if it helps or not.

My libido still is not where I would want it to be, even though I have periods that are very good. I have sex regularly each week.

I am starting to think that my libido issues must be either estrogen related or dopamine related.