HCG versus direct testosterone replacement wrt estrogen issues

[steve999]

After finding a "real" doc, I started out on HCG monotherapy at 1000 units EOD resulting in a testosterone level of 470 ng/dL (range 241-827) with estradiol at 24 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc told me to bump HCG up to 1200 units EOD resulting in a testosterone level of 633 ng/dL (range 241-827) with estradiol at 36 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc has now switched me to direct testosterone starting out at 100 mg/week. Short term plan is to get me to at least 80% upper range testosterone with lower range estrogen levels and see how libido and ED issues respond.

My question is why would direct testosterone tend to increase estradiol less than HCG?

 

[jinxie]

After finding a "real" doc, I started out on HCG monotherapy at 1000 units EOD resulting in a testosterone level of 470 ng/dL (range 241-827) with estradiol at 24 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc told me to bump HCG up to 1200 units EOD resulting in a testosterone level of 633 ng/dL (range 241-827) with estradiol at 36 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc has now switched me to direct testosterone starting out at 100 mg/week. Short term plan is to get me to at least 80% upper range testosterone with lower range estrogen levels and see how libido and ED issues respond.

My question is why would direct testosterone tend to increase estradiol less than HCG?

Probably, but your E2 is where most would expect it to be -- 1/20 to 1/30 of your test level. Time for an AI to get it down to 20-30.

 

[colkurtz_spf]

After finding a "real" doc, I started out on HCG monotherapy at 1000 units EOD resulting in a testosterone level of 470 ng/dL (range 241-827) with estradiol at 24 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc told me to bump HCG up to 1200 units EOD resulting in a testosterone level of 633 ng/dL (range 241-827) with estradiol at 36 pg/mL (range 3-70). Low libido and ED problems persisted.

My doc has now switched me to direct testosterone starting out at 100 mg/week. Short term plan is to get me to at least 80% upper range testosterone with lower range estrogen levels and see how libido and ED issues respond.

My question is why would direct testosterone tend to increase estradiol less than HCG?

EOD is too frequent. Try E3D or twice per week (which in my opinion is the best). HCG has a half life of 30 hours and testosterone levels remain elevated from 72 to 96 hours while on it. More time off gives your receptors a chance to clear.

Here's an interesting study: http://www.redorbit.com/news/health/364146/treatment_with_human_chorionic_gonadotropin_for_padam_a_preliminary_report/

 

[steve999]

Thanks for the info. I'm on direct testosterone now, but I could see trying HCG with an estrogen inhibitor at some point in the fture.

 

[jinxie]

Thanks for the info. I'm on direct testosterone now, but I could see trying HCG with an estrogen inhibitor at some point in the fture.

hCG is more likely to be aromatized -- converted into E2. If you are not concerned about maintain testicular size and function, straight test could be considered simpler/more elegant. Good luck.

 

[rick055]

More time off gives your receptors a chance to clear.

HCG (LH) receptors or T receptors?

 

[colkurtz_spf]

HCG (LH) receptors or T receptors?

From the study: We generally performed hCG injections every 2 weeks because it has been reported that the binding capacity of testicular hCG receptors is significantly reduced for 5 days after injection.

When I weened off of HCG, and took an eight month break, it took around two weeks after my last injection before I felt its absence. I'm not saying that one shot every two weeks is ideal. I experienced the best results twice per week (3 days off and 4 days off). On that schedule I had little or no aromatization and high TT and FT levels.

 

[rick055]

From the study: We generally performed hCG injections every 2 weeks because it has been reported that the binding capacity of testicular hCG receptors is significantly reduced for 5 days after injection.

When I weened off of HCG, and took an eight month break, it took around two weeks after my last injection before I felt its absence. I'm not saying that one shot every two weeks is ideal. I experienced the best results twice per week (3 days off and 4 days off). On that schedule I had little or no aromatization and high TT and FT levels.

Gotcha. I didn't understand whether it was an issue with testosterone binding or the actual HCG binding.

 

[mattmuscle]

From the study: We generally performed hCG injections every 2 weeks because it has been reported that the binding capacity of testicular hCG receptors is significantly reduced for 5 days after injection.

When I weened off of HCG, and took an eight month break, it took around two weeks after my last injection before I felt its absence. I'm not saying that one shot every two weeks is ideal. I experienced the best results twice per week (3 days off and 4 days off). On that schedule I had little or no aromatization and high TT and FT levels.

Whats also interesting in that study is that most parameters improved except for the erectile function score (IIEF-5 score) and SDS scores.

Could this be to do with such a spaced out dosing and the amount administered? There is no consideration for the effects of estrogen?

 

[colkurtz_spf]

Whats also interesting in that study is that most parameters improved except for the erectile function score (IIEF-5 score) and SDS scores.

Could this be to do with such a spaced out dosing and the amount administered? There is no consideration for the effects of estrogen?

Probably - I doubt there would be much of a rise in DHT or E2 levels dosing twice per month. In my opinion, HCG needs to be administered at least once per week to be effective.

 

[rick055]

Probably - I doubt there would be much of a rise in DHT or E2 levels dosing twice per month. In my opinion, HCG needs to be administered at least once per week to be effective.

I wonder if hCG, dosed twice weekly, would still maintain circadian output if a patient was also on T CYP at a smaller dose (say 80 mg/week).

Might work in a case where hCG is not enough in and of itself to raise serum T. Give a little boost with T CYP, but the hCG still maintains daily rhythm.

 

[jinxie]

I wonder if hCG, dosed twice weekly, would still maintain circadian output if a patient was also on T CYP at a smaller dose (say 80 mg/week).

Might work in a case where hCG is not enough in and of itself to raise serum T. Give a little boost with T CYP, but the hCG still maintains daily rhythm.

I don't think so, dude. I think the exog test shuts down the LH as well, because there is no longer an alarm to trigger that the body needs more test.

I'm still waiting to hear from someone that is on a higher dose of hCG, with a small booster dose of test. I'm yet to hear of this combo, and the results it brings. But I'm interested.

Take care.

 

[rick055]

I don't think so, dude. I think the exog test shuts down the LH as well, because there is no longer an alarm to trigger that the body needs more test.

I'm still waiting to hear from someone that is on a higher dose of hCG, with a small booster dose of test. I'm yet to hear of this combo, and the results it brings. But I'm interested.

Take care.

Exogenous T will definitely shut down LH.

But there's research (somewhere on these boards) which suggests hCG, twice weekly (say Monday/Thursday) will restore diurnal T production in some men. That's independent of LH (these men were LH suppressed from secondary hypogonadism) and due to the action of hCG .

As such, I wonder if the same would hold true for someone on T + hCG.

The T CYP would produce a baseline level of testosterone which would decay according to its half life.

But the hCG would be additive to the T-CYP and I don't see why it wouldn't restore diurnal rhythm, all else equal. You can't be any more shut down than shut down, so the T CYP shouldn't affect that part of the equation.

If this holds true, it makes an argument that T + hCG can produce similar intraday variation in serum T similar to transdermals.

Sorry if I went OT.

 

[jinxie]

Exogenous T will definitely shut down LH.

But there's research (somewhere on these boards) which suggests hCG, twice weekly (say Monday/Thursday) will restore diurnal T production in some men. That's independent of LH (these men were LH suppressed from secondary hypogonadism) and due to the action of hCG .

As such, I wonder if the same would hold true for someone on T + hCG.

The T CYP would produce a baseline level of testosterone which would decay according to its half life.

But the hCG would be additive to the T-CYP and I don't see why it wouldn't restore diurnal rhythm, all else equal. You can't be any more shut down than shut down, so the T CYP shouldn't affect that part of the equation.

If this holds true, it makes an argument that T + hCG can produce similar intraday variation in serum T similar to transdermals.

Sorry if I went OT.

Thoughtful post, Rick. I hear what you are saying, but I guess it's semantics. I would not call it diurnal, as that suggests a natural rhythm, rather than an artificial one. I think what you are proposing is a formula that produces a more steady blood level (than straight T cyp) in individuals responsive to hCG. I.e, the Crisler protocol on patients with secondary hypo. I don't think it would result in the same rhythm as a daily transdermal.

I've been wondering for some time whether someone who is secondary can have a strong response to hCG while on T cyp. If so, something like 500 IUs of hCG every 4 days, and 20 mgs of T cyp, would work really well, and probably combat some of the E2 issues that are caused by pushing TT to 900-1400. Thoughts?

 

[rick055]

I would not call it diurnal, as that suggests a natural rhythm, rather than an artificial one.

Diurnal rhythm of testosterone induced by human chorionic gonadotrophin (hCG) therapy in isolated hypogonadotrophic hypogonadism: a comparison between subcutaneous and intramuscular hCG administration

http://www.eje-online.org/cgi/content/abstract/131/2/173

 

[jinxie]

Diurnal rhythm of testosterone induced by human chorionic gonadotrophin (hCG) therapy in isolated hypogonadotrophic hypogonadism: a comparison between subcutaneous and intramuscular hCG administration

http://www.eje-online.org/cgi/content/abstract/131/2/173

But with the T injections, I dont see how it would resemble the normal ebb and flow of diurnal rhythm. In fact, even just hCG every 4 days results in much greater variation of highs and lows, so I would think. I'll read your link.

Please don't get me wrong, I appreciate the dialogue, and your intellect impresses me.

 

[jinxie]

Diurnal rhythm of testosterone induced by human chorionic gonadotrophin (hCG) therapy in isolated hypogonadotrophic hypogonadism: a comparison between subcutaneous and intramuscular hCG administration

http://www.eje-online.org/cgi/content/abstract/131/2/173

Interesting. However, it was a tiny sampling (8 patients), it was only several weeks, and it only restored rhythm in 4 of the patients. But still, there is something there. I would imagine that adding test would reduce that number by a much greater margin.

5,000 IUs is a whopper of a dose for a secondary. That would probably send my TT over 1500, probably. 3,500 per week put me over 1,200 at trough, and my E2 over 80.

What's your protocol look like, Rick?

 

[colkurtz_spf]

Interesting. However, it was a tiny sampling (8 patients), it was only several weeks, and it only restored rhythm in 4 of the patients. But still, there is something there. I would imagine that adding test would reduce that number by a much greater margin.

5,000 IUs is a whopper of a dose for a secondary. That would probably send my TT over 1500, probably. 3,500 per week put me over 1,200 at trough, and my E2 over 80.

What's your protocol look like, Rick?

It's hard to say how you would react. I did that amount and frequency for nearly three months and it wasn't until week 10 that my E2 went over 20. At one point, my TT was over 1400. TT varied between that and 1200. Now 1500 IUs E3D puts my TT between 950 and 1060 and I have to use .5 mg of Adex with the injection - go figure.

 

[colkurtz_spf]

It's hard to say how you would react. I did that amount for nearly three months and it wasn't until week 10 that my E2 went over 20. At one point, my TT was over 1400. TT varied between that and 1200. Now 1500 IUs E3D puts my TT between 950 and 1060 and I have to use .5 mg of Adex with the injection - go figure.

The last 3 weeks I've switched to twice per week. I have a feeling that I will now be able to reduce or even eliminate Adex.

 

[jinxie]

The last 3 weeks I've switched to twice per week. I have a feeling that I will now be able to reduce or even eliminate Adex.

Glad to hear this, Colkurtz.

I've concluded that it doesn't much matter for me. Regardless of my dosing, take my TT and divide it by 15-17.5, and that's my E2 -- my E2 runs a little high. More frequent dosing will drop my peak TT such that E2 doesn't get as high. I'm doing every 4 days now. Twice per week is too complicated for me as I look to inject in the mornings.

 

[colkurtz_spf]

Glad to hear this, Colkurtz.

I've concluded that it doesn't much matter for me. Regardless of my dosing, take my TT and divide it by 15-17.5, and that's my E2 -- my E2 runs a little high. More frequent dosing will drop my peak TT such that E2 doesn't get as high. I'm doing every 4 days now. Twice per week is too complicated for me as I look to inject in the mornings.

Every four days sounds good, but my schedule is hardly complicated. I inject Wednesday and Sunday evenings. My doctor instructed me to use an evening protocol three years ago. The results have been good so I never questioned him.

 

[rick055]

Every four days sounds good, but my schedule is hardly complicated. I inject Wednesday and Sunday evenings. My doctor instructed me to use an evening protocol three years ago. The results have been good so I never questioned him.

What was the reasoning behind pm shots?

 

[colkurtz_spf]

What was the reasoning behind pm shots?

I never asked. I knew he had over a decade of experience in this therapy so I went along with him. I suppose it makes sense though. HCG starts to work in a couple of hours. One of your peak T levels is early in the morning, which means levels increase during sleep. I guess night shots would keep you in sync with your rhythm. Doing it in the morning, at let's say 7 AM would start to boost your level at 9 or 10 when it would normally be on the decline. This isn't like testosterone cream.

 

[rick055]

I never asked. I knew he had over a decade of experience in this therapy so I went along with him. I suppose it makes sense though. HCG starts to work in a couple of hours. One of your peak T levels is early in the morning, which means levels increase during sleep. I guess night shots would keep you in sync with your rhythm. Doing it in the morning, at let's say 7 AM would start to boost your level at 9 or 10 when it would normally be on the decline. This isn't like testosterone cream.

Good point.

 

[jinxie]

Every four days sounds good, but my schedule is hardly complicated. I inject Wednesday and Sunday evenings. My doctor instructed me to use an evening protocol three years ago. The results have been good so I never questioned him.

Yeah, rather than complicated I should have just said to avoid me screwing the pooch, and forgeting about the evening injection. If my doctor recommended this to me, I'd do the same. Plus, who can argue with you results: your numbers are stellar, your built and lift like a frickin' Spartan (at an age that they never even lived to), and you can whoop it up on the tennis court to boot. I can only dream of getting that much better with age! Nicely done.

 

[colkurtz_spf]

Yeah, rather than complicated I should have just said to avoid me screwing the pooch, and forgeting about the evening injection. If my doctor recommended this to me, I'd do the same. Plus, who can argue with you results: your numbers are stellar, your built and lift like a frickin' Spartan (at an age that they never even lived to), and you can whoop it up on the tennis court to boot. I can only dream of getting that much better with age! Nicely done.

Thanks! I appreciate that. I don't mean to toot my horn. The fact is that I let myself go in my 30s. I can remember going to bed at night and wondering how much longer I might have to live. But with diet, exercise and the advantage of modern medicine I manage a much better quality of life now than I had then. When I hit my 40s I decided to stop placing limits on my life. I believe it's not how long you live, but how you live it long.

 

[Gutterpump]

I don't think so, dude. I think the exog test shuts down the LH as well, because there is no longer an alarm to trigger that the body needs more test.

I'm still waiting to hear from someone that is on a higher dose of hCG, with a small booster dose of test. I'm yet to hear of this combo, and the results it brings. But I'm interested.

Take care.

I think this method is a good one, I might switch to it depending on what the results of my current test turn out like.

When I did smaller shots of HCG while taking a larger shot of test, I found that I was still getting shutdown (shrinkage and some pain) unless I shot 3 days per week at around 400iu of hCG, but this would cause too much estrogen while on test as well...as it did for me. I had to use a lot of aromasin which is much stronger than adex.

But so far so good on hcg monotherapy, definitely feels better than before when on nothing. Of course starting HC is also helping a lot.

 

[EasyEJL]

I wonder how a low dose test propionate (like 15-20mg EOD) with maybe HCG at 200iu EOD as well would work out, both as far as creating relatively normal feeling pulses and overall feel