Results after varicocele embolization

[Brosef]

Last month, I had a varicocele embolization dome at the hospital by a very well respected interventional radiologist. Unfortunately, I got my blood work back today and my testosterone is still low 372ng/dL (264-916 range) but what is most concerning is my free testosterone levels 8.1ng/dL (8.7-25.1). These results were similar to before surgery and I’m left scratching my head as to what to do to fix this problem. The endocrinologist had an MRI done to make sure my pituitary gland was producing FSG and LG as it should and that’s all normal. So I was referred to the urologist which confirmed the varicocele and recommended me for the embolization. Is there anyone with some expertise that can offer some advice? Is my only option left TRT? I’m a healthy 30 year old man. Not thinking I should have this issue.

[kelkel]

Do you have your actual LH/FSH levels and ranges available?
What was your total T level prior to surgery?

[Youthful55guy]

Last month, I had a varicocele embolization dome at the hospital by a very well respected interventional radiologist. Unfortunately, I got my blood work back today and my testosterone is still low 372ng/dL (264-916 range) but what is most concerning is my free testosterone levels 8.1ng/dL (8.7-25.1). These results were similar to before surgery and I’m left scratching my head as to what to do to fix this problem. The endocrinologist had an MRI done to make sure my pituitary gland was producing FSG and LG as it should and that’s all normal. So I was referred to the urologist which confirmed the varicocele and recommended me for the embolization. Is there anyone with some expertise that can offer some advice? Is my only option left TRT? I’m a healthy 30 year old man. Not thinking I should have this issue.

Yes, your Total and Free T numbers are low and will no doubt benefit from increasing them. If fixing the varicocele has not been successful, and there's no pituitary tumor, and LH/FSH are in the normal range, you are running out of options.

I know TRT is a big commitment, but it is also a life-changing treatment for guys that really need it. You seem to be among them. If fertility (future kids) is a worry at your age, it should not be. If TRT is administered properly (i.e., small frequent dosing with an insulin syringe and with HCG in the protocol), then you should be able to preserve fertility too.

[Brosef]

@kelkel The last FSH and LH levels were checked back in October. They were both fairly low but still in normal range.

@Youthful55guy Does the HCG basically keep your nuts active or something?

Here is my bloodwork from the past year. My T was actually higher prior to surgery.


January 2017
Total Testosterone : 306 (348-1197) *Low

May 2017:
Total Testosterone: 211 (250-827) *Low
FSH 5.6 (1.6-8.0)
LSH 9.8 (1.5-9.3) H
TSH 1.29 (.4-4.5)
glucose 60 (65-99) L
creatinine 1.48 (.6-1.35)

July 2017:
Total Testosterone : 137 (250-1100) *Low
Free Testosterone: 25.3 (35-155) *Low
Sex hormone: 18 (10-50)
FSH: 7.1 (1.6-8.0)
LH: 4.4 (1.5-9.3)
TSH: 1.88 (.4-4.5)
Glucose: 79 (65-99)
Creatinine: 1.1 (.6-1.35)
B12: 754 (200-1100)
Vitamin D: 63 (30-100)

October 2017
Total Testosterone : 422 (240-950)
Free Testosterone: 14.8 (4.85-19)
FSH: 3.5 (1.0-18)
LH: 3.5 (1.8-8.6)
Prolactin: 8.8 (4.0-15.2)

December 2017
Total Testosterone : 324 (264-916)
Free Testosterone: 7.4 (8.7-25.1) *Low

February 2018
Total Testosterone : 328 (264-916)

April 2018 (1 month after varicocele surgery)
Total Testosterone : 372 (264-916)
Free Testosterone : 8.1 (8.7-25.1) *Low

I'm thinking of running a 8-12 week T and tren cycle to get me feeling normal again, then PCT and maybe start TRT at the end of the year. What do ya'll think?

[Brosef]

It's also interesting to note that February-July last year I was prescribed clomiphene and my testosterone was the lowest during that period but my FSH and LH were much higher

[Youthful55guy]

@kelkel The last FSH and LH levels were checked back in October. They were both fairly low but still in normal range.

@Youthful55guy Does the HCG basically keep your nuts active or something?

I'm thinking of running a 8-12 week T and tren cycle to get me feeling normal again, then PCT and maybe start TRT at the end of the year. What do ya'll think?

Yes, HCG at doses of 500 IU to 1000 IU per week in 3 split doses should help to maintain normal testicular size and function. Research shows that 1000 IU is optimal for maintaining fertility while on TRT in normal healthy young men (i.e., assuming no other pathological conditions preventing fertility).

What is the logic of taking a synthetic anabolic steroid with T to feel "normal"? Synthetic anabolic hormones have no place in TRT. What is your goal? To feel normal or bulk up?

Yes, trenbolone acetate may help you look buff, but it carries with it a long list of side-effects that you should not be dealing with in a TRT protocol, especially at the start. It is highly androgenic, which means it will augment the side-effects of elevated DHT from the supplemental testosterone. Worse yet, it is not metabolized by the 5-alpha reductase enzyme, so you can down a whole bottle of saw palmetto or even finasteride and it will not alter these side-effects, including: Baldness, Body hair growth, BPH, and high hemoglobin. If that's not enough to scare you, this particular hormone carries with it progestin-like activity, so estrogen control is EXTREMELY important when stacking it with testosterone in a TRT program. The combination of elevated E with a synthetic anabolic with progestin-like activity is a bad case of gynecomastia. It also is one of the worse synthetic anabolics for screwing up you lipids and causing long-term cardiovascular problems. ENOUGH SAID. I recommend you rethink this approach.

[Brosef]

Yes, HCG at doses of 500 IU to 1000 IU per week in 3 split doses should help to maintain normal testicular size and function. Research shows that 1000 IU is optimal for maintaining fertility while on TRT in normal healthy young men (i.e., assuming no other pathological conditions preventing fertility).

What is the logic of taking a synthetic anabolic steroid with T to feel "normal"? Synthetic anabolic hormones have no place in TRT. What is your goal? To feel normal or bulk up?

Yes, trenbolone acetate may help you look buff, but it carries with it a long list of side-effects that you should not be dealing with in a TRT protocol, especially at the start. It is highly androgenic, which means it will augment the side-effects of elevated DHT from the supplemental testosterone. Worse yet, it is not metabolized by the 5-alpha reductase enzyme, so you can down a whole bottle of saw palmetto or even finasteride and it will not alter these side-effects, including: Baldness, Body hair growth, BPH, and high hemoglobin. If that's not enough to scare you, this particular hormone carries with it progestin-like activity, so estrogen control is EXTREMELY important when stacking it with testosterone in a TRT program. The combination of elevated E with a synthetic anabolic with progestin-like activity is a bad case of gynecomastia. It also is one of the worse synthetic anabolics for screwing up you lipids and causing long-term cardiovascular problems. ENOUGH SAID. I recommend you rethink this approach.

Thanks so much for your reply Youthful55guy, so you would say to get me feeling normal again I should consider a low dose continual TRT with HCG 1000 /week in 3 injections a week?

I did a 12 week testosterone/ tren cycle last year as follows:

30mL of Test E @ 300mg
40mL of Tren E @ 200mg

~Week 1~

Monday :
1.5mL T
1.5mL R

Thursday :
1.5mL T
1.5mL R

Saturday :
.75mL T
1mL R

~Week 2~

Monday :

1mL T
1mL R

Thursday :

1mL T
1mL R

~Weeks 3-5~

Monday :
1mL T
1.25mL R

Thursday :
1mL T
1.25mL R

~Weeks 6-8~

Monday :
1.25mL T
1.5mL R

Thursday :
1.25mL T
1.5mL R

~Weeks 9-11~

Monday :
1.5mL T
2mL R

Thursday :
1.5mL T
2mL R

Saturday:
1mL R

~Week 12~

Monday :
1.5mL T
2mL R

Thursday :
1.75mL T
2mL R

Saturday :
2.5mL R


The only side effects I really had was really intense night sweats. Ideally I would like to do a much shorter much lighter cycle then above for the summer time and then go back to a trt.

[kelkel]

Stick to TRT like Y55 advised. Tren is a highly androgenic steroid and not to be used for TRT. It's multiple times stronger than test and is not even recommended for cycling bodybuilders until they are more advanced.

[hammerheart]

Yes, HCG at doses of 500 IU to 1000 IU per week in 3 split doses should help to maintain normal testicular size and function. Research shows that 1000 IU is optimal for maintaining fertility while on TRT in normal healthy young men (i.e., assuming no other pathological conditions preventing fertility).

What is the logic of taking a synthetic anabolic steroid with T to feel "normal"? Synthetic anabolic hormones have no place in TRT. What is your goal? To feel normal or bulk up?

Yes, trenbolone acetate may help you look buff, but it carries with it a long list of side-effects that you should not be dealing with in a TRT protocol, especially at the start. It is highly androgenic, which means it will augment the side-effects of elevated DHT from the supplemental testosterone. Worse yet, it is not metabolized by the 5-alpha reductase enzyme, so you can down a whole bottle of saw palmetto or even finasteride and it will not alter these side-effects, including: Baldness, Body hair growth, BPH, and high hemoglobin. If that's not enough to scare you, this particular hormone carries with it progestin-like activity, so estrogen control is EXTREMELY important when stacking it with testosterone in a TRT program. The combination of elevated E with a synthetic anabolic with progestin-like activity is a bad case of gynecomastia. It also is one of the worse synthetic anabolics for screwing up you lipids and causing long-term cardiovascular problems. ENOUGH SAID. I recommend you rethink this approach.

I agree that trenbolone is absolutely not needed here especially if goal in mind is "feeling normal" TRT alone is effective in that context. Just let me correct you in that despite on-paper high androgenic activity tren in fact has very poor to none affinity with 5-AR dependent tissues such as hair, scalp, prostate though yes it can increase HCT/Hgb in some, and alter lipid profile.

[Youthful55guy]

Thanks so much for your reply Youthful55guy, so you would say to get me feeling normal again I should consider a low dose continual TRT with HCG 1000 /week in 3 injections a week?

I did a 12 week testosterone/ tren cycle last year as follows:

30mL of Test E @ 300mg
40mL of Tren E @ 200mg

The only side effects I really had was really intense night sweats. Ideally I would like to do a much shorter much lighter cycle then above for the summer time and then go back to a trt.

Yes, T-eth and HCG is all you need from the start but you have to reconsider your dosage. Your previous anabolic cycle is way too high for TRT. A good TRT protocol needs to be simple and sustainable for the rest of your life. Don't go for the quick fix. Take your time and slowly dial in the dose using labs as your guide. It take your hormones (scores of them) about 6 weeks to come a new equilibrium after you make an alteration to your protocol. There's nothing you can do to rush this.

Week 1-6: About 100 mg/week (total) of T-eth. Split this into at least 2 equal doses of 50 mg. A better approach in my opinion is to split it into every 3 day dosing. Injection of 0.15 mL of 300 mg/mL T-eth solution E3D will be about right. Alternatively 0.2 mL of 200 mg/mL T-eth solution.

Use a 25G to 28G one piece insulin syringe to draw up and inject. The 28G syringe takes about a minute to draw, but worth the wait and effort to go down to that smaller needle size. Absolutely no need to go larger than a 25G needle.

Just prior to a scheduled injection during week 6, do a lab draw. Test (at a minimum) for Total T, Free T, SHBG, and E (sensitive). I would also periodically monitor your hemoglobin (CBC lab) and liver labs (CMP lab). Everything else is optional.

If after 6 weeks, you are satisfied with the Free T levels, you can add in HCG at 500 to 1000 IU per week in 3 divided doses. If you are going to do a dose adjustment, I'd hold off on starting the HCG until after T and E are dialed in.

If E is high at 6 weeks (it shouldn't be at that dose), then you can consider layering in anastrosol as an AI. However, it is extremely difficult to dose. I'd recommend using the "Vodka" / "Eye Dropper" method I've discussed in other posts. start with 3 drops per day to help take the edge off of E. Again, only if necessary. E is absolutely necessary for men. Without adequate amounts of it, we go limp with a bad case of ED and loose our libido. Enough said.

Once Free T and E are dialed in, then you can layer in HCG.

[Brosef]

Ok, that seems like a legitimate long term plan to get me feeling like my old self again.

Is there any drawback to me doing a short cycle, then PCT then getting my hormones on track with the abover recommendation of T and HCG?

[Youthful55guy]

Ok, that seems like a legitimate long term plan to get me feeling like my old self again.

Is there any drawback to me doing a short cycle, then PCT then getting my hormones on track with the abover recommendation of T and HCG?

Yeah, you'll screw up your hormones even more. The goal of TRT is a simple and sustainable protocol that yields stable hormone levels for the long haul. Every time you mess with anabolic steroids, you screw up the system further. My advice is to choose your goal. TRT or looking buff. That's not to say that with the hormones of a healthy 25 year old you can't also look buff while on TRT. It just takes more discipline and focus on nutrition and exercise.

[Brosef]

Thanks so much for yall's help through all of this. I was just wondering, would I really set myself back that much if I did one cycle per year during summer time with Tren + Test? I got such amazing results when I did it last year and I felt amazing all day every day. Also, is there another less extreme androgen I can use that will yield similar results? That with proper PCT can get me right back to where I started? I'm just caught in the middle, of course I want to feel normal again with TRT however, I would def. like to lift a lot more and feel that surge of strength and definition Tren + Test yields over summertime. I was thinking of doing this for a few more years before I go on TRT.

[Youthful55guy]

Thanks so much for yall's help through all of this. I was just wondering, would I really set myself back that much if I did one cycle per year during summer time with Tren + Test? I got such amazing results when I did it last year and I felt amazing all day every day. Also, is there another less extreme androgen I can use that will yield similar results? That with proper PCT can get me right back to where I started? I'm just caught in the middle, of course I want to feel normal again with TRT however, I would def. like to lift a lot more and feel that surge of strength and definition Tren + Test yields over summertime. I was thinking of doing this for a few more years before I go on TRT.

I wish you luck in your endeavors, but I do not provide advice on the use of anabolic steroids or non-medically necessary use of testosterone. You said you felt "amazing all day", well yeah, it was artificial. I doubt you know what normal feels like anymore. It's one of the harsh realities of using anabolic steroids and/or high doses of T. Guys loos sight of what normal feels like. Then when I/we give advice on TRT and they don't feel the same, they discount our advice.

Like I said before, you've got to choose your goal. Do you really want to feel normal, or do you want to look buff? At your age, you have a long time to go in life chasing that steroid high. I hope you find it.

[Brosef]

I wish you luck in your endeavors, but I do not provide advice on the use of anabolic steroids or non-medically necessary use of testosterone. You said you felt "amazing all day", well yeah, it was artificial. I doubt you know what normal feels like anymore. It's one of the harsh realities of using anabolic steroids and/or high doses of T. Guys loos sight of what normal feels like. Then when I/we give advice on TRT and they don't feel the same, they discount our advice.

Like I said before, you've got to choose your goal. Do you really want to feel normal, or do you want to look buff? At your age, you have a long time to go in life chasing that steroid high. I hope you find it.

@Youthful55Guy I’ve thought about this long and hard and I’ve decided that I just need to go for the long term sustainable goal of feeling normal again. I went to a Men’s Clinic here in town and got more labwork... the doctor wants me to try JUST hCG alone and see if it kickstarts my testicles to start producing more testosterone. He thinks since they’ve been impaired from the varicocele they may need a little help getting them started again. Does this seem like it could work? I got two 5,000 iu vials of powder + 1cc of sodium chloride. Should I try this for a few weeks and if it doesn’t help then introduce Test-E (low dose) to my protocol?

Btw here are my lab results :

LH : 4.3 (1.7-8.6)
FSH : 2.2 (1.5-12.4)
Total Test : 377 (264-916)
Free Test : 8.1 (8.7-25.1)

[Youthful55guy]

@Youthful55Guy I’ve thought about this long and hard and I’ve decided that I just need to go for the long term sustainable goal of feeling normal again. I went to a Men’s Clinic here in town and got more labwork... the doctor wants me to try JUST hCG alone and see if it kickstarts my testicles to start producing more testosterone. He thinks since they’ve been impaired from the varicocele they may need a little help getting them started again. Does this seem like it could work? I got two 5,000 iu vials of powder + 1cc of sodium chloride. Should I try this for a few weeks and if it doesn’t help then introduce Test-E (low dose) to my protocol?

Btw here are my lab results :

LH : 4.3 (1.7-8.6)
FSH : 2.2 (1.5-12.4)
Total Test : 377 (264-916)
Free Test : 8.1 (8.7-25.1)

Glad to hear you're not going down the anabolic hormone route to try to feel "normal". It's not a judgment on the use of anabolic hormones for guys that have short term goals of adding mass/look buff, but it's a dead end road for sustainability.


I'm not a big supporter of HCG only protocols. I've never tired one, but posts I've read from guys that have do not sound all that encouraging. In your case though, your doc's theory of kick starting the testicles might have some merit, I just don't have a lot of experience in primary hypogonadism. At the very least, I don't think it will hurt or screw you up worse in the long term. From what I know about testicular response to HCG, you're going to need at least 1000 IU per week to get the testicles to a near normal range in T production. More may be necessary, it's just an unknown for me. I personally use 1000 IU per week on top of my standard TRT protocol of 40 to 50 mg T-cyp per week. This keeps my total and free T within range (though on the high side) and side effects (of the high end T) are manageable in a long-term sustainable protocol. This also keeps my testicles at full size and ejaculate volume normal.


Looking at your labs, your LH and FSH look to be within normal, but keep in mind it takes several labs to draw that kind of conclusion. These hormones are highly episodic and you need to make sure you are obtaining the blood samples at the same time each lab, and first thing in the AM (preferably, fist appointment when they open the lab doors).

Your Total T is within range, but nothing to brag about. I'm more concerned about your Free T. You might want to consider getting your SHBG levels tested. That may be what's making you feel bad even though your Total T and gonadotropins are within range. There is a small percent of the population (5% to 10% of men by best estimates) that are genetically programmed to add an extra sugar molecule to the SHBG protein, which more than doubles it's half life. This effectively pushes your SHBG up because it is being metabolized and excreted at a slower rate.

SHBG sucks up T and only slowly releases it to free T. SHBG bound T cannot cross the blood-brain barrier, so you may have normal levels of Total T, but your brain is starved for free T. This is why you feel like $#^t with high SHBG. Also, since the T is bound, it is protected from liver metabolism and pushes your Total T labs artificially high. This is why Total T labs are not a good indicator of male health. If your SHBG is high, there are effective treatments, but it's difficult to get doctors to prescribe them because they involve the use of very low doses of certain synthetic anabolic hormones. Not at doses that will have much (if any) of an anabolic effect, but they are EXTREMELY effective at suppressing SHBG production so you don't need much. I believe I wrote a thread on SHBG control, but I don't have a link handy. You may want to do a search on the topic if your labs come back high.

[Brosef]

Ok, I will get a SHBG test today or tomorrow first AM. The local lab is only $49 for that test. If i mix the two vials it will give me 5,000 iu of HCG which will last me 5 weeks at 1,000 / week. So what is the frequency and dose you reccommend? EOD injections? I'm supposed to mix it then put in the fridge and use insulin syringes sub-Q, right? Sorry for all the questions.

[Youthful55guy]

Ok, I will get a SHBG test today or tomorrow first AM. The local lab is only $49 for that test. If i mix the two vials it will give me 5,000 iu of HCG which will last me 5 weeks at 1,000 / week. So what is the frequency and dose you reccommend? EOD injections? I'm supposed to mix it then put in the fridge and use insulin syringes sub-Q, right? Sorry for all the questions.

SHBG is not time of day dependent. You can get it tested at any time. LH/FSH ate time dependent and should be tested first thing in the AM. So should T if you are not on TRT. If you are on TRT, then it doesn't matter what time of day, simply test just prior to the next scheduled injection.

HCG should be split into a minimum of 3X per week. Many guys do it on a MWF schedule. Simply divide 1000/3 = ~330-340 IU per injection If you are on a E3D TRT schedule, then on the days of T injection is a good sustainable protocol. In this case, 1000/7 X 3 = ~430 IU per injection.

[Brosef]

SHBG is not time of day dependent. You can get it tested at any time. LH/FSH ate time dependent and should be tested first thing in the AM. So should T if you are not on TRT. If you are on TRT, then it doesn't matter what time of day, simply test just prior to the next scheduled injection.

HCG should be split into a minimum of 3X per week. Many guys do it on a MWF schedule. Simply divide 1000/3 = ~330-340 IU per injection If you are on a E3D TRT schedule, then on the days of T injection is a good sustainable protocol. In this case, 1000/7 X 3 = ~430 IU per injection.

Ok, think I’ll try without TRT for a month or so and get labs again to see if it had any impact on my natural T production. Can I do Test-E and HCG in the same syringe and just do both IM or does the Test have to be IM and the HCG sub q?
Sorry I’m such a rookie with HCG I have the 5,000 IUs, so I have to buy bacteriostatic water and a sterile empty vial and mix the powder and water in there to make 5ml of hcg then every other day inject 333 units or .33mL to get 1,000 iu a week?

[Brosef]

Hey Youthful55guy, I just got my BW back after a month of HCG... unfortunately it hasn’t done anything... my total testosterone came back at 204 ng/dL, free T at 4.1 pg/ml. I feel like I have exhausted every option to naturally raise my Test but nothing is working. I hate to start TrT at 31 but do you think this is my only option? Is it possible that I completely screwed up my hormones for life for doing one 10 week steroid cycle two years ago?!

[Brosef]

kelkel or Youthful55guy can y’all weigh in on this please?

[Youthful55guy]

Hey Youthful55guy, I just got my BW back after a month of HCG... unfortunately it hasn’t done anything... my total testosterone came back at 204 ng/dL, free T at 4.1 pg/ml. I feel like I have exhausted every option to naturally raise my Test but nothing is working. I hate to start TrT at 31 but do you think this is my only option? Is it possible that I completely screwed up my hormones for life for doing one 10 week steroid cycle two years ago?!

Can you please refresh my memory on your protocol? By the title of the string and from what I can remember without having to read through the entire string again, I understand you had varicocele surgery. This apparently has not sufficiently fixed the low T problem.

From the current post, I gather you are using HCG as a monotherapy. While I've never attempted HCG monotherapy myself, guys that I've communicated with that have tried it have generally not been satisfied. My former TRT specialist doc reiterated this point when I asked him about it years ago.

If HCG monotherapy is not working for you, as I see it, your next option would be TRT. Yes, it sucks to go on it at such a young age, but being low in T sucks even more.

[Brosef]

Ah, thanks so much for the response, yes I was on HCG by itself for a while and no increase inT was noticed, it was actually lower. So I’m guessing like you said that my only way to feel better is to opt for low dose trt, 3x a week? Coupled with HCG for fertility’s sake since I’m so young. I got a semen analysis done today and I will know in 3-5 days if I even can have children. From before my varicocele surgery my semen parameters were not capable of impregnation. So, if they’re good I think I’ll freeze some just in case it’s not good in the future.

[Youthful55guy]

Ah, thanks so much for the response, yes I was on HCG by itself for a while and no increase inT was noticed, it was actually lower. So I’m guessing like you said that my only way to feel better is to opt for low dose trt, 3x a week? Coupled with HCG for fertility’s sake since I’m so young. I got a semen analysis done today and I will know in 3-5 days if I even can have children. From before my varicocele surgery my semen parameters were not capable of impregnation. So, if they’re good I think I’ll freeze some just in case it’s not good in the future.

What was your HCG dose? It may be that you have secondary hypogonadism (testicles don't respond to LH and/or HCG). If that's the case, you may be infertile. It may also be that you are only partially non-responsive and higher doses of HCG for a couple of months may overcome the infertility issue. If that's the case, then I don't see the downside of TRT. If you have the money and/or insurance coverage, adding in HMG might be an option but it is extremely expensive and you have to maintain treatment for at least 3 months to reach full fertility (if it works at all). It takes that long for sperm cells to fully mature.