New to TRT. Androgel stopped working 2 months in. Questions about labs, HCG & Cialis

[BK12]

I'm 32 years old, 6 ft, 174 lbs, leanbody fat 10 - 15%, train 3 x week.

I recently started TRT. I had been feeling symptoms (weak erections, ED, no strength gains, no nocturnal/morning wood) for the past six years. In that time my total Test levels dropped from 360 to 325. In 2012 my primary care doc agreed to start me on Androgel 1% at 5g. Three weeks later, and feeling great, I went to an Endo. He immediately had me stop Androgel for three months to get baselines.

Baseline BW 11/1/12

Total Testosterone: 340 (ref: 300 - 1080)
Free Test: 59 (ref: 47 - 244)
Test Bioavail: 168 (ref 131 - 682)
SHBG 35 (ref 11 - 80)
LH .06 (ref: 1.3-7.2)
FSH: 2.6 (ref: 1.6 - 11.0)
Prolactin: 6.8 (ref: 0.0 - 18.0)
TSH: 5.64 (ref: .50 - 5.20)
FT4: 1.3 (ref: .8 - 1.8)
VIT D: 33 (ref: 25 - 80)
PSA: .34 (ref: 0.00 - 2.50

The endo said I didn't need Androgel and diagnosed me with hypothroid, as TSH my levels had increased from 2.6 to 5.64 in six months. I started 100mcg of Synthroid the next day and restarted the Androgel, against his recommendation.

One month later I went to a urologist that specializes in fertility treatment. I got BW and stayed on the androgel. He added HCG at 500 iu injected IM weekly. At this time I was feeling awesome, getting solid erections, having good workouts and waking up with nocturnal/morning wood. He ordered his own set of BW:

BW 11/27/12
Note: One month on 5g Androgel
Total Testosterone: 476 (ref: 280 - 800)
Free Test Calc: 16.6 (ref: 12-25)
SHBG: 34 (ref 10 - 80)
LH .05 (ref: 1.7 - 8.6)
FSH 1.6 (ref: 1.5 - 12.4)
TSH: 1.41 (ref: .30 - 4.20) *after talking 100 mcg of Synthroid for one month
TT4: 8.9 (ref: 4.3 - 12.1)

Two weeks after adding HCG my face got very oily and I stared breaking on my back,shoulders and chest. Sex drive increased but erections became lack luster .They would start strong but fade quickly into nothing. After six weeks I stopped the HCG.

Went to my urologist 3 weeks later. The acne/oil had decreased but I was having mediocre workouts, no nocturnal/morning wood and diminished sex drive. He switched me to Test Cyp at 100mg per week and that's when I found this forum. I'm so glad I did. I read up and then went in for more BW on 2/28/13. He dismissed most what I had learned. He did however, order the E2 test and wrote me for an AI pending the results. He said he may need to increase the test to 150mg per week and/or add the AI. He didn't want to re-introduce the HCG.

BW 1/31/13
Note: Three months on 5g Androgel with six week stint of HCG at 500i.u per week.
Total Testosterone: 195 (ref: 280 - 800)
Free Test Calc: 8.0 (ref: 12-25)
SHBG: 34 (ref 10 - 80)
LH .1 (ref: 1.7 - 8.6)
FSH .2 (ref: 1.5 - 12.4)
TSH: 2.20 (ref: .30 - 4.20) *after reducing Synthroid to 50 mcg 3 weeks prior
TT4: 6.6

After four weeks on the Test Cyp I'm starting to have morning wood again. Workouts feel a little better. Balls feel tighter. Skin is oily again but the acne on the arms/back/chest isn't as bad. I'm planning on dividing my test cyp up into two shots (monday/thursday). I'm anxious to get my next labs.

Here are my questions.

1. Since I have secondary hypogonadism, I'm wondering if the HCG alone would have been enough to get and keep my levels at 500, which is where I started feeling good?

2. I am considering adding HCG back in but am concerned about what happened the first time. Is it possible that HCG + Androgel raised my test levels too high initially and when I stopped the HCG, the androgel was already becoming less effective?

3. My urologist wants me to start taking Cialis at 5mg every day. The whole reason I started TRT was because I didn't want to rely on a pill to have sex. Furthermore, I have been using the lack of ED and presence of nocturnal/morning wood as a barometer that my levels were are the right track. So should I get things sorted with my the levels and then add it or just add it now?

4. Anything I missed? Suggestions?

Thanks guys. I really appreciate your help and everything I've learned thus far.

[Trific]

Welcome!

Here are my questions.

1. Since I have secondary hypogonadism, I'm wondering if the HCG alone would have been enough to get and keep my levels at 500, which is where I started feeling good? It's possible but often people feel better when it's exogeneous test that brought their test levels up but don't feel as good when it's HCG that brought their levels up even though the totals might be at the same level.

2. I am considering adding HCG back in but am concerned about what happened the first time. Is it possible that HCG + Androgel raised my test levels too high initially and when I stopped the HCG, the androgel was already becoming less effective? Quite possible.

3. My urologist wants me to start taking Cialis at 5mg every day. The whole reason I started TRT was because I didn't want to rely on a pill to have sex. Furthermore, I have been using the lack of ED and presence of nocturnal/morning wood as a barometer that my levels were are the right track. So should I get things sorted with my the levels and then add it or just add it now? Your choice but I'd probably add it now, a bunch of the guys here love cialis for it's many benefits...even in the gym.

4. Anything I missed? Suggestions? It's all a big learning experience, just keep chatting and people will keep offering ideas.

[Trific]

Here's a thread for more on cialis:

http://forums.steroid.com/showthread...ialis-2x-a-day


Me, I'd want to try to reintroduce HCG 250iu on MWF and leave my test at 50mg twice/week and do more BW in about six weeks to see how it's goin on paper. HCG tends to raise the test levels along with inflating the boys.

[VTX1800]

Welcome, glad to see your feeling better!

[GotNoBlueMilk]

Androgel doesn't "stop" working. Your protocol will need to be adjusted based on your results. Lifestyle changes, current stress, if you are fighting a cold, etc. will all impact your current T levels. Your levels are going to fluctuate from day to day, and by hour of day. Looking at your labs, your 2nd testing was not that good. I don't think the 5 mg is enough for you.

Your baseline LH was very low. This is why you have low T. HCG will help with that, but as previously stated it is not a great mono-treatment protocol. HCG also raises progesterone levels some. This is why some people have issues and increased gyno with it. A maintenance dose is good, but using it as a mono-therapy protocol can be too much for many.

My suggestion is to try and get your doc to boost the prescription. Be consistent in bloodwork testing on time of day, and in relation to when you last applied the androgel. This will help give a better, more normalized set of test results so you can more accurately follow your real progress. Keep in mind, not everyone absorbs angrogel the same. This is a big reason why some people switch from it to an injection. Some individuals just don't absorb the T well enough through the skin.

[Rusty11]

Others have answered, but I'll throw in my .02...

You're quite young to be having these issues. Something not the norm is going on. By that I mean, I was 50 before I needed trt. You're only 32.

1. Rarely is hcg, alone, enough to fix things.
2. Back when you were on the gel, hcg should have been administered at 100iu/day. That's the recommended dose for guys on gels. Don't know if you were taking 500iu in one pin. That could be responsible for the issues you discussed.
3. As already stated, cialis is much more than an ED drug.

I'm also taking 100mcg of synthroid. It's kept me at a good level. Good luck getting things worked out.