That Dull Ache

[Blankinator]

12 weeks in to TRT and last night that dull ache starts up with the boys. Ebbs and flows but not the most comfortable thing. Not sure about getting used to it.

Does that mean its time for some HCG ?

[ZenFitness]

Anytime on TRT is time for hCG provided you are secondary hypogonadism. If you have secondary, then hCG should reverse the atrophy process and give you a more well-rounded sense of well-being. As with all medications and treatments, YMMV, but this is my experience and the experience of many I have read.

[LowT Mike]

^^^^Well said. Correct. HCG keeps the boys going with allowing spermogenesis and natural endogenous production to continue.

[Blankinator]

And, if you are Primary? Same benefit?

I'm on 140 of Test Cyp every 7 days.

[LowT Mike]

If you want to keep spermogenisis going and natural T production then HCG will have to be used. If not keeping fertility intact while on TRT or atrophy of testicles dosent bother you then no need for HCG. If your diagnoses or cause of LOWT is primary then HCG wont work at all. HCG will only work on secondary hypo Dx men. Cant squeeze blood out of turnip! If you are primary then just TRT

[ZenFitness]

Cant squeeze blood out of turnip! If you are primary then just TRT

I have to say I cringe a little every time you say that... the image of nut squeezing makes me squirm

Thanks as always for your input LowT Mike... you are great to have on the forum!

[roxer]

If your diagnoses or cause of LOWT is primary then HCG wont work at all. HCG will only work on secondary hypo Dx men. Cant squeeze blood out of turnip! If you are primary then just TRT

So I understand, primary would not produce testosterone at all, right? But if my body was able to produce some test naturally or while on clomid - say I was tested up to 300ng/dl - is this still considered primary? As long as I am able to produce "some" test, is hCG OK? I use it now and notice a difference - no more ache. Would I get that affect if I was primary?

[Blankinator]

Thanks LowT Mike.

Although I am primary, I'd like to do something about the ache. Already have 3 kids so I don't give a rats about fertility.

Testicle reduction is about 30%. It wouldn't bother me but it does seem to be a downer to the missus, so, in turn, I guess I do care.

Would HCG possibly cure the ache and reduce the reduction - even though I'm primary?

[LowT Mike]

I have to say I cringe a little every time you say that... the image of nut squeezing makes me squirm

Thanks as always for your input LowT Mike... you are great to have on the forum!

hahaha. yeah thats awful imagery! Just gave myself the ebee jebbees. ughhh

[kelkel]

I have a dull ache myself. One day I'll get rid of her....



Mike, since the body has LH receptors throughout it, including the brain, isn't there value to it's use even if primary?

[LowT Mike]

So there is Primary Hypo, Secondary Hypo and also Late-Onset Hypogonadism which is where the majority of aging men fall into. Late-Onset Hypo can have charateristics of both. Slightly functioning testicles but also a weak LH signal would be an example. Older men men who fall into late-Onset and have been andropausal for 20 years have characteristics closer to Primary. Malfunctioning of the Leydig cells. Thats why HCG doesnt work well in older men and works great in most 20-40 year olds.

Kelkel-- From the research I can gather my answer would be there is greater test receptors in brain vs LH receptors. Pituitary gland in the Brain is more of a source of LH signaling or release than a receptor area....1000s of testosterone receptors in the brain...even the eye. These all respond to testosterone even exogenous test cypionate as you know. Men get a nice dopamine elevation when starting TRT. Thats why the depression is one of the first areas of pathology to lift. HCG use has been reported to have some brain pregnenalone release not substancially and no real but more of an impact on leydig cell receptors in testicles. Injecting T hits all the brain receptors needed.

[ZenFitness]

Interesting! So do 20 - 40 year olds who use hCG still gain benefit from it at age 60 if they have been using it consistently, say, from age 30? Or are there not enough studies in this area to comment?

[dreadnok89]

Hey lowtmike, if I was primary would my balls already be atrophied?

[LowT Mike]

ZenFitness-Thats an interesting thought. Unfortunatly I dont think there is enough data to make that call. HCG use in men hasnt been around long enough to do a 20-30 year case study on that particular patient base. The age demographic I gave Im speaking in terms of patient population studies when HCG would work. This studies are a generalization in my opinion but what what is taught A4M Board teachings is HCG works better in younger men due to aging lydig cells. Read below this is the best way to see if HCG works for you.

dreadnok89--Great question. Yes if you are a clear case of true primary you would have atrophied testes. Try HCG... if they regain fullness then you still have somwhat functional testes. HCG could help you. On the flip side If you atrophy at all when you begin "TRT no HCG" then you also still have somewhat functionioning testicles. HCG could help you. Ive written in other posts as barbaric of a triage as it is best way to stage effectivenes or "would HCG work for me" is to monitor testical size on T alone. Average testicle size 2.5cm-5cm. So monitor yourself before TRT and then stage testical size throughout. Go for optimal fullness. If you atrophy thats a good sign that testes are still at least somewhat functional. I know its sort of a funny subject measuring girth of testes. Its really just a rough estimate. But a great tool. In med school when your learning how to properly do a physical exam and asses genitourinary system (testes). Using your middle an index finger is just shy of 3 cm. So with the support of your thumb you can do this with ease. The fingers are really there just for a reference point. But you will be able to tell if your boys are atrophying or not. TRT alone with no HCG you generally can have a 20-50% atrophy in guys who have more secondary characteristics. Hope this helps.

[Blankinator]

On the flip side If you atrophy at all when you begin "TRT no HCG" then you also still have somewhat functionioning testicles. HCG could help you.

This is the first I've seen about a difference between primary and secondary in terms of testicle atrophy. But the explanations from LowT Mike give me the contextual understanding.

I'm primary. 12 weeks in to TRT. On the date of diag my T was at 258. So the boys were at least working some. I've experienced a 30% (in my opinion) reduction in size in the last 12 weeks.

With the onset of the dull ache this week, I'm going to discuss options for HCG with my doc next Monday.

Thanks for the replies guys.

[ZenFitness]

I thought if you were primary then your testicles would be producing no testosterone ?

[LowT Mike]

Right if you are clear cut primary the testes dont work. There are varying degress of this as I explained. Majority of andropausal men fall into Late-onset Hypogonadism male which you can have characteristics of both primary and secondary. Older men whove been andropausal from years tend to be more primary. Its not black and white.

We are diagnosing reasons for Low T not no T. Even those guys that have an LH of 20 and they have a serum T of 250 they are LowT. The cause would be primary. The testes are still somewhat working though to have any T at all. Right? The diagnoses still would be primary and adding HCG to mimic LH on top of a natural LH of 20 wouldnt have much benefit besides decreaseing the degree of atrophy.

[HRTstudent]

mike you bring up a good point that sometimes I feel gets overlooked -- and that is that it is important to note that primary does not necessarily mean NO testicular function. sometimes it might, but not always.

[LowT Mike]

^^^^Correct. Primary in most cases would just mean the cause of your LOW not NO testosterone .

[rt12008]

This is an awesome discussion. Thank you. I feel like I learned something. : )

[rt12008]

I have to say I cringe a little every time you say that... the image of nut squeezing makes me squirm

Thanks as always for your input LowT Mike... you are great to have on the forum!

I totally agree. Low T Mike is a great addition. Thank you for all your input Low T Mike.

[roxer]

^^^^Correct. Primary in most cases would just mean the cause of your LOW not NO testosterone.

Thanks much for that MikeT. I am guessing the hCG makes some contribution to my condition even if I am primary. The doctor rejected my request for new BW because I am now on hCG. So I will wait a couple more months for one as he suggested.

[LowT Mike]

After my doctors have dicussed if the patient is a good canidate for HCG (going over primary and secondary) I train docs to always ask these 3 questions. If the patient answers yes to any of the questions below... give HCG.

1) Do you wish to keep fertility intact while on TRT
2) Do you wish to father children while on TRT
3) Does testicular atrophy a concern for you.

[LowT Mike]

Thanks guys for the well received received feedback. Im hear to help.