HCG monotherapy - Need advice

[theheat]

I'm a 45yo male who went to see a HRT after my BW revealed a total T of 405 and an E level of 35. The doctor recommended 1,000 IUs of HCG 2x a week for 3 months, and a natural product to control E levels.

Everything was fine but about 4-5 weeks into it my libido crashed, which I thought was from high E so I added .25 Arim ETD, then upped it to .5 EOD. The Dr also added T cream 4 weeks ago, but my libido is still nonexistent. Should I lower my dose of HCG and continue the Arim, or keep the same dose of HCG and drop the Arim?

[kelkel]

Jeez! A few questions for you:

What was your LH, FSH, Free T, prolactin, cortisol and SHBG levels on your BW?
What natural product for E control?
Why 3 months? You're either on HCG mono or your not. What does he plan to do after 3 months?
Know that HCG mono will eventually suppress your endogenous LH production as your body will sense it does not need to produce it any more and you'll then be living off of HCG mono alone. If he was looking to see if your testicals were functioning with an HCG stimulation test all it would take is a few days to do so, not 3 months.

Moving on...

Your libido crashed "possibly" from high E. Ok, did your doc pull a sensitive E2 assay to confirm this or simply guess and add the .25 adex ETD? Know that most cycles of 500mg Test a week require only about .25mg adex EOD. Then it was upped to .5 EOD! If you were running 750-1000mgs of test per week I could see that amount. You are destined to crash your E if you have not already. You will not like it. Loss of libido, joints hurt, etc.

Now the doc adds T Cream. If your E is crashed the little bit of T cream you're on will not mitigate that much.

IMHO, your doc is guessing here and you need one that understands hormones. It's your health and it's important. My position at this point would be to drop your HCG back to 250 IU's twice per week, continue with your T cream and discontinue the adex entirely. Retest BW for TT, FT and a Sensitive E2 assay in 4 weeks.

If you have BW from immediately prior to this please post it up. It will help us help you.

Welcome to the forum Heat!

[theheat]

Thank you very much for the advice. The doctor had me take Libidostim-m which has tongat-ali and DIM. I was afraid my E would spike with 2,000 IUs of HCG a week, especially since it was already 35, so I started taking .25mg Arim on my own when I took my HCG shots. I only started taking .5mg EOD the last week as I was afraid my E was still to high, but it may have been low already and now I crashed. I just had more BW on last Fri, and I have an appt with the doctor in a few weeks, so I should know what the problem is soon. In the meantime, is there anything I can do to bring my libido up ASAP? It crashed pretty bad, and I would hate to wait 8 weeks for my E to come back up. I'll also post my other labs tonight...

[kelkel]

DIM is best taken with Zinc and Copper. Say 200, 50 & 3-4mgs respectively. You can find Zinc and Copper mixed together.
HCG in large doses like that will cause a spike in intratesticular E2 which is pretty much uncontrollable with AI's.
Other than adding more testosterone there's really not much you can do to speed up your E rising. It will come back quicker than you think if you stop all AI's.
In the meantime there's Cialis / Viagra / Trimix, etc.
You also need the proper E2 Sensitive Assay. If you use Labcorp I can give you the correct codes to make sure you get the right one.

[theheat]

Would doubling my dose of t-cream help in the short term? I was also thinking of adding pregenelone and dhea to raise E levels, although that will probably do more harm than good. I did try a 20mg Cialis last week and I still couldn't stay hard...it was pretty embarrassing. Dose stinging nettle help at all to raise free T levels?

It's bothersome that I'm in this situation considering the HRT doctor is out of network and I've had to pay over $3,000+ already for the office visit, blood test, HCG , etc. I could have done a 6 week deca /sust 250 cycle followed by HCG and felt much better, looked better, and saved money. I wish this Dr would have run a blood test 2 weeks after I started the HCG to see how I was responding and adjusted the dosage. I thought 2,000 IUs was high, and I didn't really believe the DIM was going to control the E2 so I started the Arim on my own. I believe I used about ten 1mg tablets over an 8 week period (initially .25 with every HCG dose, then .5mg EOD over the last week, as I initially thought my E2 spiked). I seem to be having more low E symptoms, as some slight knee pain has come back (after heavy squats) and I seem to have lost weight and BF while on Arim.

[Black]

Like kel stated, your E will rise faster than you think. Personally, I would try to stick it out with the current protocol you are prescribed to run. Messing around (like before) can confuse your body even more.

I wouldn't think daily test cream and HCG would cause your estrogen to rise that much. Again, like kel stated, try and see if they are running a sensative estradiol assay.

What is the reason they are prescribing you 2000iu of HCG a week? Using less than that should keep your guys stimulated enough.

[theheat]

I'm not sure why the Dr went that high on the HCG without BW in the next few weeks to see how I was responding. I had a total T of 405, so her thought was to go the HCG monotherapy route rather than TRT. She thought with some lifestyle changes and HCG she could get me up into the 600 range on my own without having me on TRT, which she said is a lifelong commitment. I told her that I wanted my T in the optimal range (800-1,200), and I wasn't sure if we would be able to achieve it with the HCG alone. She only added the T cream after I told her my libido crashed about 4-5 weeks ago.

Does DIM really work, and are it's effects comparable to a pharm like Arimidex ? I felt with the 1,000 IUs of HCG 2x a week and with already high E that the DIM was going to be insufficient so I added the .25 Arimidex 2x a week, not realizing it would be so effective. I also didn't realize that E was necessary for male libido, so I learned the hard way. I have read other posts where guys said their E went way up with 1,000 IUs of HCG a week, and they had a hard time getting it down even with Arimidex. Is it possible that my E could still be high, and wouldn't that cause libido issues as well?

I also read other posts where guys say that they can tell if their E is high or low by their libido, joint pain, bodyfat, nipple sensitivity, etc. Judging from that, I would say mine is low as I have lost weight/BF (but not strength) and I have a little joint pain, in addition to the low libido.

My original BW had the following:

TSH 1.63 range 0.4 - 4.5
T4 free 1.2 range 0.8 - 1.8
T3 free 3.7 range 2.3 -4.2
Total T 403 range 250-1100
Test. Free 60.2 range 46-224
Test bio.avail. 134.2 range 110-575
SHBG 27 range 10-50
DHT 27 range 16-79
LH 3.1 range 1.5 - 9.3
PSA 0.7
Estradiol, ultra sensitive 35 ref. Range < or = 29
I also had a cortisol test where it was within range during the day but it spiked at night (when I get home from work).
I.e. it was 3.5 where the range is 0.6-1.9
I'm 46, 6'3" 250lbs 18% BF at the time of the test 3 months ago, but I'm down to 235 now with lower BF (not sure of the %).

[kelkel]

Would doubling my dose of t-cream help in the short term? I was also thinking of adding pregenelone and dhea to raise E levels, although that will probably do more harm than good. I did try a 20mg Cialis last week and I still couldn't stay hard...it was pretty embarrassing. Dose stinging nettle help at all to raise free T levels?

Preg and DHEA are part of your cholesterol pathways (testosterone comes from cholesterol) and these supplements can do wonders if they are needed. As always, it should be based on blood work. If they are to be used the products need to be micronized. If your E is low your libido will suffer. That said, elevating your test a little can obviously help to bring it up quicker as with more test comes more conversion to E. Be careful with this if you choose this path. Stinging Nettle, Vit D, etc. can help with Free T levels by virtue of suppressing SHBG levels. Although your level is not really bad at all. SHBG is needed and you don't want to be too low as that comes with it's own issues.

It's bothersome that I'm in this situation considering the HRT doctor is out of network and I've had to pay over $3,000+ already for the office visit, blood test, HCG, etc. I could have done a 6 week deca/sust 250 cycle followed by HCG and felt much better, looked better, and saved money. I wish this Dr would have run a blood test 2 weeks after I started the HCG to see how I was responding and adjusted the dosage. I thought 2,000 IUs was high, and I didn't really believe the DIM was going to control the E2 so I started the Arim on my own. I believe I used about ten 1mg tablets over an 8 week period (initially .25 with every HCG dose, then .5mg EOD over the last week, as I initially thought my E2 spiked). I seem to be having more low E symptoms, as some slight knee pain has come back (after heavy squats) and I seem to have lost weight and BF while on Arim.

DIM can and will help with E but it's not adex and never will be. Body fat plays a big part in estrogen conversion. Especially belly fat. The more lean you are = less conversion. And your cycle example will not help. A six week long ester cycle will do nothing for you really. Test won't kick in until around week 4 and Deca won't until 5 weeks or so. HCG is always while "on" cycle, not off. Educate in this area before you cycle. There are educational threads in the AAS Q & A that will guide you, or some of us here can.

[kelkel]

My original BW had the following:

TSH 1.63 range 0.4 - 4.5
T4 free 1.2 range 0.8 - 1.8
T3 free 3.7 range 2.3 -4.2
Total T 403 range 250-1100
Test. Free 60.2 range 46-224
Test bio.avail. 134.2 range 110-575
SHBG 27 range 10-50
DHT 27 range 16-79
LH 3.1 range 1.5 - 9.3
PSA 0.7
Estradiol, ultra sensitive 35 ref. Range < or = 29
I also had a cortisol test where it was within range during the day but it spiked at night (when I get home from work).
I.e. it was 3.5 where the range is 0.6-1.9
I'm 46, 6'3" 250lbs 18% BF at the time of the test 3 months ago, but I'm down to 235 now with lower BF (not sure of the %).

Thyroid looks good with what you posted but always good to see RT3 and Antibodies as well.
SHBG mid-range which is ok but you could work to reduce it some based on your T levels. I would.
DHT is low as T is low.
LH is low. Have you cycled or used pro-hormones sometime before this blood work?
Need an E2 Sensitive Assay to be accurate.
Take 1-2 grams of C daily. It will help with your cortisol.

Know that cortisol, prolactin and thyroid issues all can impact T production. Your T is currently low as your LH (from your pituitary) is low. LH signals your testies to begin production and they're not getting much of a signal, quite honestly. If all potential causative factors can be ruled out, and there have not been any recent cycles it may just be time for TRT. Another thought would be to simply run a SERM (s) for a brief period and see if it bumps up LH production.

[theheat]

I had thought about adding 200mg of DECA a week for 12 weeks, but I'll hold off until I get everything normalized. I'm also afraid that at my age it will cause even more issues with my libido unless I'm closely monitored.

I'm thinking of switching HRT doctors, as my current one doesn't allow my PCP to run blood tests, and I have to pay out of pocket since the HRT doctor is out of network. A friend of mine goes to another doctor that has your PCP run all the tests, and the consultation feel is lower than the $400hr that I'm paying now.

I was frustrated with the lack of results and the $3,000+ I've paid so far, and I felt like I could have achieved more on my own with a cycle + PCT. I'm going to decide what the best course of action is after I get the results of last Friday's BW.

Kelkel, what would you have recommended for a protocol based on my initial labs? 250-500 IUs of HCG 2x a week with no T? I'm sure you'll agree that 1,000 IUs twice a week was too much HCG. Do you think it was possible for me to achieve ideal T levels with HCG alone? I also thought .25mg of Arimidex 2x a week was reasonable, but there is no way of knowing without the follow up BW. I wish the HRT doctor would have run more BW 4 weeks into it just to see how I was responding and then made adjustments rather than waiting almost 3 months.

[theheat]

I did use 50mg dhea and 10mg pregnenolone 1x day for a few months before the initial BW.

I actually asked the HRT doctor about using Clomid rather than HCG , but she ignored my question and just put me on the HCG. I thought the Clomid would have been cheaper, and it wouldn't have stopped me from producing LH on my own. I'm sure my LH will be in the toilet after 3 months of 2,000 IUs of HCG a week.

I did lose a lot of BF since the initial BW through a combination of early morning interval cardio (10 x 2 min), heavy weights 4-6 reps/6-10 sets every body part once a week, and the "Nutrient Timing" approach with high GI carbs during and after workout and 50/50 carb/prot meals for the next 4 hours and the rest of the day low carb.

I felt it was a catch 22 with an E2 of 35, as having higher BF was probably causing my body to aromatize more T to E2, but having higher E2 probably didn't help with losing BF. My goal would be to go from 250/18% to 235/10%, but I'm not sure I'll be able to achieve that at my age without TRT.

Thanks again for all the advice and assistance...I really appreciate your responses. I'll have to browse around on the site to get some more info, as some of my cycles were old school 6-8 weeks of test/sust with DECA , A-drol, Nolva, and a PCT of HCG.

[kelkel]

I had thought about adding 200mg of DECA a week for 12 weeks, but I'll hold off until I get everything normalized. I'm also afraid that at my age it will cause even more issues with my libido unless I'm closely monitored.

You definitely need to figure out what your future is and get stable first before adding any other compounds. Meaning trying to figure out the problem or simply accepting TRT. If the latter then your body needs time to find balance. It does not happen overnight with TRT. It can take a long while to dial in with multiple sets of BW to guide you.

I'm thinking of switching HRT doctors, as my current one doesn't allow my PCP to run blood tests, and I have to pay out of pocket since the HRT doctor is out of network. A friend of mine goes to another doctor that has your PCP run all the tests, and the consultation feel is lower than the $400hr that I'm paying now.

Take a look at LowTestosterone.com - $199 All-Included Testosterone Treatment

I was frustrated with the lack of results and the $3,000+ I've paid so far, and I felt like I could have achieved more on my own with a cycle + PCT. I'm going to decide what the best course of action is after I get the results of last Friday's BW.

Post them up here. Let us take a look.

Kelkel, what would you have recommended for a protocol based on my initial labs? 250-500 IUs of HCG 2x a week with no T? I'm sure you'll agree that 1,000 IUs twice a week was too much HCG. Do you think it was possible for me to achieve ideal T levels with HCG alone? I also thought .25mg of Arimidex 2x a week was reasonable, but there is no way of knowing without the follow up BW. I wish the HRT doctor would have run more BW 4 weeks into it just to see how I was responding and then made adjustments rather than waiting almost 3 months.

Protocol as in cycle? If that's what you mean then instead of spelling it out I'd simply refer you to Austinites "How To Run A Successful First Cycle" thread in his educational articles database. I know it's not a first cycle but it seems your past ones were lacking a bit so I'd keep it simple if and when that time comes.

Some do respond well to HCG Mono. I'm not a fan of it as I think you lose some of the subjective benefits of testosterone this way.

[kelkel]

I did use 50mg dhea and 10mg pregnenolone 1x day for a few months before the initial BW.

I actually asked the HRT doctor about using Clomid rather than HCG , but she ignored my question and just put me on the HCG. I thought the Clomid would have been cheaper, and it wouldn't have stopped me from producing LH on my own. I'm sure my LH will be in the toilet after 3 months of 2,000 IUs of HCG a week.

I did lose a lot of BF since the initial BW through a combination of early morning interval cardio (10 x 2 min), heavy weights 4-6 reps/6-10 sets every body part once a week, and the "Nutrient Timing" approach with high GI carbs during and after workout and 50/50 carb/prot meals for the next 4 hours and the rest of the day low carb.

I felt it was a catch 22 with an E2 of 35, as having higher BF was probably causing my body to aromatize more T to E2, but having higher E2 probably didn't help with losing BF. My goal would be to go from 250/18% to 235/10%, but I'm not sure I'll be able to achieve that at my age without TRT.

Thanks again for all the advice and assistance...I really appreciate your responses. I'll have to browse around on the site to get some more info, as some of my cycles were old school 6-8 weeks of test/sust with DECA, A-drol, Nolva, and a PCT of HCG.

Update us on this thread with what course of action you choose and how you do please.
Remember, the estrogen test you are working off of does not appear to be an E2 Sensitive Assay which is specific to males. Yours is not. There can be a large difference. If you use Labcorp I can provide the correct codes.
Visit the AAS Q & A as stated and read the sticky threads. Particularly Austinites Education Articles Database.

And don't use age against yourself. Many of us here are older than you. Just get dialed in medically if that's the objective and keep hitting it. You'll get there. Visit the Nutrition Forum and let the vet's there guide you. Basically free Nutritionists = great deal right?

[theheat]

I'll definitely check out lowtestosterone.com. I'm looking for a Dr that can keep the costs down and is also open minded as far as trying different protocols.

As far as my current situation, wasn't .25mg of Arimidex 2x a week reasonable for 1,000 IUs of HCG 2x a week and 20mg 1/2ml test cream everyday? If I did crash, it must have been when I upped the dose to .5mg EOD for a week as I was afraid my E2 was too high.

Should I expect my E2 and libido to rebound in 1-2 weeks without an AI, or is it going to be more like 6-8 weeks, and won't I also lose my libido if E2 goes too high? Should I just wait for any symptoms of high E2 and then go back on Arimidex .25mg 2x week? Getting E2 dialed in seems fairly difficult...

I'm upset at myself for getting in this position in the first place. I probably could have had 600+ T on my own if I had kept up the heavy squats, taken DIM/stinging nettle, slept more, reduced my stress, reduced my BF, ate some healthy fats, etc, but I let a stressful job and kids get the best of me. My HRT doctor said I'm still fairly young, and my total T wasn't terrible, so she was hoping the HCG would get me back to normal levels, but it looks like I'm heading down the TRT path now...

I'll also update the thread when I get my latest BW back...

[theheat]

Just got my latest BW:

Total T: 719. Range 250-1100
Test, free: 70.1. Range: 46-224
Test, bioavailable: 144.1. Range: 110-575
SHBG: 51. Range: 10-50
Estradiol, ultra sensitive: 23. Range: < or = 29
DHT: 52. Range: 16-79
PSA: 0.7. Range: < or = 4.0

So it looks like my E2 wasn't bad, even after upping my dose of Arimidex . I've been off Arimidex completely for about 2 weeks, so I imagine my E2 levels have come up since the BW. What I'm confused about is why my SHBG would almost double from 27 to 51 since I started HCG /test cream. Is that what's causing my free and bioavailable T to remain low? I started taking stinging nettle last week, but are there any other ways to lower SHBG?

[theheat]

I went to see my HRT Dr today, and she believes my high SHBG / low T is being caused by stress and adrenal fatigue, and she recommended some herbs (rhodiola, bacopa, etc) in addition to relaxation techniques. I told her I started stinging nettle a week ago, and she told me to continue that.

My big decision is whether to continue with the 20mg/.5ml T cream, as she wants to drop my HCG to 125 IUs 2 x a week. I'm thinking I shouldn't have started the T cream, and I should have just stuck with the HCG monotherapy 1,000 IUs 2x a week to see if it worked, as my total T was 403 to begin with, which isn't terrible. She said there is no way of knowing whether my new total T of 719 is from the HCG or the T cream which I have been on for a month. She was planning to have me on the monotherapy for 3-6 months and then reassess if I need TRT, but she added the cream a month ago as I wasn't feeling any better. She cautioned that if I stay on the cream, my own production will eventually shut down completely, even on low dose HCG.

I'm just looking for opinions: should I drop the HCG to 125 IUs 2x a week and continue 20mg/.5ml T cream daily, or should I drop the T cream and continue 1,000 IUs of HCG 2x a week and reassess in 2 months?

[theheat]

OK, so I made a decision on my own...I'm going to drop the T cream, make a few more lifestyle changes (no drinking at all and 8+ hours of sleep a night), keep taking the stinging nettle, and continue with HCG monotherapy for 3 more months: 500 IUs on M-W-F and .25mg Adex 2 x week. I'll get more BW through my PCP next month to see if I made the right decision. I just felt that my initial total T of 403 was too high to be on TRT the rest of my life, so I really want to try the monotherapy before I give up.

[theheat]

Double post by accident, sorry.

[theheat]

I recently switched to TRT and a new Dr, as I got frustrated with the lack of results with monotherapy. My new Dr prescribed 200mg T-cyp per week, .5mg Adex 3x week, and 500 IUs of HCG 2x week.

Considering that my SHBG was high and my free T was low on monotherapy (despite a total T of over 700), should I start off high on TRT with 400mg of T for 2 weeks, 200mg for 6 weeks, and 100mg for 4 weeks (adjusting the HCG dose accordingly) in order to overcome and bind the SHBG, thereby increasing my free T?

[mackbutter]

For me, sexual health is often a good indicator or many things.
I would worry that your adex 3X/week might crash your estro and that feeling suks.
500iu,2X/week sounds reasonable.

If u wanna free up Test I read that proviron is helpful so I started it and it is fantastic. Great for libido no matter what yur test dose is.
My TRT was between 125-150mg of test e /every 4 days, with 1/2 a proviron/day and between 250-500iu of HCG 2X/week and 1/4 of a letro tab/week(sometimes 1/2 tab) This worked well for me.
Again , I generally could gauge how well my doses were working based on sexual health.

[theheat]

I wish I could get some Proviron , as I really think SHBG is my problem, but I thought it wasn't available in the US? I was thinking my only alternative would be to do higher levels of T to accomplish the same thing, and I even read somewhere that Chrisler had a "mass action" TRT protocol to bring down SHBG.

I actually backed off on the Arimidex and I've only taken .5mg 2x week, as I was worried I was crashing it before while on monotherapy (at that time I was taking .25mg 2x week and I brought my E2 down from 35 to 23).

I actually divided up my T doses and did 400mg for the first two weeks, 200mg for 6 weeks, and 100mg for 4 weeks. I thought the higher dose of T up front would bring the SHBG down and increase my free T, however I'm 4 weeks into it and I still don't feel any better (slow recovery, no motivation, no sex drive, mild depression, etc). I actually felt better on the higher dose monotherapy (1,000 IUs 2x week) and I've gained 7lbs of fat since transitioning to TRT.

I'm heading in for BW in a few weeks, and I'll post it up when I get it, but until then, any advice is appreciated...

[theheat]

OK, so this may be my final post on this thread as as I don't seem to be getting much advice or feedback, so I've been making the best decisions I can based on the information available to me at the time. I wanted to keep this in one thread in the event someone asked to see my blood work, as it's already in this thread.

Anyways, I stopped monotherapy after getting my total T over 700 but not feeling any better since my BAT only went up to 140. I then started TRT at 200mg cyp a week, 500 IUs of HCG (2 doses of 250), and 3x.5mg Arimidex . I decided on my own to up the dose to 400mg the first two weeks (I'll have to drop to 100mg the last 4) and I cut my dose of Arimidex to 1mg per week. 4 weeks into it I don't feel any better, so I asked for a slightly higher dose in an attempt to force down the SHBG since Proviron isn't available. Mr. doctor recommended Danazol instead at 25mg for 30 days. My concern is that it's hepatoxic in addition to being very expensive ($240 for 30 -25mg tabs), and that my SHBG might rebound once I come off it. Any advice at this point would be appreciated, as I have absolutely no libido, energy, recovery after 4 weeks at a fairly high dose. Should I try the Danazol or just give it more time?

[OingoBoingo]

IMO, you should settle on a reasonable treatment plan, ride it out for 6-8 weeks, and then see what the blood work says. That's how TRT works.

200mg per week is not a reasonable place to start. Dr. Crisler starts his guys off at 80mg per week, and then titrates the dose. Crisler's protocol also includes 700IU hCG per week.

Changes don't happen overnight. And it can take weeks for your E2 to come back once you've tanked it.

[theheat]

I thought the HCG monotherapy was reasonable at 1,000 IUs 2x week and .25mg Arimidex 2x week, and I did wait and give that a try for over 5 months, but the other Dr I was seeing told me that 6 months is the limit for momotherapy and that I'd have to come off after that. I did get my total T up over 700, but and gains in free T were blocked by the SHBG doubling. If I stayed with the same doctor for TRT I would have been on 60mg cyp and 125 IUs x 2 HCG a week, so I switched to a more progressive doctor. I know the SHBG is my problem, and that all I have done is switch one form of T for another. I intend to give this new protocol time, as the doses prescribed are more than reasonable, but I was also wondering if there was any reliable way to bring down the SHBG.