Questions about initiating HCG therapy while on TRT

[Equipeeler]

Hi everyone,

I am not a frequent poster here on the board but am an avid follower. My journey on TRT was initially a very rocky road until I discovered this board. Long story short, my knowledge base expanded immensely after spending time reading the information here and asking questions. Currently my TRT therapy has been very successful, my athletic training has hit a new level, and my quality of life is in a place I never dreamed possible. My work with an Anti Aging Regenerative Medicine doc has been the best thing that has every happened to me besides my wife and kids. Actually, my goal now is to try to make it to the Cross Fit games as a senior (51 years old).

Enough about all my excitement, my big question is about HCG therapy while on TRT. My doc has me on Test Cyp 60mg every 3.5 days, 8mg Progesterone SID, Ipamorelin 300mcg/Sermorelin 200Mcg 3x daily mixed, and Cialis 5mg BID. I take the HGH stimulators early at 4:30am, 8am post workout, and before bed at night. For my estrogen, I am maintained well with transdermal Chrysin SID and Dimension 3 2 capsules daily. I am on other supplements such as Vit D, DHEA, asprin,etc, (all others not hormone related). I am unable to process folic acid so I am on methyl folate and eat no artificial folic acid. My diet is about 90% gluten and dairy free.

I am steering to the direction of HCG because as one would expect, there is a fair amount of testicular shrinkage. I was also wondering about different issues that this may assist me with. For me, sex is generally good at night when I am not too tired (usually from long work day and hard workouts after waking at 4am). I do notice that some times it is very difficult to ejaculate and I will just loose an erection. Sort of like the feeling is just not there, no matter how hard I try. It happens maybe 15% of the time, keep in mind I always have Cialis on board. Not sure if its a being tired thing, result of my treatment(something missing), or just age creeping up on me. I am hoping that the gods of this board will help shine a little light on this subject. My latest blood work was in July and all was right on target and the issues I describe were there then. I have read lots of the information about twice weekly injections and EOD therapy with HCG. I am searching for opinions on dosages, intervals of therapy, timing of shots vs. testosterone injections etc... Also, is there anything I am missing that may be causing the sexual issues I have described. My wife is just happy as can be and says don't worry about it as she has never seen me this happy. For myself, I want to be the best I can be.
Thanks in advance for sharing your knowledge, it is greatly appreciated. I consider this board has basically saved my life.

[2Sox]

Nice post.

In my experience, intimacy was greatly improved after I began taking hCG . The changes were dramatic. As has been said many times here, aside from normalizing the size and feel of your stones, your orgasms will be greatly improved and your ejaculate volume will increase noticeably. My feeling, and that of many others, is that hCG just makes you feel like a normally functioning man with a healthy libido. And without it, the difference is very stark.

Dosing seems to depend on many factors - age being one of them - but a good starting point would be 250iu two times a week. Look up the Crisler Protocol for hCG to get an idea of dosing. I take 100iu hCG daily with my T - all SQ - in the same syringe.

[kelkel]

It sounds like your doc is very forward thinking. Considering the protocol he has you on (which I like) I'm surprised you are not already on HCG . With your twice weekly protocol there's no timing issues to worry about with HCG. That's really only needed on a once per week protocol. It's point was to use it both one and two days before your test shot to keep your T levels bumped based on your test level declining. That said, I agree with Sox, twice per week would be a great start. Just take it the same day you do your test. Same syringe is fine as well.

What's your doc's logic for not initiating this therapy previously?
I'm curious if you've tracked your IGF-1 levels pre-Ipam and Sermorelin and if so, how much did they change?
Ipam can raise prolactin, depending on dose. Elevated prolactin can equal libido issues. Not saying that's the case here. Just pointing it out..
Re injectable Ipam and Sermorelin and their related costs, take a look into "MK677" as an oral GH releaser.
What exactly is your E2 level? If your doc's testing estradiol it's the wrong test btw.

[Equipeeler]

Nice post.

In my experience, intimacy was greatly improved after I began taking hCG . The changes were dramatic. As has been said many times here, aside from normalizing the size and feel of your stones, your orgasms will be greatly improved and your ejaculate volume will increase noticeably. My feeling, and that of many others, is that hCG just makes you feel like a normally functioning man with a healthy libido. And without it, the difference is very stark.

Dosing seems to depend on many factors - age being one of them - but a good starting point would be 250iu two times a week. Look up the Crisler Protocol for hCG to get an idea of dosing. I take 100iu hCG daily with my T - all SQ - in the same syringe.

2sox,
Thank you so much for the words of wisdom, the response is much appreciated. I looked through the protocol and think I am going to go with the twice weekly 250IU. I am able to get a product produced by Merk, lyophilized 10K IU vial for really cheap price.
With your experience, how long did it take you to see the changes in testicular size and the improved intimacy issues? I look forward to moving ahead and will for sure keep the board updated. Again, thanks. This board is such a valuable source to so many in the dark.

[Equipeeler]

It sounds like your doc is very forward thinking. Considering the protocol he has you on (which I like) I'm surprised you are not already on HCG . With your twice weekly protocol there's no timing issues to worry about with HCG. That's really only needed on a once per week protocol. It's point was to use it both one and two days before your test shot to keep your T levels bumped based on your test level declining. That said, I agree with Sox, twice per week would be a great start. Just take it the same day you do your test. Same syringe is fine as well.

What's your doc's logic for not initiating this therapy previously?
I'm curious if you've tracked your IGF-1 levels pre-Ipam and Sermorelin and if so, how much did they change?
Ipam can raise prolactin, depending on dose. Elevated prolactin can equal libido issues. Not saying that's the case here. Just pointing it out..
Re injectable Ipam and Sermorelin and their related costs, take a look into "MK677" as an oral GH releaser.
What exactly is your E2 level? If your doc's testing estradiol it's the wrong test btw.

Kel,
Thank you for your response and to begin, it's a long story. First of all, the "doc" is a she and I am so happy I found her. I had problems with endocrinologists, urologist, and family physician in the past and after taking advise of this board, searched and found a Fellow in A4M. I did all the applicable blood test for TRT as she saw fit, 24 hour urine collection, food allergy testing, and some genetic testing. I found out I was having problems with dairy, soy, gluten, and a number of other things. My cortisol levels were sky high, I am homozygous for MTHFR(can not process Folic acid predisposing me to clots while on TRT), my homocysteine levels were high, test was low, growth hormone almost zero, IGF was low, estrogen was high....... I could go on all day here. Anyway, we instituted test cyp 100mg E3.5D progesterone 8mg SID, Chrysin, and Dimension3, 10g glutamine SID, DHEA 25mg, vits with 5 methyl folate, and massive changes in my diet. I travel a lot so the diet was difficult to manage but did so.
My blood was checked after 3 months and the test was high as well as the estrogen. That was the primary testing done. We dropped by test Cyp. To 60mg E3.5D and kept all else the same. She said she wanted to fight the estrogen by the conservative route first before going with the AI medications. My blood was checked in 3 months again and estrogen and testosterone were in good ranges. She knows I am athletic, so at that time, she brought up the subject of raising my GH levels and we started this protocol. My GH levels are scheduled to be checked at the end of the year. The plan was to be on for about 5 months before checking since I have told her I feel really good and have noticed changes since I started using the Serm/IPA combo treatment. I, too, am anxious to see the levels but am fine on waiting for my next battery of testing to be done.
On no instituting HCG right away, she brought it up early on in my therapy but decided to wait because of all the battles I was fighting at the time. She is conservative in her approach to therapy. Basically, take care of the major issues first and then knock out the smaller ones as we go. I think her logic is working with patient compliance. You know when you tell someone change everything about yourself and here take these 25 shots weekly. I am sure many would throw up their hands and just not start thinking they have found another quack! Anyway, the HCG is game on and I am going to start with the 250IU with my testosterone.
As for the MK677, I have seen the name but really don't know much about it. I will look into it for sure with your suggestion. I was under the impression that IPA had the lowest ability to raise prolactin levels and that why I went that route. My doc usually stays with Serm because of is approval you know. She suggested the IPA but medically can not script that as you know. I was getting it from Peptide sciences. In your experience or knowledge base, is 300mcg IPA able to raise prolactin or is that more of a patient specific thing(like its raised on some and not on others). In your experience, are there any negative with the use of MK677? Can it be taken while on Serm while dropping the IPA (I am reading that this may be what your suggesting).

On the estrogen testing, I do not have my blood tests with me as I am out for the weekend. We discussed the "sensitive" estrogen issue and she specifically wrote the tests numbers on my script for LabCorp to run. Now, if they did not follow the numbers and went by the boxes that were checked, that's another thing. I will look close on Monday and follow up with that information.

Sorry to be soooo long winded, but this is really important to me. It is because of you guys that I have my life back. My doc said I was a walking heart attack or stroke! At 51 that's scary stuff.

[daveinquito]

Regarding the sexual issue, my doctor has me on daily Cialis as well (5mg). He told me to take an additional 5 mg pill if things look good for sex. It has done me wonders.

[2Sox]

2sox,
2sox,
With your experience, how long did it take you to see the changes in testicular size and the improved intimacy issues?
.

Not more than a couple of weeks, as I recall. T made for increased desire within a couple of weeks also. But the hCG made for a very noticeable, and very intense increase in pleasure. And at my age, it's something to be grateful for!

[kelkel]

Well, it really does sound like you've found a good doc, which unfortunately can be rare. I agree with her methodology of a "one thing at a time" approach. When to many changes are made at once it's hard to tell what helps or hurts. Only thing I disagree with it the initial application of 100 mgs twice weekly. I just never understood docs's initiating TRT at the high end and then having to mitigate the issues (like E2) that undoubtedly arise, as opposed to starting conservatively and titrating up based on BW.

I'm very curious about your GH & IGF-1 levels as well. GH testing, especially when not on actual GH or GHRH / GHRP's is almost useless as it's pulsatile in nature. An arginine stimulation test is really needed for initial assessment.

Yes, it normally takes a large amount of IPA to elevate prolactin. That said, we all respond differently and I wanted you to be aware, that's all. Re Mk677 take a look at the below study:

Two-month treatment of obese subjects with the oral growth hormone (GH) secretagogue MK-677 increases GH secretion, fat-free mass, and energy expen... - PubMed - NCBI

We are all glad to help. Stick around and keep us updated on your results. The members will especially find the results of your Ipa and Sermorelin run of interest.

[Equipeeler]

Yes, my TRT was initiated on the high end of the dosing spectrum with 100mg bi weekly of test cyp. It all stems from my precious experience with transdermal testosterone therapy . When I initially visited my new doc, I had been using a transdermal forms of testosterone . Over a two year period of not being able to significantly my levels, my pharmacist changed the formulation three times to get me to absorb the medication better. At the end, I was using an alcohol based testosterone at 150mg/daily and could not get my levels about 275-300. My new doc knows the quality of the pharmacy I was using and was thinking I was processing the hormone at an abnormal rate as my levels should have been higher on it. I was very diligent with proper timing and location of application. Anyway, she said we can start at the high end or the low end and work to find out where we need to be. I was so frustrated about the whole process at the time, I suggested the high end. Nothing regrettable there as it was managed quite easily.
This MK677 sounds very interesting. I read a number of member logs yesterday and am looking forward to delving deeper. I would like to know where I sit with my current protocol though. What I think I will do is get back with my doc and get a script for testing my GH and IGF levels. Are you suggesting that I do an arginine stimulation test for that? What else would you suggest. I want out have some information handy when I speak to my doc. Also, I am taking the injections at 4:30am, workout generally 5-7am and then inject again at 7:30-8:00am. Last time is before bed at night. I generally do my blood work at 7:45-8:00am on an a 12 hour fast. How should I arrange my IPA/Serm injections around the testing.
Again, thanks for your time and I will be sure to keep the board updated with my results.

[kelkel]

No, not suggesting an arginine stim test, just explaining it and making the point that basic GH testing isn't that effective.
I'd maintain your normal injection protocol during your BW. It's where "you live" so why alter it for the test. Let the test show exactly how you are on a normal day.

[Equipeeler]

No, not suggesting an arginine stim test, just explaining it and making the point that basic GH testing isn't that effective.
I'd maintain your normal injection protocol during your BW. It's where "you live" so why alter it for the test. Let the test show exactly how you are on a normal day.

Understand. I went through my stock of peptides this morning pre pulling injections for the week. It looks like I have about three weeks supply left, I will try to get my levels pulled prior to running out. If changes need to be made, I can do them at that point. I have been on the protocol long enough to see a change in the levels in in fact there is one. May be a placebo effect, but I sure feel like I am seeing positive benefits.

[APIs]

I am unable to process folic acid so I am on methyl folate and eat no artificial folic acid.

OP, I'm just curious, but do you take a prescription/drug form of Methyl Folate or do you take an OTC Supplement for this (if so which one)? Reason being, my Wife may be in this category and I'm finding that unless you take the true form called CALCIUM L-5-METHYLTETRAHYDROFOLATE, USP your body does not convert Folic Acid to the needed L-Methyl Folate. This true form is also very expensive whether it's an OTC Supplement or via Prescription. Thanks...

[Equipeeler]

OP, I'm just curious, but do you take a prescription/drug form of Methyl Folate or do you take an OTC Supplement for this (if so which one)? Reason being, my Wife may be in this category and I'm finding that unless you take the true form called CALCIUM L-5-METHYLTETRAHYDROFOLATE, USP your body does not convert Folic Acid to the needed L-Methyl Folate. This true form is also very expensive whether it's an OTC Supplement or via Prescription. Thanks...

I have been taking an OTC supplement which is a multivitamin. It is called "Phyto Multi without Iron". Since I started on this, about 10 months ago and took Folic acid out of the diet, I can tell some major changes. The amount of anxiety has decreased dramatically. Also, my wife says I have changed from a stressed out Type A personality to almost a Type B. My dove sells the Phyto Multi so that was my first source. I now get it on Amazon. Actually just got it the other day 120 capsules for $58. If it is only the 5 methyl folate you are after, you can also try Xymogen branded product called
5-MTHF. Have not checked on the price but I am sure it will be a lot cheaper. Hope this helps.