37 y/o contemplating TRT, pls help him

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Originally Posted by Ephemeral

Unfortunately direct free T is not available here, neither is sensitive E2. :( I'd have to travel to another country (or send my blood somehow) to get those, and it would probably cost a lot.

An online calculator (that takes total T, SHBG and albumin) puts my free T at 9.12 ng/dl, which is not great but not terrible either. I'd like to be above 15 at all times, but 12 the very least (assuming I don't run into any problems).

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I would agree that Free T should be higher, but it's difficult to compare the calculated method to the direct method for measuring it.

Just for comparison, Here are the LabCorp direct method reference ranges for various age groups:

* 20-29 years 9.3-26.5 picogram/mL
* 30-39 years 8.7-25.1 picogram/mL
* 40-49 years 6.8-21.5 picogram/mL
* 50-59 years 7.2-24.0 picogram/mL
* 60+ years 6.6-18.1 picogram/mL

My goal is the upper 75th percentile for a 25-35 year old guy, which is about 21 to 22 pg/mL using the LabCorp direct method.

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Originally Posted by Youthful55guy

I doubt that the HCg will have that great of an influence of Total or Free T, but it might bump it up a little.

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Well you showed me a study a few months ago, and according to that 750 IU a week can raise total T quite a bit:

https://forums.steroid.com/hormone-r...ml#post7366947

He's the extract and my interpretation of the data presented in that study of 6 healthy volunteers receiving 200 mg/week of T-eth to suppress endogenous LH/FSH production.
Attachment 172742

Figure caption from article
FIG. 2. Serum T during the treatment phase by group. Values are the
mean  SEM (bars). The shaded box represents the normal reference
range of serum T in healthy men for this assay. Serum T increased
from baseline in all four groups in response to TE (200 mg, im, weekly;
P0.05) and remained elevated during the treatment phase. The two
higher hCG dose groups (250 and 500 IU, sc, every other day) had
serum T levels above the normal range during the treatment phase.

My interpretation of the data
The above graph shows that 125 IU HCG E2D (438 IU/wk) did not significantly affect T production in 6 healthy young male volunteers receiving 200 mg T-Eth per week. However both 250 IU E2D (875 IU/wk) and 500 IU E2D (1,750 IU/wk) were effective in increasing serum T levels. In both groups, there was an equivalent boost of about 10 nmol/L (~290 ng/dL).

So yes, there should be a slight bump of perhaps up to 300 ng/dL in T production from HCG doses >875 IU per week. My guess is that it's not a yes or no response, but rather a dose-response. The more HCG you use, the greater will be the T response, but only to a certain point. My guess is that the receptors in the testicles may get saturated around 875 IU/week, as they did not show a significant increase after that amount. Keep in mind the low number of volunteers in the study and that they used a cross-over design. A more definitive answer would come from a much larger RCT study, but I doubt that will ever be funded.

Update:

4 weeks after adding 250iu HCG EOD (875 per week) my total T increased from 14 to 23 nmol/l (range: 6 - 27), as we predicted. I started to have quite bad acne on my left upper arm, lots of small spots and some big ones, but I can live with that. No other sides.
My E2 got out of range a bit, 277 pmol/l (0 - 172), it's the ECLIA type, but still, maybe that's too high.

At that point I changed from subq injections to quads and had another BW 6 weeks later, I just got the results today. T increased from 23 to 31, E2 from 277 to 357. Everything else is in range, acne is the same.
I probably need to do something about the E2, I'll talk to the doc about it. Either I decrease my HCG and/or T dose or I start taking some AI.

I feel about the same as when I switched to quads, maybe a bit better. Gym has been great, libido is quite high.
I've gained 15kg since I started TRT, it was pretty much a dirty bulk lol, I start cutting tomorrow. It's gonna be tough because I could eat all day.

Youthful55guy, what do you recommend about the E2?

Quote:

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Originally Posted by Ephemeral

Update:

4 weeks after adding 250iu HCG EOD (875 per week) my total T increased from 14 to 23 nmol/l (range: 6 - 27), as we predicted. I started to have quite bad acne on my left upper arm, lots of small spots and some big ones, but I can live with that. No other sides.
My E2 got out of range a bit, 277 pmol/l (0 - 172), it's the ECLIA type, but still, maybe that's too high.

At that point I changed from subq injections to quads and had another BW 6 weeks later, I just got the results today. T increased from 23 to 31, E2 from 277 to 357. Everything else is in range, acne is the same.
I probably need to do something about the E2, I'll talk to the doc about it. Either I decrease my HCG and/or T dose or I start taking some AI.

I feel about the same as when I switched to quads, maybe a bit better. Gym has been great, libido is quite high.
I've gained 15kg since I started TRT, it was pretty much a dirty bulk lol, I start cutting tomorrow. It's gonna be tough because I could eat all day.

Youthful55guy, what do you recommend about the E2?

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Yeah, time to think about doing something about the E2. This may be what's driving the acne issue too. I have high DHT and normal E2 and I never get acne. I think acne is driven more of an E2 issue than DHT, but I've never researched the topic.

Since you are out of range on the Total T, I'd start there and pull that back into range. It would be better if we knew your Free T levels rather than just Total T. Total T can be misleading if SHBG is high. Regardless, reducing Total T should help to reduce conversion to E2.

Your HCG dose is not excessive in my experience, but it is a much more expensive source of T than supplemental T. Consider 250 IU E3D (583 IU/week). This should be enough to prevent testicular atrophy and drop the Total T down. Otherwise, drop down on the T. My experience (see my recently posted labs) is that when you are on a protocol of frequent injections of small doses of T that maintains you T levels constantly within range (no big spikes), your E2 conversion should also be 'normal' and E2 will remain within range without an AI. if you choose to use an AI like anastrozole, be very cautious, as it's easy to crash E and that can be worse than Low T for erections, libido, and overall cognitive ability. Consider the Vodka/eye dropper method starting at about 3 drops per day (0.3 mg per week).

Update after 6 weeks:

I've decreased the HCG to 500 IU a week as we talked about it. Surprisingly my total T is 25% higher than last time! That puts me 43% above range (38.8 nmol, range is 6.1 - 27.1), pretty crazy for just 100mg a week, when some people are on 150 or even 200.
SHBG is higher too though, 32 nmol/l from 26, it probably fluctuates quite a bit.
E2 has decreased, but still 20% above range. I have fewer pimples but it's still a problem.
My HDL has been dropping over the last few months, now I'm a bit below range, everything else is cool.

I should probably decrease my T dose, right? 90 or 80mg a week. That should get my E2 and hopefully HDL in range.

Quote:

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Originally Posted by Ephemeral

Update after 6 weeks:

I've decreased the HCG to 500 IU a week as we talked about it. Surprisingly my total T is 25% higher than last time! That puts me 43% above range (38.8 nmol, range is 6.1 - 27.1), pretty crazy for just 100mg a week, when some people are on 150 or even 200.
SHBG is higher too though, 32 nmol/l from 26, it probably fluctuates quite a bit.
E2 has decreased, but still 20% above range. I have fewer pimples but it's still a problem.
My HDL has been dropping over the last few months, now I'm a bit below range, everything else is cool.

I should probably decrease my T dose, right? 90 or 80mg a week. That should get my E2 and hopefully HDL in range.

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I would get your Free T checked before making any adjustments. Your T dose should be based on Free T and not Total T. If that is out of range, then yes, lower the dose.

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Originally Posted by Youthful55guy

I would get your Free T checked before making any adjustments. Your T dose should be based on Free T and not Total T. If that is out of range, then yes, lower the dose.

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Unfortunately free T is not available here in any of the labs. :(

Keep posting here man. I’m following your thread. Wishing you the best.

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Originally Posted by TRTdrew

Keep posting here man. I’m following your thread. Wishing you the best.

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Hey thanks man! :) I lowered my T dose to 90mg per week, we'll see what happens in another 6 weeks.