Anabolic Steroid Induced Hypogonadism (ASIH) Treated with HCG

[AnabolicDoc]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2360778/

Abstract

A case is presented of a young competitive body-builder who abused anabolic steroid drugs and developed profound symptomatic hypogonadotrophic hypogonadism. With the help of prescribed testosterone (Sustanon ) he stopped taking anabolic drugs, and later stopped Sustanon also. Hypogonadism returned, but was successfully treated with weekly injections of human chorionic gonadotropin for three months. Testicular function remained normal thereafter on no treatment. The use of human chorionic gonadotropin should be considered in prolonged hypogonadotrophic hypogonadism due to anabolic steroid abuse .

If you click on the link at the beginning, look below the Abstract and you will find a link to the full text of the article in both html and pdf formats.

The patient used AAS for 6 months and was then on TRT for 15 months (with Sustanon 250mg every 2 weeks). He was then treated with hCG 10,000 units weekly x 1 month, then 5,000 units weekly x 1 month, and then 2,500 units weekly x 1 month, then no more treatment. The patient was eugonadal within 1 week of treatment initiation and remained so in the 30 month post-treatment follow-up, during which time the patient was under no treatment.

This is just a case report so it is difficult to draw concrete conclusions from it. However, this is an example that demonstrates that hCG alone can potentially be used for PCT and that hCG-induced Leydig cell desensitization, at the very least, does not happen to everyone.

[MickeyKnox]

Wow, 10k/wk. And that was back in '98 too. Interesting read for sure Doc. Thanks for sharing!

[kelkel]

Good read Doc!

[Armykid93]

Awesome read and holy hell kel!

Are you trying to turn your legs into a road map?

[AnabolicDoc]

Glad you guys liked it!

Where are all the HCG -PCT naysayers to refute the results of this study? :-) I'm mostly kidding as this was only done with one subject, but I expected that some ppl would try to dispute the conclusions that can be drawn from this study. I like the usual respectful educated discourse that goes on here.

[MickeyKnox]

Perhaps because this data was recorded with one subject, as you already pointed out, the results are simply a plausible scenario using the protocols outlined in this study.

BUT one thing to keep in mind, and that caught my eye, was that after the FIRST supra physical injection of 10k IU's hCG the subject was examined and found to be eugonadal. I think that's worth noting.

[AnabolicDoc]

So you think the rest of the injections may not have been necessary? I think anyone with ASIH would be eugonadal after a 10,000 unit injection and with a 24 hour half-life, that would definitely keep him eugonadal until the next weekly injection.

[MickeyKnox]

I have no idea and your guess is as good as mine Doc. Im just commenting on what i felt was worth noting. But, it would be interesting to know exactly at what point he would not have required any additional hCG .

[AnabolicDoc]

Agreed!

[human project]

Agreed!

So a 10k shot wouldent shut down the Lydig cells?? I've always stayed around 250 for fear or this...

[AnabolicDoc]

I have yet to read anything that proves leydig cell desensitization is a real phenomenon in vitro and I don't believe it occurs. Many experts in this field are of same belief. Although on this forum there seems to be some support for both sides.

[Lemonada8]

just saw this.. I am definately a nay-sayer for using HCG as a PCT. It does nothing to modulate secretion from the pituitary.

as for ^^ the post above..

"Ligand-induced down-regulation of testicular and ovarian luteinizing hormone (LH) receptors is preceded by tissue-specific inhibition of alternatively processed LH receptor transcripts."
Ligand-induced down-regulation of testicular ... [Mol Endocrinol. 1991] - PubMed - NCBI

...After 6 and 12 h of treatment with 200 or 10 IU hCG, respectively, hybridization to the larger mRNA species decreased by more than 60%, preceding decreases in testicular [125I]hCG binding. These transcripts were further inhibited (greater than 93%) between 24-72 h after hCG treatment and returned to 40% and 100% of control levels by days 6 and 9, respectively. In contrast, the truncated 1.8-kb LH receptor transcript was not affected by hCG treatment, indicating a differential suppressive effect of the ligand on its receptor mRNA levels

"Evidence that human chorionic gonadotropin /luteinizing hormone receptor down-regulation involves decreased levels of receptor messenger ribonucleic acid"
Evidence that human chorionic gonadotropin/lut... [Endocrinology. 1991] - PubMed - NCBI

...These results suggest that hCG-induced down-regulation of the LH/hCG receptor in luteal cells involves regulation of the receptors at the message level.

^ granted yes, its not in a male.. but we have the same set of genes, just some get activated and some dont.. and I wouldnt think that estrogen modulated histone regulation for gene expression would have a large effect on the receptor in the cell.


"LH action in the Leydig cell: modulation by angiotensin II and corticotropin releasing hormone, and regulation of P450(17) alpha mRNA."
LH action in the Leydig cell: modulation b... [J Steroid Biochem. 1989] - PubMed - NCBI

...Gonadotropin-induced desensitization in adult rat tests include an estrogen mediated steroidogenic lesion of the microsomal enzymes 17 alpha-hydroxylase/17,20-desmolase...... Low dose hCG treatment caused an early increase in mRNA levels followed by a return to control values at later times, while with higher desensitizing doses the initial increase in mRNA was followed by a marked reduction in mRNA at 24 h and a small recovery at 48 h

^ This makes me lean toward the fact that HCG is known to increase estrogen in the testes, and that may be the reason for desensitization that occurs following high doses

"Modulation of Leydig Cell Androgen Biosynthesis and Cytochrome P-450 Levels during Estrogen Treatment and Human Chorionic Gonadotropin-induced Desensitization"
Modulation of Leydig cell androgen biosynthesis and cytochrome P-450 levels during estrogen treatment and human chorionic gonadotropin-induced desensitization.

...In addition, the larger dose of hCG caused an earlier biosynthetic defect due to impaired formation of pregnenolone from endogenous precursors. Dose-dependent inhibition of both 17a-hydroxylase and 17,20-desmolase activities by 30% and 90% was observed after treatment with 2 and 10 pg of hCG, respectively

I cant find any research on bio-active LH levels and how they respond with the addition of HCG, however i have found some that describe this with high doses, long term use of clomid. That the more LH is in the system, the more bio-inactive LH is produced which is "shootin blanks" b/c it doesnt react at the receptor level to initiate secretion however it does play a part in the feedback loop where the body senses that there is enough LH in the system.

As you can see, there are many studes out there that back up the claim of desensitization, and for the users here that are already having supraphysiological levels of test and estrogen; I definately lean towards that desensitization is definately a possibility and has a much greater chance to occur in this setting than a non-AAS user.

[AnabolicDoc]

Your first study doesn't prove your point, rather it backs up the contrary. The second is in women and the third is in rats. You summed it up yourself, that you "can't find any research on bioactive LH levels and how they respond with the addition of hcg ". That's what I said in my previous post - that I've never read anything to that effect.

I believe that hcg will not cause leydig cell desensitization but I'm open to the contrary and always present both sides. I'm not sure why you find it necessary to try to push your ideas into others by incorrectly manipulating a few semi-pertinent (if that) studies that are no where near conclusive of results in human men. They're are so many experts on both sides of the fence, what makes you sure you're right?

Oh and please stop giving out potentially lethal advice, such as the guy with the DVT on Coumadin who you told to add aspirin. Learn to be more humble before you kill someone.

I'm so curious, what year of med school are you in?

[Lemonada8]

Your first study doesn't prove your point, rather it backs up the contrary. The second is in women and the third is in rats. You summed it up yourself, that you "can't find any research on bioactive LH levels and how they respond with the addition of hcg ". That's what I said in my previous post - that I've never read anything to that effect.
I believe that hcg will not cause leydig cell desensitization but I'm open to the contrary and always present both sides. I'm not sure why you find it necessary to try to push your ideas into others by incorrectly manipulating a few semi-pertinent (if that) studies that are no where near conclusive of results in human men. They're are so many experts on both sides of the fence, what makes you sure you're right?
Oh and please stop giving out potentially lethal advice, such as the guy with the DVT on Coumadin who you told to add aspirin. Learn to be more humble before you kill someone.
I'm so curious, what year of med school are you in?

first off, I said for the guy w/ DVT to talk to his doc about the aspirin, as it would alter the warfarin dosages. I was not saying " do this", but giving an option for him to discuss with his doc. I dont know what you are trying to say about being humble in that regard. I was merely giving another option for him to discuss, which I said anyways.

As for your response;

Another article discussing desensitization.

http://www.ncbi.nlm.nih.gov/pubmed/6323862
"Hormonal regulation of androgen production by the Leydig cell"
^^ just read the abstract. I dont feel like giving the entire abstract here.

I dont understand how the first study proves the contrary? Taken from the abstract, first line. " In testicular Leydig and ovarian luteal cells, treatment with LH/hCG decreases LH receptor content. Although suppression of LH-binding sites may result from ligand-induced receptor internalization, sequestration, and/or phosphorylation, the gonadotropins may also regulate receptor mRNA levels.".
That pretty much sums up my point. This article was examining the possibility of the mRNA also being a modulator of desensitization; with the fact of supression occurs, and the researchers want to find out what the mechanism is that causes this.

2nd, I already commented on the fact that it was in women; but you must have missed it.

3rd, if you are going to disregard all studies done on rats with this topic, then you will never see any studies done of this accord in the plausible future. To use that as your defense for your point, saying that "I have yet to read anything that proves leydig cell desensitization is a real phenomenon in vitro "; is not a very good defense. The lack of perfectly analyzed studies done on a topic, does not mean that there is an absence of fact in the topic. Very rarely will a single study accompany all of the different variables in a certain topic of discussion, and support the claims made by either side. That is why it takes several studies to be analyzed and facts to be inferred between studies; with the more similar stated results the stronger the claim.

I dont find it necessary to push my ideas; I presented my side with a couple studies that support my claim. I gave reference to them, I stated what facts I gathered from the studies, and presented it. I was showing my support for my side, and provided backup via academic studies. Yes there are "so many experts on both sides of the fence", but dont resort to failing to respond to the debate at hand and resort to attacks on my validity ( the DVT issue, and the sarcasm).

What makes me think I'm so right? I dont think I'm perfectly right, but to present a claim that I think is truthful; there has to be some arrogance in defending that claim and stand up for it. However, since there was no actual academic retort following; I am left thinking that you really dont have a solid viewpoint on this topic and are upset because I challenged your viewpoint.

Its a real shame that people want us to believe whatever they claim, but when their ideas are pressed; so many fail to actually present the facts which form the basis of their claim and resort to validity attack.

[austinite]

first off, I said for the guy w/ DVT to talk to his doc about the aspirin

No you didn't.

Do you take asprin? starting a aspirin daily will also help w/ DVT issues.


careful w/ Warfarin, follow the dosages properly and dont adjust them w/o doc supervision.

[Lemonada8]

Read the next post. Not that hard.

... * blah had alot of other text up here.. but not important right now *

If you do start an aspirin regimen, be sure to discuss this w/ ur doc; it may affect the dosages of warfarin.

[austinite]

Read the next post. Not that hard.

Spare me your smart ass comment. But yeah, a follow up an hour later. Either way you recommended it, and that was Docs point. Anyway, I'll let Doc handle this thread. He's got it under control.

[Lemonada8]

Spare me your smart ass comment..

Ditto.

[AnabolicDoc]

Thanks austinite.

[AnabolicDoc]

Lemonada, I presented the alternate viewpoint in my previous post - the one before you jumped in. I almost always try to do that bc solid concrete evidence is not available for many of these topics. I don't respond to your posts in general bc I'm here for enjoyment, not frustration and aggravation.

It seems that with any other member who disagrees with me, we're able to have a civil academic discourse but your offensive straight out of the gate and this is not the first time. Furthermore, the post previous to your entry in this thread was a response to a question directed at me - so I gave my opinion and acknowledged that there is a popular counter view.

The other reason I refuse to entertain your posts, more than I currently do is bc of limited time, but let me explain. I have a job, a wife, family, and friends (as many of us here do). I spend a few hours a week on this site, maybe more as I sign on for a few minutes at a time frequently throughout the day. I divide my total time available here into a few categories:
1 - learning from others experiences and posts, and engaging in them
2 - interacting and reading casual posts, such as crazy Mike's interview or the like
3 - Responding to PMs, which consists largely of other members seeking my advice, but also with some of the friends I've made here.

I don't leave time to give detailed responses to your know contrary posts (that are not supported by the evidence as you think). Maybe one day I'll be as smart and knowledgeable as you - all I can do is hope. I'll ask admin to start redirecting my PMs to you so they can get better advice.

Btw, I don't believe you answered my question regarding what year of med school/PA school/Nursing school you are in?

[human project]

just saw this.. I am definately a nay-sayer for using HCG as a PCT. It does nothing to modulate secretion from the pituitary.

as for ^^ the post above..

"Ligand-induced down-regulation of testicular and ovarian luteinizing hormone (LH) receptors is preceded by tissue-specific inhibition of alternatively processed LH receptor transcripts."
Ligand-induced down-regulation of testicular ... [Mol Endocrinol. 1991] - PubMed - NCBI

"Evidence that human chorionic gonadotropin /luteinizing hormone receptor down-regulation involves decreased levels of receptor messenger ribonucleic acid"
Evidence that human chorionic gonadotropin/lut... [Endocrinology. 1991] - PubMed - NCBI

^ granted yes, its not in a male.. but we have the same set of genes, just some get activated and some dont.. and I wouldnt think that estrogen modulated histone regulation for gene expression would have a large effect on the receptor in the cell.

"LH action in the Leydig cell: modulation by angiotensin II and corticotropin releasing hormone, and regulation of P450(17) alpha mRNA."
LH action in the Leydig cell: modulation b... [J Steroid Biochem. 1989] - PubMed - NCBI

^ This makes me lean toward the fact that HCG is known to increase estrogen in the testes, and that may be the reason for desensitization that occurs following high doses

"Modulation of Leydig Cell Androgen Biosynthesis and Cytochrome P-450 Levels during Estrogen Treatment and Human Chorionic Gonadotropin-induced Desensitization"
Modulation of Leydig cell androgen biosynthesis and cytochrome P-450 levels during estrogen treatment and human chorionic gonadotropin-induced desensitization.

I cant find any research on bio-active LH levels and how they respond with the addition of HCG, however i have found some that describe this with high doses, long term use of clomid. That the more LH is in the system, the more bio-inactive LH is produced which is "shootin blanks" b/c it doesnt react at the receptor level to initiate secretion however it does play a part in the feedback loop where the body senses that there is enough LH in the system.

As you can see, there are many studes out there that back up the claim of desensitization, and for the users here that are already having supraphysiological levels of test and estrogen; I definately lean towards that desensitization is definately a possibility and has a much greater chance to occur in this setting than a non-AAS user.

Isnt the study just stating that there was no down regulation of actual hormones secreted in the body after a 6-9 days period of time....??? The study doesn't say how the Lydig cells were directly affected...

Actual hormone levels bounce up and down constantly especially for someone taking something that directly effects a huge part of the system.... It seems that there are studies onhcg's effect on down regulation,/suppression/,desentation that all conflict with one another... All I personally know as a fact is that hcg raises my estrogen level bad and caused me to get girls pregnant on during a contest prep....

[Lemonada8]

** anabolicdoc**. I dont feel that i was offensive out of the gate. I stated my viewpoint and followed with some studies that supported my claim. As for an academic discourse, you have yet to actually respond in an academic manner. The only responses that have come from you in this thread have been a slander on my validity, followed by a supportive post on why your valid in your claim, yet nowhere is there any academic discussion. Then following up with a nice bit of sarcasm, really living true to your words there.
" Furthermore, the post previous to your entry in this thread was a response to a question directed at me - so I gave my opinion and acknowledged that there is a popular counter view. " Yes you did. I dont see how that is relavent here? You gave your opinion, I asked for some backup, you gave it, end of story. I dont know how that relates to here.
Seems you have nothing else to offer this discussion, so I'm done.


**Human project** That is a good point, there wasnt any long term information on the results of the HCG usage, but more of an initial desensitization. I dont know about long term effects associated with the desensitization, if it returns back to normal levels or if it has changed at all.
HCG is known to increase estrogen levels in the testes, which i said earlier, and may also play a part in the desensitization.
This desensitization/ downregulation of receptors, I would think, only hampers the recovery process of the HPTA to functioning levels. Prolonging the length of imbalance because of HCG's use as a crutch.

Thank you for academically responding, its refreshing.

[AnabolicDoc]

I'll start by saying that I cannot believe that I'm even responding to you and I am ashamed of myself for getting caught up in this. It's just that there is so much wrong in your post that I cannot help myself.

In your post where you cited loosely related studies, there were so many problems with their application to human males. These were pointed out in a prior post by me and others, yet you have not meaningfully replied. When I was asked for my opinion on this, I very clearly stated that I have never read any conclusive evidence stating that Leydig cell desensitization occurs. You have so aptly confirmed this as well. Am I supposed to find studies that cite the lack of studies proving the theory you support? Additionally, I started this thread with a post regarding a study in which a man was very successfully treated with hcg as monotherapy for ASIH. This study clearly does not support your point of view, but rather the exact opposite - the man's HPTA was in fact restarted by the administration of hcg monotherapy.

I am so curious to know, how many patients with hypogonadotropic (secondary) hypogonadism have you treated with hcg monotherapy and have seen the need for continuing escalating doses, presumptively due to desensitization? The answer is none. I can say that I at least know a few of my patients, but furthermore I trust my colleagues who have collectively treated thousands of patients as such. There are examples on this forum as well. Most notably, Ronnie Rowland advocates to many who seek his consult that they use hcg and/or hmg alone for PCT (as much as 2500iu eod). I am unsure of Ronnie's academic background, but he certainly has his share of experience. How is it that he has seen successful results with this method if the theory you support is so concretely true? Dr. Scaly has treated thousands of patients with ASIH and claims he never noted a single instance of Leydig cell desensitization. Regardless of his legal troubles, which were based on questionable grounds concerning inappropriate prescribing practices of AAS, his opinion is significant and meaningful.

Again, while above are just some of the reasons I do not believe desensitization to hcg occurs in the male human body, I still acknowledge it as a valid claim bc there are ppl out there with more experience and education than me who support it. But what I do firmly believe is that there is hardly concrete evidence supporting it, which was what I stated from the beginning (and what you have been trying to disprove)?

I am curious to know, how come you keep avoiding the question regarding your current level of education? How about experience?

If you respond I will read your reply, mostly bc I want to know what year and what type of school you are in (if any). However, it is highly unlikely I will make a return post directed at you bc I feel that I have much better things to do with my time to be blunt - spend time with my family, friends, work, watch TV, or even respond to other threads, posts, and PMs on this forum.

[AD]

Bump. Nice article. And a very nice aftermath