Adding HCG to TRT = E2 Gone Wild?

[zerodarkthirty]

I have been on TRT for about 2 months now. It has NOT been great (at all). Several times I just wished that I had never started down this path.

I had about a week where energy levels, libido, and mental clarity were improved. I am an extremely athletic guy (endurance sports and weight training) with a BF of <10% pre-TRT, and now I'd bet I'm at the 16% mark. Belly fat has gone through the roof since starting (with diet/exercise remaining largely unchanged). I've been on gels, now compounded creams. Gels shut me down completely after about 2 weeks. Cream (200mg/day) seems a lot better in terms of strength, but I never did have the overall "life boost" like I did with the gels. Dr. added AI after 1 month after E2 levels were very high and Total Test had gone to 65. (Initially at 261).

So, let me say that I think I'm a high aromatizer of Test to E2. Addition of the AI seemed to help a bit, but nothing great.

Ok, so last week I started low dosage of HCG due to testicular atrophy. On Saturday (day 3) of HCG, I felt like I was going to croak. Dizzy, confused, extreme fatigue, mental fog x 1000, zero libido, etc. I read GD's sticky and comments from other posts that introduction of HCG can cause E2 aromatization which an AI doesn't really do much for. I noticed that yesterday I had gone a few hours without eating and felt like my blood sugar had crashed in a way that I had not experienced before. I'm thinking the HCG is messing with that, too.

Thoughts? Stop the HCG? Get a pill splitter and take more frequent doses of the AI? Do creams/gels tend to cause folks to aromatize more than shots?

[xcraider37]

Did you ever up your dose of the gel? Such as after a few weeks of 5g of gel, you need to increase the dose because your natural test shutdown. You need blood work and to me more reading on this site will do you some good. Educate yourself my friend. A new doc may help also. Also it takes a while to dial in your protocol be patient. Go by how you feel but have bw to back it up.

[zerodarkthirty]

Yes, I've read all of the stickies and posted BW in earlier posts. Without doing that again, initial Test was 261, then after 2 weeks of 60 mg, then 120 mg of gel, my total test went to 65, with E2 around 50 (in a range of 0-35). I know everyone says to be patient, and I'm not looking to feel like superman overnight. What I am tired of is feeling like I'm taking kryptonite everyday.

[LT75]

Why not stop the gel/cream and go to injections twice a week to stabilize your levels? Shots twice a week will lower estrogen conversion.

[tripperdogg]

Good call LT75. Thats what I was thinking.

[zerodarkthirty]

Ok, this is what I'm getting at LT75 and Tripper..... I think this might be the way to go, but I was trying to remember if you typically aromatize more with the gels or the shots?

[Black]

Ok, this is what I'm getting at LT75 and Tripper..... I think this might be the way to go, but I was trying to remember if you typically aromatize more with the gels or the shots?

I may be wrong, but I believe aromatization of test is higher with injections, due to the larger, less frequent doses than it is with topicals, because of the opposite (smaller, more frequent doses).

[zerodarkthirty]

That's what I thought, but wanted to confer with an expert first.

[jasondd1]

Im the opposite. Test cream plus hcg and my e2 levels were 8. My doc added in estrogen to my compound to help bring them up. That and i added dhea and preg, hopefully i can stop the estrogen after 2 months or so once the dhea kicks in. Are you taking dhea?

[zerodarkthirty]

Yes, 50 mg/day. Also 25 mg. preg per GD's recommendations.

[steroid.com 1]

I am going to jump in here...

First and foremost, do you have any recent blood work that you can post either pre TRT or post? Both would be ideal.

You may very well be estrogen dominant; but we need to see blood work to make that determination. Your Doctor put you on an AI, what blood work did he use to make an assessment and what type and dosage of an AI are you taking?

Low doses of HCG rarely increase E2; we see this only in higher doses like >500 iu daily. The sticky talks to higher levels of intratesticular E2 but we see this only in higher doses of HCG. And yes, AI are not very effective in controlling intratesticular E2.

Daily transdermals when used in the correct dosages generally don't impact E2; it's one of the better benefits. That being said, you could very well be an over responder and converting to E2 if estrogen dominant.

The symptoms you describe are not typical complaints but we're all different and respond differently.

Please post your blood work, without it we can't make any reasonable assessment of your situation.

[zerodarkthirty]

Thanks, Gd. I'll dig up the BW later today and post.

[steroid.com 1]

Thanks, Gd. I'll dig up the BW later today and post.

Remember to add ranges as well.

The vets will jump and help you my friend.

[zerodarkthirty]

Ok, here are the labs (again, I've only got what I've posted):

1-7-13: Pre TRT BW

White blood cells -- 4.9 (3.3-10.5)
Red blood cells -- 5.36 (4.15-5.75)
Hemo -- 15.9 (12.8-16.9)
Hemato -- 46.7 (38.8-50.2)
MCV -- 87.2 (78-100)
MCH -- 29.6 (27-31)
MCHC -- 33.9 (32-36)
RDW -- 12.9 (11.5-14.5)
Platelet -- 175 (150-450)
MPV -- 8.1 (6-9.5)
Neutrophils -- 55 (44-74)
Lymphocytes -- 35 (20-50
Monocytes -- 8 (2-13)
Eosinophils 1 (0-7)
Basophils 1 (0-2)

TOTAL TEST: 261 (240-827 ng/dL)

TSH: 1.14 (.35-4.94 uIU/mL)

PSA: .4 ng/mL (0-4.00)

1-29-13 Bloodwork: nearly one month on TRT:

DHEA -- 156 (110-370)
Estradiol -- 49.5 (0-39 pg/mL)
Total Test: 65 ng/dL

2-5-13 Bloodwork:

Total Test: 261 (240-827) Dr at the time did not run E2, but I'd bet my left nut it's out of the park now.

Current protocol:

100 IU HCG daily
50,000 IU Vitamin D 1x/week (prescription...doc said I was low)
Compounded cream: 200 mg/day, ED
50 mg DHEA
50 mg Preg
Multi-vitamin
high-end fish oil
.25 Arimidex 4 times/week

I called doc and told her I felt like total crap (suspecting high aromatization to E2) and she is having me cut the Test dose by half starting tomorrow.


Thanks for any insight guys. I REALLY appreciate it.

[jasondd1]

Im no expert like these guys but man your numbers seem odd.

[zerodarkthirty]

Well, that's why I'm calling in the big guns to straighten me out!

[steroid.com 1]

Ok, here are the labs (again, I've only got what I've posted):

Let's take a look at what's important to us from a hormonal perspective.
1-7-13: Pre TRT BW

White blood cells -- 4.9 (3.3-10.5)
Red blood cells -- 5.36 (4.15-5.75)
Hemo -- 15.9 (12.8-16.9)
Hemato -- 46.7 (38.8-50.2)
MCV -- 87.2 (78-100)
MCH -- 29.6 (27-31)
MCHC -- 33.9 (32-36)
RDW -- 12.9 (11.5-14.5)
Platelet -- 175 (150-450)
MPV -- 8.1 (6-9.5)
Neutrophils -- 55 (44-74)
Lymphocytes -- 35 (20-50
Monocytes -- 8 (2-13)
Eosinophils 1 (0-7)
Basophils 1 (0-2)

TOTAL TEST: 261 (240-827 ng/dL)
Very low and without question Hypogonadal.

TSH: 1.14 (.35-4.94 uIU/mL)
TSH is fine, but you know we need to see complete Thyroid work up done anytime a man presents with your low Testosterone serum levels...it's a must have and well beyond just TSH. Your Doc should have run these for you at the time or just after your initial labs to rule out Hypothyroidism.

PSA: .4 ng/mL (0-4.00)
Nice but before TRT.

1-29-13 Bloodwork: nearly one month on TRT:
Enough time on TD.

DHEA -- 156 (110-370)
Low and your supplementing now so we need to see follow up labs.

Estradiol -- 49.5 (0-39 pg/mL)
Elevated before you started your TRT protocol and your Doc said what about this???

Total Test: 65 ng/dL

2-5-13 Bloodwork:

Total Test: 261 (240-827) Dr at the time did not run E2, but I'd bet my left nut it's out of the park now.
This is all you have post TRT labs??? Your protocol says you are taking .25 mg of an AI 4 times a week for 1 mg per week. That's a lot for someone on a transdermal. I would suspect that your E2 levels are tanked to be totally honest. Read the sticky on Estradiol and Google Low Estrogen Symptoms and see if that sounds like you. You still need a complete Thyroid workup as well as a E2 sensitive assay ASAP.


Current protocol:

100 IU HCG daily
50,000 IU Vitamin D 1x/week (prescription...doc said I was low)
Compounded cream: 200 mg/day, ED
50 mg DHEA
50 mg Preg
Multi-vitamin
high-end fish oil
.25 Arimidex 4 times/week
I doubt

I called doc and told her I felt like total crap (suspecting high aromatization to E2) and she is having me cut the Test dose by half starting tomorrow.
NO!!!!! You need more blood work done. You need to have an E2 sensitive assay run ASAP as I suspect your E2 is tanked. Most men on a TD don't even need an AI and 1 mg is a lot for someone using a daily TD!!!


Thanks for any insight guys. I REALLY appreciate it.

Bold. Talk to her about what I just wrote before you change anything...seriously.

gd

[zerodarkthirty]

gd,

Thanks so much. One thing I will note is that there was no E2 test run pre-TRT. That high number for E2 was after one month of TRT. I'll go in and have BW run tomorrow. I was planning to get BW for:

DHEA
Total Test
Estradiol (sensitive assay)
PSA
LH/TSH

What else? This BW is just for my own purposes. I'm scheduled to go in 2 weeks for another workup.

I really don't think I've got low E2. I took .25 mg Arimidex yesterday and feel 100x better today. I also have reduced sensitivity in nipples. Yesterday I was totally crushed (fatigue/zero libido/motivation) and that was 2 days since any AI. Today I'm MUCH better. Not great, but not wasted. I would think that if my E2 was at the bottom, the AI taken yesterday would have made me feel like poop today. No?

[steroid.com 1]

Ok the E2 one month on TRT; were you taking the AI during that first month or was prescribed after E2 was pulled?

Read the sticky by kel on finding a TRT Doc, post BW labs you need are listed there.

Get a complete Thyroid workup including TSH, FT4, FT3, RT3 and Thyroid Antibodies...insist on this.

I still think 1 mg of an AI on such a small daily dose your E2 is tanked; hell, I took that much on 120 mg Test IM weekly and I was at 12 pg/ml...again do your research on symptoms and tell us if it sounds like you...

Remember, most men don't need an AI on daily TDs.

[zerodarkthirty]

No AI was taken during the first month of TRT. It was prescribed after E2 was tested high.

I understand that most folks don't need an AI when on a transdermal....hmmm. I'll study up on low E symptoms. Thanks again, gd.

[steroid.com 1]

Hey man, I am not saying emphatically that you don't still have elevated E2 levels but when you consider that:

1. Your pre AI E2 level was 49.5 pg/ml, that isn't "off the charts" high like we see in here sometimes. Yes, it's elevated and even some lifestyle changes, diet and exercise could bring that down.
2. 1 mg of Arimidex weekly is a lot and enough for even for some men injecting 100 mg to 200 mg weekly (we see less with men injecting twice weekly) to manage E2...that's not your protocol.
3. An Aromatase Inhibitor like you're taking is a very powerful antagonist and can drop your 49.5 to the 20's pg/ml in no time
4. Your taking a low dose transdermal where most men don't need an AI...

See what I mean.

Now that being said, could you still have elevated E2 levels?

Yes!

We're all different and we all respond differently; for one you may just be an under responder to the AI...it happens...but rarely.

All said and done, blood work will only tell us the truth and if your blood work comes back with elevated E2 it will only go to show us that nothing is certain in TRT, or any medical protocol for that matter, and we need to rely solely on how we each respond and go from there.

Keep us posted on your new BW when you get it as I for one am very very interested.

Peace.

gd

[zerodarkthirty]

Absolutely. Will do. Thank you again.

[sparverius]

You might consider stopping the DHEA, pregnenolone and HCG for now. Unlike T you don't need any of those to be acceptably well adjusted. Your reaction to them may not be what is considered normal here. Mine isn't. DHEA and HCG make me depressed. HCG completely kills my athletic performance (endurance training, not in the gym). Tiny amounts of preg (1/4 a 5mg pill) initially made me so wired I was unable to sit still. Reading here you would not see any of those results, but that's what happens to me.

If you can cut your protocol down to the core you will have fewer variables to deal with. Once you get to where things are working ok you can try the ancillaries one at a time so you can understand their effect on you.

I did not need any AI when I was on gel, even high amounts of it. But I need a lot on injections (7/8 mg/week on 120mg Test Cyp/week).

[zerodarkthirty]

Well, here are "some" numbers. The most critical obviously for this post hasn't come back (E2 sensitive).

DHEA: 452 (110-370 mcg/dL)

FSH: 1.2 mIU/mL (.9-11.9)

T4: free: 1.3 (.7-1.5 ng/dL)

TSH: 1.32 (.35-4.94 uIU/mL)

T3: free: 3.6 (1.7-3.7 pg/mL)

Total TEST: 386 (241-827 ng/dL)

Subjectively, I feel like #*$(&#. I have since beginning TRT (save about 7 days in). I have always suspected based on the way I feel and symptoms that I am a high aromatizer to E2. Dosage of the AI confirms this (in my mind) the following day. I always feel slightly better on the day after taking the AI.

Thoughts? Obviously I cannot wait to see the Estradiol level. Is there any other clues in the other numbers? I defer to the experts....

[steroid.com 1]

Well, here are "some" numbers. The most critical obviously for this post hasn't come back (E2 sensitive).

DHEA: 452 (110-370 mcg/dL)
Excellent. This is really nice and anything at or over the range is good. This is best at peak value.

FSH: 1.2 mIU/mL (.9-11.9)
Tanked because you are HPTA suppressed.

T4: free: 1.3 (.7-1.5 ng/dL)
Good. T4 is in a nice range.

TSH: 1.32 (.35-4.94 uIU/mL)
Good. Anything between 1 and 2 is a nice place to live.

T3: free: 3.6 (1.7-3.7 pg/mL)
Excellent! Converting T4 to T3 nicely...no thyroid issues for you my friend

Total TEST: 386 (241-827 ng/dL)
This is very poor and you know that...

Subjectively, I feel like #*$(&#. I have since beginning TRT (save about 7 days in). I have always suspected based on the way I feel and symptoms that I am a high aromatizer to E2. Dosage of the AI confirms this (in my mind) the following day. I always feel slightly better on the day after taking the AI.
Well, your total test is not very good and you may be right that you are converting your Test into E2 and why you feel like you do. Get that E2 assay as soon as you can.

Thoughts? Obviously I cannot wait to see the Estradiol level. Is there any other clues in the other numbers? I defer to the experts....

Bold. Except Total Test and not seeing E2 you look fine...but these two hold the key to your Valhalla!

[zerodarkthirty]

Thank you, gd. I'd buy you a beer if you were around! I really appreciate it.

[zerodarkthirty]

Well, I should have known better than to doubt you, gd. Hahahha!

ESTRADIOL sensitive: 9 pg/mL (<=29)

Now what?

I'm still a poor absorber of the cream, even at the 200mg dose per day. Dr. appt. is on Monday. I'm switching to shots. I suppose never doubt the power of Arimidex, esp. when on TDs. Either way I was still having horrible panic attacks.

[steroid.com 1]

Ah ha!

Read back on the logic in this thread and you will see how I (and others a well) came to the suppressed E2 level assessment...it only made sense.

Your panic attacks are due to your low E2 levels and possibly low SHBG as well. You can add in Flax Seed and Soy to your supplements to boost your E2 levels and need to get off your AI as well.

If I were you this is what I'd ask for on Monday:

1. Start twice weekly Testosterone Cyp injections of 50 mg each.
2. Three times per week 250 iu of HCG
3. 50 mg of micronized Pregnenolone and DHEA daily.
4. No AI till next round of blood work when this protocol is launched in 6 weeks and make E2 management decisions at that point based on labs.

As noted, and please everyone pay attention to this point; Aromitaze Inhibitors are very powerful antagonists in men and even in the lowest doses can it have the effects that zero experienced. It's why we inject twice or even three times weekly to keep serum levels balanced and stable and avoid the peak and valleys one large injection can cause enhancing aromitization. Just a word to the wise

Keep us posted in this thread how your appointment goes on Monday and glade to see that you got some things figured out...this is a process as you know but you're getting there!

gd

[zerodarkthirty]

I'll keep you posted. Thanks again, gd.

[2Sox]

Fantastic thread! I really learned a lot from reading it.

[MickeyKnox]

"Dr." GD at it again.

Good job GD. This was a pleasure to read.

[steroid.com 1]

^^^^

[zerodarkthirty]

Ah ha!

Read back on the logic in this thread and you will see how I (and others a well) came to the suppressed E2 level assessment...it only made sense.

Your panic attacks are due to your low E2 levels and possibly low SHBG as well. You can add in Flax Seed and Soy to your supplements to boost your E2 levels and need to get off your AI as well.

If I were you this is what I'd ask for on Monday:

1. Start twice weekly Testosterone Cyp injections of 50 mg each.
2. Three times per week 250 iu of HCG
3. 50 mg of micronized Pregnenolone and DHEA daily.
4. No AI till next round of blood work when this protocol is launched in 6 weeks and make E2 management decisions at that point based on labs.

As noted, and please everyone pay attention to this point; Aromitaze Inhibitors are very powerful antagonists in men and even in the lowest doses can it have the effects that zero experienced. It's why we inject twice or even three times weekly to keep serum levels balanced and stable and avoid the peak and valleys one large injection can cause enhancing aromitization. Just a word to the wise

Keep us posted in this thread how your appointment goes on Monday and glade to see that you got some things figured out...this is a process as you know but you're getting there!

gd

DONE, with a few minor exceptions. First injection of Test Cyp, check.

[Trific]

Sweet! Maybe now you can get dialed into a Happy place....

[zerodarkthirty]

Roger that. I'm ready.

[clarky.]

GD your a intelligent man.

[zerodarkthirty]

Hey guys,

It has been awhile since I last checked in. Just got my BW after 2 more months on test cyp injections (twice weekly, sub-q at 60 mg each). Also doing HCG at 100 IU daily. Stopped all DHEA and Preg because I was having panic attacks. No more panic attacks now. Everything else is just ho-hum. I don't feel much better at all, to be honest. I've been on TRT now since January. Initial pre-TRT level was 261.

This is all my doc ordered:

E2 Sensitive: 28 pg/mL
FSH: 1 IU/L (1.55-9.74)

Total Test: 592 ng/dL (132-813)
Free Test: 11.8 pg/mL (8.75-25.1)

Doc now wants me to increase test cyp injections to .7 mL every 7 days (which I'll probably split doses and continue to inject twice weekly). I'm all ears. Thanks.

[steroid.com 1]

Of what you have here things look okay with the exception of suppressed Free Test.

I'd want to know what your SHBG lab looks like.

It may be elevated causing a lot of your testosterone to bind up doing you no good.

You should feel better but again I'd like to see Free Test at the higher end of the reference range not near the bottom...know what I mean?

[zerodarkthirty]

Thanks, GD.

Right. I'll see if I can get SHBG pulled next time. Let's say that SHBG is a problem. Then what?

[steroid.com 1]

Thanks, GD.

Right. I'll see if I can get SHBG pulled next time. Let's say that SHBG is a problem. Then what?

If SHBG is high you can always suppress it with one injection a week and not twice.