For those whose Doc's won't prescribe HCG

[steroid.com 1]

Print this study abstract and force them to read it:

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island

Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin (HCG). Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotro- pin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

[jomamma007]

stickyyyyyyy

[steroid.com 1]

stickyyyyyyy

Good point and why didn't I think of that

I have edit rights to my stickies...this will be added as an update.

Good stuff eh?

[APIs]

Wow, here's the proof whether you can get your partner pregnant while on TRT (& HCG)...

[AnabolicDoc]

Hey GD,

This post of yours is really priceless for all the forum members seeing docs who refuse hCG. Great find! This study abstract is very concise and an excellent printout to bring to the doctor's office.

Some stubborn doctors wishing to hold on to their beliefs may try to discredit the study by citing small sample size and lack of a control group. So I think it may be helpful to also print some informational material on the benefits of hCG, such as gdevine's sticky on hCG. Also, below I posted an abstract of a similar study that has a control group. The link to the PubMed site of the abstract is at the very bottom of this post. If you click on the link and scroll down, you will find a link to the full text of this study as well as links to abstracts of a similar nature.


Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression.

Authors

Coviello AD, et al. Show all

Journal

J Clin Endocrinol Metab. 2005 May;90(5):2595-602. Epub 2005 Feb 15.

Affiliation

Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. [email protected]

Abstract

In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T), suggesting that high ITT is needed relative to serum T for normal spermatogenesis in men. However, the quantitative relationship between ITT and spermatogenesis is not known. To begin to address this issue experimentally, we determined the dose-response relationship between human chorionic gonadotropin (hCG) and ITT to ascertain the minimum dose needed to maintain ITT in the normal range. Twenty-nine men with normal reproductive physiology were randomized to receive 200 mg T enanthate weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. Baseline serum T (14.1 nmol/liter) was 1.2% of ITT (1174 nmol/liter). LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94% (1234 to 72 nmol/liter) in the T enanthate/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Posttreatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression. Extensions of this study will allow determination of the ITT concentration threshold required to maintain spermatogenesis in man.

PMID 15713727 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/m/pubmed/15713727/

[steroid.com 1]

Excellent Doc, thank you.

I need to search for papers and/or stuides proving HCG as a true analog of LH as well; but these studies validate that as well.

[HRTstudent]

Lipshultz has numerous publications and articles on HCG if you want to read more. He's based out of Baylor med school.

[Trific]

So maybe the guys on TRT that want to get their gals preggo could follow that article's recipe of 500iu of HCG EOD...

That's 1000iu more than what the guys usually dose HCG...

[2Sox]

Thanks, G. Right to the point. Do you have the link to the original? I'm emailing my urologist tonight.

[steroid.com 1]

So maybe the guys on TRT that want to get their gals preggo could follow that article's recipe of 500iu of HCG EOD...

That's 1000iu more than what the guys usually dose HCG...

Dr. Crisler has stated many times that he's had many many men on little at 100 to 200 iu's a month who were completely shut down get their women prego!

[Rusty11]

Great info, gd. Unfortunately for an old fart like me, if I show this to my endo, he'll say, "See Russ, just like we discussed, hCG is for guys wanting to have kids". crap

[steroid.com 1]

Great info, gd. Unfortunately for an old fart like me, if I show this to my endo, he'll say, "See Russ, just like we discussed, hCG is for guys wanting to have kids". crap

Or that you want your testicles to function properly not just for aesthetics but for the physiological reasons. Your testes produce much more than Testosterone and as an LH analog HCG binds to LH receptors throughout the body and brain...that's how I'd reason it.

[Trific]

Dr. Crisler has stated many times that he's had many many men on little at 100 to 200 iu's a month who were completely shut down get their women prego!

Wow, guess they don't need more than usual HCG then....

[MickeyKnox]

Another fabulous find! Good work GD, as always!

[VTX1800]

This is enlightening, I'm 29 on TRT for 4 weeks and tryin to get my wife knocked up. (Lookin for our first child) THERE IS HOPE!!!!!! Lol

[Perseverance1]

So these guys stayed on their TRT dose and just used HCG and BOOM pregnant? Looking for cliff notes here.

[human project]

Print this study abstract and force them to read it:

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island

Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin (HCG). Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotro- pin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

I never come off and def have no problems having kids...... Just my 2cents...

[steroid.com 1]

Dr. Crisler jokes at how many of his men on TRT/HCG get prego...thousands he says.

[sirupate]

Great info, gd. Unfortunately for an old fart like me, if I show this to my endo, he'll say, "See Russ, just like we discussed, hCG is for guys wanting to have kids". crap

Yes, I can see mine saying the same to me. Late 50's, already had my kids and don't want more. Ergo, no need for hCG.

[2Sox]

Yes, I can see mine saying the same to me. Late 50's, already had my kids and don't want more. Ergo, no need for hCG.

My wife and I are past the age of having children also, but I'm still after my urologist to treat with Hcg. I have only taken three shots to date (at another clinic) and I'm beginning to feel completely different already - whole - like things should be.

IMO, there is absolutely no reason a MD should not treat with Hcg if a patient requests it and there are no associated medical issues.

[ozley62]

I'm 50 yrs old and been on TRT for 3 yrs, I've gone through 4 doctors before I got one to even check E2 levels. And I had to stomp a fit like a 2 year old to get that...lol! I'm certainly not interested in any more kids, but would definitely like to feel my best. I'll show this to my Dr. the next time I go in.

[steroid.com 1]

Yes, I can see mine saying the same to me. Late 50's, already had my kids and don't want more. Ergo, no need for hCG.

I'll say it again; HCG as an LH analog is a sex hormone that does much much more than just keeping spermatogenesis in place.

In fact, 50% or more of men on TRT still produce some volume of Sperm even when HPTA suppressed.

[human project]

I'll say it again; HCG as an LH analog is a sex hormone that does much much more than just keeping spermatogenesis in place.

In fact, 50% or more of men on TRT still produce some volume of Sperm even when HPTA suppressed.

Well ya.... Doesn't the liquid in sperm come from your vasdefrins "I can't spell and I don't google on here"... That's a completely different mechanism then the pituitary pathway.....

[steroid.com 1]

About 50% or so of men who are supplementary suppressed will stop the process of spermatogenesis another 50% or so will still have some production albeit very small without HCG.

But it only takes one sperm cell to hit its mark and do its thing!

[2Sox]

But it only takes one sperm cell to hit its mark and do its thing!

And if it doesn't, you can always try again...and again... and...

[Rusty11]

My wife and I are past the age of having children also, but I'm still after my urologist to treat with Hcg. I have only taken three shots to date (at another clinic) and I'm beginning to feel completely different already - whole - like things should be.

IMO, there is absolutely no reason a MD should not treat with Hcg if a patient requests it and there are no associated medical issues.

Yes, it didn't take me long to feel better than I had in a long time...both physically and psychologically. Don't even know if I'd be interested in continuing trt if I had to give up the hCG. Good stuff!
And, a lot of us owe a big "thank you" to gd for giving us the info. I'd be left in the dark if not for that sticky.

[steroid.com 1]

Muchas gracias Rusty!

[dreadnok89]

Hey gd, before i started androgel and at 90 test count i was still a hornball and had 0 ere tion problems or sperm problems. I havent used hcg in like 8 months and im still producing sperm it seems. I would like to get more hcg tho to keep myself regular

[AnabolicDoc]

I'm not on TRT currently but I have been in the past. I emailed the two articles above to a new urologist I'm seeing as I may go back on TRT soon and I want to have things lined up for when I'm ready. This doc, who happens to specialize in infertility, was under the impression that you cannot give HCG with TRT - crazy right? So I'm very excited to see what she has to say in regards to these two studies. I will let you guys know if I was able to convert her. I offered to send her additional literature if she was interested but she only write back that she hasn't had a chance to read the articles yet. Meanwhile each abstract takes 2 minutes to read. We'll see what happens.

[steroid.com 1]

She's a traditionally trained Doc so unless she's open minded and willing to learn what the cutting edge A4M Doc's know...good luck.

There's just too many Doc's who are either slammed with their practice and don't have time to learn or have egos that just get in the way.

Either way, it's the patient who needs to manage and control their health care.

Doctor's work for patients and they are paid for that service just like a car mechanic.

The patient must make the final decisions re their health.

Read Dr. John Crisler's paper on HCG...this is one cat who totally gets it!!!!

[system admin]

Excellent stuff G

[AnabolicDoc]

I'm not on TRT currently but I have been in the past. I emailed the two articles above to a new urologist I'm seeing as I may go back on TRT soon and I want to have things lined up for when I'm ready. This doc, who happens to specialize in infertility, was under the impression that you cannot give HCG with TRT - crazy right? So I'm very excited to see what she has to say in regards to these two studies. I will let you guys know if I was able to convert her. I offered to send her additional literature if she was interested but she only write back that she hasn't had a chance to read the articles yet. Meanwhile each abstract takes 2 minutes to read. We'll see what happens.

So my doc got back to me and not only was she convinced by the studies I sent her (the two studies at the beginning of this thread) but she pointed me to a new article that came out on March 1, 2013 in Fertility and Sterility about a study done by Dr. Edward Kim, which came to the same conclusions.

Here s the link to the PubMed abstract of the study:
http://www.ncbi.nlm.nih.gov/pubmed/?...f+hypogonadism

Her is the link to the article in Fertility and Sterility that is about the study:
http://fertstertforum.com/kime-hypog...ale-fertility/

Now, it gets better. If you click on the 2nd link, and scroll down to the comment section, there is a comment by Edmund Ko (who I think is a urologist). Here is an excerpt from his comment:
"We, as a community of Urologists treating Men's Health and Hypogonadism, need to develop Best Practices Guidelines for these medications so that treatment protocols are consistent across practices. This will clear up a lot of the confusion that exists even within our own societies. When I look at the treatment algorithms in the male bodybuilding sites online, it seems like they have their act together better than we do even though there is no scientific data behind it... much to my chagrin."

This seams like a really big step in the right direction for patients and doctors alike in the realm of TRT. Now gdevine just has to convince them to give hcg to men on TRT who do not wish to maintain fertility :-) which I do agree with, but I think needs to be evaluated on a case-by-case basis.

[steroid.com 1]

Best Practice Guidelines would be a huge step in the right direction for the general medical community at large. In the HRT community, and most for A4M Doc's, they understand the best protocols and have "Best Practices Guidelines" as they were trained correctly in how to treat hypogonadal (Primary/Secondary) men.

Read Dr. John Crisler's paper on TRT: A Recipe for Success. In this paper he lays out his best practices in fine detail. It may in and of itself may be one of the best papers yet on the subject.

I love the reference to the "bodybuilding sites" and I wouldn't be surprised if he wasn't referencing our forum to be honest as I think (and I am not trying to be biased here) we are the best HRT forum on the Internet today.

As for the scientific data, he's right; there isn't much and I don't believe we will see any new studies as well. HCG has been out there for a long time and the drug companies really have no reason to invest in these types of studies.

In the first study this sentence worries me: "At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data". Truth, but the facts are that for many men on exogenous testosterone E follows T. If estrogen is not managed correctly and reaches supraphysiological levels it can present some very serious health issues in a man not discounting malignancy and cardiovascular diseases. You can dump all the testosterone you want into a man but if he has a higher then normal aromatase activity all the T in the world won't do the man any good.

I do believe that we have a lot of medical practitioners visit our forum here and learn as noted above. We can point the finger at the drug companies for not conducting more clinical studies but the fact remains it's the Physician and other medical professionals who need to research and learn about HRT in both men and women BEFORE they prescribe treatment.

Good find Doc

[EverettCD]

Thank you for posting the articles AnabolicDoc. The second link: http://fertstertforum.com/kime-hypog...ale-fertility/ caught my eye, my Dr. is one of the authors.

[AnabolicDoc]

In the first study this sentence worries me: "At present, routine use of aromatase inhibitors is not recommended based on a lack of long-term data". Truth, but the facts are that for many men on exogenous testosterone E follows T. If estrogen is not managed correctly and reaches supraphysiological levels it can present some very serious health issues in a man not discounting malignancy and cardiovascular diseases. You can dump all the testosterone you want into a man but if he has a higher then normal aromatase activity all the T in the world won't do the man any good.

I think he's referring to aromatase inhibitors as monotherapy for hypogonadism.

[steroid.com 1]

I think he's referring to aromatase inhibitors as monotherapy for hypogonadism.

I may have missed that and he's right as a monotherapy it's rarely effective.

However, his concern is the use of an AI with no clinical understanding of potential long term risks in men.

What's the difference between using it for monotherapy, or for controlling aromatase activity, as both are long term treatments?

[AnabolicDoc]

I totally hear what you're saying. I just think despite the lack of evidence it's obvious (to the author and others) that excessive estrogen in men needs to be controlled. Evidence or not, I think the use of an AI to control high estrogen, with TRT or not, is a completely different argument than using an AI as monotherapy. Either way, we're getting off topic. I think this study and article is a great step for TRT.

[kelkel]

Outstanding find Doc! Put all of these items together and present them to your doc they will be hard pressed to tell you no. BTW, many HCG packgage inserts now include Hypogonadism as a legitimate use.

And when it comes to the Bodybuilding comment. Many in science have known for a long time that the bodybuilding community is and has been in the forefront of many scientific advances when it comes to uses/treatment with many anabolics and related ancillaries.

[2Sox]

So my doc got back to me and not only was she convinced by the studies I sent her (the two studies at the beginning of this thread) but she pointed me to a new article that came out on March 1, 2013 in Fertility and Sterility about a study done by Dr. Edward Kim, which came to the same conclusions.

Here s the link to the PubMed abstract of the study:
http://www.ncbi.nlm.nih.gov/pubmed/?...f+hypogonadism

Her is the link to the article in Fertility and Sterility that is about the study:
http://fertstertforum.com/kime-hypog...ale-fertility/

Now, it gets better. If you click on the 2nd link, and scroll down to the comment section, there is a comment by Edmund Ko (who I think is a urologist). Here is an excerpt from his comment:
"We, as a community of Urologists treating Men's Health and Hypogonadism, need to develop Best Practices Guidelines for these medications so that treatment protocols are consistent across practices. This will clear up a lot of the confusion that exists even within our own societies. When I look at the treatment algorithms in the male bodybuilding sites online, it seems like they have their act together better than we do even though there is no scientific data behind it... much to my chagrin."

This seams like a really big step in the right direction for patients and doctors alike in the realm of TRT. Now gdevine just has to convince them to give hcg to men on TRT who do not wish to maintain fertility :-) which I do agree with, but I think needs to be evaluated on a case-by-case basis.

This is great stuff! I have more information to send to that doctor in Brooklyn, NY I've been corresponding with. (Another thread.) Thanks!

[AnabolicDoc]

So my doc got back to me and not only was she convinced by the studies I sent her (the two studies at the beginning of this thread) but she pointed me to a new article that came out on March 1, 2013 in Fertility and Sterility about a study done by Dr. Edward Kim, which came to the same conclusions.

Here s the link to the PubMed abstract of the study:
http://www.ncbi.nlm.nih.gov/pubmed/?...f+hypogonadism

Her is the link to the article in Fertility and Sterility that is about the study:
http://fertstertforum.com/kime-hypog...ale-fertility/

Now, it gets better. If you click on the 2nd link, and scroll down to the comment section, there is a comment by Edmund Ko (who I think is a urologist). Here is an excerpt from his comment:
"We, as a community of Urologists treating Men's Health and Hypogonadism, need to develop Best Practices Guidelines for these medications so that treatment protocols are consistent across practices. This will clear up a lot of the confusion that exists even within our own societies. When I look at the treatment algorithms in the male bodybuilding sites online, it seems like they have their act together better than we do even though there is no scientific data behind it... much to my chagrin."

This seams like a really big step in the right direction for patients and doctors alike in the realm of TRT. Now gdevine just has to convince them to give hcg to men on TRT who do not wish to maintain fertility :-) which I do agree with, but I think needs to be evaluated on a case-by-case basis.

I'm really surprised by the limited number of responses regarding this post, especially regarding the urologist's comment on how the BB sites have their acts together. I'm not expecting ppl to be screaming from their rooftops, just a little positive feedback :-)