Advice needed on TRT / Treatment options

[strife2981]

Hey Kel, I received my thyroid and MRI results. Both came back negative. The thyroid results are as follows:

TSH 1.16 on scale of .4 to 4.5 mIU/L
T3 Free 3.0 on scale of 2.3 to 4.2 PG/ML
T4 Free 1.5 on scale of .8 to 1.8 NG/DL
Thyroid Peroxidase AB <1 with range up to <9 iu/ml
Thyroid Antibodies <1

I talked to my endocrinologist on the phone and his recommendation is 200mg/dl testosterone cyponate weekly. I inquired about hcg for maintaining testicle size and fertility and he said that I wouldn't take the hcg until I was interested in having kids. At that time, I would discontinue the testosterone and use hcg or other fertility methods. He also indicated that I could try hcg mono-therapy. I asked him about combining both testosterone and hcg and it didn't seem like that was a treatment plan that he was interested in. He also mentioned that insurance wouldn't cover both. In a way, he almost seemed opposed but I didn't press it and figured that I would post here first to get input.

Is hcg mono therapy something worth considering? If not, and the testosterone route is the best option, should I be more adamant about combining with hcg?

[kelkel]

Hey Kel, I received my thyroid and MRI results. Both came back negative. The thyroid results are as follows:

TSH 1.16 on scale of .4 to 4.5 mIU/L
T3 Free 3.0 on scale of 2.3 to 4.2 PG/ML
T4 Free 1.5 on scale of .8 to 1.8 NG/DL
Thyroid Peroxidase AB <1 with range up to <9 iu/ml
Thyroid Antibodies <1

I talked to my endocrinologist on the phone and his recommendation is 200mg/dl testosterone cyponate weekly. I inquired about hcg for maintaining testicle size and fertility and he said that I wouldn't take the hcg until I was interested in having kids. At that time, I would discontinue the testosterone and use hcg or other fertility methods. He also indicated that I could try hcg mono-therapy. I asked him about combining both testosterone and hcg and it didn't seem like that was a treatment plan that he was interested in. He also mentioned that insurance wouldn't cover both. In a way, he almost seemed opposed but I didn't press it and figured that I would post here first to get input.

Is hcg mono therapy something worth considering? If not, and the testosterone route is the best option, should I be more adamant about combining with hcg?

Good numbers. HCG is also used to maintain testicular function which is way more than just cosmetic. Google Dr. Crislers paper on HCG and present it to your doc. He needs to study up a bit. I'm not a fan of HCG mono and many of the respected docs in this field simply state that the benefits are not the same as exogenous testosterone.

I also agree with Beethoven that 200 mgs is starting at the high end. I never understand why doc's do this with testosterone when they don't do it with other meds. Why increase the risk for sides exponentially when you can start lower and titrate up based on BW. If you do start at that dose you're about guaranteed to need an anti-estrogen. Did he discuss this with you? If not, this shows a severe lack of knowledge on his part. Small, incremental changes in doses always work best.

[strife2981]

Thanks for the input Kel, Beethoven and hakk14dl.

To answer your question above Kel, no, he did not discuss AI's or anti-estrogens over the phone but did talk about them with me today in person. I went there today to talk about the options of Test Cyp, HCG Mono, Test Cyp + HCG, Clomiphene Citrate or do nothing. I did have a copy of Dr Crislers papers but chose not to use it as I will explain further in this post.

- I definitely did not want to do nothing.

- Clomid would be my first choice considering my desire to preserve fertility but I've read so many accounts of the emotional issues that can accompany its use that I elected not to go that route. I am already prone to depression and suffer pretty bad with it so didn't feel exacerbating that problem was a good choice for me.

- I was not interested in Testosterone alone because of the testicular atrophy and I also did not want to roll those dice and come to a day where I would like to have children and be completely or partially impaired because of it - or - need a long recovery period with HCG to get to a point where I was again fertile.

- Testosterone + HCG would have been my second choice but was something that my endo did not seem completely open to and he did not seem to think insurance would cover both substances. I believe he could be persuaded into it but I decided not to press the issue at this time using the logic I am about to describe. Please tell me if this is faulty logic...

I chose to go with HCG Mono for a three month period to evaluate its efficacy. As already stated, my first choice of clomid is not a good fit for my particular situation. It is my understanding that a 3x weekly dose of 500iu's or 350iu's every other day has been shown to have a positive impact on testosterone and spermatogenesis and that such a dose does not put me at high risk for desensitization. I am aware the HCG mono protocol may not provide all the other positive benefits of TRT + HCG. However, the advantage for me would be the possibility that it may provide at least SOME, although not guaranteed, therapeutic benefit. Additionally, it is my assumption that over the next three months, my fertility would increase thus providing me with an option that may or may not exist today... which is to bank sperm. At that point, I would at least have that in my back pocket if everything else failed and I had to go with testosterone replacement. Perhaps it would bring peace of mind knowing that I did everything that I could that was available to me. Once that is accomplished, and if HCG is not providing the therapeutic benefits, I feel that I would be in a good position with my doctor to lobby for adding testosterone to my protocol.

What do you guys think? Thanks in advance for taking your time to read this or provide you valuable insight...