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Treatment options for Hypogonadism

Originally Posted by Titleist
I’ve settled in to a nice weekly injection and I’ve never felt better.

Titleist,
If I understand you correctly, you inject T once every 7 days? If so, what’s your dose and do you have any mood swings?


Starting stats 3/2/12: BPEL 5.625, EG 5.375, Flaccid L 3.50, Flaccid G 5.125, Mild to moderate ED

Goals: It's growing and looking good. ED is slightly better. 4/30

I was just on Meso RX forum. Here’s a link about HCG. Sounds like there may be a shortage. It may be smart to stock up as best as possible.

http://thinksteroids.com/forum/mens…-134319736.html


Starting stats 3/2/12: BPEL 5.625, EG 5.375, Flaccid L 3.50, Flaccid G 5.125, Mild to moderate ED

Goals: It's growing and looking good. ED is slightly better. 4/30

Originally Posted by bowie knife
Titleist,
If I understand you correctly, you inject T once every 7 days? If so, what’s your dose and do you have any mood swings?

I’m at .5ml with no side affects or mood swings.


Started 7.75x5.75

Currently: 9.75bpX6.75eg My Picture Thread

Goal:10.0bpX7.25mseg Building a thicker unit, click by click, pump by pump, jelq by jelq!

Originally Posted by meatbuilder
Also, since I’m not going to pretend I’m concerned about fertility, it seems possible that most doctors would offer me HCG in any case, but I’m curious how it works in conjunction with TRT.

I’m primary, and convinced my doc to add low-dose hCG to my TRT regimen in November. The short answer is that it has made a huge difference in mood, (confidence, centeredness, etc) also seems to have eradicated some of the residual “low test symptoms” (problem solving, analytical skills, mental clarity) I was still having.

Seems like a fair number of docs are up to speed on this protocol on the east and west coast.

Tired as heck right now, but I’ve posted some stuff on the reasoning behind adding hCG to TRT. Will dig around for those and either link or repost it in the next several days.

Originally Posted by sta-kool
I’m primary, and convinced my doc to add low-dose hCG to my TRT regimen in November.

Tired as heck right now, but I’ve posted some stuff on the reasoning behind adding hCG to TRT. Will dig around for those and either link or repost it in the next several days.

In addition to being helpful, you are evidently quite a persuasive devil!

If I get to the point of TRT, and something still seems missing after I give it a fair chance (2-3 months?), I will take up this issue.

Originally Posted by sta-kool
I’d say a week or so. Worsened and sort crashed at week 3.

If past experience is any indication, I should get some of the feelings of calmness and well being in a week.

Yes, testosterone at room temperature, stored in the dark.

Yes, hCG refrigerated. The couple times I have traveled I put the vial in a Baggie with small refreezable ice pack in my carry-on. Then straight to the hotel room’s mini-fridge. But yeah, it is kinda a pain in the ass.

Thank you for the input. Maybe a portable insulin fridge would be something to consider? :)

For what it`s worth, I was with a specialist for an ultra sound check today. I did not expect him to find anything, but I was a little curious about my testicles. According to him, they were just as good as the rest of my body and functioned fine. The size was 4 cm length, which according to him is normal. I later read that the average is 5 cm, so perhaps they are a little smaller than average.

On Wednesday I`m scheduled for an appointment with my current “liberal” GP. At the least, I expect to get testogel since he prescribed andriol. Hopefully, he will give me HCG as well also. Seeing how women are prescribed this stuff and inject on their own, I can`t see why he would not let me try it. After all, the literature clearly states that it is for men with low testosterone.

In fact, I think I will propose that we try HCG alone for 3 weeks first before introducing testosterone. If I get a nice boost from HCG alone, maybe that`s all I need. What do you think?

And btw, do you use an AI?

Thanks again,

Renholder

Renholder - keep us posted on the doc visit. Best AI is to lose body fat. However it is hard to lose fat if you have low testosterone, so get your test levels in order.

Meatbuilder - I have a hunch your doc will be up on the HRT + low dose hCG protocol.

Here’s one of my posts explaining why HRT + low dose hCG for guys with primary testicular failure:

sta-kool - Treatment options for Hypogonadism

Here’s a link to the full ksman post I am quoting. Worth reading the whole post if you get the chance?

http://tnation.t-nation.com/free_on…_for_injections

The JCEM article I shared with my doctor:

sta-kool - Treatment options for Hypogonadism


Last edited by sta-kool : 04-30-2012 at .

Renholder: looks like you’re on your way. Good luck!

Sta-kool: Thanks for the links. Not sure how I missed those before. The T-nation info makes me realize what a complex process it can be to adjust hormonal levels. Have you had any issues with estradiol levels or had to adjust your replacement regimen to keep E2 in line? No one measured my estradiol levels so far, but it sounds like something that would definitely be monitored during TRT, if not before starting.

The endocrinology article is very interesting. It definitely shows that hCG has a significant impact on intratesticular T in healthy men even when LH is suppressed. If I’m reading it correctly, the authors think that the hCG probably works by stimulating Leydig cell steroidogenesis. (Although I’m not concerned about sperm production, which seems to be the underlying focus of this study, I’m guessing that Leydig cells would also be where pregnenolone is made too?)

I don’t know enough about Leydig cell function in guys with primary hypogonadism and probably assumed (without basis) that they weren’t functioning at all. In this study, the authors drew no conclusion about the response that might be expected from hypogonadal men who could have had a potentially prolonged period of suppressed hormonal levels. However, since other folks recognize hCG as a treatment therapy for at least secondary hypogonadism, I take that as just a cautionary note about the limits of this particular study.

Anyway, although I still don’t grasp how this really works, this would at least help me raise some of the right questions when its time to discuss TRT with my doctor. So, thanks!

Originally Posted by sta-kool
Renholder - keep us posted on the doc visit. Best AI is to lose body fat. However it is hard to lose fat if you have low testosterone, so get your test levels in order.

Will do.

But I would like to hear what you think about starting with HCG monotherapy first? The call is basically mine, since this is not something the doctor know anything about, believe it or not. So I need to speak with authority tomorrow.

I think I will propose 3 weeks of monotherapy and then take bloodwork. If both physical results and bloodwork confirm it`s a success, maybe that is all I need. If not, then add testosterone to the mix. :)

Why not give it a try if your doc is willing. Somewhere in here I “think” quoted a post about Dr. Eugene Shippen’s hCG protocol for guys with secondary testicular failure. If not, here is the link to that post.

A Primer on HCG and Dr. Shippen's HCG Protocol (2 of 8) (hypothalamus depression nail testicular down)
http://www.mombu.com/medicine/medic…wn-2307457.html

(From what I gather, Shippen has presented this in his book. But it must be a newer version than what I have? Any body have the latest version?)

Just saw this article summary at PubMed. May be helpful?

Hormonal therapy of male hypogonadism.
Endocrinol Metab Clin North Am. 1994 Dec;23(4):857-75.
Matsumoto AM.
Department of Medicine, University of Washington School of Medicine, Seattle.
http://www.ncbi.nlm.nih.gov/pubmed/7705324

Originally Posted by sta-kool
Why not give it a try if your doc is willing. Somewhere in here I “think” quoted a post about Dr. Eugene Shippen’s hCG protocol for guys with secondary testicular failure. If not, here is the link to that post.

A Primer on HCG and Dr. Shippen's HCG Protocol (2 of 8) (hypothalamus depression nail testicular down)
http://www.mombu.com/medicine/medic…wn-2307457.html

(From what I gather, Shippen has presented this in his book. But it must be a newer version than what I have? Any body have the latest version?)

Just saw this article summary at PubMed. May be helpful?

Hormonal therapy of male hypogonadism.
Endocrinol Metab Clin North Am. 1994 Dec;23(4):857-75.
Matsumoto AM.
Department of Medicine, University of Washington School of Medicine, Seattle.
http://www.ncbi.nlm.nih.gov/pubmed/7705324

Yes, I already read that protocol and it is part of the reason I`m interested in trying it. As far as I have experienced, a lot of people actually are successful with HCG alone. I spoke to a guy who`s on 750 IE twice per week for several years now and actually prefers it to regular TRT (which he`ve tried).

As I understand it, Shippen prefers to treat his secondary patients with HCG exlusively (possibly an AI) if it works for them.

Will be exciting tomorrow. Tired of being disappointed by doctors, so I expect the worst, but ready to be pleasantly surprised. :)

Well, that went well.

I will not bore you guys with details, but let`s just say that my visit with the doctor was fairly hilarious and despite knowing a thing or two on the subject, his lack of knowledge on the subject is still impressive. On top of that he had a medical student with him, so I had to bring my best game. The truth is that I think he is one of the best guys I could be with here in Norway, since he is fairly liberal and willing to let me try stuff.

So now, I have prescription for HCG that will last me for months. He prescribed 5000 IE per week, which is the standard protocol according to the manufacturer. However, my research indicates that as monotherapy, 1500 IE per week is more like it so that is probably what I will settle on. Some say 200 IE ED, 250 IE EOD or even 750 IE twice per week. I think I`ll probably settle on a EOD schedule or E3D.

The problem is that I have not gotten a hold of bacteriostatic water or sterile vials, so I could not split it up as I wanted to since the package came with only 1 ml of water. Because of that, I decided to inject 2500 IE in my belly 10 minutes ago, until I find a way to properly divide the product. It seems like I may even have to order this stuff from outside the country, so we`ll see what happens.

He seemed eager to prescribe testosterone as well, but I convinced him that I want to try this method first and see if it works. Scheduled for a follow-up in 6 weeks, but I think I`ll try to get in as soon as 4 weeks, at least if I don`t feel any better. I suppose an AI may be due, but I did not want to push it today.

If anyone want to learn how to manipulate doctors, I think I can offer a few clues. The key is to be smarter than them, but smart enough that you don`t show him you`re smarter than him or act arrogant. Gently lead him where you want him to by having the proper knowledge, ask a few stupid questions that you know he can answer such that he does not lose his pride and then try to give him the impression that it`s his idea. :)

I`m excited to see if this stuff actually works and I wish you other guys who are struggling the best of luck in the time to come!

Regards,

Renholder

GOOD WORK! So glad it worked out the way you were hoping. Sounds like you were left with almost a blank check on your dosing regimen, which seems both freeing and a little intimidating. Maybe Sta-kool will have useful thoughts on that. In general, I think you would probably want to go with the lowest total dose that works, but I don’t know how you’d gauge that, especially when you don’t expect overnight results even with a correct dose. I do think I read that high dose hCG over an extended period can cause primary hypogonadism. I don’t recall what levels they were talking about - but probably higher than what you are considering.

Your approach to dealing with doctors sounds about like what I shoot for, but I think it helps if (1) you have a liberal doctor, and (2) you have enough of a relationship with your doctor to be able to read each other pretty well. In my case, I’m not sure about the former yet, and I working on building the latter.

Once again: WELL DONE!

Excellent news! There are some dosage recs in that Shippen post, point 4 in Shippen’s email to the poster. He also suggests following up with labs for Test and E2 after 2 to 3 weeks while setting dosage. So good call on trying to get in for labs a little sooner rather than later.

I am doing 250 on Mon, Wed, Fri, Sat. Was supposed to do it EOD, but too dumb to keep track, so doc said “what the hell just inject on these days.”

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