What is the best dose of HCG? Dr Saya presents two case studies.

[Vince]

Are there any advantages on doing HCG on the same day of T cyp? or is it better to do it before of after the T cyp injection day? I'm doing 2x a week 500 UI on the days I inject T cyp (80mg twice a week), and I've notice significant testicular shrinkage. So I was wondering if there is something with timing that can help with testicular shrinkage.

I thought I would add my 2 cents, I've always injected my HCG on the same day as my T. Never had any testicle shrinkage, so I agree with VC, no timing issues with HCG, as long as you're injecting at least twice weekly.

 

[blackebob]

I tried finding any update to this where the dosage testing was 250,300 or such. Anybody know if there was a further study as the good Dr hinted to?

 

[Dr Justin Saya MD]

I tried finding any update to this where the dosage testing was 250,300 or such. Anybody know if there was a further study as the good Dr hinted to?

No further study just yet, but through experience can say that 250iu to 350iu either EOD or TIW seems to work fine for many guys.

 

[blackebob]

Thank you for the reply doctor. I was prescribed 125mg HCG 2 times a week, 2 days before T injection. I'm guessing based on your graph I should step it up to 250 2 times a week, like she first wrote the script for before it was lost and rewritten for 125mg.

Thank you for your time and your help but mostly for your time that's the greatest gift you can give to all of us God bless you

 

[Dr Justin Saya MD]

Thank you for the reply doctor. I was prescribed 125mg HCG 2 times a week, 2 days before T injection. I'm guessing based on your graph I should step it up to 250 2 times a week, like she first wrote the script for before it was lost and rewritten for 125mg.

Thank you for your time and your help but mostly for your time that's the greatest gift you can give to all of us God bless you

You made my day blackebob and you're very welcome.

 

[Charliebizz]

I might have missed it but is there a correlation between serum hcg levels and actual lh stimulation. Since we can't test it through actually lh test? Or do I have this wrong.

 

[Dr Justin Saya MD]

I might have missed it but is there a correlation between serum hcg levels and actual lh stimulation. Since we can't test it through actually lh test? Or do I have this wrong.

Trying to approximate serum LH levels with serum HCG levels. Straightforward in the sense that they are routinely measured in the same units...not straightforward in the sense of the half-life differences and the pulsatile nature of endogenous LH, as noted in the paper.

 

[Charliebizz]

I found this study interesting https://www.sciencedirect.com/science/article/pii/S0303720713005248

maybe this is why hcg doesn't always work the same way for certain men. Could it be following the wrong pathways for what some of us need ?

 

[Dr Justin Saya MD]

I found this study interesting https://www.sciencedirect.com/science/article/pii/S0303720713005248

maybe this is why hcg doesn't always work the same way for certain men. Could it be following the wrong pathways for what some of us need ?

Indeed. We must keep in mind that hCG is an analog of LH, but is NOT LH itself. Hence, there are *some* variations in downstream influences (mRNA expression, protein synthesis, etc). Unfortunately the only way to attempt to precisely mimic endogenous LH would be with a lyophilized LH product, but would have to be administered via an insulin pump-like apparatus owing to the short half life and pulsatile secretion pattern (unless willing to inject many times daily).

 

[readyforchange]

I personally believe *most* guys will do fine without any special concern for disproportionate E2 increase in HCG doses up to 500iu BIW.

I've only seen disproportionate increases in E2 (i.e. increases in E2 above and beyond what would be expected by the increase in T levels from the HCG) with larger doses of HCG (had a guy last week from another clinic taking 1000iu BIW, had E2 level in the 80's with total T only in the 700's...not obese either, I would attribute that to the large HCG dosage). As long as guys stay at or below 500iu per injection (BIW...ONLY TIW if absolutely needed for fertility or atrophy reasons) most should be okay with respect to E concerns.

Dr. Saya,

I'm a Defy patient as well -- 6 months.

Starting out, I was on 80mg Test Cyp, 250IU's HCG, and .25 anastrozole (all twice per week).

After three months, my labs came back with Total T above 1500, Free T 42, and E2 at 49 --- and I was feeling it. Fatigue had returned, lots of water rentention, anxiety, etc.

Dr. Caulkins lowered T to 70mg and upped HCG to 500IU's (again all twice per week) and had me double up on anastrozole for 1-2 weeks to get E2 back down.

I felt GREAT for about 2-3 weeks.

The, as the anxiety and water retention set in yet again, I went in and had E2 pulled and it came back at 69 -- it had gone up 20 after reducing weekly test cyp by 20mg.

Am I jumping to conclusions here, or would this make it seem like HCG -- even at just 500 twice per week -- is aromatizng pretty strongly in me? I also noticed that my skin has gotten MUCH worse since increasing HCG -- I never had acne, even during puberty, and now I have what looks like acne or a rash all over my chest and back and even down my arms by my elbows. I'm beginning to think some testicular atrophy doesn't sound so bad...

I just did 6 month labs and will be scheduling a tele-appointment with (hopefully you) when those labs come back. Currently, I'm all over the place and can't seem to get to a good, consistent place.

 

[Dr Justin Saya MD]

Dr. Saya,

I'm a Defy patient as well -- 6 months.

Starting out, I was on 80mg Test Cyp, 250IU's HCG, and .25 anastrozole (all twice per week).

After three months, my labs came back with Total T above 1500, Free T 42, and E2 at 49 --- and I was feeling it. Fatigue had returned, lots of water rentention, anxiety, etc.

Dr. Caulkins lowered T to 70mg and upped HCG to 500IU's (again all twice per week) and had me double up on anastrozole for 1-2 weeks to get E2 back down.

I felt GREAT for about 2-3 weeks.

The, as the anxiety and water retention set in yet again, I went in and had E2 pulled and it came back at 69 -- it had gone up 20 after reducing weekly test cyp by 20mg.

Am I jumping to conclusions here, or would this make it seem like HCG -- even at just 500 twice per week -- is aromatizng pretty strongly in me? I also noticed that my skin has gotten MUCH worse since increasing HCG -- I never had acne, even during puberty, and now I have what looks like acne or a rash all over my chest and back and even down my arms by my elbows. I'm beginning to think some testicular atrophy doesn't sound so bad...

I just did 6 month labs and will be scheduling a tele-appointment with (hopefully you) when those labs come back. Currently, I'm all over the place and can't seem to get to a good, consistent place.

It sounds as if that may be the case for you. Change the variable (cut hCG down a bit) to refute or validate.

 

[Rez23]

This is an amazing thread, just want to say thank you to all, especially Dr Saya. This question is for you;

You mentioned that its possible to not use any AI’s if the hcg dosage was up to 500 ui bi weekly, but how about your recommended dosge, 250-350 eod, can you bypass using an AI with that dosage? I have just begun using hcg as mono therapy and I really hate AI. Even at .25 2x week. If so, how much AI do i need for that dosage? And I am assuming 250-350 eod is better than 500 bi weekly, correct? Thanks doc, this thread is amazing.

 

[Dr Justin Saya MD]

This is an amazing thread, just want to say thank you to all, especially Dr Saya. This question is for you;

You mentioned that its possible to not use any AI’s if the hcg dosage was up to 500 ui bi weekly, but how about your recommended dosge, 250-350 eod, can you bypass using an AI with that dosage? I have just begun using hcg as mono therapy and I really hate AI. Even at .25 2x week. If so, how much AI do i need for that dosage? And I am assuming 250-350 eod is better than 500 bi weekly, correct? Thanks doc, this thread is amazing.

There are other variables that also contribute to whether or not a specific patient will need an AI beyond HCG dosage. The higher the dosage of HCG there can be further increase in estradiol, but often this is clinically relevant and more pronounced at much higher HCG doses than we use (eg >500iu per injection).

 

[Rez23]

There are other variables that also contribute to whether or not a specific patient will need an AI beyond HCG dosage. The higher the dosage of HCG there can be further increase in estradiol, but often this is clinically relevant and more pronounced at much higher HCG doses than we use (eg >500iu per injection).

Ok, so does that mean that with a dosage of 250-350 IU eod, that Al wouldn't be required? Generally?
I'm new to all this, so I really appreciate it.
I've actually been having a really rough time. I began treatment at 1000iu eod about 10 days ago. My doctor wanted to start me on a high dosage and find out if HCG would work, as mono therapy. The first day was amazing, albeit placebo probably, I worked out twice, something I never do, and had a productive day. I felt like a million bucks.
The next day, was when I began my arimidex, 1mg. Thats when I began to feel off. I felt moody, irritable, out of it, tired, etc.
But then the next day, my next HCG injection, it got even weirder, as when I took it, also at a 1000iu , I felt so light headed and out of it, that I couldn't do anything that day and had to stay home. Physically, I wasn't able to drive a car. The same thing happened the next injection, 2 days later.
So, then I lowered it to 500iu every other day. It's been about a week at 500iu eod, and while I can go to work and drive, it's pretty difficult to do on the days I do the injection, and furthermore, there is this intense depression and irritableness that I have. I stopped the AI, which I thought was the source of the problems, and restarted 7 days in, 2 days ago, at .25mg, but it doesn't seem to have made a huge difference, though I am far less 'moody' or feeling like a girl, the way I did, when it was 1mg. I was having all kinds of weird emotions then, such as intense jealousy, up /down, etc.
Anyways, this irritableness and depression are rough, I'm not getting any work done, and I have been feeling consistablty terrible ever since I began HCG, with the exception of the very first day, which I now think was placebo. I am leaning towards lowering it to 250-350iu eod. I am feeling that perhaps 500iu is too high for me. It's barely bearable. I don't think I can tolerate it for much longer. The only positive benefits I am noticing is increased urge to masturbate , and larger testicle size, so it must be doing something. What are your thoughts on the dosage? Could this be dosage related, E2 related (I hate the AI though, even at .25mg, but not quite as bad or close to the feelings before), or simply HCG doesn't work for me? If it were you, would you lower the dosage and see if that works?

 

[OMI100]

Rez, what is your AI dose protocol?
How much and how often?

 

[Rez23]

Like I mentioned ,

I’m on day 11 of hcg injections with eod protocol starting at 1000iu then moving to 500iu a week ago.
On day 2, one day after my first injection, I began with 1mg arimidex. But I felt terrible (moody, like a girl, anxious, dark, jealous) so I stopped arimidex until a week later, day 8, this past thu, and started it back up at .25mg. It’s supposed to be every 3 days.

 

[OMI100]

1mg per week?
0.25 mg per week?
or
?

 

[lowe2sucks]

Like I mentioned ,

I’m on day 11 of hcg injections with eod protocol starting at 1000iu then moving to 500iu a week ago.
On day 2, one day after my first injection, I began with 1mg arimidex. But I felt terrible (moody, like a girl, anxious, dark, jealous) so I stopped arimidex until a week later, day 8, this past thu, and started it back up at .25mg. It’s supposed to be every 3 days.

this is exactly how I feel when aromatase is supressed (moody, dark, jealous) glad I am not the only one

 

[OMI100]

Hmmmm
May be going off track here and you may want to start a thread just on proper AI dosing.
Things like what E2 test was ran...
Sensitive VS standard test?
BIG difference if dosing against the WRONG test...
Reading with ranges.
Arimidex is some VERY powerful stuff..
A LITTLE goes a long way.
Other labs w/ranges.

 

[Rez23]

Im just wondering if i can abstain from arimidex with an eod 350iu hcg dosage. Doc mentioned that bi-weekly was ok but im wondering if eod would apply at that dosage or is 500iu bi weekly better.