62 y.o. with new dedication to hypoG control. Past TRT - current hCG monotherapy - many labs

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Re-Ride

Member
mods: please move this if it's in the wrong place.

summary: I used hCG monotherapy successfully to raise T in less than a month from a starting point of 298 total / 88 free to 693. I am 62 y.o.and had been diagnosed with secondary hypogonadism more than 20 years ago.

Although prescribed from diagnosis of hypoG, TRT (injections> patches>Androgel) gel was only used sporadically if at all since 2000 and not at all in the last 6 months. Throughout this period T was tested at least bi-annually and continuously returned as hypogonadal.

Noted here and elsewhere hCG has been used successfully with Novadex and Clomid to re-start the HPT axis in non-hypogonadal men as part of PCT. The goal here is to see what sustained natural T level can be obtained following a similar protocol and without T.

Help is sought on selection of tests, timing of tests and when or if SERMS should be added.

Dosing: The pkg insert suggested 4,000 IU 3 x weekly which was followed for eight weeks. In retrospect an initial dose of 600 to 2500 IU would likely have been more approriate. Unsurprisingly nipples became sensitized with increasing pain at week 6. Estradiol (standard) was checked for the first time at week 8 (6/09/15) and found to be high at 83. Treatment was suspended by pt for several weeks while Arimidex and smaller syringes were obtained and nipple pain receded.
From April 09 to June 09 100,000 IU total had been administered on the initial protocol (12,000 IU/wek) prior to treatment interption. Resumption of treatment was tried at 500 IU for a week and had no effect. 2,000 IU MWF seems to be the current minium effective dose to restore energy and positive outlook but no labs have been done since June 09.
---

Hi, I'm really glad to have found this site. Empowered with knowledge I hope to turn around years of extremely poor management of hypoG which is just one complication from a complex underlying condition.

Please see the lab values posted in my profile. There are many more spanning decades but only one for E2 to my knowlege. Too bad these are not on a spread sheet but they can be manually researched.

For someone that does an extreme amount of research on line regarding health and diet I have no explanation for having remained so ignorant for so long on the basics of TRT and endocrinology. Until recently I actually believed the propaganda on T.

I was diagnosed with secondary hypoG many years ago which was attributed to either an underlying chronic infection or the meds prescribed to control it. HypoG was first treated by hCG then shots, then patches and finally Androgel when it was released in 2000. Although TRT was managed very poorly I managed to get by for years with a fairly active life through my 40's and 50's.

In 2005-2007 sports orthopedic injuries led to atrophy in my L quadriceps for which I pursued intensive physical therapy without result. Loss of muscle mass then spread. Neither I nor my doc made the endocrine connection.

I was was on Androgel and compliant at the time of PT but with no adequate labs being done. Nothing more than total T was ever assayed. Serum goals were not discussed. Physical therapy failure was blamed entirely on the underlying condition.

I became increasingly inactive. In 2011 I moved to a rural location with the expectation of more outdoor rec opportunity. That never materialized. If my care was poor before, now it was in the dark ages.

Through ignorance both on my part and the doctors treating me I reached unprecedented lows by February 2015 with disabling fatigue, low motivation, severe mental fog and more. Oddly ED and libido were rarely issues. This may have been due to a high T/Free ratio of 3.4 when last measured in Feb prior to beginning hCG. A medication I had been on since the late 90's was known to cause depression, metabolic disorders and bone loss. I blamed everything on this med not hormone levels.

The only testing done through my new primary care doc was pretty much at my insistence. By February we had ruled out cardio vascular issues and just about everything else. The results of many tests were considered "unremarkable". According to him T ~ 300 was just fine. His attitude became one that I need to go to a shrink. That really pissed me off. There was too much physical malaise to blame it all on psyc but I still wasn't considering endocrine issues.

My first experience at treating the hypoG had been decades ago. hCG had been the very first treatment. I recalled how well hCG had made me feel, better than I'd ever felt on all subsequent TRT, and became intent on trying it again. I was finally able to get in to see an endo in Feb 2015. After some testing, which did not include everything recommended here, he put me on hCG starting in April per the pkg insert: 4,000 IU 3 times weekly. I knew enough that this seemed high and subsequently found myself here on Excelmale.

I understand that hCG mono is not regarded as a long term solution here but I do hold out hope that diet and lifestyle changes might allow me to remain off TRT. I am prepared to go cyp+hGc if necessary. As of June I am finally off the metabolic destroying med that I had been on since the late 90's.

Gynocomasty has been an issue for me on and off over the years. It has been connected to my underlying condition as well as the metabolic killing drug. Therefore I was not surprised to see it flare up on hCG. I asked for and received Arimidex but so far have only taken less than one mg total in .25mg doses. I'm not sure what dose to take but it seems that .25mg 2x week 24hs following hCG might be appropriate.

I am here for review of labs and discuss options as I learn more.
 
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Vettester Chris

Super Moderator
Re-ride, welcome to EM! Thanks for posting up a very detailed account of your history with hypogonadism. I will go to your profile and look at your lab values. Feel free to post them up on this thread if you want. Thanks again for joining!
 

Vettester Chris

Super Moderator
Re-ride, I went through your labs. If you get a chance, please post up the reference ranges. Vitamin D3 should be standard, you're at 22, IMO you will want that up > 65. It's quite common to see Vitamin D tanked as we get older, so look at some therapeutic dosages to get this value up, and/or talk to your physician about some short-term Drisdol.

On your thyroid, like mentioned, will need the reference ranges on the Free T4, and will also need other labs ... Free T3, Reverse T3, TSH, Antibodies (TPO & TgAb). Skip the antibodies if you have been ruled out on autoimmune disorders in the past.

Cholesterol seems to be a subject with what you presented. Didn't know if you had a plan of attack for this, or any steps to be taken by your physician?
 

Re-Ride

Member
Thanks Chris.
TSH 0.34 - 4.82 uIU/mL: 1.57uIU/ml(4:25pm, January 22,15) 2.71(February 10, 2015)

[TD="class: nameCol srchbl"]T4 Free[/TD]
[TD="class: infoCol"]0.59 - 1.61 ng/dL[/TD]
[TD="class: importantCol"]

[/TD]


I was lucky to get the T4. Both the endo and the new prim care MD refuse to test further insisting that the TSH proves everything is fine. I have put it in writing to them that thyroid insufficiency is a known issue for pt like me and that my symptoms are consistent with it. Can you link me to something that will change their mind? Interviewing new docs again next month.

Lipids have been skewed for years from the meds I've been taking. I'm off those as of June. It will be interesting to see what happens on the upcoming test.

Likewise Vit D has been low for years. Had been on 50k ergocalciferol (D2) "because that's all anybody needs". LOL, been on 10k/day liquid D3 drops for months but serum levels are hardly moving This phenomena has been noted here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898848/
 
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Vettester Chris

Super Moderator
Re-ride, don't feel alone, the majority of GP's and endos fall flat on this subject, day-in and day-out!

OK, we can use the two (2) labs you provided as an argument to what your physicians are stating ... So, if TSH is the "be-all, end-all" for thyroid, then your 1.57uIU result is about spot-on optimal. Being that number is in the lower end, it should reflect that your actual thyroid hormone level is very good(?). Oh wait, your Free T4 result reflects that you are at 21.5% of your reference range value, when many of the best minds on this subject would say that your free serum (T4 & T3) should be in the 50% to 80% area of the reference range.

Your results alone prove that TSH only is unreliable at best!! Working on a negative feedback loop, wouldn't it be "High" if your thyroid hormone levels were low? Now, the other variables are Free T3, which if elevated could indicate pooling "if" you find the Reverse T3 ratio is not sufficient. There's a variety of factors that can play into this, but the first step is getting the correct thyroid labs. The best starting place for you on this subject IMO is www.stopthethyroidmadness.com ... I can point you to other experts like Dr. Bruce Rind, and some other thyroid communities if needed, but start with STTM.com to get a real feel with all of these talking points.
 

Re-Ride

Member
Thanks for pointing out that the free T4 is much less than would be expected. Already been to STTM... got traps set up in the forest out back now and harvesting critter thyroids just in case :) :)

The endo, in spite of his senior years, has taken an open-minded approach to hCG. It's pro'ly best not to challenge his peachy fine thyroid eval right now. He reluctantly ordered estradiol but then Rx-ed Arimidex right away which is a great indication that he'll eventually come around. Meanwhile I'll be look for another GP that will order what I ask for since the current one messaged me a warning to "stop reading that stuff on the net".

Insight I've gained since February:
- rule out thyroid before proceeding with TRT
- cycles and crashing; given the sporadic use of A-gel it's amazing that my 2/10/15 numbers were not worse. Never start TRT unless you know what PCT is. Consistency essential; slight adjustments followed by labs
- aromatase/E2 testing /belly fat
- gyno becomes fibrous and irreversible after a year
- proceed with caution least you end up as the "Estrogen Sex Slave" https://estrogendiaries.wordpress.com/2012/10/30/my-life-as-an-estrogen-sex-slave/


2/10/15 ( off all supplementation)
tot T= 298, free=88
FSH=7.4
LH=3.4
FREE T4=8.1
Prolactin 7.9

25 HYDOXY D= 22 ( up from 12 in May 2014 ) June 09 was 25

[TD="class: infoCol"][/TD]
[TD="class: importantCol"][/TD]

 

[TD="class: srchbl, colspan: 4"]This Total 25-OHD assay measures the sum of 25-hydroxy (D2 and D3) vitamin D
metabolites. Therapy indications are based on Total 25-OHD, as follows:
Deficiency: Less than 20 ng/mL
Insufficiency: 20-29 ng/mL[/TD]



Magnesium =2.2
IGF I Somatomedin C=316H (41 - 279 ng/ml),

PSA= 1.84 on 8/2012 then 0.64 on 5/21/15

KIDNEY 1/22/15:
Creatinine= 0.68 mg/dL (0.60 - 1.10 )IDMS-traceable method
history: 11/10/13... 5/21/14...1/22/15...5/21/15

[TH="class: scroll"][/TH]
[TH="class: scroll"][/TH]
[TH="class: scroll"][/TH]
[TH="class: scroll"] CR 0.63 0.61 0.68 0.69[/TH]


GFR 107 108 103 102
CR is barely within range. Any problem with this?

GFR Est-Other >60 See Cmnt 103
GFR Est-African American >60 See Cmnt 119
Units: mL/min/1.73 m2. Estimated glomerular filtration rate values are
calculated using the CKD-EPI equation.

5/21/15:
Hemoglobin A1c =5.0 (4.8 - 5.6 %)
Average Glucose 97
past results: 12/03/14 A1c= 5.4 glu=108

Zinc= 126 (60 - 130 ug/dL) on 6/09/15

6/09/15:
DHEA-S: High! but I was on oral supplementation (brand Extenze ) for the prior few weeks. Discontinued on 6/10
DHEA Sulfate = 442H (25 - 95 ug/dL for 60-69y.0) 442 H

CHOLESTEROL: Tested Aug 2012 //Dec 2014 // May 21 2015 ( 6 weeks on hCG)

Downward trend on Lovaza and diet mod. : 222(2012) 223( Dec 2014) 212(May 21,2015)
HDL= 43/44/45 unchanged on hCG
LDL: 138 H(2012) 143(dec2014) 131 H =May 2015, decreased after 6 weeks on hCG
VDL Calculated: 40 37 35
Triglycerides: 8 point drop on hCG but it was trending lower. 201/185/173

note: meds known to cause high trigs discontinued June 2015 after decades of use.

Comp Metabolic Panel 5/21/15: nothing flagged

Fasting Blood Sugar: Glucose, Fasting 70 - 99 mg/dL 100H on 12/03/14 ... improved to 90(5/21/15) after six weeks hCG w/0 any diet mod or medicine changes.

OLD Comp Panel from 11/10/2013 1 pm:

[TD="class: nameCol srchbl"]WBC[/TD]
[TD="class: infoCol"]4.0 - 11.0 K/uL
[/TD]
[TD="class: importantCol"]7.8[/TD]

 

[TD="class: nameCol srchbl"]RBC[/TD]
[TD="class: infoCol"]4.40 - 6.00 M/uL
[/TD]
[TD="class: importantCol"]4.74[/TD]

 

[TD="class: nameCol srchbl"]Hemoglobin[/TD]
[TD="class: infoCol"]13.5 - 18.0 g/dL
[/TD]
[TD="class: importantCol"]15.0[/TD]

 

[TD="class: nameCol srchbl"]Hematocrit[/TD]
[TD="class: infoCol"]40.0 - 52.0 %
[/TD]
[TD="class: importantCol"]43.0[/TD]

 

[TD="class: nameCol srchbl"]MCV[/TD]
[TD="class: infoCol"]80 - 100 fL
[/TD]
[TD="class: importantCol"]91[/TD]

 

[TD="class: nameCol srchbl"]MCH[/TD]
[TD="class: infoCol"]27.0 - 33.0 pg
[/TD]
[TD="class: importantCol"]31.6[/TD]

 

[TD="class: nameCol srchbl"]MCHC[/TD]
[TD="class: infoCol"]31.0 - 36.0 g/dL
[/TD]
[TD="class: importantCol"]34.9[/TD]

 

[TD="class: nameCol srchbl"]RDW[/TD]
[TD="class: infoCol"]<16.4 %
[/TD]
[TD="class: importantCol"]13.1[/TD]

 

[TD="class: nameCol srchbl"]Platelet Count[/TD]
[TD="class: infoCol"]150 - 400 K/uL
[/TD]
[TD="class: importantCol"]178[/TD]

 

[TD="class: nameCol srchbl"]Differential Type[/TD]
[TD="class: infoCol"][/TD]
[TD="class: importantCol"]Automated[/TD]

 

[TD="class: nameCol srchbl"]Neutrophil %[/TD]
[TD="class: infoCol"]49.0 - 74.0 %
[/TD]
[TD="class: importantCol"]48[/TD]

L

[TD="class: nameCol srchbl"]Lymphocyte %[/TD]
[TD="class: infoCol"]26.0 - 46.0 %
[/TD]
[TD="class: importantCol"]44[/TD]

 

[TD="class: nameCol srchbl"]Monocyte %[/TD]
[TD="class: infoCol"]2.0 - 12.0 %
[/TD]
[TD="class: importantCol"]6[/TD]

 

[TD="class: nameCol srchbl"]Eosinophil %[/TD]
[TD="class: infoCol"]0.0 - 5.0 %
[/TD]
[TD="class: importantCol"]2[/TD]

 

[TD="class: nameCol srchbl"]Basophil %[/TD]
[TD="class: infoCol"]0.0 - 2.0 %
[/TD]
[TD="class: importantCol"]0[/TD]

 

[TD="class: nameCol srchbl"]Abs Neutrophil[/TD]
[TD="class: infoCol"]2.0 - 8.0 K/uL
[/TD]
[TD="class: importantCol"]3.6[/TD]

 

[TD="class: nameCol srchbl"]Abs Lymphocyte[/TD]
[TD="class: infoCol"]1.0 - 5.1 K/uL
[/TD]
[TD="class: importantCol"]3.5[/TD]

 

[TD="class: nameCol srchbl"]Abs Monocyte[/TD]
[TD="class: infoCol"]0.0 - 0.8 K/uL
[/TD]
[TD="class: importantCol"]0.5[/TD]

 

[TD="class: nameCol srchbl"]Abs Eosinophil[/TD]
[TD="class: infoCol"]0.0 - 0.5 K/uL
[/TD]
[TD="class: importantCol"]0.2[/TD]

 

[TD="class: nameCol srchbl"]Abs Basophil[/TD]
[TD="class: infoCol"]0.0 - 0.2 K/uL
[/TD]
[TD="class: importantCol"]0.0[/TD]

 

Collected:11/10/2013 1:07 PM
 
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