HCG restart attempt.

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Kimpe

Member
I've been on HCG from June 15, for an attempt to restart my own testosterone production.
My trt doctor prescribed a huge amount of 5000iu 2x week. I did that first, and then spared it out to 2500iu EOD after few weeks, because of the huge 5000iu dose at once seemed to give me elevated heart rate and BP.

Here's my blood results:

July 7 (on 5000iu 2x week)
Total testosterone: 21,6nmol/l (8-29).
If an internet converter is correct, that converts to 623ng/dl
I got only total testosterone at that time, because I wanted to just see if I've recovered at all.

July 30 (on 2500iu EOD)
Total testosterone: 17,7nmol/l (8-29) = 511ng/dl(?)
Free testosterone: 287pmol/l (155-800)
SHBG: 30nmol/l (15-95)
E2: 0,15nmol/l (<0,15)
Ferritin: 53.6µg/l (28.0-370.0 )
Hgb: 156g/l (134-167)
HKR: 44,9% (39-50)


As you can see, my free testosterone is pretty low, which is disappointing after 1,5 months with hcg.
Estrogen is actually pretty high for that testosterone number right?
I've been feeling pretty tired and crappy, libido is also pretty low.
There are some good days where I feel more energetic and actually have sexual urges, but those days are rare.

What do you guys think of my results? What would you do if you were me?
Should I just continue with hcg and hope for the best, or are my balls just ruined and there is nothing else for me to do than just hop back on trt?
 
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Cataceous

Super Moderator
That kind of dosing is likely well above what's optimal for testosterone production. Per this research, when you go too high with hCG the testosterone level actually declines.

What is your goal? HCG monotherapy indefinitely? Transition to a SERM indefinitely? Transition to all natural? If staying on hCG then you'd want to find the lowest effective dose. Unless you have a lot of confidence in the free T test you should go by Tru-T calculated free T instead. Tru-T for your recent results is around 17 ng/dL, which is into the healthy normal range of 16-31. You can probably do better with a lower dose of hCG.

If not staying on hCG then you're ready for the next step. One possibility is to add a SERM while staying on hCG a little longer. Alternatively you could just switch to the SERM. You have already reactivated your testicles, now you need to rev up your hypothalamus to make GnRH and your pituitary to make LH and FSH.
 

Kimpe

Member
That kind of dosing is likely well above what's optimal for testosterone production. Per this research, when you go too high with hCG the testosterone level actually declines.

What is your goal? HCG monotherapy indefinitely? Transition to a SERM indefinitely? Transition to all natural? If staying on hCG then you'd want to find the lowest effective dose. Unless you have a lot of confidence in the free T test you should go by Tru-T calculated free T instead. Tru-T for your recent results is around 17 ng/dL, which is into the healthy normal range of 16-31. You can probably do better with a lower dose of hCG.

If not staying on hCG then you're ready for the next step. One possibility is to add a SERM while staying on hCG a little longer. Alternatively you could just switch to the SERM. You have already reactivated your testicles, now you need to rev up your hypothalamus to make GnRH and your pituitary to make LH and FSH.
Thanks for the answer.
My goal is to switch to tamoxifen after hcg.
I'll email my doctor these results and hopefully he will agree with the switch. No way I want to be on just hcg forever. Way too tired from using only that.

I just fear that my levels will just not recover and I'll just need to hop back on trt, but I just have to see this card.
Really fed up with being this tired tho.. Energy is what I miss in trt.
 

Kimpe

Member
Here are some new labs.

E2: 0.17nmol/l (<0.15)
Total testosterone: 16.5nmol/l (8-29).
SHBG: 28nmol/l (15-95)
Free testosterone: 274pmol/l (155-800)

Estrogen is over the range, and seems a bit high for such a low testosterone number right?
Free test is shit tbh.
Also my T level is actually a bit lower than last time, altought I know this might just be normal fluctuation, but you would hope the level would increase during treatment.

How does this look?
I'm considering lowering the hcg dose from the 2500iu EOD to 1250 EOD or 3xweek, just in case the claims of high doses hurting your balls are actually true.

Edit: Oh and an update on how I've been feeling:
-Fatigue
-Low libido
-Anxiety
-Brain fog. This is the worst symptom.
-Loss of interest on things
 

Kimpe

Member
A little update on my situation.
Doctor prescribed tamoxifen 20mg/d, so I'm going to stop HCG and switch to it.

I do hope that the brain fog goes away. It's not that bad anymore anyways, and I hope it was just a side effect from HCG.
Doctor advised me to start the tamoxifen tomorrow, get bloods after a month and see him after that.

How I've been feeling lately:
+Surprisingly energetic
+Positive mood, not cranky or irritated
+No migraines so far
+Less heart palpitations
+Better blood pressure
-Slight brain fog on some days
-Weird tingling on different spots on my body

I hope that tamoxifen will treat me well.
 

Kimpe

Member
Day 9 with Tamoxifen 20mg/d
-Terrible anxiety. I have a 24/7 panic attack feeling. Just unbearable. Fucking bullshit, I'll not be taking tamoxifen anymore
-Blood pressure is elevated
-ZERO libido. Dick is in a shrimp mode.

Fuck this shit
 
Last edited:

JimGainz

Well-Known Member
You should get yourself an appointment at Defy medical ASAP. I have never heard of such a protocol requiring that much HCG. Typically 500 mg every other day for a few weeks, then followed by 12 to 20 mg of Clomid for a month usually does it for a restart.

A few more things: first of all Clomid is much better pituitary agonist than Tamaxofin so if you were going this route - take Clomid.
But, as you have experienced, there are a significant amount of side effects from all of these drugs.

In fact, from personal experience, one of the worst anxiety type side effects I had was when I was trying to do a restart and I was taking 40 mg of Tamaxifin combined with 20 mg of Clomid per day - after three or four days I was out of my mind and stopped everything but the effects lasted about three weeks. I finally went back to pinning hCG and getting back on testosterone and I was fine

In any case, it’s hard to tell if it’s the amount of drugs you’re taking or the combination but like I said you got to get to a doctor that is knowledgeable and get you squared away, that is the only way to tell if you are eligible for a restart or if you need to remain on TRT
 

Kimpe

Member
You should get yourself an appointment at Defy medical ASAP. I have never heard of such a protocol requiring that much HCG. Typically 500 mg every other day for a few weeks, then followed by 12 to 20 mg of Clomid for a month usually does it for a restart.

A few more things: first of all Clomid is much better pituitary agonist than Tamaxofin so if you were going this route - take Clomid.
But, as you have experienced, there are a significant amount of side effects from all of these drugs.

In fact, from personal experience, one of the worst anxiety type side effects I had was when I was trying to do a restart and I was taking 40 mg of Tamaxifin combined with 20 mg of Clomid per day - after three or four days I was out of my mind and stopped everything but the effects lasted about three weeks. I finally went back to pinning hCG and getting back on testosterone and I was fine

In any case, it’s hard to tell if it’s the amount of drugs you’re taking or the combination but like I said you got to get to a doctor that is knowledgeable and get you squared away, that is the only way to tell if you are eligible for a restart or if you need to remain on TRT
Tamoxifen is the only one they use in my country. So clomid is off the limits for me, and since I don't live in the US I can't use Defy either.

I got bloods after 2 weeks of Tamoxifen 20mg/d.
Now I know 2 weeks is way too early for bloods, but I wanted to see if the medicine had started to do anything.
My testosterone labs were:

Total testosterone 1.0 nmol/l (8-29)
SHBG: 32 nmol/l (15-95)
Free testosterone: 16 pmol/l (155-800)
Should have taken LH too but didn't

Even though two weeks is a short time, I recon my level should be at least a bit higher than that, right?? Shit!

Anyways, my new TRT doc said that I should just continue with trt, which I think is the right thing to do.
He told me to contact fertility doctor, and now I'm back on hcg with a smaller dose of 2500iu 2x week.
The plan is to freeze some sperm and then hop back on TRT.
Bummer, since I would have loved to be without any medication, but it seems it's just not possible.
 

JRos895

Active Member
@Cataceous

You’ve posted that study demonstrating that 1000iu EOD of HCG is the most effective for T production (a great study despite its small sample size so a big thank you for that).

Do you know of any studies that analyze the most effective HCG dosing protocol for sperm production?
 

Cataceous

Super Moderator
@Cataceous

You’ve posted that study demonstrating that 1000iu EOD of HCG is the most effective for T production (a great study despite its small sample size so a big thank you for that).

Do you know of any studies that analyze the most effective HCG dosing protocol for sperm production?
Maybe @madman has such a study at his fingertips. The oft-cited study I'm familiar with is the one finding the minimum necessary dose to attain normal intratesticular testosterone, which is a prerequisite for normal sperm production. This was around 250-300 IU EOD. But that's probably lower than the "most effective" protocol.
 

madman

Super Moderator
@Cataceous

You’ve posted that study demonstrating that 1000iu EOD of HCG is the most effective for T production (a great study despite its small sample size so a big thank you for that).

Do you know of any studies that analyze the most effective HCG dosing protocol for sperm production

The combination of hCG + hMG or FSH may be more effective for improving sperm quantity/quality, and testicular volume.

hCG 500 IU 2-3 times/week or EOD.

Some men may need higher doses of hCG.

hMG or rhFSH at a dose of 75–150 IU 3 times/week or EOD.


* HCG can significantly increase intratesticular testosterone in a dose-dependent manner, with dosages between 250 and 500 IU seeming to be optimal to restore physiological intratesticular testosterone levels

* No studies in humans that clearly define a cutoff of intratesticular testosterone (or reference serum testosterone) that is
necessary to maintain optimal spermatogenesis

*Further randomized, prospective studies are necessary to elucidate the most effective treatment programs both DURING and AFTER TTh.





Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery (2020)


CONCLUSIONS


Initiating testosterone replacement therapy requires an open and honest discussion between the physician and the patient. The risks, benefits, alternatives, and expectations must be reviewed in detail with a specific focus on the reproductive implications involved with treatment. While many side effects of TTh such as cardiovascular impact remain surrounded in controversy, the findings of decreased intratesticular testosterone and subsequent impaired sperm production are well-documented. Fortunately, the aforementioned maneuvers show promise in maintaining testicular health throughout treatment while facilitating the successful restoration of fertility when trying for pregnancy. CC and HCG both play pivotal roles in helping to restore spermatogenesis in these men. Further randomized, prospective studies are necessary to elucidate the most effective treatment programs both during and after TTh. In the meantime, men considering TTh who are interested in preserving fertility should be treated by experts familiar with the intricacies of these medical regimens.

Screenshot (9792).png







Conclusions

Our results reiterate that FSH in combination with hCG may be considered as an alternative to combination hCG and clomiphene in the treatment of testosterone-induced azoospermia. FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate being three times faster in the FSH group. Additionally, patients who have failed dual therapy with hCG and clomiphene should be considered for subsequent




Screenshot (9791).png

* No studies in humans that clearly define a cutoff of intratesticular testosterone (or reference serum testosterone) that is necessary to maintain optimal spermatogenesis




Regarding fertility:







Conclusions

Our results reiterate that FSH in combination with hCG may be considered as an alternative to combination hCG and clomiphene in the treatment of testosterone-induced azoospermia. FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate being three times faster in the FSH group. Additionally, patients who have failed dual therapy with hCG and clomiphene should be considered for subsequent








CONCLUSION

Treatment with clomiphene citrate can be associated with a decrease in semen count, concentration, motility, morphology, and total motile sperm count in up to 20% of patients. Among men who had a decline in semen parameters, 17% of them may not recover following discontinuation of therapy. The benefits of therapy should be weighed against potential negative impacts on fertility, and close follow-up should be maintained. More studies should report on the decline in semen parameters so the magnitude of this effect can be more easily measured by reproductive specialists in the future.
























 

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JRos895

Active Member
Thank you for the comprehensive reply @madman.

Part of the reason I ask is I’ve been very interested in Dr. Saya’s fertility rankings posted below (HCG Monotherapy to Clomid Ratio For Fertility):

“1. Clomid/SERM treatment
2(A). HCG + HMG (or lyophilized FSH)
2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.
3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)
3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)
4. TRT/AAS with no concurrent HCG.”

My question is—couldn’t TRT+HCG in some cases be better for fertility than higher dose HCG Monotherapy?

I assume Dr Saya (@Dr Justin Saya MD maybe you can comment on this) placed HCG Monotherapy above T+HCG since the additional T is additionally suppressive. 100mg TC + 500iu EOD is worse for fertility than simply 500iu EOD, for example.

But couldn’t 100mg TC + 500iu EOD be better for fertility than say 1000iu or 1500 iu EOD (which are also standard monotherapy doses)? If 1000iu EOD is equally or more suppressive than 100mg TC + 500iu EOD (which seems like a reasonable assumption especially if one has a weak pituitary in which case both protocols may bring LH+FSH to 0), then wouldn’t it best to use the smallest dose possible to maintain normal ITT levels (which 500iu and less has shown to do)? Larger doses could bring a greater risk of desensitization or could cause excess intratesticular estradiol which is bad for fertility.
 
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