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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
The endocrinologist's guide to managing self-treating patients
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<blockquote data-quote="Re-Ride" data-source="post: 27408" data-attributes="member: 8395"><p>Being in the lower 20% of "normal range" is fine with these guys. </p><p></p><p>Under the heading "Effective Treatment of steroid abuse related Hypogonadism" they agree that hCG has a legitimate use in treating secondary hypogonadism:</p><p></p><p>[" Clinical indications for hCG use in men are for the treatment of T deficiency and/or induction of</p><p>spermatogenesis in gonadotrophindeficient</p><p>adults (typically with concomitant FSH therapy in the latter role) "] , but</p><p></p><p>["we found that AAS users misused hCG by men (for) sustained suppression of their hypothalamus–pituitary–testicular axis from prolonged use of high dose AAS use, in an attempt to increase endogenous testicular T secretion"] [ "In reality, this merely prolongs suppression of the hypothalamus–pituitary–testicular axis, which is the root cause of the reduction in testicular size and serum T levels."]</p><p></p><p>They don't seem to acknowledge that hCG use is legitimate for PCT. As far as Excel-Mates are concerned that's fine. We are not engaged in post cycle therapy.</p><p></p><p>["In a small case series of 13 azoospermic men with acquired gonadotrophin deficiency ( from juicing?), hCG in combination with FSH was successful in stimulating and maintaining spermatogenesis in hypogonadotrophic, hypogonadal men.</p><p>[45] Lowdose hCG with testosterone supplementation has also been shown to be effective in maintaining</p><p>spermatogenesis, although whether this can translate to successful pregnancies is uncertain.[46] In the context of</p><p>AAS use, hCG has been shown to be effective in accelerating testicular production of testosterone and reversing</p><p>azoospermia, but evidence is only available from case reports."] </p><p></p><p>In understanding the frustration we often encounter in seeking legitimate HRT we can look to the authors' conclusions which are mixed. </p><p></p><p>[" The treatment of ASIH and subsequent subfertility remains inadequately studied, and many clinicians have</p><p>limited experience with regard to managing men with Anabolic Steroid-Induce Hypogonadism. AAS users appear to be well aware of this and may thus tend to give less weighting to clinician recommendations than those of 'online expert users'."]</p><p></p><p>Wait and see approach:</p><p></p><p>[" hCG, SERMs and AIs are amongst the drugs commonly used to counteract the side effects of ASIH. Although</p><p>some of these are certainly effective in the context of congenital (or pituitary lesionrelated) hypogonadotrophic</p><p>hypogonadism,[74] the extent to which data from medical treatments can be compared and extrapolated to ASIH</p><p>is uncertain. This is because the pathophysiology of ASIH may be more complex, representing a combination of</p><p>the endocrine disruption and direct testicular toxicity related to the supraphysiological doses or multiple drug</p><p>combinations used by users.[75]</p><p></p><p>We recommend that, based on currently available evidence, if fertility is desired, the logical first-line</p><p>management is to cease using AAS along with any other potentially 'culprit' agents (e.g. marijuana, opioids,</p><p>methamphetamine, cocaine), with serial semen analysis."]</p><p></p><p>[" However, what if the period of biochemical recovery from ASIH is prolonged and associated with relationship endangering</p><p>features, and/or the partner's age militates against a prolonged watch-and-wait</p><p>strategy in respect of fertility? A judgmental approach imputing patient 'fault' may not be hugely effective, whereas involvement of community based addiction teams can be invaluable. "]</p><p></p><p>O.K. well maybe we were a bit hasty above:</p><p></p><p>[" If spontaneous reversal of hypogonadism does not occur with expectant management within a reasonable</p><p>time frame as discussed above, then use of hCG ± hMG, SERMs or AIs is potentially effective alternatives.[75]</p><p> </p><p>My conclusion: It's easy to see why clinicians are reluctant to offer HRT patients the best available protocol. We are most likely illicit drug addicts. Clinicians are still lacking clear guidelines for testing and treating non-steroid abusing hypogonatic males. </p><p></p><p>Excelmale sends a clear and consistent message: "HRT is a last resort and a life-long commitment. Make lifestyle changes first. Get labs and understand them. Track your progress and have clear serum goals. Rely on how you feel in setting those goals rather than be obsessed with numbers. If you do need HRT, by all means get it under qualified medical supervision, don't suffer."</p></blockquote><p></p>
[QUOTE="Re-Ride, post: 27408, member: 8395"] Being in the lower 20% of "normal range" is fine with these guys. Under the heading "Effective Treatment of steroid abuse related Hypogonadism" they agree that hCG has a legitimate use in treating secondary hypogonadism: [" Clinical indications for hCG use in men are for the treatment of T deficiency and/or induction of spermatogenesis in gonadotrophindeficient adults (typically with concomitant FSH therapy in the latter role) "] , but ["we found that AAS users misused hCG by men (for) sustained suppression of their hypothalamus–pituitary–testicular axis from prolonged use of high dose AAS use, in an attempt to increase endogenous testicular T secretion"] [ "In reality, this merely prolongs suppression of the hypothalamus–pituitary–testicular axis, which is the root cause of the reduction in testicular size and serum T levels."] They don't seem to acknowledge that hCG use is legitimate for PCT. As far as Excel-Mates are concerned that's fine. We are not engaged in post cycle therapy. ["In a small case series of 13 azoospermic men with acquired gonadotrophin deficiency ( from juicing?), hCG in combination with FSH was successful in stimulating and maintaining spermatogenesis in hypogonadotrophic, hypogonadal men. [45] Lowdose hCG with testosterone supplementation has also been shown to be effective in maintaining spermatogenesis, although whether this can translate to successful pregnancies is uncertain.[46] In the context of AAS use, hCG has been shown to be effective in accelerating testicular production of testosterone and reversing azoospermia, but evidence is only available from case reports."] In understanding the frustration we often encounter in seeking legitimate HRT we can look to the authors' conclusions which are mixed. [" The treatment of ASIH and subsequent subfertility remains inadequately studied, and many clinicians have limited experience with regard to managing men with Anabolic Steroid-Induce Hypogonadism. AAS users appear to be well aware of this and may thus tend to give less weighting to clinician recommendations than those of 'online expert users'."] Wait and see approach: [" hCG, SERMs and AIs are amongst the drugs commonly used to counteract the side effects of ASIH. Although some of these are certainly effective in the context of congenital (or pituitary lesionrelated) hypogonadotrophic hypogonadism,[74] the extent to which data from medical treatments can be compared and extrapolated to ASIH is uncertain. This is because the pathophysiology of ASIH may be more complex, representing a combination of the endocrine disruption and direct testicular toxicity related to the supraphysiological doses or multiple drug combinations used by users.[75] We recommend that, based on currently available evidence, if fertility is desired, the logical first-line management is to cease using AAS along with any other potentially 'culprit' agents (e.g. marijuana, opioids, methamphetamine, cocaine), with serial semen analysis."] [" However, what if the period of biochemical recovery from ASIH is prolonged and associated with relationship endangering features, and/or the partner's age militates against a prolonged watch-and-wait strategy in respect of fertility? A judgmental approach imputing patient 'fault' may not be hugely effective, whereas involvement of community based addiction teams can be invaluable. "] O.K. well maybe we were a bit hasty above: [" If spontaneous reversal of hypogonadism does not occur with expectant management within a reasonable time frame as discussed above, then use of hCG ± hMG, SERMs or AIs is potentially effective alternatives.[75] My conclusion: It's easy to see why clinicians are reluctant to offer HRT patients the best available protocol. We are most likely illicit drug addicts. Clinicians are still lacking clear guidelines for testing and treating non-steroid abusing hypogonatic males. Excelmale sends a clear and consistent message: "HRT is a last resort and a life-long commitment. Make lifestyle changes first. Get labs and understand them. Track your progress and have clear serum goals. Rely on how you feel in setting those goals rather than be obsessed with numbers. If you do need HRT, by all means get it under qualified medical supervision, don't suffer." [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Side Effect Management
The endocrinologist's guide to managing self-treating patients
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