Building a TRT protocol around hCG

[Guided_by_Voices]

Just to be clear, I'm not advocating for abnormally high estradiol levels. When I was talking about honesty around trade-offs, I meant being clear-eyed about the likely damage of inhibiting aromatase. Some people have the idea that if you modestly and carefully inhibit aromatase, just the right amount, leaving serum estradiol at a normal healthy male level, you should be safe. I used to subscribe to this, but no longer, after delving deeper into the physiology. I don't want to derail the thread too much talking about estrogen control, but it might be useful to understand why someone who prizes their health would do well to avoid it (and remain within their natural limits of E2 handling instead).

In both endothelium and brain tissue, testosterone unopposed by estradiol is toxic. In the endothelium, testosterone causes oxidative stress and is vasoconstrictive - estradiol counteracts this by increasing eNOS, upregulating endogenous antioxidant enzymes, and inhibiting the testosterone-induced increase in NADPH oxidase. In the brain, testosterone can cause excitotoxicity by increasing glutamate neurotransmission, as well as causing oxidative stress, mitochondrial dysfunction, and inflammation. Estradiol counteracts all of these again, by reducing glutamate receptor sensitivity and upregulating GABA, increasing antioxidant enzyme expression, reducing mitochondrial ROS production, and inhibiting inflammation.

Women are not as dependent on the local production of estradiol for tissue protection, due to their much higher circulating levels of estradiol, and much lower circulating levels of testosterone. Men need the help of aromatase to produce locally high levels of estradiol in tissues (higher than can diffuse in from serum) to act as an antidote to testosterone's toxicity. Normal male levels of circulating E2 will often not be sufficient to overcome local tissue deficits of estradiol and skewed local T/E2 ratios caused by aromatase inhibition.

How do we know that, you wonder. We can start with the billion anecdotes of men who suffer various types of low estrogen side effects as a result of estrogen control, despite normal serum E2. Joint pain, fatigue, depression, ED, loss of libido, etc are all common effects of AIs or aromatase-inhibiting androgens in men who still have apparently adequate serum E2. Then, there's a great study with aromatase inhibition in men, which inhibited estradiol just a little bit, and had a very disproportionate effect on endothelial function: https://www.ahajournals.org/doi/10.1161/01.res.0000103633.57225.bc

Their E2 started at 85.4 pmol/L (23.3 pg/mL) and was dropped to 64.3 pmol/L (17.5 pg/mL) with 1 mg anastrozole weekly. This apparently modest 25% reduction of serum E2 caused their flow-mediated dilation response to drop by 50%, from 9.4% to 4.7%. This massive change, double the magnitude of the serum change in estradiol, should discourage anyone from thinking serum E2 accurately reflects what's happening in tissues.

You may be thinking, "I keep my serum E2 higher than that, and use less AI than that, so I probably have nothing to worry about." Test, don't guess. I don't want to share his medical information, but estrogen control as a TRT strategy has not worked out well for one member here that I speak to privately - serial carotid IMTs have showed major recent thickening, equivalent to ~10 years of vascular aging in just one year's time.

Have you run into any strategies for raising E2 in those of us who are perpetually low? I use HCG and my T is high normal but E2 is constantly very low.

 

[FunkOdyssey]

Have you run into any strategies for raising E2 in those of us who are perpetually low? I use HCG and my T is high normal but E2 is constantly very low.

DHEA can raise it somewhat. The most reliable method is to supplement E2 directly though, crazy as it sounds. Your clinic will almost certainly help if you want to go that route, or you can procure it yourself from sources that cater to the trans market: Home - DIYHRT.Market

I like injections over oral, as oral E2 elevates SHBG more than other delivery methods, and also increases clotting risk, which is not an issue with injections.

I used my wife's estradiol cypionate one time to rescue myself from a low E2 hole I was in and it worked very well.

 

[Willyt]

I have kept going back and forth with hCG myself. I've noticed, now that I have some Janoshik-verified potent hCG (eutrig), if I take 250 iu EOD, after a few doses my libido goes from the usual dead state to pretty damn high. It is actually the most dramatic libido result I've experienced, besides an occasional blip after increasing testosterone dose.

When you experience this libido from HCG, it is steady? Or a spike x hours after injection?

Also, are the results sustainable when taking EOD HCG for 6+ consecutive months? Or will you have to cycle on and off?

The reason I ask is because protocol change has been the only thing that ever triggered libido for me with TRT. Whether this is due to a temporary dopamine spike or some magical T/E2 balance remains a mystery.

 

[FunkOdyssey]

When you experience this libido from HCG, it is steady? Or a spike x hours after injection?

So far, there have been some windows of improved libido, that have varied between a few hours to most of a day.

Also, are the results sustainable when taking EOD HCG for 6+ consecutive months? Or will you have to cycle on and off?

I have no idea. It seems like most of the people who benefit from hCG use it continuously, although I've heard at least one anecdote where it only worked when cycled.

The reason I ask is because protocol change has been the only thing that ever triggered libido for me with TRT. Whether this is due to a temporary dopamine spike or some magical T/E2 balance remains a mystery.

I know what you mean. I have had some of these windows also when changing my protocol, so I am hoping this bit of early success with hCG is not just one of those, but it could be.

 

[Seagal]

This study is from 2003. Very interesting. Strange it didn't come up earlier at excelmale.

 

[SS1LE]

So I have been taking the puretrig brand from reliablerx, which for sure has to be real and at its full strength. I have been dosing 250IU EOD for 8 weeks. My first couple injections early on gave me cold hands and feet...very odd. I then did get a nice mood boost and libido from weeks 2-5, then went down hill slowly to where I actually have no libido and moody. Usually my e2 sits between 10-20pg with T only to the point I did inject estradiol valerate to get it up in to the 30-50pg range. Well I just had a estradiol test (I always get the standard , CRP is low ). So with this test being so high I assume is what's causing the issues , So I will need to get at a lower dose of the HCG, which according to those jano tests out there puretrig should only be about 600iu in a 5000iu vial.....I know now that cannot be believed. Going to stop HCG for 2 weeks to get back to baseline and try 125iu EOD.

 

[FunkOdyssey]

Usually my e2 sits between 10-20pg with T only to the point I did inject estradiol valerate to get it up in to the 30-50pg range.

Wow! Let me get this straight: you added 250 iu EOD to a protocol that otherwise would produce 10-20 pg/mL e2, and your E2 is now 86 pg/mL? If so, that's the craziest hCG e2 spike I've ever heard of. And yeah, that could certainly explain the loss of libido and moodiness.

What effect did it have on T and SHBG?

 

[SS1LE]

Wow! Let me get this straight: you added 250 iu EOD to a protocol that otherwise would produce 10-20 pg/mL e2, and your E2 is now 86 pg/mL? If so, that's the craziest hCG e2 spike I've ever heard of. And yeah, that could certainly explain the loss of libido and moodiness.

What effect did it have on T and SHBG?

I didn't not get SHBG , still awaiting the testosterone results. Blood draw was the same time this past Friday, so should be here soon I would think.