About to Start a New Protocol

[Astro]

No. Actually not cheaper. My Xyosted is 100% covered by insurance.

My new doctor is out-of-state and can't write prescriptions for California. The drugs are shipped to me--also from out-of-state. I'm paying for everything (drugs, needles, lab tests). My TRT has gone from "free" to "spendy". I might be able to get some reimbursement for some of it (like some of the lab tests). But I doubt I'll get help on anything else.

Looking at the big picture--this is really pretty stupid. The insurance company would save a lot of money by approving my switch from Xyosted to syringe injecting. I will try to reach out to them and explore what it might take to get coverage, but I'm not holding my breath.

 

[Astro]

HCG two weeks in. I started HCG on 6-June. I was prescribed 1,000 IU/week (500IU E-3.5D). My Testosterone dose has remained unchanged for 9 weeks at 75mg Test-en/weekly.

I was cautious with HCG because I'd seen other men post about bad reactions. I got the sense (from one of this Forum's polls) that about 30% of HCG users had bad reactions. I started low at 200 IU. I had no site reaction, no physical reaction and no mental reaction. My second dose (3.5 days later) was increased to 400 IU. Still no adverse reactions, so I repeated this for the 3rd and 4th dose. Had diarrhea about 2-hours after this last dose. I ate some unusual foods the day before, so I couldn't blame the HCG with any certainty.

I wanted to get onto my Doctor's protocol (500 IU/ E-3.5 days), so for my 5th dose I took 500 IU at 6 PM. Within a few hours I became agitated and nervous. Later that night I could not sleep. Around midnight I took a small dose of Melatonin (1.5mg--which usually knocks me out) and still could not sleep. When I got up the next morning (and all day long) I was a wreck. I was still agitated, felt mildly hung-over, felt "off" like when you have a cold or flu, my "awake resting heart rate" increased from about 68/70 (normal) to about 80/82 and I also had a mild headache. I skipped going to the gym that day and I was generally unproductive all day. I mostly just lounged around feeling awful.

This reaction was about 70% gone the following day, but I still did not feel normal. I still felt "off" but I went to the gym anyway and did a moderate workout (moderate weights and no cardio). The day after that I felt nearly fine.

I don't want to give up HCG too soon. I understand there may be a period where my body makes adjustments. Today was time for my next dose. So I dropped it way down to 160 IU. This is even lower than my original starting dose 2 weeks ago. I'm hopeful this won't produce significant side effects. My understanding is that 300 IU/week is about the lowest dose that keeps the testes "functional".

I can also report that over this first 2 weeks I have experienced some positive effects. My libido (which was at zero), is showing small signs of recovery. I found myself admiring some of the women at the gym. I'm also experiencing daily morning wood.

 

[Astro]

Update on my HCG journey.

I have successfully, but slowly, brought my HCG dose up from 320/wk to 600/week (300 E-3.5 days). My body has now adapted to the HCG and I no longer have acute side effects. After a month of being on HCG I did some blood tests. I've posted these below, along with prior labs (both from Quest). Having documented one month on HCG, I then raised my Testosterone dose to 120mg/week (T-cyp 60mg E-3.5 days). I'll test for that in about 2 months.

I assumed my Estradiol was climbing due to adding the HCG. I've been noticing some nipple sensitivity. The sensitivity is minor. I notice it only when I'm putting on a shirt, or showering when I happen to brush past my chest and hit a nipple--it stings a bit. There is no itchiness, like others have reported. I've been assuming that increasing Estradiol was a goal--not a problem. According to Vergel's ratio I should be trying to double my E-2.

Well, apparently the HCG is not affecting my E-2 at the dose I was taking--judging by my latest labs.

Prior Labs (4/29/25) Protocol: 75mg T-en/weekly (no HCG and no DHEA)
Total Testosterone 1102 ng/dl
Estradiol (sens) 29 pg/ml (range: 29 or less)
Ratio (T/E2): 38
Ideal Ratio: 14 to 20
Free Test. 80.6 pb/ml (30-135)
DHEA-S 12 mcg/dl (20-217)

New Labs (6/26/25) Protocol: 75mg T-en/weekly + 250mg HCG E-3.5 days + DHEA 15mg/D
Total-T 1340 ng/dl
E-2 (sens) 35
Ratio T/E-2 38.3
Free-T 172.3
DHEA-S 136

Comparing these tests, my E-2 dropped slightly but my Free-T more than doubled!
If I'm getting nipple sensitivity, this suggests either too much HCG or too much Test, or both. I might try a small dose of AI just to see the effect. If the effect is positive I would probably start lowering my Test-dose. I'd like to avoid taking an AI long-term, if possible.

It seems like a conundrum: To reach Vergel's Ratio I need more E-2, but to address nipple-sensitivity I need less.

I'm beginning to get discouraged. I've been on Test for 7 months at various doses and HCG for about 1 month. My libido, energy, brain fog and social interest, are only mildly better than when I started. My ED and sensitivity are worse than before I started. I do have a bit more energy and my depression has mostly gone away. These benefits are worth continuing, but I was expecting a whole lot more. I'm obviously not dialed-in yet.

 

[Guided_by_Voices]

Update on my HCG journey.

I have successfully, but slowly, brought my HCG dose up from 320/wk to 600/week (300 E-3.5 days). My body has now adapted to the HCG and I no longer have acute side effects. After a month of being on HCG I did some blood tests. I'll post results when available in a few days. Having done all that, I recently raised my Testosterone dose to 120mg/week (T-cyp 60mg E-3.5 days).

However, I suspect my Estradiol is now climbing. I am noticing some nipple sensitivity. This started occurring before the increase in Test, so I'll primarily blame the HCG (although the increased Test surely contributes. The sensitivity is minor. I notice it only when I'm putting on a shirt, or showering when I happen to brush past my chest and hit a nipple--it stings a bit. There is no itchiness, that others have reported.

I've been assuming that increasing Estradiol was a goal--not a problem. According to Vergel's ratio I should be trying to double my E-2.

Most recent Labs (4/29/25)
Total Testosterone 1102 ng/dl
Estradiol (sens) 29 pg/ml
Ratio: 38
Ideal Ratio: 14 to 20

If I'm getting nipple sensitivity, this suggests either too much HCG or too much Test, or both. It will be interesting to see what the new labs show. I might try an AI just to see the effect. If the effect is positive I would probably start lowering my Test-dose or HCG dose. I'd like to avoid taking an AI, if possible.

At present I'm beginning to get discouraged. I've been on Test for 7 months at various doses and HCG for about 1 month. My libido, energy, brain fog, social interest, ED, sensitivity, etc are only mildly better than when I started. I do have a bit more energy and my depression has mostly gone away. These benefits are worth continuing, but I was expecting a whole lot more. I'm obviously not dialed-in yet.

I just went back and read your initial post, and unless I missed it somewhere else, I don't see where you've done a thorough check-up with a Holistic/Integrative Doc, someone who would check for nutrient status, long-term infections (e.g. lyme) and other things that could cause your symptoms. There are tons of things beyond anabolic hormones that could cause your symptoms. From what I remember of thyroid issues, many people benefit from thyroid supplementation who appear normal on the TSH tests, so going to a Doc who specializes in chronic fatigue sounds like a good option.

 

[Astro]

I just went back and read your initial post, and unless I missed it somewhere else, I don't see where you've done a thorough check-up with a Holistic/Integrative Doc, someone who would check for nutrient status, long-term infections (e.g. lyme) and other things that could cause your symptoms. There are tons of things beyond anabolic hormones that could cause your symptoms. From what I remember of thyroid issues, many people benefit from thyroid supplementation who appear normal on the TSH tests, so going to a Doc who specializes in chronic fatigue sounds like a good option.

Thanks for the advice.

My endo is aware of my somewhat-low thyroid and IGF-1. He said getting my Testosterone, Pregnenolone and DHEA balanced may fix the Thyroid and Growth Hormone. If these remain a problem, he will likely give me thyroid meds. I know many of my symptoms sound like low HGH, so that is also a possibility down the road (probably via peptides). I had not considered long-term infections. I may look into that.

Having said all that, I'm very wary of doing more than one thing at a time. I have to be patient and see what each intervention does before launching into something new.

 

[Astro]

It's been quite a while since I've posted. There is a lot to catch up on.

I managed to ramp up my HCG to the full dose recommended by my Endo (500 IU E-3.5D). Got to this point on July-14.

My sleep had been poor, my libido was non-existent, my penis was essentially numb (no more erotic than my thumb) and I was unable to achieve orgasms. This was all new and very discouraging. The drop in sexual function seemed to start shortly after resuming the HCG. During July I also caught a nasty sinus/chest cold (I have COPD, and almost any chest cold will be nasty with lots of coughing and phlegm). The cold lasted 3 weeks and was finally cured with antibiotics.

The cold kept me out of the gym for about 3 weeks, so I had to ramp back into my workout routine. This took about 8 days (I go to the gym 3 days per week--each normal session has about 1-hr of weights/balance/core followed by 25-30 min of stair climbing w/target heart rate of 130 BPM). After about 3 gym sessions (Aug-1) I was fully ramped-in including full aerobics work.

Around the end of the first week of August I noticed some erotic feeling returning to my penis and under good circumstances I was able to orgasm again--but it took a long time and was generally weak overall (sensitivity and intensity). I assume my body was finally adjusting to the new protocol. This improved over the next week or two and is now almost back to low-normal.
__________________________________________________________________________________________
Aug-11: Got new labs (LabCorp) in preparation for my next Endo consultation:

Free Test: 28 (6.6 - 18.1)
E-2: 69.9 (8 - 35)
DHEA-S: 218 (31 - 295)
SHBG: 69.4 (19.3 - 76.4)
Pregnenolone: <10 (<151)
Hemoglobin: 15.9 (13 - 17 7)
Hematocrit: 49.1 (37.5 - 51)
TSH: 4.87 (0.45 - 45)
T3: 2.8 (2 - 4.4)
T4: 1.15 (0.92 - 1.68)
RT3: 17.6 (9.2 - 24.1)
_________
Ferritin: 16 (24 - 380)--this was not tested/this datum is from lab on 6/26 (Quest)
__________________________________________________________________
August-14: Went to the gym. Did a good full workout on weights/balance/core. Then started on the stair-climber. I usually do this with my eyes closed and listening to music. I felt different this time--weak and out of breath. I glanced at the elapsed time and it was only 7 minutes--and I was already tired. I went a few more minutes and quit early (for the first time in over a year). Went home and took a nap.

When I woke up I was agitated and "speedy" (like way too much caffeine), my pulse was 12 BPM above normal, my blood-O2 was down around 92-95% (normally 98-99%) and my breathing was constricted. These effects lasted 3 days and slowly wore off on the 3rd day.

If I had to guess, I would speculate that my body had dumped a load of hormones into my bloodstream--probably thyroid or adrenal glands, but I really don't know. Based on my new lab numbers, I am hypo-thyroid (a conclusion confirmed by my Endo). But before starting any therapy I will need to do more labs (cortisol-saliva, Hashimoto antibodies) and will need to get my iron significantly higher (and my cortisol--if it happens to test low).

I decided to quit the HCG. My Endo supported this decision. I also stopped taking DHEA supplements, although they clearly had improved my labs (back in April my DHEA-s was at 12 mcg/dl and well below the normal range).

Aug 26: Consult with my Endo--He seemed alarmed by my E-2 number. It is above range (but my testosterone is above range, too!). He suggested keeping my Testosterone dose at 120/week but adding 0.0625mg (1/2 tab) Anastrozole per week (plus dropping the HCG), to see how that affects E-2 and my symptoms. If I'm feeling better we might stop the AI and lower my Test dose a bit. He also wanted me to experiment with a lower dose of DHEA to find something that I could tolerate without feeling dizzy and having poor sleep. I'll do blood tests again in 6 weeks. Once my Iron has improved we can start discussing Thyroid issues. I suspect my Thyroid is holding me back on a lot of issues.

Atrophy Question:
I've been without HCG now for almost a month. I think the testicular atrophy is begining (I've been through this drill once before--I originally started HCG 7 months after starting TRT when my nuts were quite atrophied). I'm curious about one aspect of atrophy. At some future date I may want to try using scrotal cream for a portion of my Testosterone dose. The purpose would be to increase my DHT--which might improve my sexual functions (libido, penis-sensitivity, orgasmic-intensity). Would atrophied testicles be useless in converting a higher percentage of T-cream into DHT, compared to other skin areas? In other words, does scrotal application work because of the thin skin, or because of the proximity to functioning testes?

 

[Cataceous]

... Would atrophied testicles be useless in converting a higher percentage of T-cream into DHT, compared to other skin areas? In other words, does scrotal application work because of the thin skin, or because of the proximity to functioning testes?

It's actually neither, though the former—the thin, permeable skin—increases absorption efficiency. It's the prevalence of 5-alpha reductase in the scrotal skin that boosts production of DHT. There can also be a fair bit of aromatase, boosting estradiol as well in many cases. The testes don't play a role, as the absorbed hormones go into circulation.

 

[Astro]

It's actually neither, though the former—the thin, permeable skin—increases absorption efficiency. It's the prevalence of 5-alpha reductase in the scrotal skin that boosts production of DHT. There can also be a fair bit of aromatase, boosting estradiol as well in many cases. The testes don't play a role, as the absorbed hormones go into circulation.

Wow! Thank you for that. It's a nice, clear explanation (and good news for me!). That's what I love about this forum. So many folks with knowledge, and a willingness to share it.

 

[madman]

It's been quite a while since I've posted. There is a lot to catch up on.

I managed to ramp up my HCG to the full dose recommended by my Endo (500 IU E-3.5D). Got to this point on July-14.

My sleep had been poor, my libido was non-existent, my penis was essentially numb (no more erotic than my thumb) and I was unable to achieve orgasms. This was all new and very discouraging. The drop in sexual function seemed to start shortly after resuming the HCG. During July I also caught a nasty sinus/chest cold (I have COPD, and almost any chest cold will be nasty with lots of coughing and phlegm). The cold lasted 3 weeks and was finally cured with antibiotics.

The cold kept me out of the gym for about 3 weeks, so I had to ramp back into my workout routine. This took about 8 days (I go to the gym 3 days per week--each normal session has about 1-hr of weights/balance/core followed by 25-30 min of stair climbing w/target heart rate of 130 BPM). After about 3 gym sessions (Aug-1) I was fully ramped-in including full aerobics work.

Around the end of the first week of August I noticed some erotic feeling returning to my penis and under good circumstances I was able to orgasm again--but it took a long time and was generally weak overall (sensitivity and intensity). I assume my body was finally adjusting to the new protocol. This improved over the next week or two and is now almost back to low-normal.
__________________________________________________________________________________________
Aug-11: Got new labs (LabCorp) in preparation for my next Endo consultation:

Free Test: 28 (6.6 - 18.1)
E-2: 69.9 (8 - 35)
DHEA-S: 218 (31 - 295)
SHBG: 69.4 (19.3 - 76.4)
Pregnenolone: <10 (<151)
Hemoglobin: 15.9 (13 - 17 7)
Hematocrit: 49.1 (37.5 - 51)
TSH: 4.87 (0.45 - 45)
T3: 2.8 (2 - 4.4)
T4: 1.15 (0.92 - 1.68)
RT3: 17.6 (9.2 - 24.1)
_________
Ferritin: 16 (24 - 380)--this was not tested/this datum is from lab on 6/26 (Quest)
__________________________________________________________________
August-14: Went to the gym. Did a good full workout on weights/balance/core. Then started on the stair-climber. I usually do this with my eyes closed and listening to music. I felt different this time--weak and out of breath. I glanced at the elapsed time and it was only 7 minutes--and I was already tired. I went a few more minutes and quit early (for the first time in over a year). Went home and took a nap.

When I woke up I was agitated and "speedy" (like way too much caffeine), my pulse was 12 BPM above normal, my blood-O2 was down around 92-95% (normally 98-99%) and my breathing was constricted. These effects lasted 3 days and slowly wore off on the 3rd day.

If I had to guess, I would speculate that my body had dumped a load of hormones into my bloodstream--probably thyroid or adrenal glands, but I really don't know. Based on my new lab numbers, I am hypo-thyroid (a conclusion confirmed by my Endo). But before starting any therapy I will need to do more labs (cortisol-saliva, Hashimoto antibodies) and will need to get my iron significantly higher (and my cortisol--if it happens to test low).

I decided to quit the HCG. My Endo supported this decision. I also stopped taking DHEA supplements, although they clearly had improved my labs (back in April my DHEA-s was at 12 mcg/dl and well below the normal range).

Aug 26: Consult with my Endo--He seemed alarmed by my E-2 number. It is above range (but my testosterone is above range, too!). He suggested keeping my Testosterone dose at 120/week but adding 0.0625mg (1/2 tab) Anastrozole per week (plus dropping the HCG), to see how that affects E-2 and my symptoms. If I'm feeling better we might stop the AI and lower my Test dose a bit. He also wanted me to experiment with a lower dose of DHEA to find something that I could tolerate without feeling dizzy and having poor sleep. I'll do blood tests again in 6 weeks. Once my Iron has improved we can start discussing Thyroid issues. I suspect my Thyroid is holding me back on a lot of issues.

Atrophy Question:
I've been without HCG now for almost a month. I think the testicular atrophy is begining (I've been through this drill once before--I originally started HCG 7 months after starting TRT when my nuts were quite atrophied). I'm curious about one aspect of atrophy. At some future date I may want to try using scrotal cream for a portion of my Testosterone dose. The purpose would be to increase my DHT--which might improve my sexual functions (libido, penis-sensitivity, orgasmic-intensity). Would atrophied testicles be useless in converting a higher percentage of T-cream into DHT, compared to other skin areas? In other words, does scrotal application work because of the thin skin, or because of the proximity to functioning testes?

Need to retest your FT as you had it tested using a known to be inaccurate assay the standard IA.

No one should be using/relying on such!

144980: Testosterone, Free, Direct

Labcorp test details for Testosterone, Free, Direct

www.labcorp.com

As I stated in my previous replies FT is the critical fraction here and in order to know where it truly sits you need to use the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

You can easily pay out of pocket and. do your own labs through Nelson's discounted labs which uses Quest Diagnostics.

This is the panel you want to get when testing your TT and more importantly FT which uses the most accurate assay for TT (LC/MS-MS) and FT (Equilibrium Dialysis).

$49.00

Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

If you live outside of the US and do not have access to such then you would need to use/rely upon the linear law-of-mass action cFTV which will give a good approximation.

The standard immunoassay should not be used/relied upon!

You can easily calculate it online for free by plugging in your TT, SHBG and Albumin.

Free & Bioavailable Testosterone calculator

Again we always want to test at the true trough (lowest point) before your next injection.

You are injecting 120 mg T/week split twice-weekly (60 mg every 3.5 days).

True trough would be 84 hrs post-injection.

Were your most recent labs done at true trough and if so where does your trough TT sit?

We already know your SHBG 69.4 nmol/L and if you never had your Albumin tested you can easily use the default 4.3 g/dL.

You crashed your ferritin and chances are you may have low iron.

Need to test your ferritin/iron and even then you need to get your ferritin up as crashing your iron can open up another can of worms especially thyroid function.






Aug-11: Got new labs (LabCorp) in preparation for my next Endo consultation:

Free Test: 28 (6.6 - 18.1)
E-2: 69.9 (8 - 35)
DHEA-S: 218 (31 - 295)
SHBG: 69.4 (19.3 - 76.4)
Pregnenolone: <10 (<151)
Hemoglobin: 15.9 (13 - 17 7)
Hematocrit: 49.1 (37.5 - 51)
TSH: 4.87 (0.45 - 45)
T3: 2.8 (2 - 4.4)
T4: 1.15 (0.92 - 1.68)
RT3: 17.6 (9.2 - 24.1)
_________
Ferritin: 16 (24 - 380)--this was not tested/this datum is from lab on 6/26 (Quest)