TRT + HCG - The Gyno Monster?! My Trials and Tribulations

Hey fellas,

First off - been reading here for quite some time and love the forums. The information and contributions made here are invaluable.

I was recently started on TRT due to hormone issues I've battled for approximately 10 years. Long story short, I've tried 3-4 Clomid and/or Nolva restarts and while they me going again (secondary), I just crash when I come off. With the help of a top notch Dr, I started TRT approximately a month ago.

My initial TRT regimen was 140mg test cyp per week (spread over a few injections), 250iu HCG twice a week, .25mg adex EOD, cabergoline .5mg twice a week. While I understand most guys don't start with adex and caber - I have been with my Dr for three years and these have been used in my previous protocols (restarts) to control estrogen and prolactin. They were kept as is until my next appointment with full bloodwork.

First few days of test cyp felt amazing... then I added HCG, a single 250iu injection, and wow... it went downhill fast. Almost immediate anxiety, loss of appetite, and worst - my nipples lit on fire. Some pre-existing gyno immediately flared up. I continued on the regimen for two weeks and had two small blood draws during that time.

1 week into treatment - TT 1200 (ref 348-1197), Sensitive E 9 (ref range 3-70)
2 weeks into treatment - TT +1500, Sensitive E 13

During all of this, I thought my chest was going to explode the gyno was so irritating. Despite low E, which made me feel like shit, and caber for prolactin, my nipples were still raging. I called the Dr in a panic after the second week, well before my next appointment, and he said I could cut the test cyp dose in half.

In order to feel better for a major life event I had coming up, I dropped the HCG completely, and lowered the test cyp does to 100mg per week. After a week, I felt amazing for a few days, just in time for the big day.

This past week, I have tried to add HCG back in to keep on the prescribed regimen, and low and behold, even at a single dose of 200iu, all the sides are back. Just a single injection got them all going.

HCG is like devil juice to my body - immediate anxiety, zero appetite, nipples lit on fire. Is there any warrant to my thought that all of this is due to the HCG pushing me over my bodies natural threshold for handling testosterone? Could lowering the test cyp dose even further, to say, 60mg per week help in controlling these sides? Just seems odd that most men love HCG, and I get the sweats just thinking about it.

Could I just be a hyper responder to HCG and lower doses, say, 200iu total a week, keep my boys in-tact? I haven't been able to find much about Drs recommending anything under 250iu twice weekly.

I have an appointment with the Dr next week, and am waiting on a full set of labwork to come in with all the major players tested on it. I suppose its just hard to sit around with burning nipples, and not make some small adjustments.

Anyway - just a rant - with some dire need for advice.

Thanks!
Jim

For starters, many (not all) of the symptoms you described are related to your very suppressed estrogen levels.

In fact, I'd ask your Doctor to come off the AI all together until the next blood work indicates elevated E2 and than a AI protocol can be started.

Most men don't need an AI and with the amount you were taking and is what is giving you a lot of the neg sides.

Now for HCG, I have never heard of the symptoms you describe being related to HCG.

HCG is an LH analog and the body sees it just as if it were naturally produced LH so it's difficult to imagine your gyno (if you really have Gyno, which I don't think you do) and other related symptoms are associated with its use.

That being said, HCG is known neurohormone and does act on the peripheral part of the brain and usually provides men with a better sense of well being and improved libido...almost opposite of your reaction.

You may want to reduce your dosage to 100 iu per injection for 5 injections M-F and see if that has less impact.

IMO, you need to stop the AI and allow your E2 to rebound as soon as possible as I think this is where your problems are.

Gyno at your E2 levels is almost impossible and it takes a long long time for Gyno to even start-up so it just may be sensitive nipples due to your increased Testosterone serum levels, which is normal for many men, and will subside in time.

Gene,

Much appreciated. I hadn't heard that even the increase in T can cause nipple issues that just subside over time. I have had itchy/sensitive nipples for years, but I have been on a testosterone roller coaster trying to restart. Some readings were as low as 300 during the restart, while others were near 1000. I suppose those fluctuations could have caused the sensitivity, much like I am experiencing now.

As far as the gyno - I do have a lump (from the past), that may or may not be getting bigger. I am likely blowing things WAY out of proportion, since I am in somewhat of a panic state. I suppose worst case, if I can't get the glands to cool off a bit, Dr Crisler offers a surgery to remove them.

E2... my nemesis. You are right on all counts here. Obviously my E2 is too low. The Dr has mentioned that as the treatment progresses, I need to watch what happens on the blood draws, and adjust adex as needed. I only talk to him every month or two, so in the interim, its on me to make the adjustments. I have a pretty firm grip on where I need to be... and its not between E2 of 5-15. I suppose I just get scared to lower adex dose as in my head, its fighting off the "gyno" that I may or may not have.

I don't want to completely cut out HCG before speaking with the Dr, so I will take your advice and try 100iu injections, totaling my prescribed weekly dose.

Again, thanks for the input. It really helps calm my nerve.

-Jim

Being in a "panic" state can cause your reaction; I know, I've been there.

Relax, get E2 back into the 20's if you can, do the lower doses of HCG and see if that helps.

BTW, Pregnenelone can help with some of that anxiety as well. Might want to try adding in 50 mg a day and see how you feel.

With E2 being so low, what you might be experiencing is the effects of estrogen rebound. The AI could be tanking your E2 and at the time of your labs it's trying to increase back to a normal level. Like Gene stated, it might be wise to stop the AI and let it rebound to a healthy level. If it is estrogen rebound, the sensitivity issue will diminish fairly quick ... A SERM like Nolvadex can be administered in small daily dosages, and it will mitigate the sensitivity at the receptor sites in the nipple region. Talk with your physician to see if this might be worth exploring. I've personally been through this as well, so it's not all that uncommon.

Chris,

I tried a dose of Nolva for a few weeks when it first kicked up with no relief. This is different than just some slightly itchy nipples. Its an all consuming feeling/sensation in the chest. I have had small sensation come and go many time, but this is brutal. Further, when I moved to just 100mg test cyp weekly, it resided almost immediately. Just this week, I reintroduced HCG and its back with a vengeance. So far, even at the very small dose of 100iu, its causing issues.

-Jim

Jimstigator said:

Chris,

I tried a dose of Nolva for a few weeks when it first kicked up with no relief. This is different than just some slightly itchy nipples. Its an all consuming feeling/sensation in the chest. I have had small sensation come and go many time, but this is brutal. Further, when I moved to just 100mg test cyp weekly, it resided almost immediately. Just this week, I reintroduced HCG and its back with a vengeance. So far, even at the very small dose of 100iu, its causing issues.

-Jim

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Jim - I've counseled men for years on TRT and the severity of your symptoms is a first for me.

I've never heard of "an consuming feelings/sensation in the chest" from Testosterone Replacement in the normal range and never heard that about HCG.

I'd talk to your Doctor about this and look into other causes and maybe get a complete blood work up done to see if anything is way off.

Nelson Vergel said:

Gynecomastia: Clinical evaluation and management

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What if this is true, and HCG can actually cause gyno despite E2, prolactin, and progesterone all under control?

http://www.ncbi.nlm.nih.gov/pubmed/15292356

Jim - you're quite the mystery. I start HCG next week and have researched it to best set realistic expectations for myself and I haven't read about anyone having the problems you think you have from HCG. As for your nipple issues, I too have had rather significant nipple issues since starting TRT, but after the doc cut my cyp dose in 1/2, the nipple issues went away rather quickly. Sounds like you tried Nolvadex with no luck. Have you had that lump checked out? Have you talked with a plastic surgeon about your gyno? I had gyno surgery several years ago with great results (glandular excision with liposuction). Sounds like you've got a ton of anxiety about this, which will make your symptoms feel even worse. Like Gene said, talk with your doctor about this to rule out any other causes.

Jimstigator,just came across your thread,and was wondering how yor doing?I too have some pre existing gyno and will be starting trt soon,after seeing another doc for a second opinion. Funny,I just left a plastic surgeon just now,and he refused surgery for fear that what little I have,will cause an indentation if removed.

Just too touch on what was said,if you think about it too much,it can "appear" to be a bigger problem in your head I too have a tendency too think about it too much.i guess you gotta learn too let it go.
I hope to hear how it's goin

hfbjr said:

Jimstigator,just came across your thread,and was wondering how yor doing?I too have some pre existing gyno and will be starting trt soon,after seeing another doc for a second opinion. Funny,I just left a plastic surgeon just now,and he refused surgery for fear that what little I have,will cause an indentation if removed.

Just too touch on what was said,if you think about it too much,it can "appear" to be a bigger problem in your head I too have a tendency too think about it too much.i guess you gotta learn too let it go.
I hope to hear how it's goin

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I saw someone who specialized in gyno - Dr. John Crisler. I still have far more nip sensitivity than the normal guy, but, the ridiculous amounts of excess tissue are gone. About 6 months after the procedure, I tried HCG at 50iu EOD for a while and it worked without aggravating anything. Fertility numbers started to climb. I moved to 50iu ED and they got back to normal. I am now on 100iu daily and its working out ok.

I have found I am hyper estrogen sensitive. If my sensitive E is in the 30s, the nip irritation gets really bad. Very small doses of adex keep it in the 20s and the sensitivity is tolerable... kind of.

-Jim

What procedure did you have jim

hfbjr said:

What procedure did you have jim

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Gyno removal.

Back in mid-80s, coming off cycle, hCG gave me gyno. Removed surgically.

Your E is very low. Low E can cause similar side effects like you have mentioned.

I have had gyno come on pretty quickly before, within a few days