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?