Cessation of TRT a good idea for me?
- Thread starter klepp0906
- Start date
slicktop
Active Member
also: "When you are on testosterone therapy, it is inevitable that your cholesterol level will go up. Cholesterol is the beginning chemical structure for many of our hormones. The enzyme that begins the changes of cholesterol into other hormones is stimulated by LH. When taking testosterone, LH is suppressed. When you inject the HCG, the enzyme is stimulated again and the pathway flows normally." Why you need HCG if you are on testosterone therapy.
TLDR: HCG supports the enzyme that helps you make lots of other hormones, and can bring other levels up to where your body wants them to be. Win/win.
TLDR: HCG supports the enzyme that helps you make lots of other hormones, and can bring other levels up to where your body wants them to be. Win/win.
mmmm. So based on the dosages and numbers I reported above, what would you suggest I change my dosing to? is it linear? aka if I did 60 every 3 days, id do 30eod or 15 daily?
I know without keeping my TT at or above range I dont get my FT high enough to feel the benefit. Fortunately as many of my labs show, ive been over range and the doctor is okay with it (presumably because i wasnt astronomically over).
you see, ive heard time and time again how thats basically central to a solid trt protocol. The only thing thus far thats kept me from demanding it on the basis my nuts are the size of grapes, is the fact im married and my wife could care less lol.
ive also read that it can cause crazy elevations in E2 and its not meant to be used perpetually/long term.
the only obstacle to looking into that is as i mentioned, my doc. While he flat out told me he cant prescribe it (whether cant = wont, or gp's actually cant i have no idea) he gives me a ton of freedom otherwise. He prescribes me 200mg a week and allows me to self inject which i gather not all docs do.
Do endocrinologists tend to prescribe hcg or does that take an actual trt clinic? Getting it covered by insurance is a necessity for me so operating under the assumption i cant get something like defy covered - that limits my options of course.
xqfq
Active Member
I disagree with the assumption that without LH serum cholesterol will increase. While this seems like sound deductive reasoning, it’s not how cholesterol works in the body. We also see no statistically significant rise in LDL-C in TRT studies. Studies on PCSK9 inhibitors which drove LDL-C to single digits saw no change in sex hormones.
Note that higher doses of statins may decrease sex hormones, but that is because statins drop the synthesis of cholesterol within most cells in the body to some degree, not because they lower LDL-C.
slicktop
Active Member
Your doc: he can/ he won't. It's off label for men, which means insurance wouldn't likely cover it and lots of docs are terrified of off label scripts. HCG isn't that expensive, and there are other routes of obtaining it. I'll leave it at that. I think you can also do just ancillaries (HCG and thyroid meds) through Defy as well, and keep your doc going for test and AI. They used to do that, not 100% if they still do.
It can cause some initial elevations of E2 because your nads are coming back online and producing some of their own test again, so there's more there to aromatize. I'd wager your current AI dosing with some DIM added would keep it under control (it did with me at least). Chances are good that you'll "get used to it" and produce less E2 and need less AI over time- especially with daily test shots.
Do you have kindle unlimited? If so, you can read Jay Cutlers "The Testosterone Optimization Therapy Bible" for free. You can sign up for a free trial and read it and then cancel, too. Good material with lots of research and info. He's not as strong a proponent for HCG in that book as he is currently, though.
It can cause some initial elevations of E2 because your nads are coming back online and producing some of their own test again, so there's more there to aromatize. I'd wager your current AI dosing with some DIM added would keep it under control (it did with me at least). Chances are good that you'll "get used to it" and produce less E2 and need less AI over time- especially with daily test shots.
Do you have kindle unlimited? If so, you can read Jay Cutlers "The Testosterone Optimization Therapy Bible" for free. You can sign up for a free trial and read it and then cancel, too. Good material with lots of research and info. He's not as strong a proponent for HCG in that book as he is currently, though.
fwiw here are my cholesterol labs
Not sure which is the good and which is the bad, but in general both seemed to have gone down. I have cleaned up my diet dramatically since prior of course, and the TRT started in summer of 2018 for reference. Prior labs are due to the initial labs and kidney cancer stuff that followed.
Not sure which is the good and which is the bad, but in general both seemed to have gone down. I have cleaned up my diet dramatically since prior of course, and the TRT started in summer of 2018 for reference. Prior labs are due to the initial labs and kidney cancer stuff that followed.
slicktop
Active Member
Hmmm...that's not how I interpreted it. I understood it to mean that exogenous testosterone is going to increase your cholesterol, and the introduction of HCG mimics LH, stimulating the enzymes, and helps bring cholesterol back down. My own TRT history followed this theory as well.
hmm, didnt know he had a book on trt. Interesting. I dont have kindle unlimited but I am an amazon prime member and I think they have some kinda deal w/ that or at least a trial. Will take a peek. Gonna look into this DIM stuff too. Dont think ive ever heard anything about it.
Will have to look into how pricey hcg is and go from there. never been motivated to as i wasnt sure if it would bring anything to the table other than keeping fertility which i DEFINITELY dont want any more of and nutsize which I can live without.
xqfq
Active Member
Yeah, what I’m saying is that it doesn’t work that way. At least as far as I can tell. It seems like it would make sense that HCG would “suck” the LDL-C out of the blood, but cells synthesize the cholesterol they need-including the gonads. The lipoproteins floating in the blood’s primary value is to transport triglycerides (energy) and phospholipids, not to transport cholesterol.
If you had a rise in total cholesterol or LDL-C it was likely related to other factors (diet, weight gain/loss, phases of the moon) besides HCG. That’s my guess at least.
Vince
Super Moderator
I would cut way back on the AI. Use as little as possible. Just enough to keep the side effects away. Some men can run there E2 levels, a lot higher than 30.
xqfq
Active Member
SKIP TO BELOW THE DOTTED LINE IF YOU DONT WANT THE HISTORY
So im going to try to make a long (~2 year) story as short and concise as possible. Since i believe its relevant.... I was a long term opiate addict. I finished that miserable journey with a few years of methadone treatment which is known to rock bottom testosterone.
Few years after getting clean I wasnt feeling up to snuff and most of the symptoms (bad sleep, trouble concentrating, low libido) were posters for low T so I went for blood. (as someone who avoids the dr like a plague, assume i had to feel pretty awful to make this step. It was my first blood draw in my life @ 35 lol)
Ultimately the blood draw returned a few things that took precedent. My ALP was triple OOR which led to tests determining I had kidney cancer. So went through surgery and knocked that off the list. Afterwards, the reasons for the elevated ALP had to be determined. Surprise, I had(have) pagets disease as well. Good times.
Anyways, the test showed my TT had recovered to 497. for 36 y/o this didnt seem to be good to me. Of course, turns out its quite average - but the prevailing idea that more test is better, coupled with my symptoms had me hell bent on TRT. Unfortunately, based on the TT number alone (its all he ran that time) I was declined.
I went on a mission to get as lean as possible. Again, misguided into thinking the leaner you are, the better as far as naturally inflating T numbers. I dieted hard at a deficit for about 6 months and got very lean. Too lean. Inlaws were voicing concern to my wife behind my back. I loved the 10 pack but evidently my face looked like skeletor ;p
In the end, i had expected my libido and energy to go up, but as informed minds know - this had the opposite effect. I felt worse than ever.
Went for more labs and as I now know, my hormones were bottomed out, helped along by dieting. TT was 197 on a 400-1080 and FT was 40 on a 49-212. The doc then started me on TRT.
Now fast forward. Ive gone through this entire time trying to dial in, and im close - at least by the numbers. Only partially by the way I feel. Ive been able to keep my TT at the tippy top of the range (little over/under depending) and my FT in between 150-200 on the same scale. E2 is between 20-30 with <1mg arimidex spread out during the week.
Im currently on SubQ as i really dont want to eviscerate my muscle over time and i lost 2 injection sites when i started routinely nailing nerves in my quads. very unpleasant. Anyways the subQ has me feeling worse, which is likely a result of the same dose resulting in lower TT/FT and higher E2. Perhaps due to the slower release resulting in a lower peak as well.
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TRT has definitely provided me with a more even mood. Generally better. It hasnt done "magic" for my energy, but in general it is improved as well. Libido is usually better. So what is the problem you say? (and after the novel, the reason for my post ;p)
1) It has given me some BPH symptoms. I basically have to wring out my penis after urinating lest i dribble in my boxers. Undoubtedly due to the fact my prostate numbers (which while still good) have gone up by ~25%. As a flip side, its made orgasms basically like magic.
2) It has made my appetite insatiable. I used to be able to diet and cut fat very easily. Now i struggle. Struggle might be an understatement. I even wake in the middle of the night to eat now.
3) The biggest caveat. It gave me terrible ED. Terrible as in, I can barely get an erection good enough for penetration let alone maintain it. Viagra allows a return to form, but for gods sake I dont want to have to take more medication.
4) my DHT is 517 on a 106-719. Obviously in range, but high enough to literally annihilate my hairline. I always had some recession, but the amount of hair im losing now is very upsetting. had to change my hairstyle. It was always going to happen, it just would have been much later.
5) Systolic BP is up in the high 130's low 140's however Im not sure if this was present before, as it runs in my family and I am getting older. Also controllable with diet if i get to a low enough weight.
In the end, im really concerned about how things are effecting my health. After the cancer scare, im a bit of a hypochondriac i guess. Longevity doesnt run in the family, and heart disease does. Also the ED thing in and of itself is a HUGE problem for me, also can be caused by hardening of arteries or whatnot and Im beginning to wonder if TRT is having long term deterimental effects on my health.
Especially since we lack data from people who have used it for 30+ years like I will end up doing should i stay on it (and last that long).
In short, is it realistic to think that after a year or two I can come off with the proper protocol and restore myself to the ~500 range, or do you guys think staying on is my best bet? I dont know what part broke my erections but if nothing else, I cant live with that.
Would I simply request HCG and nolvadex from the doc and run them for a month or so and hope for the best?
totally torn.
Sorry for the book.
I too come from a family with a lot of early heart disease. It's why I became obsessed with cardiovascular health. The good news is that heart disease is almost always preventable / stoppable.
If I was in your shoes (and I kind of am!), I would:
* Get your BP consistently under 120/80 by any means necessary, including antihypertensive medication if required. I bet it could be fixed by fiddling with your HRT protocol, but if you can't fix it don't sit around with a systolic of 140. Get it down now and figure out the underlying cause later. You can always stop or take less hypertensive medication if needed. But keep in mind that most hypertension is 'essential' - with no known cause. For many, medication for blood pressure is just a fact of life.
You are young, so aggressive treatment of BP has less risk. For older people, aggressive treatment could mean a fall or injury (from being dizzy/passing out), which carries risk of bone breaking, etc in older people.
* Figure out how to do HRT without an AI if at all possible. While this is obviously debatable, I personally believe that AIs may have delirious effects on the cardiovascular system independent of their reduction of serum estradiol. But even if they don't, having a higher E2 is likely more beneficial for your cardiovascular health than having a lower E2 -- provided your blood pressure is controlled. Obviously quality of life / etc must be balanced here, but if you're not feeling great right now and you're taking an AI, there is little risk in stopping or reducing the AI and seeing how things go over 5-6 weeks.
If you're more at risk for CVD (as I am), I would err on the side of being overly cautious and reduce or eliminate the AI if at all possible!
FWIW, I do daily subQ of 20mg testosterone enanthate, 150IU HCG EOD, no AI. This puts my TT around 952 ng/dL, E2 sensitive around 45 pg/mL, SHBG 43. I am almost exactly your age so I share your worries.
I had water retention and ankle swelling early on. It went away, no AI required. I am not yet sure of the cause in my case, but if you search around you will find many stories of men with these symptoms early on with HRT, and for most men these symptoms go away in time regardless of AI usage.
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thank you very much for that solid post. I would loathe having to inject daily, but it would certainly be offset by the chance for no AI. Perhaps ill drop the AI and move from 60 E3D to 40 E2D to start.
I hate that im so far along and still messing with it but it is what it is. Should i taper off the AI you think, or drop it cold turkey? I heard theres a rebound effect?
Also, since we do seem very similar as far as most things go - you dont have issues with libido or ED then?
Ive been indoctrinated pretty heavily with the higher dose lesser frequency for higher shbg that im going to have to willpower myself into this, but if it can alleviate the need for an AI its an easy win.
I cant argue the BP thing, unfortunately thats gonna take time. Its entirely controlled by weight and diet for me and i let off the reigns a bit much for the winter season this time. I went from 185-205 since the end of august.
after xmas ill be going back on the straight n narrow and its likely for good this time. no more loosening up for the winter. Just cant get away with that anymore lol.
xqfq
Active Member
I’ve never had issues with ED while on HRT, though I didn’t have morning/night erections consistently until about six months in. I’m not sure why. I had moderate ED prior to HRT and sometimes took cialis prior to sex. Now I’d be sacred to even try it- so unnecessary for me!
My libido is good but was never that poor before HRT.
Be sure and check your BP daily (AM on waking before eating or supplements is usually recommended) if you’re not already. While you may be able to control your BP with diet and weight loss, keep in mind that the fact it jumps up with poor diet and some extra weight may mean you carry risk even when your BP is more normal.
I was opposed to daily injections but actually find them easier than the 3x a week I was doing before. No need to remember anything-it’s just something I do when I wake up like putting on my pants. Maybe down the road I’ll get sick of it and scale back, but it hasn’t been as big of an issue as I feared so far.
hmmm, much to think about. As far as more frequent injections, I just cant imagine plowing through 365 syringes a year every year lol. I think ive been nudged enough to at least look into moving to EoD and dropping the AI though.
Just gotta figure out the dosing. because of shbg I have to get my TT so darned high to start feeling well, i dont want it to end up sabotaging me in other areas like hematocrit/bp/estrogen.
Still wont know till I try, and its dead middle of winter so nows as good a time as any.
appreciate everyones time very much!
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