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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
HCG + HMG Therapy Once a Week for Spermatogenesis in Hypogonadotropic Hypogonadism
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<blockquote data-quote="madman" data-source="post: 233855" data-attributes="member: 13851"><p><strong>Discussion</strong></p><p></p><p><em><strong>This is the first study to investigate the efficacy of weekly gonadotropin therapy on spermatogenesis in HH patients. </strong>We found that the general success rate was 74% (119/160), the median time for achieving the first sperm was 13 months, and basal testicular size was a favorable predictor for earlier spermatogenesis.</em></p><p><em></em></p><p><em>Various regimens of gonadotropin treatment have been used in clinical practice. Typically, HCG/HMG is administered 2 or 3 times a week.8-10 In clinical practice, many patients are high school or college students, and therefore, injections 2 or 3 times a week are often inconvenient, time-consuming, and difficult to adhere to. Earlier studies have confirmed that patients administered medication once a day have better compliance than patients administered medication 2 to 3 times a day.17 Similarly, weekly injections of long-acting human recombinant growth hormones also significantly improved patient adherence and compliance compared with daily injections.11 Therefore, it is believed that weekly gonadotropin treatment may promote therapy adherence and compliance.</em></p><p><em></em></p><p><em>Among CHH patients, 78% (74/95) succeeded in spermatogenesis with gonadotropin treatment once a week. This result was similar to the twice-a-week regimen, which had a success rate of 75% to 85%.5-7 <strong>Compared with the 2 times a week strategy, the weekly injection group had a similar rate of spermatogenesis, the median time of sperm appearance, sperm concentration, and sperm progressive motility. <u>These results seem inconsistent with previous studies suggesting multiple low-dose HCG administration, in contrast to a single high dose, enhances Leydig cell steroidogenesis</u>.18</strong> <strong><u>However, patients in the weekly group had a larger basal testicular volume, earlier age at diagnosis and initial treatment, a lower percentage of cryptorchidism, prior androgen treatment, and a higher percentage of previous gonadotropin treatment compared with the twice-a-week regimen, which may have predisposed this group to greater success in the weekly treatment</u>. <u>Further cohorts with similar baselines are needed to better illustrate this question</u>.</strong></em></p><p><em><strong></strong></em></p><p><em><strong>However, our study pointed out the possibility of gonadotropin therapy with a lower injection frequency</strong></em></p><p></p><p></p><p></p><p></p><p><strong>Differential Effect of Single High Dose and Divided Small Dose Administration of Human Chorionic Gonadotropin on Leydig Cell Steroidogenic Desensitization (1984)</strong></p><p><em>A. G. H. SMALS, G. F. F. M. PIETERS, G. H. J. BOERS, J. M. M. RAEMAKERS, A. R. M. M. HERMUS, Th. J. BENRAAD, and P. W. C. KLOPPENBORG</em></p><p></p><p></p><p><strong>ABSTRACT</strong> </p><p></p><p><em><strong>This study compared the effect of a single high dose of hCG (1500 IU) with that of the same dose administered in multiple small doses (300 IU, once daily for 5 days) on Leydig cell steroidogenesis.</strong> Administration of a single high dose of hCG to seven healthy men raised the mean plasma testosterone (T) level to peak levels of 2.1 ± 0.2 (SEM) X the baseline value at 48 h. Thereafter plasma T decreased to below normal (0.7 ± 0.1 X baseline) 7 days after the injection. The mean 17-hydroxyprogesterone (17-OHP) level peaked at 24 h (2.5 ± 0.2 x baseline) and then also fell to a nadir value of 0.6 ± 0.2 x baseline on day 7. Reflecting the early accumulation of 17-OHP over T, the 17 OHP/T ratio reached its maximum (1.6 ± 0.1 X baseline) at 24 h at the same time when plasma estradiol [(E2) 4.4 ± 0.6 x baseline] and the ratio E2/T (2.7 ± 0.3 X baseline) achieved their maximal values. Administration of 1500 IU hCG in five divided doses of 300 IU daily increased the mean plasma T levels to a peak value of 2.1 ± 0.2 x baseline at 5 days and the levels remained elevated thereafter. The response of T as reflected by the area under the curve was almost twice as great as in the single dose study (2844 ± 360 vs. 1647 ± 214). In contrast to the single high dose experiment, mean plasma 17-OHP levels in the divided dose protocol did not peak at 24 h but only gradually increased. As the increase of T exceeded the 17-OHP increase at almost all time intervals, no accumulation of 17-OHP over T occurred as in the single dose experiment. Instead, the 17-OHP/ T ratio fell to a nadir value of 0.6± 0.1 X baseline on day 7. The initial E2 peak was absent in the divided dose protocol and the E2/T ratio only marginally increased. Considering both experiments together a close relation was found between the hCG induced increases in E2 and 17-OHP (r = +0.88, P < 0.001), as well as the ratio 17 OHP/T (r = +0.64, P< 0.02). Multiple small dose hCG administration in contrast to a single high dose does not desensitize but rather enhances Leydig cell steroidogenesis, probably by preventing the early accumulation of E2 and thereby the steroidogenic enzyme suppression which occurs after massive doses of hCG. </em></p></blockquote><p></p>
[QUOTE="madman, post: 233855, member: 13851"] [B]Discussion[/B] [I][B]This is the first study to investigate the efficacy of weekly gonadotropin therapy on spermatogenesis in HH patients. [/B]We found that the general success rate was 74% (119/160), the median time for achieving the first sperm was 13 months, and basal testicular size was a favorable predictor for earlier spermatogenesis. Various regimens of gonadotropin treatment have been used in clinical practice. Typically, HCG/HMG is administered 2 or 3 times a week.8-10 In clinical practice, many patients are high school or college students, and therefore, injections 2 or 3 times a week are often inconvenient, time-consuming, and difficult to adhere to. Earlier studies have confirmed that patients administered medication once a day have better compliance than patients administered medication 2 to 3 times a day.17 Similarly, weekly injections of long-acting human recombinant growth hormones also significantly improved patient adherence and compliance compared with daily injections.11 Therefore, it is believed that weekly gonadotropin treatment may promote therapy adherence and compliance. Among CHH patients, 78% (74/95) succeeded in spermatogenesis with gonadotropin treatment once a week. This result was similar to the twice-a-week regimen, which had a success rate of 75% to 85%.5-7 [B]Compared with the 2 times a week strategy, the weekly injection group had a similar rate of spermatogenesis, the median time of sperm appearance, sperm concentration, and sperm progressive motility. [U]These results seem inconsistent with previous studies suggesting multiple low-dose HCG administration, in contrast to a single high dose, enhances Leydig cell steroidogenesis[/U].18[/B] [B][U]However, patients in the weekly group had a larger basal testicular volume, earlier age at diagnosis and initial treatment, a lower percentage of cryptorchidism, prior androgen treatment, and a higher percentage of previous gonadotropin treatment compared with the twice-a-week regimen, which may have predisposed this group to greater success in the weekly treatment[/U]. [U]Further cohorts with similar baselines are needed to better illustrate this question[/U]. However, our study pointed out the possibility of gonadotropin therapy with a lower injection frequency[/B][/I] [B]Differential Effect of Single High Dose and Divided Small Dose Administration of Human Chorionic Gonadotropin on Leydig Cell Steroidogenic Desensitization (1984)[/B] [I]A. G. H. SMALS, G. F. F. M. PIETERS, G. H. J. BOERS, J. M. M. RAEMAKERS, A. R. M. M. HERMUS, Th. J. BENRAAD, and P. W. C. KLOPPENBORG[/I] [B]ABSTRACT[/B] [I][B]This study compared the effect of a single high dose of hCG (1500 IU) with that of the same dose administered in multiple small doses (300 IU, once daily for 5 days) on Leydig cell steroidogenesis.[/B] Administration of a single high dose of hCG to seven healthy men raised the mean plasma testosterone (T) level to peak levels of 2.1 ± 0.2 (SEM) X the baseline value at 48 h. Thereafter plasma T decreased to below normal (0.7 ± 0.1 X baseline) 7 days after the injection. The mean 17-hydroxyprogesterone (17-OHP) level peaked at 24 h (2.5 ± 0.2 x baseline) and then also fell to a nadir value of 0.6 ± 0.2 x baseline on day 7. Reflecting the early accumulation of 17-OHP over T, the 17 OHP/T ratio reached its maximum (1.6 ± 0.1 X baseline) at 24 h at the same time when plasma estradiol [(E2) 4.4 ± 0.6 x baseline] and the ratio E2/T (2.7 ± 0.3 X baseline) achieved their maximal values. Administration of 1500 IU hCG in five divided doses of 300 IU daily increased the mean plasma T levels to a peak value of 2.1 ± 0.2 x baseline at 5 days and the levels remained elevated thereafter. The response of T as reflected by the area under the curve was almost twice as great as in the single dose study (2844 ± 360 vs. 1647 ± 214). In contrast to the single high dose experiment, mean plasma 17-OHP levels in the divided dose protocol did not peak at 24 h but only gradually increased. As the increase of T exceeded the 17-OHP increase at almost all time intervals, no accumulation of 17-OHP over T occurred as in the single dose experiment. Instead, the 17-OHP/ T ratio fell to a nadir value of 0.6± 0.1 X baseline on day 7. The initial E2 peak was absent in the divided dose protocol and the E2/T ratio only marginally increased. Considering both experiments together a close relation was found between the hCG induced increases in E2 and 17-OHP (r = +0.88, P < 0.001), as well as the ratio 17 OHP/T (r = +0.64, P< 0.02). Multiple small dose hCG administration in contrast to a single high dose does not desensitize but rather enhances Leydig cell steroidogenesis, probably by preventing the early accumulation of E2 and thereby the steroidogenic enzyme suppression which occurs after massive doses of hCG. [/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
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HCG + HMG Therapy Once a Week for Spermatogenesis in Hypogonadotropic Hypogonadism
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