HCG Monotherapy, should I stay on it?

[bluezebra5]

Cheers guys,


I'm a 22 year old male, recently found to have very low testosterone (139ng/dL). Doc prescribed Clomid, which got my levels up (to 600) with no symptomatic improvement (seems like the norm with Clomid unfortunately).


I've been prescribed HCG at 4000 iu/week (daily injections) and after a few months of trial and error with dosing/frequency, and the addition of arimidex as an AI, I'm now in the normal range and feeling less crummy. Latest labs had me at 900, estradiol at 39 (a bit high, I know, but nipple sensitivity has subsided)


I wanted to ask some of our local experts, (as well as anyone who's been through this process), what can I do maximize the physiological and subjective benefits of my treatment? Should I be pushing my doctor towards a T+HCG protocol? Any young guys able to compare their experiences with each?



Are there any deficiencies that could be holding me back? Rate-limiting steps I should be aware of? I've recently added Vitamin D, Zinc, and Magnesium.



Any supplements I should consider that might maximize the free (unbound) testosterone that I'm getting?


Thanks everyone.

 

[Vettester Chris]

bluezebra, glad you joined, thanks for posting. At 22yo, I would definitely hope that your physician has investigated your HPTA suppression situation and ruled out any tumors/adenoma, or other conditions effecting the pituitary? Sounds like your testicular function is positive if you're able to get 900ng/dl on HCG Mono.

If there's no turning back and you're prepared for the life-long journey of exogenous therapy, I would indeed consider looking at a combination of test cyp/enth in conjunction with a smaller amount of HCG. By doing this, I think you will see more stable and controllable serum levels, and I think it might be easier to manage your E2, considering intratesticular E2 can sometimes be problematic for some on HCG mono programs.

To maximize your benefits ... Look at the whole picture and aim to keep everything in balance. TRT is only as effective as many of the other hormones; both upstream and downstream. On your end, this will require a lot more comprehensive lab work than what you would probably be needing if you weren't on TRT, but that's just part of what's needed "IF" you want this to be successful.

With a good physician, you will frequently want to review your CBC's, metabolic profile, lipids, and relevant hormone panels, i.e, cortisol, DHEA, thyroid, E2 sensitive, D3 (as you noted) .. etc. RBC and HCT will need to be addressed, where most of us donate blood to help keep managed. Iron & ferritin can tend to drop when donating, so again, it's a complete program that needs to be managed adequately across the board.

You will find this forum to be a huge advantage as your personal program evolves. None of us will attempt to be your doctor and tell you what you "must" do, the decisions you make will ultimately be between you and your physician. Everyone's situation is unique, so what one guys does won't necessarily be a good thing for the next guy to do ... However, you will get solid, honest comments from a very versatile group, with years of experiences.

 

[bluezebra5]

Thanks Chris. I really appreciate the detailed response.


I've seen a few doctors: a urologist (with experience in andrology), an endocrinologist, and a neurosurgeon. The urologist is running the show, and he is clearly the most progressive of the bunch. He cares deeply about how I'm doing, quantitatively and subjectively and I just can't say enough about the guy. He's also the only one who seems to believe me when I say I've never touched an anabolic agent. I understand that it's the easiest explanation for my presentation, but it's frustrating that almost everyone I've seen jumps to this conclusion.


Regarding my HPTA suppression, it's a bit of a mystery. First labs (February 2013) had me at 139 ng/dL. This was confirmed a week or so later at 170 ng/dL. LH was low-normal. Prolactin normal. CBC and metabolic panel were unremarkable with the exception of a liver enzyme, ALT I believe, was very slightly elevated (high but in range).


Despite the prolactin value, I asked to get a pituitary MRI, as I had presented before with neurologic symptoms (March 2012), some sort of seizure/sudden fainting, though we never figured out what it was. MRI showed a pituitary microadenoma, which I suppose is non functioning. And no one seems to think it's implicated in the hypogonadism.


I responded quickly to Clomid, but with little symptomatic improvement, and with a sudden onset of visual disturbances (Floaters in my case). So we made the switch to HCG five months ago. I've had significant improvement in my ADAM score. Strength has improved, libido is there, but not great by any means.


Aromatization has definitely been an issue. I got fiery nipples not long after beginning HCG mono, and started anastrozole (1mg/week). Sensitivity did not subside and I began to feel nodules, so we immediately went to 2mg/week. No breast symptoms since then. Oddly, my libido seemed to tank when we did this, despite my E2 being 39 at T of 900.


I guess I'm not sure if there's no turning back. I'm certainly ready to be on HRT forever, but I would also like to have some clue as to what's caused all of this.


I remember bringing up HCG+T back before we even started Clomid. My doctor seemed hesitant to do this, and I hardly knew anything at the time so I didn't ask questions. I am wondering what would be the best way to present the idea. Additionally, I am very close to the Houston area, so a visit to Dr. Lipshultz is an option, though I have no idea how that would work insurance-wise.

 

[bluezebra5]

Would anyone be able to offer a subjective comparison of HCG monotherapy vs Testosterone + HCG? I am hesitant to switch being that I've shown so much improvement in less than 6 months on HCG alone. But if the consensus is that I might "feel" much better at a given level on TRT/HCG rather than monotherapy, I think I'm ready to jump in.