How long does it take for HCG to kick in, or am I being impatient?

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Kris

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Hello. Newbie here, based in the UK. Excuse long post. I’ve been on TRT for a decade now, for secondary hypogonadism, with many ups and downs. That darn pituitary gland! I’ll cover my full story another day, in case it helps others, but only in the past two years have I had treatment that has helped after going to a private doctor rather than the National Health Service.

Even with this treatment – Sustanon 250 injections with Anastrazole to stop my estradiol shooting up - I’ve still struggled with tiredness and ED. So, a few weeks ago, under supervision from my doc, I stopped my meds briefly.

My expectation was that the ED would go away for a bit and then I’d crash again. And that’s exactly what happened - the ED went away and my mood and energy improved. I felt really good for a few days, and then, as my testosterone levels inevitably plummeted, I felt terrible again, so I started on my meds again.

This was really useful as it allowed us to identify that there was scope to tweak my treatment as the likelihood was that the reactivation of LH (and possibly FSH) made my private parts work naturally again - until the huge drop in testosterone outweighed everything.

So now I’ve started on HCG – 250iu injections three times a week, equating to 875iu a week. This is on top of 0.25ml Sustanon and 0.5mg Anastrazole twice a week. I should add here that I was on 0.25mg Anastrazole twice a week, but within a week of starting the HCG I started to get pain under my nipples and general tenderness and warmth in those areas. The increase in dosage, to prevent gynecomastia, seems to have helped although the tenderness hasn’t gone completely. I guess I just need to wait and see. I’m aware how difficult it is the balance hormones but obviously I want to head-off gynecomastia before it develops.

So far, three weeks on, I haven’t experienced the ED improvements, although I think my mood and energy levels have improved a bit. Sleep is still dreadful.

I’ve searched the site and watched some of Nelson’s videos, but my questions are:

  • How long does it take for HCG to work? I’m guessing it takes a while for it to build up to a stage where it is able to properly mimic LH.
  • I’ve heard that it takes a month or so, but if there’s no improvement after that, should I increase my HCG dosage (in conjunction with my doc) to 375iu (ie from 0.1ml to 0.15ml)?
  • Or should I try Clomiphene instead?
  • Whilst typing, I’ve just found this useful thread, so my final question is: ‘Am I just being impatient?
Again, excuse the long post, but hopefully the context helps. If you’ve got this far, thanks for reading.
 
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It seems unlikely that you would experience a rapid return of LH production after pausing TRT. Another explanation for your feeling better is that your testosterone level drifted down through a range that is more natural and appropriate for you. While the full picture is unlikely to be this simple, it is true that excessive dosing of testosterone accounts for a lot of misery. Virtually all guys who develop hypogonadism did not need an aromatase inhibitor when they were eugonadal. So why should they need one if they simply start replacing the missing testosterone? It's mainly because most end up using more testosterone than they ever made naturally. Beyond that, hCG use complicates the situation, as it stimulates estradiol production, and hCG's long half-life means it's not possible to reproduce normal LH activity.

For some perspective on your dosing, if you're taking 125 mg/week of Sustanon 250 then you are taking in twice as much testosterone as the average healthy young guy makes naturally. If I were you I would want to revert to the preferred low-and-slow approach. This means something like 60-80 mg/week Sustanon 250 in divided doses, and at most 500 IU/week hCG, also in divided doses. No AI. Unfortunately, reducing the dose can temporarily lead to a return of symptoms. But it is worth riding this out so that you can fairly evaluate how you feel with levels that are more physiological.
 
I think the problem is sustanon and the four different half-lives causing overstimulation. Try something with a shorter half-life and see if that will cure your issues.

I recall members in the past going from sustanon to cypionate/enanthate and it seems to cure all their problems.
 
It seems unlikely that you would experience a rapid return of LH production after pausing TRT. Another explanation for your feeling better is that your testosterone level drifted down through a range that is more natural and appropriate for you. While the full picture is unlikely to be this simple, it is true that excessive dosing of testosterone accounts for a lot of misery. Virtually all guys who develop hypogonadism did not need an aromatase inhibitor when they were eugonadal. So why should they need one if they simply start replacing the missing testosterone? It's mainly because most end up using more testosterone than they ever made naturally. Beyond that, hCG use complicates the situation, as it stimulates estradiol production, and hCG's long half-life means it's not possible to reproduce normal LH activity.

For some perspective on your dosing, if you're taking 125 mg/week of Sustanon 250 then you are taking in twice as much testosterone as the average healthy young guy makes naturally. If I were you I would want to revert to the preferred low-and-slow approach. This means something like 60-80 mg/week Sustanon 250 in divided doses, and at most 500 IU/week hCG, also in divided doses. No AI. Unfortunately, reducing the dose can temporarily lead to a return of symptoms. But it is worth riding this out so that you can fairly evaluate how you feel with levels that are more physiological.
Excellent answer.
 
Hello. Newbie here, based in the UK. Excuse long post. I’ve been on TRT for a decade now, for secondary hypogonadism, with many ups and downs. That darn pituitary gland! I’ll cover my full story another day, in case it helps others, but only in the past two years have I had treatment that has helped after going to a private doctor rather than the National Health Service.

Even with this treatment – Sustanon 250 injections with Anastrazole to stop my estradiol shooting up - I’ve still struggled with tiredness and ED. So, a few weeks ago, under supervision from my doc, I stopped my meds briefly.

My expectation was that the ED would go away for a bit and then I’d crash again. And that’s exactly what happened - the ED went away and my mood and energy improved. I felt really good for a few days, and then, as my testosterone levels inevitably plummeted, I felt terrible again, so I started on my meds again.

This was really useful as it allowed us to identify that there was scope to tweak my treatment as the likelihood was that the reactivation of LH (and possibly FSH) made my private parts work naturally again - until the huge drop in testosterone outweighed everything.

So now I’ve started on HCG – 250iu injections three times a week, equating to 875iu a week. This is on top of 0.25ml Sustanon and 0.5mg Anastrazole twice a week. I should add here that I was on 0.25mg Anastrazole twice a week, but within a week of starting the HCG I started to get pain under my nipples and general tenderness and warmth in those areas. The increase in dosage, to prevent gynecomastia, seems to have helped although the tenderness hasn’t gone completely. I guess I just need to wait and see. I’m aware how difficult it is the balance hormones but obviously I want to head-off gynecomastia before it develops.

So far, three weeks on, I haven’t experienced the ED improvements, although I think my mood and energy levels have improved a bit. Sleep is still dreadful.

I’ve searched the site and watched some of Nelson’s videos, but my questions are:

  • How long does it take for HCG to work? I’m guessing it takes a while for it to build up to a stage where it is able to properly mimic LH.
  • I’ve heard that it takes a month or so, but if there’s no improvement after that, should I increase my HCG dosage (in conjunction with my doc) to 375iu (ie from 0.1ml to 0.15ml)?
  • Or should I try Clomiphene instead?
  • Whilst typing, I’ve just found this useful thread, so my final question is: ‘Am I just being impatient?
Again, excuse the long post, but hopefully the context helps. If you’ve got this far, thanks for reading.
Cataceous gave you the best advice you are going to get in your particular case. You are on too high of a dose. You also want to eliminate the AI, which a lower dose would likely accomplish.

I will add that any new variable requires time, usually around 8 weeks to really notice the effects. That is when you make any necessary adjustments. So yes, you are being impatient ;)

Also, your post is not too long. You did a great job of detailing your situation.
 
Also, don’t forget about TRT’s effect on sodium reabsorption. If you’re holding on to too much sodium, water, this can make one feel unwell and even cause mood disturbances.

I would expect somebody holding onto too much extracellular fluid to feel better pausing TRT. Eating healthy and lifting weights can turn this extracellular fluid into intracellular.

 
Last edited:
It seems unlikely that you would experience a rapid return of LH production after pausing TRT. Another explanation for your feeling better is that your testosterone level drifted down through a range that is more natural and appropriate for you. While the full picture is unlikely to be this simple, it is true that excessive dosing of testosterone accounts for a lot of misery. Virtually all guys who develop hypogonadism did not need an aromatase inhibitor when they were eugonadal. So why should they need one if they simply start replacing the missing testosterone? It's mainly because most end up using more testosterone than they ever made naturally. Beyond that, hCG use complicates the situation, as it stimulates estradiol production, and hCG's long half-life means it's not possible to reproduce normal LH activity.

For some perspective on your dosing, if you're taking 125 mg/week of Sustanon 250 then you are taking in twice as much testosterone as the average healthy young guy makes naturally. If I were you I would want to revert to the preferred low-and-slow approach. This means something like 60-80 mg/week Sustanon 250 in divided doses, and at most 500 IU/week hCG, also in divided doses. No AI. Unfortunately, reducing the dose can temporarily lead to a return of symptoms. But it is worth riding this out so that you can fairly evaluate how you feel with levels that are more physiological.
Thanks @Cataceous. That's very interesting. The high-dosing does sound like it's worth a look. I'll reduce it myself a little and catch up with the doc in the new year regarding going further. I don't want to make too many changes without him as he may refuse to treat me!

With respect to AIs, unfortunately I do seem to need them. In my original post, I didn't mention my past - after being diagnosed with secondary hypogonadism in 2010 I struggled with testosterone supplementation. I used the gels (and Nebido briefly) but my estradiol shot up by 600% and I felt dreadful. So I ended up yoyo-ing with treatment - I felt awful when I wasn't on it and felt terrible after a few weeks of being on it. It was a horrible rollercoaster for 10 years. At the time I was having treatment on the NHS and NHS doctors can't prescribe AIs for TRT. Then, in 2020 I went private. First we used Sustanon, but I felt lousy again, so we added an AI. My quality of life improved significantly although I've been far from perfect even since then - still more tired than I should be and ED. For some reason a lot of my exogenous testosterone converts to estradiol, but then again it could be that the gels I took all those years ago were at a high dose too (half a sachet of Testogel a day still equates to 175mg a week). Low and slow again I guess! UPDATE: I've just checked and apparently only 10% of the testosterone in gels is absorbed, so in that case it looks like I was on a low dose which led to the high estradiol, so maybe I do have an issue with aromatisation?

Thanks again for your reply - I have a lot of thinking and tweaking to do. TRT is so complex!
 
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Cataceous gave you the best advice you are going to get in your particular case. You are on too high of a dose. You also want to eliminate the AI, which a lower dose would likely accomplish.

I will add that any new variable requires time, usually around 8 weeks to really notice the effects. That is when you make any necessary adjustments. So yes, you are being impatient ;)

Also, your post is not too long. You did a great job of detailing your situation.
Thanks @BadassBlues. Yeah - I have to admit, after 13 years of treatment which has yielded far from optimal results, I do struggle with patience. I just want to feel normal again and have some energy. This responses to this post have been well worth it though - plenty to look at and tweak. Will give it some time and report back!
 
Also, don’t forget about TRT’s effect on sodium reabsorption. If you’re holding on to too much sodium, water, this can make one feel unwell and even cause mood disturbances.

I would expect somebody holding onto too much extracellular fluid to feel better pausing TRT. Eating healthy and lifting weights can turn this extracellular fluid into intracellular.

Thanks @Systemlord. Alas, I tried enanthate a few months ago when there was a shortage of Sustanon in the UK, but didn't get on with it. ☹️ I'll look into the extracellular fluid issue you mention, but when it comes to lifting weights and diet you'll be pleased to know that I work out a few times a week and have recently switched to a vegan diet to see if it helps too. Thanks again.
 
It seems unlikely that you would experience a rapid return of LH production after pausing TRT. Another explanation for your feeling better is that your testosterone level drifted down through a range that is more natural and appropriate for you. While the full picture is unlikely to be this simple, it is true that excessive dosing of testosterone accounts for a lot of misery. Virtually all guys who develop hypogonadism did not need an aromatase inhibitor when they were eugonadal. So why should they need one if they simply start replacing the missing testosterone? It's mainly because most end up using more testosterone than they ever made naturally. Beyond that, hCG use complicates the situation, as it stimulates estradiol production, and hCG's long half-life means it's not possible to reproduce normal LH activity.

For some perspective on your dosing, if you're taking 125 mg/week of Sustanon 250 then you are taking in twice as much testosterone as the average healthy young guy makes naturally. If I were you I would want to revert to the preferred low-and-slow approach. This means something like 60-80 mg/week Sustanon 250 in divided doses, and at most 500 IU/week hCG, also in divided doses. No AI. Unfortunately, reducing the dose can temporarily lead to a return of symptoms. But it is worth riding this out so that you can fairly evaluate how you feel with levels that are more physiological.
@Cataceous @BadassBlues @Systemlord Hi gents. Hope you don't mind the follow-up. In line with @Cataceous comments I wonder if some blood results might help to pinpoint whether I'm on too high a dose.

On TRT, my testosterone was 692ng/dL and estradiol 2832pg/dL. Free T was above normal range. (I was on 0.25ml Sustanon and 0.25mg Anastrazole twice a week. Blood test taken in early in the morning prior to when I would have taken my next injection.)

I then stopped treatment. About three weeks later I felt good mentally and 'down below' for a few days. I then immediately had some more blood tests which showed:

My testosterone had dropped to 285ng/dL and estradiol 1,446pg/dL, Free T was now in the normal range.

(The next day my levels continued to drop and I felt dreadful. This was expected, so I went back onto my meds.)

So, I'm just wondering, could 285-350 be my physiological norm or does that sound too low? Most posts seem to suggest that above 500 is 'optimal'.

Looking forward to your thoughts.

Cheers.

Kris

PS UK measurements are in nmol/L so I had to convert to ng/dl. If I told you my T was 24 I think you'd have been very worried! Hopefully I have used the correct conversions!
 
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On TRT, my testosterone was 692ng/dL and estradiol 2832pg/dL.
C-reactive protein is likely elevated giving you a false high E2 value.

So, I'm just wondering, could 285-350 be my physiological norm or does that sound too low? Most posts seem to suggest that above 500 is 'optimal'.
The top 25 percentile reduces prostate cancer risk by 53% and heart attack risk 30%. The majority of me should maintain 550> ng/dL who have low-midrange SHBG. Men with higher SHBG may need to get Total T higher to achieve healthy Free T.
 
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C-reactive protein is likely elevated giving you a false high E2 value.


The top 25 percentile reduces prostate cancer risk by 53% and heart attack risk 30%. The majority of me should maintain 550> ng/dL who have low-midrange SHBG. Men with higher SHBG may need to get Total T higher to achieve healthy Free T.
Thanks @Systemlord. With respect to the E2, I'm assuming that I have converted it from 104.0 pmol/L correctly using this calculator.

I don't know much about C-reactive protein but I can get that checked. I used to have high liver enzymes due to glandular fever over 30 years ago but that has since settled down. However, even if there is an issue there, I know that in the past, without taking an AI, I have felt utterly dreadful and my E2 levels were literally three times higher than that reading.

And with a potentially low testosterone level I'm looking at increased prostate cancer and heart attack too?! Could Christmas be more merry? (Laughing emoji!)
 
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It seems unlikely that you would experience a rapid return of LH production after pausing TRT. Another explanation for your feeling better is that your testosterone level drifted down through a range that is more natural and appropriate for you. While the full picture is unlikely to be this simple, it is true that excessive dosing of testosterone accounts for a lot of misery. Virtually all guys who develop hypogonadism did not need an aromatase inhibitor when they were eugonadal. So why should they need one if they simply start replacing the missing testosterone? It's mainly because most end up using more testosterone than they ever made naturally. Beyond that, hCG use complicates the situation, as it stimulates estradiol production, and hCG's long half-life means it's not possible to reproduce normal LH activity.

For some perspective on your dosing, if you're taking 125 mg/week of Sustanon 250 then you are taking in twice as much testosterone as the average healthy young guy makes naturally. If I were you I would want to revert to the preferred low-and-slow approach. This means something like 60-80 mg/week Sustanon 250 in divided doses, and at most 500 IU/week hCG, also in divided doses. No AI. Unfortunately, reducing the dose can temporarily lead to a return of symptoms. But it is worth riding this out so that you can fairly evaluate how you feel with levels that are more physiological.
Would it be possible for you moderators to Pin a "recommemded" beginners starting protocol based on "forum consensus" /"experience - ie this kinda post.
I absolutely appreciate we/you are not Drs, and this would not be deemed "medical advice", but is the collective findings of many forum users.
At least newbies could make judgement on the Dr's recomendations, maybe seek alternative Drs if they
judge them to be outdated or bad practise ?
just a thought ? Seems high dosing is all to common a practise.
Appreciate may be legal implications .

whoops found Nelsons fantastic clinical guide - may i suggest an update to a more conservative 60mg/wk x3 a week as baseline starting point, as per Catecous recomendations above - low & slow ?

Testosterone Cypionate Injections:

100 mg per week or 50 mg twice per week. Check TT and FT at follow up (week 6 0r 8) and titrate dose to achieve TT >600 ng/dL Max dose: 250 mg/week (or 125 mg twice per week). Injections are performed using a 26 or 27 gauge ½ inch insulin syringe subcutaneously on the abdominal area or intramuscularly on glutes, shoulders or hamstrings.
 
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