Long-Term HCG Monotherapy Results

[obesechess]

Hi folks,

Longtime lurker, first time poster. I see some familiar names here, though I tend to use different names on different forums.

I am 34 years old. I've been on HCG Monotherapy for almost seven years now, starting in January of 2017. I was on clomid from 2014-2017, but we could never get my estrogen under control, so we switched to HCG mono. It has generally been smooth sailing - I get blood work every six to twelve months and each time, my test levels are in the 550+ ng/dL range, estrogen in the low to mid twenties, no side effects, feeling great generally.

At my most recent set of annual blood work, however, my numbers were as follows:
Total T: 378ng/dL
e2 17ng/mL

This seemed low, and my lipid values were a bit high (I've kept almost 100lbs off for a decade and am in the process of trying to drop another 20 as advised after this recent workup).

So, I dropped about five pounds and went back in for a more complete workup this past weekend:
Total T: 340ng/dL (continuing to decrease)
Free T: 88pg/mL
% Free Test: 2.6
SHBG: 14nmol/L (low)
E2: 2pg/mL (Yes, 2. I am fairly confident that this is wrong - my E2 seems to randomly drop into the single digits once a year)
Prolactin: 5.9ng/mL

I am curious as to what to explore next with my doctor. We've got a call booked for next weekend and I want to be as informed as possible. I'm not really having any "symptoms" per se - I'm not having serious performance issues in the bedroom, I'm not having trouble losing weight or gaining muscle etc, but of course if things can be optimized and made better I would like that. My doctor is great and I trust him, I just want to be informed. I would prefer to stay on the HCG or adjacent (non-TRT) route for as long as possible, but I do regard TRT as an inevitability at some point.

My thought here is that I am on a pretty low dose of HCG - 2000iu a week - so I’m thinking the first order of business (other than continuing to lose weight) should be to up that a bit, which is a bummer because it’s doubled in price over the past year.

But, you folks seem knowledgeable, so I figure I'd consult with y'all for anything we may be missing and worth bringing up.

Cheers!

 

[obesechess]

Alright, I've got an idea.

I have read a few studies suggesting that tamoxifen citrate (Nolvadex) may have a synergistic effect in increasing testosterone in the case of long-term HCG monotherapy as it can block desensitization of the leydig cells (example: Tamoxifen suppresses gonadotropin-induced 17 alpha-hydroxyprogesterone accumulation in normal men. Smals AG, Pieters GF, Drayer JI, Boers GH, Benraad TJ, Kloppenborg PW. J Clin Endocrinol Metab. 1980 Nov;51(5):1026-9) and has a different mechanism of action in increasing exogenous testosterone. Might ask my doctor about throwing that into the mix.

Let me know if I'm nuts.

 

[sammmy]

You have a decent free T and you don't have any symptoms of low free T. I wouldn't fuck that up by "optimizing" anything.

You can probably increase your SHBG by further weight loss. Then your circulating total T will also increase. The free T may or may not increase.

 

[obesechess]

You have a decent free T and you don't have any symptoms of low free T. I wouldn't fuck that up by "optimizing" anything.

You can probably increase your SHBG by further weight loss. Then your circulating total T will also increase. The free T may or may not increase.

I appreciate the perspective! I recently started taking a supplement containing boron, which can lower SHBG, so I may drop that as well. My apologies for not mentioning that in the original post.

In the interest of completeness, the only other supplements I take are a stim-free preworkout, fish oil, a multivitamin, zinc and magnesium at night, l-methylfolate, and creatine. I am currently around 25% BF per a bodpod scan, hoping to get down to 17%.

Again, thanks for the insight.

 

[Systemlord]

Men on high dose hCG mono therapy tend to see a decline in levels over time. I realize high dose is relative to whom we are talking about, because our tolerances to these compounds are very individual.

The 550 ng/dL previous was good, however the 340’s for someone on hormone replacement therapy, I can’t understand how this translates in being a good level.

If you stay at these levels long enough, maybe not right away, but you may notice a decline in the way you feel over time.

The weight loss would typically see a reduction in aromatase enzymes, which resides in visceral fat tissue, and therefore a decrease in estrogen.

A double whammy, your testosterone is lower than previously, as is your estrogen and for this reason I think your estrogen value is accurate.

Just out of curiosity, why are you resistant to TRT?

 

[obesechess]

Men on high dose hCG mono therapy tend to see a decline in levels over time. I realize high dose is relative to whom we are talking about, because our tolerances to these compounds are very individual.

The 550 ng/dL previous was good, however the 340’s for someone on hormone replacement therapy, I can’t understand how this translates in being a good level.

If you stay at these levels long enough, you may notice a decline in the way you feel over time and not right away.

Just out of curiosity, why are you resistant to TRT?

Eyyy, there’s a familiar name! And yeah, I mean, I certainly don’t feel as good as I did at 550 but I also don’t feel as bad as I did at, uh, 97. It’s very fuzzy, like I can’t articulate the specifics I just feel like I’m not feeling as good as I could be. But that could be unrelated to my testosterone!

a few reasons re TRT, but the biggest one is that my doctor - who is a very qualified doctor at a local research hospital who specializes in treating hypogonadism in men under 50, I found him via T-Nation and have been working with him for many years - is not sold on the efficacy of TRT+HCG for preserving fertility and I’m not sold on whether or not I’m going to want kids.

Your above comment about declining levels over time is what interested me in the tamoxifen - I assume that the declining levels are due to desensitization of the leydig cells, or whatever mechanism by which that happens is at least related, so if I can fix that in a comparatively cheap and easy way I’d want to experiment with that first.

Cheers!

 

[Guided_by_Voices]

A few ideas...
- I believe zinc inhibits aromatase so you might want to reduce that. If you're eating a lot of beef as you should be, you should be getting zinc there.
- As a low aromatizer myself, there are a lot of things that may reduce aromatase (melatonin being another) so I would be aware of anything you are taking and whether it could be a risk
- If you are putting the body into a "starvation-like" state of stress via calorie restriction alone as a way to lose "weight" (which should be "lose fat") that in itself could explain the lower T which could in turn explain the lower E. I would attempt to lose fat by moving your diet in a carnivore-esque direction, eliminating seed oils and a-cellular carbs (anything with flour or sugar or otherwise processed), adding some walking, and eating within an 8 hour window, and see how that goes.
- BTW, congratulations on such a large sustained fat loss! Very few people are able to accomplish that.
In general, there are a lot of things that could be in play beyond sex hormones.

 

[obesechess]

A few ideas...
- I believe zinc inhibits aromatase so you might want to reduce that. If you're eating a lot of beef as you should be, you should be getting zinc there.
- As a low aromatizer myself, there are a lot of things that may reduce aromatase (melatonin being another) so I would be aware of anything you are taking and whether it could be a risk
- If you are putting the body into a "starvation-like" state of stress via calorie restriction alone as a way to lose "weight" (which should be "lose fat") that in itself could explain the lower T which could in turn explain the lower E. I would attempt to lose fat by moving your diet in a carnivore-esque direction, eliminating seed oils and a-cellular carbs (anything with flour or sugar or otherwise processed), adding some walking, and eating within an 8 hour window, and see how that goes.
- BTW, congratulations on such a large sustained fat loss! Very few people are able to accomplish that.
In general, there are a lot of things that could be in play beyond sex hormones.

Hi there! Thanks for hopping in.

I’ll address these in order:
re 1 and 2, if I understand you correctly, zinc and other things I may be taking may be inhibiting aromatization, explaining the low e2. This is possible but as the e2 has been low-ish about once a year since I started getting blood work every 6 months I am inclined to regard it as a fluke, especially since with no other changes to supplementation it was in the high teens last month (though I concede that that’s still lower than normal). I will keep this in mind as something to discuss with the doctor.
re 3 I am indeed at a caloric deficit, but I’m also doing cardio and have been doing IF for years with good results (I have a ten hour eating window vs 8 just due to my schedule). I have tried ketogenic diets and other such extremely low carb diets in the past and have felt very bad on them and didn’t notice a significant difference in weight loss, so I tend to avoid them, however my diet is generally very good: I generally live on lean meats, legumes, brown rice, oats, and fresh fruits and vegetables. I generally avoid processed foods, fried foods, sweets, snacks, etc. - I am going to see if I can get my hands on a CGM to make monitoring this stuff easier, though.
Re 4, thanks! You’ll all be shocked to learn that it takes hard work and discipline to build sustainable healthy habits, I’m sure.

So, yeah, it could be a number of external factors influencing things and maybe once those get sorted out I’ll be back into the normal range - I just don’t really love that 340 number nor that, uh, 2.

 

[obesechess]

Doctor says no tamoxifen, he doesn't use it. He wants me to drastically increase my HCG dose and drop anastrozole. I have proposed something different, because they cannot keep my dumb ass off of PubMed.

This study found that daily, small doses of HCG not only prevent your leydig cells from being desensitized, but actually INCREASES leydig cell sensitivity and prevents estrogen accumulation and aromatization.

Differential effect of single high dose and divided small dose administration of human chorionic gonadotropin on Leydig cell steroidogenic desensitization - PubMed

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. Administration of a single high dose of hCG to seven healthy men raised the mean plasma...

pubmed.ncbi.nlm.nih.gov

So I am going to try my current dose but split up daily and drop the anastrozole entirely (assuming he does not say "what the hell are you doing, get off of PubMed you idiot").

I am thinking this has the benefit of being very close to my current protocol but dosed more evenly, preventing peaks and valleys, less stuff in my system (no more anastrozole), and seems to have a good scientific backing. As always you are all welcome to call me an idiot, but "very slightly modifying my dose schedule" seems like a good small step in the right direction.

 

[Guided_by_Voices]

Doctor says no tamoxifen, he doesn't use it. He wants me to drastically increase my HCG dose and drop anastrozole. I have proposed something different, because they cannot keep my dumb ass off of PubMed.

This study found that daily, small doses of HCG not only prevent your leydig cells from being desensitized, but actually INCREASES leydig cell sensitivity and prevents estrogen accumulation and aromatization.

Differential effect of single high dose and divided small dose administration of human chorionic gonadotropin on Leydig cell steroidogenic desensitization - PubMed

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. Administration of a single high dose of hCG to seven healthy men raised the mean plasma...

pubmed.ncbi.nlm.nih.gov

So I am going to try my current dose but split up daily and drop the anastrozole entirely (assuming he does not say "what the hell are you doing, get off of PubMed you idiot").

I am thinking this has the benefit of being very close to my current protocol but dosed more evenly, preventing peaks and valleys, less stuff in my system (no more anastrozole), and seems to have a good scientific backing. As always you are all welcome to call me an idiot, but "very slightly modifying my dose schedule" seems like a good small step in the right direction.

Ultimately, there is no substitute for trial and error, hopefully guided by reasonable hypotheses. We don't know exactly what is going on in the body or what outcomes will result without experimentation.

 

[obesechess]

Totally, yeah. Also, I swore I wrote more in the above post.

So, basically, I'm at 2,000iu right now, injected as 1,000iu twice a week. The doctor wants me to go up to 2,500iu twice a week (5000iu weekly). This is a non-starter for the simple fact that a 10000iu vial has just doubled in price at Costco up to $260 and I don't have an extra $520 kicking around every month. For financial reasons, I can't do 5,000iu a week no matter what.

However, my thinking is that by injecting 300iu a day, I keep the weekly dosage almost static (2,100iu vs 2,000) but smooth out the peaks and valleys since HCG has a 30 hour half life, and theoretically I don't run into the same level of leydig cell desensitization caused by too much 17 alpha-hydroxyprogesterone.

Oh yeah, and it looks like too much 17 alpha-hydroxyprogesterone can also cause insulin resistance and difficulty losing weight, which, if I am right, would explain why I've had so much trouble getting the last 15-20lbs off. Obesity-induced excess of 17-hydroxyprogesterone promotes hyperglycemia through activation of glucocorticoid receptor

So, this minor adjustment feels very low-risk, high-reward. I'm gonna keep reading up before I have to start cooking.

 

[obesechess]

Anecdotal could-be-placebo results after four days of 300iu a day: holding surprisingly little water after a big holiday meal, libido through the roof.

 

[obesechess]

Alright, doctor is on board with my plan - I found a few more studies regarding the benefits of smaller, more regular doses, too, so that's also encouraging. We are going to re-test in a month. Also 2500iu twice a week was a typo on their end, thank goodness. If my current change to the dosing protocol doesn't work we are going to bump up to 2500 weekly - basically keep gradually increasing and re-testing to a certain point, which I think is the right approach. I'll check back with everyone in a month. If we don't see a good change at 2500iu/wk, we will look into other options.

Anecdotally, I cannot highly enough recommend smaller doses of HCG more regularly to anyone reading this thread who is either on, or considering, HCG monotherapy. This was a very good decision.

 

[Bob62]

The primary cause of the low T before you even started HCG is relevent now. If you had primary hypogonadism then the underlying cause may be progressing .
Also assuming you have confidence in the potency of your HCG batch . You may want to do a serum HCG level at peak about 6 hours after your shot to ensure you are getting reasonable serum HCG levels.
Tks the link for the adjusted daily dose protocol for HCG , interesting.

 

[obesechess]

This is all without consulting all the notes I took at the time of diagnosis so details may be wrong or spotty, but my recollection is that I am primary. I believe that my LH and FSH were always "normal" but on the low end of normal - not in a way that suggested anything wrong with the hypothalamus or pituitary, and I had no other symptoms of dysfunction in either place. I was, however, over the course of my life starting in first grade and going through college, hospitalized about a half dozen times for testicular torsion and varioceles, and that's not counting how many shots to the nuts I took doing wacky stunts and/or getting in fights, so it's likely that there was some structural damage to the testicles that caused them to produce testosterone less efficiently.

One week in and my anecdotal thoughts since adjusting the dosing protocol, with no other changes to dose, diet, exercise, etc, just dosing 300iu/day intead of 1000iu twice a week: I seem to be putting on strength more quickly at the gym, I still seem to be retaining a lot less water, and I would casually describe my libido as "distracting." With the usual disclaimer that this could all be placebo, I am very interested to see what the blood work says next month.

Quick Edit re the above: I realize that "seem to be putting on strength more quickly" is particularly nebulous after one week, what I mean is that I normally try to add at least 5lbs to every lift every week and this past week I've tried for adding 10+ with good success. Again, I am willing to concede that that could have happened either way, but that's what I mean.

 

[Jucaro]

This is all without consulting all the notes I took at the time of diagnosis so details may be wrong or spotty, but my recollection is that I am primary. I believe that my LH and FSH were always "normal" but on the low end of normal - not in a way that suggested anything wrong with the hypothalamus or pituitary, and I had no other symptoms of dysfunction in either place. I was, however, over the course of my life starting in first grade and going through college, hospitalized about a half dozen times for testicular torsion and varioceles, and that's not counting how many shots to the nuts I took doing wacky stunts and/or getting in fights, so it's likely that there was some structural damage to the testicles that caused them to produce testosterone less efficiently.

One week in and my anecdotal thoughts since adjusting the dosing protocol, with no other changes to dose, diet, exercise, etc, just dosing 300iu/day intead of 1000iu twice a week: I seem to be putting on strength more quickly at the gym, I still seem to be retaining a lot less water, and I would casually describe my libido as "distracting." With the usual disclaimer that this could all be placebo, I am very interested to see what the blood work says next month.

Thanks. Keep us updated!

 

[Bob62]

This is all without consulting all the notes I took at the time of diagnosis so details may be wrong or spotty, but my recollection is that I am primary. I believe that my LH and FSH were always "normal" but on the low end of normal - not in a way that suggested anything wrong with the hypothalamus or pituitary, and I had no other symptoms of dysfunction in either place. I was, however, over the course of my life starting in first grade and going through college, hospitalized about a half dozen times for testicular torsion and varioceles, and that's not counting how many shots to the nuts I took doing wacky stunts and/or getting in fights, so it's likely that there was some structural damage to the testicles that caused them to produce testosterone less efficiently.

One week in and my anecdotal thoughts since adjusting the dosing protocol, with no other changes to dose, diet, exercise, etc, just dosing 300iu/day intead of 1000iu twice a week: I seem to be putting on strength more quickly at the gym, I still seem to be retaining a lot less water, and I would casually describe my libido as "distracting." With the usual disclaimer that this could all be placebo, I am very interested to see what the blood work says next month.

Quick Edit re the above: I realize that "seem to be putting on strength more quickly" is particularly nebulous after one week, what I mean is that I normally try to add at least 5lbs to every lift every week and this past week I've tried for adding 10+ with good success. Again, I am willing to concede that that could have happened either way, but that's what I mean.

Thanks the info. In which case you may be looking at the original testicular failure whatever the cause catching up ,not HCG downregulation per se. In any case hope adjust dose and or protocol helps. If not at least you know next step likely to be test based TRT if needed

 

[obesechess]

Six month update. I made no changes to my protocol other than dosing 300iu daily as described above for the reasons outlined in the studies above. I mentioned I felt great and the numbers bear that out:

Total T 707
e2 39 (a little high but proportionately fine and I’m having no side effects that indicate elevated e2, ie moodiness, sore nips, etc)

So, in my little n=1 study I’d say dosing every day is the way to go.

 

[Systemlord]

Total T 707
e2 39 (a little high but proportionately fine and I’m having no side effects that indicate elevated e2, ie moodiness, sore nips, etc)

The normal ranges for estrogen were derived from men with a total testosterone under 500, therefore your estrogen is not a little high given that your total testosterone is 707.

 

[obesechess]

The normal ranges for estrogen were derived from men with a total testosterone under 500, therefore your estrogen is not a little high given that your total testosterone is 707.

True! I meant it is higher than it historically has been for me and outside of the “normal” reference ranges for this lab, but you’re right, that context is important.