Maintaining LH & FSH on TRT

[BigJahnny]

Hello,

I’m curious how a man can maintain optimal LH and FSH levels while on TRT? Is it possible to be on testosterone injections and a fertility drug and still be able to maintain good LH and FSH numbers ?
I keep seeing postings from people who are going to primebody anti aging clinic and they have optimal testosterone levels and still have good LH and FSH numbers.

I’ve previously been on testosterone injections and hcg, testosterone and clomid and now just clomid and hcg and I’ve still had extremely low LH and FSH.
I’m just curious if proper LH and FSH numbers can be achieved while on trt and if so, how ?

 

[Cataceous]

I wasn't aware that Primebody was into this. Any links to sample protocols? What I have seen is Royal Medical Center giving infrequent very large doses of gonadorelin. Their results suggest that this does lead to normal FSH and LH in those on TRT, at least for a limited period after each injection. What's less clear is whether the subjective results are at all comparable to those seen when using hCG, or when using somewhat more realistic dosing of gonadorelin. Normally men have more like 10-20 pulses of LH each day. It seems questionable that eliciting two pulses a week with very large amounts of gonadorelin is remotely similar.

The reason why you haven't been able to maintain LH and FSH on TRT is because androgens independently provide negative feedback to the hypothalamus, suppressing GnRH production. GnRH is the signal to the pituitary to make LH. Estrogens create negative feedback at both the hypothalamus and the pituitary, but this can be blocked with a SERM such as Clomid.

 

[MjPep71]

I do not have adverse reactions to HCG, just not getting much results (gone as high as 500iu 3x per week). I know Nelson said Kisspeptin -10 is a waste of time and I can’t find anyone on any forum who has stated that it did or didn’t work for them in regards to TRT. My thought is why not give it a try as the cost is reasonable and is not reported to have side effects. I also read that gonadorelin and HCG should not be done at the same time. Has anyone experimented with this? I’m always suspicious that maybe my HCG wasn’t a good batch etc. as I know some people find it works great for them. I’m due for bloodwork soon so ill wait to see where I’m at and then I’m planning on adding 25mg of Clomid to see what happens. HCG / Clomid / Gonadorelin / Kisspeptin ??? Anyone do combinations of any of these with any success in maintaining levels / testicle size and increased volume?

 

[Cataceous]

I used hCG prior to and during my transition to gonadorelin. I assume the effects could be somewhat additive. One of the goals of the exercise was to find a better alternative to hCG, which is unnaturally long-acting compared to LH. I found that the combination of gonadorelin and enclomiphene prevented testicular atrophy and preserved fertility while I continued with TRT. However, there aren't many guys interested in multiple daily injections of gonadorelin, which may be necessary to get the best results. For me the results have been worthwhile, and I'm about to start my third year of the treatment.

 

[MjPep71]

Thanks Cataceuos - I just read some of your previous threads that helped also. Appreciate it. Going to try and be patient and wait for the next round of blood and then try adding the Clomid. Sounds like 12.5 or 25mg eod is going to be best to start. It’s already on the way otherwise i would have tried to get the Enclomiphene.

 

[Phil Goodman]

I used hCG prior to and during my transition to gonadorelin. I assume the effects could be somewhat additive. One of the goals of the exercise was to find a better alternative to hCG, which is unnaturally long-acting compared to LH. I found that the combination of gonadorelin and enclomiphene prevented testicular atrophy and preserved fertility while I continued with TRT. However, there aren't many guys interested in multiple daily injections of gonadorelin, which may be necessary to get the best results. For me the results have been worthwhile, and I'm about to start my third year of the treatment.

Interested in some aspects of this and would like to pick your brain since I think you’re the only one I’ve seen stick with this type of protocol(pun only slightly intended).

How would you compare gonadorelin to HCG(as far as effects, as I know the frequency/process will be very different)?

I am not opposed to trying gonadorelin, especially if HCG continues to be an issue. But even if both are available I wouldn’t mind going with gonadorelin if the benefits are good enough to warrant the consistent application. With that being said, do you still use it along with enclomiphene or just by itself? Also, what do you think is the minimal amount of times to apply and still see meaningful benefits? Would once/day be worth it? I could probably do multiple times/day Fri.-Mon. and then twice/day Tues.-Thurs. I imagine that would be enough to see good benefits, but have never looked into the studies or pharmacology of it so I would like to hear from someone with so much firsthand experience.


Also, as a heads up you’ll probably be getting more questions like this since the Defy email was sent out today about issues with HCG and the types of alternatives they will provide.

 

[Cataceous]

...
How would you compare gonadorelin to HCG(as far as effects, as I know the frequency/process will be very different)?

I am not opposed to trying gonadorelin, especially if HCG continues to be an issue. But even if both are available I wouldn’t mind going with gonadorelin if the benefits are good enough to warrant the consistent application. With that being said, do you still use it along with enclomiphene or just by itself? Also, what do you think is the minimal amount of times to apply and still see meaningful benefits? Would once/day be worth it? I could probably do multiple times/day Fri.-Mon. and then twice/day Tues.-Thurs. ...

As background to others: hCG is nominally replacing the LH that's suppressed under TRT. GnRH is the upstream hormone to LH, and is also suppressed under TRT. One hypothesis is that GnRH has wider importance, as evidenced by the appearance of receptors for it in a variety of locations outside of the pituitary. Gonadorelin is synthetic GnRH, and I use it in an attempt to replace the missing GnRH. For me this correlated with improved sexual function, a recovery of libido and a noticeable improvement in cognition.

I've commented that while I initially did well with hCG added to TRT, as time went by I could not achieve the right balance. The hCG would raise my estradiol by ~20 pg/mL, which may then have pushed up prolactin, leading to sexual side effects. I experimented with both anastrozole and cabergoline, but the results were lackluster at best.

For me at least, enclomiphene must be used with gonadorelin to stimulate LH production. I've made a couple attempts at reducing or eliminating it, but each time the subjective and objective results deteriorated. The worry with enclomiphene is that in some guys it may actually create an imbalance. This speculation is brought about by the inconsistent subjective results seen in guys on monotherapy. If synthetic LH were affordable and available then I wouldn't hesitate to try adding it to the gonadorelin while foregoing the enclomiphene.

I don't know the minimum frequency of gonadorelin delivery needed to provide adequate results. If GnRH does indeed do useful things beyond make LH then any daily exposure could still be better than none. I think the 5-6 doses a day I use provide benefits even though it's not close to the natural ~16. It's possible that 2-3 doses wouldn't be much different. I recently heard that it may be possible to obtain gonadorelin as a nasal spray. If so this would potentially make frequent dosing more palatable.

 

[Systemlord]

I’ve previously been on testosterone injections and hcg, testosterone and clomid and now just clomid and hcg and I’ve still had extremely low LH and FSH.

This may be indicating a pituitary problem.

 

[Cataceous]

...
I’ve previously been on testosterone injections and hcg, testosterone and clomid and now just clomid and hcg and I’ve still had extremely low LH and FSH.
...

This may be indicating a pituitary problem.

Or not. Every one of those treatments can be suppressive. Using Clomid alone is the way to find out.

 

[TRicker]

I wasn't aware that Primebody was into this. Any links to sample protocols? What I have seen is Royal Medical Center giving infrequent very large doses of gonadorelin. Their results suggest that this does lead to normal FSH and LH in those on TRT, at least for a limited period after each injection.

Do you know the dosages/frequency RMC uses of Gonadorelin?
Also, how much is too much, as I've heard it can have the opposite effect in very high dosages? I could be wrong on that though.
I believe you use 20mcg of gonadorelin 5x/day, with 12.5mg of enclomiphene per day, along with your TRT, if I'm correct?

My clinic is now replacing hcg with clomiphene, and I have a feeling they are going to have a lot of unhappy patients. They also charge ~$400 for a 3 month supply of clomiphene, so this whole 'compounding hcg being illegal' situation is going lose them business.

 

[Cataceous]

Do you know the dosages/frequency RMC uses of Gonadorelin?
Also, how much is too much, as I've heard it can have the opposite effect in very high dosages? I could be wrong on that though.
I believe you use 20mcg of gonadorelin 5x/day, with 12.5mg of enclomiphene per day, along with your TRT, if I'm correct?

My clinic is now replacing hcg with clomiphene, and I have a feeling they are going to have a lot of unhappy patients. They also charge ~$400 for a 3 month supply of clomiphene, so this whole 'compounding hcg being illegal' situation is going lose them business.

We learned about and discussed the RMC protocol here. It is probably 50-100 mcg given twice a week. In the literature the highest pulsed dose I've seen is 30 mcg, with 5-20 more typical. I do take 20 mcg 5x/day. Jason Sypolt describes problems occurring when guys take isolated doses of 500 mcg. Isolated overdoses like this may or may not yield the "opposite effect." Such injections usually would not do this because of the very short half-life—though at 500 mcg, who knows. What is known is that a constant infusion of GnRH disables the HPTA. This led to the development of long-lived GnRH analogs, such as triptorelin. Even infrequent injections of such drugs lead to chemical castration.