Trying HCG once more - dosage and advice?

[smokedsalmon]

I've done poorly the last couple times I tried HCG, but my girlfriend and doctor and I decided to give it one more shot to help preserve fertility in the coming years. Plus, this is the first year that I've learned to leave my T cyp dose alone, and have really positive/consistent results.

I inject 150mg/week (daily). I have seen some fluctuation in my levels between bottles, but I don't mess with it as I feel great. My TT is higher than I'd like, but as I discussed with my dr, I don't want to chase a number if I'm feeling fine. I should also add that I've never had an issue with high E2, even when it was at 60 on 200mg/week. Here's my most recent bloodwork:

My dr (Dr Michael Rotman) suggested 1000IU/week. I believe Dr Saya originally prescribed me 900IU/week. Both times I've tried it, I felt bloated, red, my blood pressure spiked, I was anxious, and my sleep and libido suffered. But I'm in a more stable place now so I promised the girlfriend I'd try once more for a couple of weeks.

Any suggestions on dosing or anything else to consider? I was considering lowering my T dose at the same time, but now thinking I should just add a little HCG, see how it goes, and then check my levels in a few months rather than changing multiple things at once. Learned that lesson!

Thanks for any advice guys.

 

[madman]

I've done poorly the last couple times I tried HCG, but my girlfriend and doctor and I decided to give it one more shot to help preserve fertility in the coming years. Plus, this is the first year that I've learned to leave my T cyp dose alone, and have really positive/consistent results.

I inject 150mg/week (daily). I have seen some fluctuation in my levels between bottles, but I don't mess with it as I feel great. My TT is higher than I'd like, but as I discussed with my dr, I don't want to chase a number if I'm feeling fine. I should also add that I've never had an issue with high E2, even when it was at 60 on 200mg/week. Here's my most recent bloodwork:

View attachment 10831
View attachment 10832

My dr (Dr Michael Rotman) suggested 1000IU/week. I believe Dr Saya originally prescribed me 900IU/week. Both times I've tried it, I felt bloated, red, my blood pressure spiked, I was anxious, and my sleep and libido suffered. But I'm in a more stable place now so I promised the girlfriend I'd try once more for a couple of weeks.

Any suggestions on dosing or anything else to consider? I was considering lowering my T dose at the same time, but now thinking I should just add a little HCG, see how it goes, and then check my levels in a few months rather than changing multiple things at once. Learned that lesson!

Thanks for any advice guys.

Although your TT is very high almost 1500 ng/dL and seeing as you are injecting daily (minimized peak--->trough) I see no issues if you feel well overall and are not experiencing any sides but even then I would be more concerned with where your FT sits as I bet it is much higher than you think.

You are relying on the outdated linear law-of-mass action calculated Vermeulen method.

If anything you should be testing it using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration to truly know where your TT sits on such protocol.

Again if you feel well overall and blood markers are healthy then that is what truly matters.

Just keep in mind that if you plan on adding hCG than you easily have room to lower your dose slightly and bring down your FT as adding in the hCG (depending on the dose used) may very well drive your FT levels up higher which would not be needed.

Doubtful you would feel worse off if your TT/FT levels were slightly lower.

Seeing as your TT/FT levels are already high then I would add in a lower dose of hCG to start with.

 

[madman]

Stop wasting your time when getting labs and use the right testing method for FT!

Total and Free Testosterone Test Panel plus Hematocrit

Lowest Cost Hematocrit, Total and Free Testosterone Test Panel for Men on TRT

www.discountedlabs.com

Where does your hemoglobin/hematocrit sit on such protocol?

 

[Vince]

I agreed with madman, if you’re feeling good, don’t mess with it.

I am somewhat surprised that you’re feeling so good at that high level.

I also wonder, what your hct running at?

 

[smokedsalmon]

Although your TT is very high almost 1500 ng/dL and seeing as you are injecting daily (minimized peak--->trough) I see no issues if you feel well overall and are not experiencing any sides but even then I would be more concerned with where your FT sits as I bet it is much higher than you think.

You are relying on the outdated linear law-of-mass action calculated Vermeulen method.

If anything you should be testing it using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration to truly know where your TT sits on such protocol.

Again if you feel well overall and blood markers are healthy then that is what truly matters.

Just keep in mind that if you plan on adding hCG than you easily have room to lower your dose slightly and bring down your FT as adding in the hCG (depending on the dose used) may very well drive your FT levels up higher which would not be needed.

Doubtful you would feel worse off if your TT/FT levels were slightly lower.

Seeing as your TT/FT levels are already high then I would add in a lower dose of hCG to start with.

I agreed with madman, if you’re feeling good, don’t mess with it.

I am somewhat surprised that you’re feeling so good at that high level.

I also wonder, what your hct running at?

Thanks guys. I'm shocked I don't feel anxious and angry at this dose. I also feel it may be inaccurate as my FT and E2 are much lower than they were when my TT came back at 1500 on 200mg/week. This test was done by my urologist, using an unknown lab out of his office. I have a physical this week, so I may ask for them to test my levels. Although I'm not trying to get "feedback" (aka "lower your dose mister!!") from TRT irrelevant doctors.

Here's my blood markers. My HCT actually went down from when my TT came back at 833 last time, and that was on 182mg/week. So again, I wonder if the test was inaccurate. When it was at 1500, I was lashing out at everyone and constantly anxious.

I think I may see if my TT was even accurate before trying HCG again. If it's not really 1400, then I may keep my T dose where it is as that takes so much longer to adjust.

 

[madman]

Thanks guys. I'm shocked I don't feel anxious and angry at this dose. I also feel it may be inaccurate as my FT and E2 are much lower than they were when my TT came back at 1500 on 200mg/week. This test was done by my urologist, using an unknown lab out of his office. I have a physical this week, so I may ask for them to test my levels. Although I'm not trying to get "feedback" (aka "lower your dose mister!!") from TRT irrelevant doctors.

Here's my blood markers. My HCT actually went down from when my TT came back at 833 last time, and that was on 182mg/week. So again, I wonder if the test was inaccurate. When it was at 1500, I was lashing out at everyone and constantly anxious.
View attachment 10842

I think I may see if my TT was even accurate before trying HCG again. If it's not really 1400, then I may keep my T dose where it is as that takes so much longer to adjust.

Post# 3 re-test using an accurate assay for FT which also includes TT (LC/MS-MS).

 

[rayrock1]

Did Dr Rotman put you on daily injections at 150mg/week or did you get to that protocol/dose yourself by experimenting on how you felt? will you be injecting daily the HCG as well?

 

[smokedsalmon]

Did Dr Rotman put you on daily injections at 150mg/week or did you get to that protocol/dose yourself by experimenting on how you felt? will you be injecting daily the HCG as well?

Got there myself back when I was seeing Dr Saya. So I'm figuring HCG every other day.

 

[Ardoc2]

Salmon, I am 3 months into an experiment with daily low dose HCG that seems to be going well so far. I became sensitive to HCG, after using it for years without noticeable issues (very similar to what you describe). I decided to try one more time at a low daily dose of 50iu/day. My expectation was that i would titrate up slowly to hopefully find an amount that gave me the libido boost, testicular size, feeling of well-being etc without bringing on the sides. I found that 50iu started to give these benefits after about 2 months including an increase in testicle size. They are not as big as when I was doing the higher HCG on a consistent basis but seem reasonably close. I have been happy so far to the point that I don't think I will increase the dose unless/until the benefits diminish.

 

[rayrock1]

is there an effective min dosage of hcg? or can it be administered, broken up in as many doses per week as desired. I am on 600iu's a week. my Dr said to inject twice weekly, not on same day as T.C, he stated because its too much of an estrogen rush,. He told me to inject the day before my Test.injection day. my question. to lower e2 values, can I inject 2 days before 150 i's each and still be effective?

 

[Ardoc2]

Personally, I don't know the answer to that, and I kinda doubt there is a definitive answer (hopefully Madman or another knowledgeable member can provide you some direction). I had heard there may be a minimum threshold with numbers like 100iu - 150iu being the minimum effective amount per injection but I don't know how to qualify that? In fact these threshold numbers were why i chose 50iu/daily to start, assuming it to be an ineffectual dosage and that i could introduce that amount without sides and slowly titrate up to see if i could get the positives without the sides. So far at least, 50iu seems to have made an improvement in my case. (Placebo??)

 

[Deleted member 16042]

A couple years ago, the late Dr Crisler changed his opinion about dosing HCG. The outdated "Crisler protocol" he advocated in 2004 was generally T dosing 1x/week and HCG a couple days before next T injection.

However, he pretty well abandoned weekly T dosing for more frequent smaller doses subQ, and changed his tune to HCG daily: Should Men on Testosterone Test Their Free Estradiol ?

That older protocol is considered extinct, gone the way of the dodo, but I am not surprised to see something similar suggested here again. History repeats itself and old adages die hard.

Some men take Dr Saya's small study showing blood levels of HCG based on dose to mean higher doses are better, but that's not what he actually said in his narrative/interpretation of his results.

So what's the best? The opinions and results are still all over the map for different individuals. Vince likes 500iu 2/week and has done well on this for years. I tried that and had terrible estrogen swings. Now I am using 150iu coadministered with T cyp EOD, but might do even better on less QD.

The way to find out what works for you is to try different things, give each new dosage adjustment ample time, so that you are not chasing your tail. In this regard, I think it's great how Ardoc is approaching it.


To the OP... salmon: I believe your weekly T dose is much too high. It puts your free T much higher than necessary, is prone to drive high hematocrit, and E2. And though there is probably a saturation point in terms of T shutting down LH and the subsequent effect on testes, more T ain't better past that point, and trying to dose enough HCG to make testes feel better while avoiding high E2, is problematic. I've been through something similar myself, and what worked was reducing T, and HCG doses. It took along time to iron out dosages that brought my Free T and E2 into tolerable and beneficial range. And reductions are not easy, in fact dabbling in withdrawal Hell.

 

[smokedsalmon]

Salmon, I am 3 months into an experiment with daily low dose HCG that seems to be going well so far. I became sensitive to HCG, after using it for years without noticeable issues (very similar to what you describe). I decided to try one more time at a low daily dose of 50iu/day. My expectation was that i would titrate up slowly to hopefully find an amount that gave me the libido boost, testicular size, feeling of well-being etc without bringing on the sides. I found that 50iu started to give these benefits after about 2 months including an increase in testicle size. They are not as big as when I was doing the higher HCG on a consistent basis but seem reasonably close. I have been happy so far to the point that I don't think I will increase the dose unless/until the benefits diminish.

Curious how this goes for you man. I think I'm just going to go for it, 300IU every other day.

I'm still using the last of my Empower T cyp, and I want to try this before I run out and switch to the brand from Dr Rotman's pharmacy. I've seen way too much fluctation.

 

[madman]

Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression

In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T

academic.oup.com

Discussion

A significant intratesticular fluid to serum T gradient was observed in this group of young normal men at baseline. In this study, serum T was 1.2% of ITT, an 84-fold gradient. A similar testicular to serum gradient has been reported in studies of testicular biopsy tissue in the 1970s (19) as well as more recently (9, 13). However, the absolute ITT levels reported in testicular homogenates are higher than the ITT levels found in the testicular fluid aspirates in this study. This difference is probably the result of the release of cellular T stores in testicular homogenates compared with secreted T in fluid aspirates obtained with minimal cellular disruption. Normal intratesticular fluid T concentrations were maintained by low doses of hCG (125, 250, and 500 IU every other day for 3 wk) in men with gonadotropin suppression from exogenous T. Presumably, normal ITT levels within the testis should support normal spermatogenesis.




As expected, we observed that serum gonadotropin levels were significantly reduced by exogenous T in this study. Gonadotropin suppression without hCG administration caused dramatic reductions in ITT (94%) from baseline in the TE and placebo hCG group. Exogenous TE (200 mg weekly) has also been shown to reduce sperm production to azoospermic levels in approximately 70% of Caucasian men (7, 8). Spermatogenesis was not assessed in this 3-wk study, but in a previous study of normal men (n 7) with gonadotropin suppression induced with 6 months of T and a progestin, levonorgestrel (LNG), intratesticular fluid T was suppressed 98% from baseline (15).




In this study, hCG increased the ITT concentration, presumably through stimulation of Leydig cell steroidogenesis. The dose of hCG required to maintain baseline ITT concentrations in men with maximal gonadotropin suppression is significantly lower than that historically used in the treatment of infertility due to hypogonadotropic hypogonadism.





A review of the literature reveals a broad range of relatively high doses of gonadotropin replacement using hCG ranging from 1250 IU three times weekly to 3000 IU twice weekly (29 –32). Even higher doses of hCG (5000 IU, three times per week) have been shown to be safe in experimental models of gonadotropin withdrawal (33, 34). Regimens of 2000 IU administered im two or three times weekly have been used with hCG dose adjustment according to serum T levels with a goal of normal physiological serum T levels (32, 35, 36). This approach is based on the assumption that if normal serum T levels were established by hCG administration, ITT concentrations would be sufficient to support normal spermatogenesis. However, ITT was never directly assessed in these studies. The minimum hCG dose needed to restore ITT to levels sufficient for initiating and maintaining spermatogenesis is not known.





All three hCG groups in this study (125, 250, and 500 IU, given every other day) maintained ITT at levels statistically indistinguishable from the baseline. These doses are 10–20% of the doses commonly used in male infertility treatment (1250–2000 IU, two or three times weekly). Endocrinologists and andrologists have been aware that the doses of hCG traditionally used to treat certain types of infertility are supraphysiological and may expose patients to high levels of T and estradiol, with the consequent risk of clinically significant gynecomastia (37). The ability to prescribe hCG doses at lower levels to target normal serum and ITT and normal spermatogenesis would be useful for this patient population.





However, men rendered hypogonadotropic with exogenous T administration are different from men with infertility due to hypogonadotropic hypogonadism in two important ways. First, the study participants started with normal gonadotropin levels and were treated with high dose TE to induce gonadotropin withdrawal at the same time they were treated with hCG with the aim of maintaining ITT. In contrast, hypogonadotropic infertile men are treated with either T replacement or hCG for fertility, but not both simultaneously. The weekly administration of TE raised serum T levels significantly in all groups and may have resulted in higher ITT concentrations than would have been observed in a patient with hypogonadotropic hypogonadism receiving hCG therapy alone. Second, in the clinical setting, ITT production and spermatogenesis have to be induced after a prolonged period of gonadotropin deficiency. Therefore, the low-dose hCG used in this study may not normalize ITT in hypogonadotropic infertile men. However, lower hCG doses than those traditionally used may be sufficient to restore spermatogenesis.





In summary, assessment of the testicular hormonal environment through percutaneous fluid aspiration has shown a similar testis to serum T gradient as previous testicular biopsy studies in men and rats. Additionally, low doses of hCG maintain baseline levels of ITT in men with gonadotropin withdrawal from exogenous T administration. Lower doses of hCG may be as effective in treating male infertility due to hypogonadotropism as the higher doses used historically. Selective replacement of LH activity with low-dose hCG, as demonstrated in this study, will allow the design of future studies investigating the relative roles of intratesticular androgens and FSH in the control of human spermatogenesis. Such work will be applicable to the goal of developing uniformly effective male contraception.

Dose-Dependent Increase in Intratesticular Testosterone by Very Low-Dose Human Chorionic Gonadotropin in Normal Men with Experimental Gonadotropin Deficiency

Context and Objective: In men with infertility secondary to gonadotropin deficiency, treatment with relatively high dosages of human chorionic gonadotropin

academic.oup.com

Discussion

In the study, we used testicular aspiration, coupled with gonadotropin suppression, and graded, low doses of hCG to determine the dose-response relationship between intratesticular androgens and hCG in man. This study is the first to examine the relationship of such low doses of hCG with intratesticular androgens and to correlate the concentrations of intratesticular androgens with contemporaneously measured serum hormones. Interestingly, we have shown that IT-T concentrations remain much higher than serum testosterone concentrations despite marked LH suppression. Furthermore, we have demonstrated that very low-level LH-like stimulation of the testes with hCG increases IT-T in a dose-dependent manner. Importantly, our results suggest that the threshold dose for stimulating IT-T in humans is likely to lie between 15 and 60 IU of hCG. The measurement of IT-T, coupled with sensitive and specific liquid chromatography-tandem mass spectrometry hormone measurements, and longer-term low-dose gonadotropin administration in this experimental gonadotropin-deficient human model will permit more detailed investigation of the hormonal regulation of spermatogenesis in man than previously possible.

Normal men appear to be more sensitive to hCG than infertile men with hypogonadotropic hypogonadism. This difference in sensitivity is likely due to the fact that steroidogenesis in men with long-term gonadotropin deficiency is impaired, possibly secondary to Leydig cell immaturity. A similar phenomenon has been observed in the hpg mouse, in which larger doses of gonadotropins are required to initiate spermatogenesis than to maintain it once established (19). Our previous work in this area, which used doses of hCG closer to those used in hypogonadotropic infertile men, resulted in IT-T concentrations that were not significantly lower than normal (15). Therefore, in this study, we chose very low doses of hCG to better understand the full dose-response relationship. Notably, in this study, we found that having normal serum testosterone while receiving hCG does not correspond to an IT-T concentration similar to those observed at baseline. The implications of this for the induction of spermatogenesis in men with hypogonadotropic hypogonadism are unknown. However, it is possible that the observation that serum hCG is highly correlated with IT-T may prove useful in the treatment of men with infertility from gonadotropin deficiency. As a result, clinicians may consider measuring both serum testosterone and serum hCG to ensure the adequacy of treatment; however, future studies of the relationship between serum hCG and IT-T in men with hypogonadotropic hypogonadism will be required to determine the utility of this measurement.





In conclusion, this study demonstrates the strong dose-response relationship between IT-T and very low-dose hCG administration in gonadotropin-suppressed men. This work provides crucial information for future studies determining the role of intratesticular androgens on spermatogenesis in men and may improve the treatment of men with infertility and inform efforts to develop male hormonal contraceptives.

 

[smokedsalmon]

A couple years ago, the late Dr Crisler changed his opinion about dosing HCG. The outdated "Crisler protocol" he advocated in 2004 was generally T dosing 1x/week and HCG a couple days before next T injection.

However, he pretty well abandoned weekly T dosing for more frequent smaller doses subQ, and changed his tune to HCG daily: Should Men on Testosterone Test Their Free Estradiol ?

That older protocol is considered extinct, gone the way of the dodo, but I am not surprised to see something similar suggested here again. History repeats itself and old adages die hard.

Some men take Dr Saya's small study showing blood levels of HCG based on dose to mean higher doses are better, but that's not what he actually said in his narrative/interpretation of his results.

So what's the best? The opinions and results are still all over the map for different individuals. Vince likes 500iu 2/week and has done well on this for years. I tried that and had terrible estrogen swings. Now I am using 150iu coadministered with T cyp EOD, but might do even better on less QD.

The way to find out what works for you is to try different things, give each new dosage adjustment ample time, so that you are not chasing your tail. In this regard, I think it's great how Ardoc is approaching it.


To the OP... salmon: I believe your weekly T dose is much too high. It puts your free T much higher than necessary, is prone to drive high hematocrit, and E2. And though there is probably a saturation point in terms of T shutting down LH and the subsequent effect on testes, more T ain't better past that point, and trying to dose enough HCG to make testes feel better while avoiding high E2, is problematic. I've been through something similar myself, and what worked was reducing T, and HCG doses. It took along time to iron out dosages that brought my Free T and E2 into tolerable and beneficial range. And reductions are not easy, in fact dabbling in withdrawal Hell.

I'm trying to have my levels retested today. I feel well, so I don't want to drop them aggressively like I have in the past. Thing is, months ago I was at a nice 800 TT off the same dose.

 

[smokedsalmon]

Thanks for the post Madman. I've heard about this in a Youtube video, that new research is showing smaller doses may work just as well for keeping the testicals alive. I wouldn't mind that in an effort to keep mine from producing sperm yet - I'm still a few years away from having kids and enjoying the added security of not being fertile and ending up in a tough situation.

 

[Deleted member 16042]

I'm trying to have my levels retested today. I feel well, so I don't want to drop them aggressively like I have in the past. Thing is, months ago I was at a nice 800 TT off the same dose.

Focus on Free T.

Thanks for the post Madman. I've heard about this in a Youtube video, that new research is showing smaller doses may work just as well for keeping the testicals alive. I wouldn't mind that in an effort to keep mine from producing sperm yet - I'm still a few years away from having kids and enjoying the added security of not being fertile and ending up in a tough situation.

Anectdotal N=1; I have experimented with how low to go. For me there is a point where not enough HCG results in shrinkage, retraction and pain during orgasm. I take the lowest amount that is reasonably effective.

So keep them alive, or titrate to level of symptoms?

 

[smokedsalmon]

Focus on Free T.




Anectdotal N=1; I have experimented with how low to go. For me there is a point where not enough HCG results in shrinkage, retraction and pain during orgasm. I take the lowest amount that is reasonably effective.

So keep them alive, or titrate to level of symptoms?

I've always gotten the best symptom relief over 30 FT I've noticed. But when I start pushing it past 40, I notice I get really moody. My bloodwork still comes back good though. I do donate blood regularly too to keep this in check.

It's tough for me to titrate to symptoms with HCG as I really don't have any - just trying to preserve my balls for future use. No major shrinkage or anything. I do get some pain during orgasm sometimes, but that's rare due to an antidepressant I'm on (Nardil).

One more question - does dropping my 150mg week T dose to 100 and trying 125IU HCG every other day sound reasonable? Almost makes me wonder if my HCG side effects were from too much TT.

 

[3DMission]

@smokedsalmon is your goal to get pregnant now? Or you just want to maintain fertility/prevent testicular atrophy?

I conceived my first child on CLOMID and my last two kids on HCG.

 

[smokedsalmon]

@smokedsalmon is your goal to get pregnant now? Or you just want to maintain fertility/prevent testicular atrophy?

I conceived my first child on CLOMID and my last two kids on HCG.

appreciate this reply a ton. I just want to maintain fertility. I’d prefer to avoid any accidents until we’re ready though.