What's the lowest recommended dose of T to add to HCG mono?

[HR_Watson]

Like the thread title says - I'm curious to know what the lowest possible dose of T I could add to HCG mono without inducing primary testicular shutdown?

I'm secondary and have been on HCG + AI for a year and a half now with great results, but unfortunately, I've crashed my E.

I'm injecting 2000 units of HCG weekly, broken up into three doses (750, 750, 500 units)
I developed gyno, so I went on Nolva to get it under control and then Letro to keep it that way.
I was taking 1.5mg of Letrozole, broken up into .5mg doses, three times a week. That was causing hair loss and acne, so I dropped down to 1mg a week, and felt fine. Not as great as when I was HCG mono, but not as bad as when I was on clomid, and no gyno.

I started feeling symptomatic again about two months ago. Zero sex drive, extreme fatigue, ED, mood swings, depression.

My wife is 6 months pregnant, so I thought maybe some of her hormones were affecting me, or that I was just tired/stressed. I was convinced the HCG wasn't working any longer, but after getting my labs, I was shocked to see my T was at 890, but my E was <12.
LH and FSH indicate the HCG is still working, and that I'm still secondary, which is great.

I'm clearly experiencing the dreaded E2 crash and need to come off the Letro.

I've always felt best when my T was above 1000...but I've found that having a healthy E2 level almost made more of a difference.

Thoughts on how I can balance things?
I'm still responding well to HCG, but was considering going on the non-generic version to see if I get better results.

I was also thinking about adding the lowest possible supplemental T to help get me over the hump get my levels back over 1000, where I felt best, but maybe dropping the Let will help boost things.

Thanks!

 

[Mr S]

I don’t really have an answer for you but I can share my experience.
My Dr. Has me on 100 mg T Cypionate weekly and 500iu HCG EOD protocol. The 500iu hCG is Lipshultz protocol for patients on TRT. As far as dosage goes, I’ve heard by and large the minimum is 80mg/week to show results. However, that dosage doesn’t include HCG. Yes, low dose injections of exogenous testosterone brings levels up in some men. Some men use even less T than 80mg to optimize their levels.
Obviously your numbers are good on a low dose of HCG monotherapy, but you don’t feel fine. I also take Cialis Daily (5mg) which is believed to increase T among other benefits. I was on TRT for 12 weeks (no HCG at all in the protocol) and came off for 3 months. I had at the moment experienced some testicular atrophy which resolved within a week or so after stopping TRT. The protocol I describe above is recent- 10 days.

 

[Vince Carter]

Have you or are you using any other AI besides Letro and/or Nolva?
If you add any amount of T you'll get shutdown.

 

[Mr S]

Have you or are you using any other AI besides Letro and/or Nolva?
If you add any amount of T you'll get shutdown.

Bit isn’t it reversible if he chooses to stop exogenous testosterone? He’s already on HCG

 

[Blackhawk]

IMO, get off the AI first and get E2 back in a good place.

Testosterone is not a supplement.

 

[JimGainz]

I did HCG mono for a while at 500 IU eod with an AI and then added androgel (10 g / day). My T was in the 900s and E2 was around 40-60. Switching to injectable T at 100 mg / week with HCG at 350 IU 2x week has been a much better protocol. If you are looking for a number - I would say 80 mg of Test would be minimum but if you are having Gyno issues drop HCG to 250 IU Eod with that and assess.

 

[Cataceous]

...
LH and FSH indicate the HCG is still working, and that I'm still secondary, which is great.
...

Because LH and FSH are suppressed to low levels? Otherwise hard to understand, because in the vast majority of cases hCG is highly suppressive. When you're already suppressed you can add any amount of exogenous testosterone without further effects on these markers.

 

[Mr S]

Because LH and FSH are suppressed to low levels? Otherwise hard to understand, because in the vast majority of cases hCG is highly suppressive. When you're already suppressed you can add any amount of exogenous testosterone without further effects on these markers.

That’s a piece of the puzzle that I don’t understand quite well to be honest. HCG mimics LH to avoid its suppression hence the reason why it’s added to TRT protocols. Under that rationale, my urologist put me on Pregnyl. I don’t care about fertility at all. But I do care about testicular atrophy. I’m fine atrophy wise at the moment even before HCG but as time passes will it stop working and just suppress my LH even more? In other words, will I end up with raisins anyway?

 

[Cataceous]

That’s a piece of the puzzle that I don’t understand quite well to be honest. HCG mimics LH to avoid its suppression hence the reason why it’s added to TRT protocols. Under that rationale, my urologist put me on Pregnyl. I don’t care about fertility at all. But I do care about testicular atrophy. I’m fine atrophy wise at the moment even before HCG but as time passes will it stop working and just suppress my LH even more? In other words, will I end up with raisins anyway?

Correction: hCG mimics LH and replaces some of the LH that is almost always completely suppressed under TRT. In addition, in secondary hypogonadism hCG monotherapy almost always stimulates enough testosterone production to completely suppress LH and FSH.

Not everyone experiences noticeable testicular atrophy under TRT—with suppressed LH, but there may be other benefits to keeping LH receptors stimulated.

 

[Mr S]

Correction: hCG mimics LH and replaces some of the LH that is almost always completely suppressed under TRT. In addition, in secondary hypogonadism hCG monotherapy almost always stimulates enough testosterone production to completely suppress LH and FSH.

Not everyone experiences noticeable testicular atrophy under TRT—with suppressed LH, but there may be other benefits to keeping LH receptors stimulated.

I get it now. Thanks!

 

[HR_Watson]

Correction: hCG mimics LH and replaces some of the LH that is almost always completely suppressed under TRT. In addition, in secondary hypogonadism hCG monotherapy almost always stimulates enough testosterone production to completely suppress LH and FSH.

Not everyone experiences noticeable testicular atrophy under TRT—with suppressed LH, but there may be other benefits to keeping LH receptors stimulated.

First, for some reason, I stopped receiving notices when people respond to my thread, so I didn't see this until today.

This is super helpful, thank you!
One question: Vince suggests that any addition of T will induce shutdown. Isn't the point of taking hCG with T to avoid a shutdown? My MD claims that he has a lot of men on both and that they're still fertile.

Meanwhile, I've cut back the AI to half the dosage. No gyno yet.
My MD switched me from generic hCG to Pregnyl, and upped my dosage slightly from 2000 units weekly to 2,250 weekly (750 units x 3 times a week).

I'm going in for testing this week and we'll see how things are looking and I'll report back.

I'm definitely better than I was when I posted this two months ago - but my erections are still really weak, my penis and testes have shrunk significantly - and my ejaculation is about a third of what it was previously.

Maybe it's the pregnancy hormones affecting me - maybe it's the AI - we'll see soon enough.

 

[Cataceous]

...
One question: Vince suggests that any addition of T will induce shutdown. Isn't the point of taking hCG with T to avoid a shutdown? My MD claims that he has a lot of men on both and that they're still fertile.
...

It's a question of which parts of the hypothalamus-pituitary-testicular-axis (HPTA) are being suppressed. Over time, a sufficient amount of exogenous testosterone—e.g. from TRT—usually suppresses LH and FSH to low levels via suppression at the hypothalamus and pituitary. Lack of LH leads to testicular suppression, and typically endogenous testosterone production is reduced or eliminated. Testicular atrophy often results. hCG is different, in that administration stimulates endogenous testicular testosterone production along with estradiol. It's these endogenous hormones that suppress LH and FSH via the hypothalamus and pituitary. But hCG is effectively replacing the LH, so there's not testicular suppression.

 

[HR_Watson]

So just did a full panel, and indeed my T levels have dropped about a third from where they normally are from roughly 950/1000 to 740.

Unfortunately, this jives with all the literature I've read on expecting fathers - in theory, T levels drop a full third, which is exactly where I am.

I don't know if it's wise messing with things right now, and I should probably suffer through this...they say levels start to increase again after 3 months with the newborn.

I'm especially sensitive to hormonal shifts, so I'm really feeling the dip.

I might start another thread - I'm curious if anyone else has experienced this.

 

[HR_Watson]

It's a question of which parts of the hypothalamus-pituitary-testicular-axis (HPTA) are being suppressed. Over time, a sufficient amount of exogenous testosterone—e.g. from TRT—usually suppresses LH and FSH to low levels via suppression at the hypothalamus and pituitary. Lack of LH leads to testicular suppression, and typically endogenous testosterone production is reduced or eliminated. Testicular atrophy often results. hCG is different, in that administration stimulates endogenous testicular testosterone production along with estradiol. It's these endogenous hormones that suppress LH and FSH via the hypothalamus and pituitary. But hCG is effectively replacing the LH, so there's not testicular suppression.

Yes, that’s my understanding of it - that things like Clomid or hCG only suppress at the pituitary level, so in theory, testicular function remains. That’s been my case thus far, which is why I’m not especially anxious to add T to the mix, except that I’m really starting to feel crappy.

My MD recommended Natesto as one option - it’s an intranasal T spray, supposedly it doesn’t suppress at the testicular level. But it causes sinus infections, and I’ve got a bad history of sinusitis, so that’s not really an option for me.

 

[Mr S]

It's a question of which parts of the hypothalamus-pituitary-testicular-axis (HPTA) are being suppressed. Over time, a sufficient amount of exogenous testosterone—e.g. from TRT—usually suppresses LH and FSH to low levels via suppression at the hypothalamus and pituitary. Lack of LH leads to testicular suppression, and typically endogenous testosterone production is reduced or eliminated. Testicular atrophy often results. hCG is different, in that administration stimulates endogenous testicular testosterone production along with estradiol. It's these endogenous hormones that suppress LH and FSH via the hypothalamus and pituitary. But hCG is effectively replacing the LH, so there's not testicular suppression.

What happens when you stop HCG though?

 

[Cataceous]

What happens when you stop HCG though?

The testes gradually produce less and less testosterone, which also reduces estradiol. This reduces negative feedback at the hypothalamus and pituitary, so over time they start functioning again, with the hypothalamus delivering GnRH to the pituitary, and the pituitary delivering LH and FSH to the testes. This endogenous stimulation of the testes eventually causes testosterone production to reach a new equilibrium.

 

[HR_Watson]

What happens when you stop HCG though?

I'm curious - can you tell me more about your protocol Mr S? You mentioned that you're currently taking 100 of T and 1500 (500x3) of hCG? No AI?

What are your T and E levels, if you don't mind sharing? And no indications of testicular shutdown on that protocol? You mentioned you experienced some testicular shrinkage.

I'm starting to realize that these symptoms have way more to do with my crashed E than with my T levels. Aside from the T symptoms, there's some things unique to low E - specifically, really low energy and severe joint pain.

 

[Mr S]

The testes gradually produce less and less testosterone, which also reduces estradiol. This reduces negative feedback at the hypothalamus and pituitary, so over time they start functioning again, with the hypothalamus delivering GnRH to the pituitary, and the pituitary delivering LH and FSH to the testes. This endogenous stimulation of the testes eventually causes testosterone production to reach a new equilibrium

I'm curious - can you tell me more about your protocol Mr S? You mentioned that you're currently taking 100 of T and 1500 (500x3) of hCG? No AI?

What are your T and E levels, if you don't mind sharing? And no indications of testicular shutdown on that protocol? You mentioned you experienced some testicular shrinkage.

I'm starting to realize that these symptoms have way more to do with my crashed E than with my T levels. Aside from the T symptoms, there's some things unique to low E - specifically, really low energy and severe joint pain.

My protocol is as you said 100 T Cypionate once a week and 500iu HCG EOD or 250iu ED no AI. This protocol is recent and my next labs are at the end of this month. Then I’ll know exactly what my numbers are and I can let you know. I also take 5mg Cialis Daily. Yes, I experienced testicular atrophy but it resolved on its owns after stopping cold turkey due to the lack of supplies while on a long trip (Cypionate). When I restarted TRT (3 months after my quitting) my urologist prescribed HCG to avoid atrophy and that’s the protocol in which I’m on now. HCG has worked as I don’t see any atrophy at all. My T was 700 at trough dropping to 280 (310 pre TRT, range 300-1000) while off TRT but not HCG involved. My estradiol was I believe in the upper 20s but I was on 140mg Cypionate at that time. New protocol long wait. We’ll see