@chaos 126 wrote:

Someone told me that I should not take my HCG during the week I am going to run labs, as it can falsely elevate estrogens. My doc never mentioned this.

Is there a correct way to do this? Or is it one of interpretation?

@pmgamer18 129 wrote:

This is true look at HCG like hitting the nitro switch in your hot rod it shoots up T and E2 levels for that day for some it can last longer. I do my T shots every 3 days and HCG the 2 days each in between my T shots. When I do my labs I stop the HCG a week before my labs. Other wise my labs are all over the place from test to test I do labs every 8 weeks. Dr. John was the one that told me not to do HCG before labs.
Phil

Testosterone’s half-life is between 10 to 100 minutes. Estrogen’s is longer. Testosterone and estrogen’s lifespan in the body is prolonged by sex hormone binding globulin (SHBG). The more SHBG, the longer testosterone and estrogen can last. Without SHBG, testosterone would last less than 8 hours in the body.

HCG increases testosterone and estradiol but the levels are not going to be stable since the levels will shoot up then ramp down during the day.

When using oil-based transdermal testosterone, a similar problem occurs. With one 10% cream, for example, the peak of testosterone can reach 4000 but then it drops to a hypogonadal state by the end of the day.

When you have such highs and lows, it is useful to do two levels. One level is shortly after the injection of HCG. This is called a PEAK level. Then you get a level before the injection of HCG. This is called a TROUGH level. Having both levels gives a better clinical picture of what is happening. Many times, a trough level is all that is needed. But there are times when both are needed to clarify the situation.

Note that when a person is on HCG monotherapy, one can’t simply stop using HCG before the lab test. You want to know what is actually happening with the patient. You want to know what the peaks and troughs are so you can more clearly inform and guide the patient on what is happening.

If all you want is a trough level, the lowest level a person could have, then getting the lab test done before the HCG injection is done would tell you.

When doing Dr. Crisler’s protocol of both testosterone cypionate as the main treatment, and HCG in small doses for testicular function, then one needs to monitor testosterone and estradiol generally at the trough level of testosterone from treatment with testosterone cypionate. Thus it makes sense to avoid HCG prior to the lab test. HCG isn’t the primary treatment.

Under certain circumstances, a peak test, additionally, would also be useful – a test after the injection of testosterone and after an injection of HCG to find out what is happening. One can find out where estradiol is peaking to determine if this peak is causing problems like gynecomastia or anxiety or mood problems, that would otherwise be hidden if a trough level was only done.

@chaos 131 wrote:

What is your opinion as to the steadiest release from a transdermal. I used them prior to injectibles, but my testosterone never increased, just DHT. I used androgel and a 10% PLO.

People on the boards told me I didn’t absorb (since T didn’t increase), but my doc said the increase in DHT was proof something absorbed, though he was uncertain as to why all of it seemed to go to DHT.

Speaking to your comment, he postulated I absorbed it “in one shot” as opposed to a steady release, so I therefore had a spike in DHT, similar to the spike the day after an IM injection.

Ideally, for hormone replacement therapy, the transdermally based hormone is transferred into the fat layer of the skin. From there, the hormone can be released gradually into the bloodstream, producing stable level.

Alcohol-based gels are more useful for hormone replacement since they allow the hormone to be absorbed into the skin fat and to be slowly released into the blood stream.

Oil-based transdermal gels or creams – such as the PLO gels – are good for rapidly introducing substances into the system. They aren’t as useful for hormone replacement therapy because they cause the hormone to bypass the skin fat and allow the hormone to directly go into the blood stream. This causes a large peak and a rapid fall in blood levels.

Both alcohol-based and oil-based gels or creams will result in good absorption generally. They generally result in predictable blood levels of hormones and medications. If the blood level does not go up, then it is not being absorbed. Thus if a testosterone transdermal does not result in an appreciable increase in testosterone it is not well absorbed.

Some people will have difficult absorbing a transdermal preparation. For example, people with hypothyroidism, can develop mxedema. This is a thickening of the skin due to the accumulation of mucin – a glue that holds cells together. This prevents transdermal absorption. In my patients, if a person develops lower thyroid hormone levels from either transdermal testosterone or estradiol, testosterone and estradiol levels fall. When I address thyroid hormone, testosterone and estradiol will again be abssorbed and levels rise. Other reasons for non-absorption include possible ethnic differences or genetic differences in skin such as oilier skin, etc.

One other reason a hormone level does not go up is that the dose used is too low. For example, many patients are given one 5 gram packet of Androgel to use. This is too low for many men. Since there is negative feedback controlling testosterone production, at a certain dose, the dose is too low to make up for the loss of one’s testicular testosterone production, when exogenous testosterone is added. Testosterone level actually will decrease when only 1 5-gram pack is used in many men. The percentage of men where testosterone will be low rather than high decreases when two 5-gram packs of Androgel are used. This would be the starting dose I would use. In these men, there is evidence of absorption – such as DHT (dihydrotestosterone) levels going up. But testosterone is either the same or LOWER. In these men, testosterone in Androgel IS absorbed. But the dose is too low.

I never did good on Androgel then tried Testim same thing levels got a little higher. I have a thyroid problem and oily skin on 10 g’s my best levels were 550 the lab we use there range was 272 to 1592 so 550 is dam low. My DHT in time went up 3x’s above the top of the range. I had sore joints and muscles going to shots of Depo Testosterone and adding hcg my pain was gone. So for the yrs. I was on gels I was house bound.

I still tell men when going on TRT to try the gels or creams they keep most men leveled from day to day. On shots you high after the shot then low by the next one adding hcg helps keep levels up.

I was thinking about this going back to gels and using HCG never did this but I am doing so good on what I am doing I feel it’s better to leave it alone.