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Hi Dr. Mariano,
I was searching the internet for post regarding hcg monotherapy and came across this website. I saw some of you posts and though I would pm you for some advise. About 4.5 years ago I experienced what seemed to be a sudden and dramatic decrease in sex drive along with an ability to get/maintain erections. I had my levels checked and was told they were fine, just in the low-normal range. The first time they came back at 417 and the second time at 397. My problem persisted however and I started to notice a deterioration in my physical being, i.e., i was more tired and unable to tolerate my workouts like before. I found an endocrinologist and had my levels tested again. Upon seeing me he told me flat out that I had no hormonal problem (based on my body) and wrote me a script of viagra (for the confidence boost) and sent me off to get some blood work done to make sure. This time my levels came back below the normal range, along with suppressed LH and FSH levels. He re-tested with the same results. After doing an MRI and asking my some questions (most notably about my sense of smell and taste) he concluded that I have a variation of kallmans syndrome (due to the non functioning pituitary and my weak sense of smell). He put me on 5g of androgel which worked for about a week. After 2.5 months on it i felt just as bad and my t-levels were actually lower than before. He wanted to up the dose but i insisted on hcg because it seemed more convenient and i wanted to retain testicular function. He started me off on 2000iu once a week IM injection. I learned how to do IM injections myself and told him I would start injecting on my own. I played around with injection schedules as well as IM and subQ injections and have gotten fairly good results. During this past summer I was injecting 1250iu 2X a week subq. This got my TT levels above 700 and my free T in the upper range; once even exceeding the upper range. My e2 has been on the high side however, around 35-38. I have taken arimidex but it doesn’t seem to help. This perplexed me until read that HCG cause a lot of intratesticular aromatese activity which arimidex does not affect. I have decided not to experiment with ED subQ injections of 300iu per day. My hope is that the lower dose (2100 iu versus the previous 2500iu) given everyday will not cause such spikes in e2. I have been on this schedule for 16 days. I have stopped taking arimidex just so i can test my levels and see what e2 reading i get with this schedule.
You seem to be knowledgeable on this topic. Before this started my sex drive was through the roof and i could get erections at the site of a womans shoulder. It is completely opposite for me now. Despite having T levels in the upper range i have never gotten back to that. In fact they have only brought me back to mediocre levels for brief periods of time. Some people have suggested that i switch to T injections because for some reason they are able to increase sex drive, while the T produced by hcg injections does not (this has always sounded weird to me, but anecdotally it holds). I would like to get my sex drive back and if you can suggest anything that would be greatly appreciated. I have been trying to isolate what could be the factor but there is too much information and too many theories. Lack of andorgen receptors, DHT too low, e2 too high, to frequent doses of hcg, not frequent enough. shoot T instead of hcg, its all psychological, etc. I was going to give ed injections a chance (until the end of april maybe) and if that didn’t work i wanted to try applying a little compounded t-cream to the scrotum to see if i could elevate my dht and see any difference. If that fails i want to freeze some sperm and try T injections since some people swear by their efficacy when hcg has failed. What do you think?
Thanks
With whatever method to raise testosterone (T injections, HCG, etc), generally, I would try to target a testosterone level of at least 650 ng/ml. Once that is achieved, if any problem remains, then that means there are problems in the rest of the system, not just testosterone signaling.
Whether one uses HCG or not depends on whether or not he wants to maintain testicular function. Since thyroid releasing hormone is also produced along with testosterone by the testes, then HCG injections may have the advantage of also maintaining thyroid hormone signaling. This is in contrast to exogenous testosterone treatment, where thyroid signaling is reduced with treatment and also needs to be adjusted to maintain function.
I generally prefer daily HCG injections. This more closely emulates physiologic production, with peaks of testosterone production that are not so high that estradiol production also becomes a problem.
Not every man requires treatment with Arimidex to control estrogen. Very few of the men I treat require it, even with estradiol levels in the high 30s. Some need it since the higher estradiol levels may cause downstream problems resulting in anxiety – for example, by reducing free thyroid hormone or increasing immune system inflammatory signaling or by direct estrogen nervous system effects on behavior. Some men feel worse when Arimidex is added to control estradiol production. Arimidex may cause other changes in ilntercellular signaling other than just blocking Aromatase enzyme which may be poorly studied, causing adverse effects aside from those obtained from blocking Aromatase.
In any case, once target testosterone levels are reached, yet problems occur, then it is important to evaluate the rest of the system. For example, nutritional status needs to be evaluated. Thyroid hormone, immune system function, nervous system function, etc. need also be optimized to improve function.
Sex drive – as a mental function – has multiple determinants, not only testosterone. Energy is generally not a direct effect of testosterone. Other signaling systems have that role. One common reason men may see me is that an evaluation for these other problems were not previously done or can be done by their current provider. Thus, despite what seems to be optimal testosterone levels achieved in treatment, they still are poorly functioning.
@DrMariano 2897 wrote:
With whatever method to raise testosterone (T injections, HCG, etc), generally, I would try to target a testosterone level of at least 650 ng/ml. Once that is achieved, if any problem remains, then that means there are problems in the rest of the system, not just testosterone signaling.
Whether one uses HCG or not depends on whether or not he wants to maintain testicular function. Since thyroid releasing hormone is also produced along with testosterone by the testes, then HCG injections may have the advantage of also maintaining thyroid hormone signaling. This is in contrast to exogenous testosterone treatment, where thyroid signaling is reduced with treatment and also needs to be adjusted to maintain function.
I generally prefer daily HCG injections. This more closely emulates physiologic production, with peaks of testosterone production that are not so high that estradiol production also becomes a problem.
Not every man requires treatment with Arimidex to control estrogen. Very few of the men I treat require it, even with estradiol levels in the high 30s. Some need it since the higher estradiol levels may cause downstream problems resulting in anxiety – for example, by reducing free thyroid hormone or increasing immune system inflammatory signaling or by direct estrogen nervous system effects on behavior. Some men feel worse when Arimidex is added to control estradiol production. Arimidex may cause other changes in ilntercellular signaling other than just blocking Aromatase enzyme which may be poorly studied, causing adverse effects aside from those obtained from blocking Aromatase.
In any case, once target testosterone levels are reached, yet problems occur, then it is important to evaluate the rest of the system. For example, nutritional status needs to be evaluated. Thyroid hormone, immune system function, nervous system function, etc. need also be optimized to improve function.
Sex drive – as a mental function – has multiple determinants, not only testosterone. Energy is generally not a direct effect of testosterone. Other signaling systems have that role. One common reason men may see me is that an evaluation for these other problems were not previously done or can be done by their current provider. Thus, despite what seems to be optimal testosterone levels achieved in treatment, they still are poorly functioning.
DR M are you referring to the trough or median when T levels are at 650?
When giving endogenous testosterone I feel that there is a 200-300 difference in ones own vs endogenous. For example a person that is one TRT may feel good at 700-800 but a person on HCG only which is being made with their own testosterone feels good at 500-600 at trough provided all other hormones and signalling are in balance So is TRT really bioidentical? I tihnk its a very misleading terms. Tell you the truth if I had the opportunity to do it I do the pellets because they are more steady and less fluctations of e2@hardasnails1973 3020 wrote:
DR M are you referring to the trough or median when T levels are at 650?
When giving endogenous testosterone I feel that there is a 200-300 difference in ones own vs endogenous. For example a person that is one TRT may feel good at 700-800 but a person on HCG only which is being made with their own testosterone feels good at 500-600 at trough provided all other hormones and signalling are in balance So is TRT really bioidentical? I tihnk its a very misleading terms. Tell you the truth if I had the opportunity to do it I do the pellets because they are more steady and less fluctations of e2T levels may be either trough or median depending on practitioner preference, while keeping in mind the possibility of supraphysiologic levels in either case (and the adverse effects that may or may not occur with supraphysiologic levels).
Hormone replacement therapy is “bioidentical” in regard to using the same hormones the body produces. For example, for testosterone, one uses testosterone. For thyroid hormone, one uses thyroid hormone.
HCG therapy for men isn’t exactly bioidentical using this definition since men don’t produce HCG.
No treatment is exactly the identical to nature in terms of route, dosing, blood level changes through the day or week. None. We just try to as closely as possible mimic nature while making things convenient to a patient so a person can adhere to treatment.
For example, generally hormone is fully absorbed from the intestinal tract (though some, such as estrogens have some form of hepato-intestinal recirculation). It is thus, for example, not actually natural for a person to take a hormone orally, transdermally, or even by injection. This is why non-physiologic interactions or complications occur.
For example, since 90 percent of immune system white blood cells are circulating around the intestinal system, just outside the intestinal walls, and since they can sample intestinal contents for pathogens, oral thyroid hormone can affect the immune system negatively. This possibility has to be taken into account in treatment. Similarly with Vitamin D.
Similarly, it isn’t “natural” to introduce testosterone transdermally. The high alpha-reductase enzyme concentration in the skin in men means transdermal testosterone can result in excessive DHT production.
Etc. Etc.
The best that can be done is to try to come close to what is physiologic with a person, while attempting to minimize adverse effects, while maintaining convenience of treatment.
For example, if one is taking oral thyroid hormone, particularly T3, one can take it with food (particularly since it is well absorbed), to minimize negative interactions with the immune system (such as may occur with T3 treatments on an empty stomach). Whether or not negative interactions occur depends on the person, thus this maneuver doesn’t need to be done with everyone.
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