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Elsewhere, Dr. M stated that HCG is usually withheld the week someone draws labs because it can falsely elevate estrogen.
I do not understand the mechanism whereby the labs could be falsely elevated. Is it because HCG is cross reactive for estradiol as it can be for LH depending on the assay?
And when we say falsely elevated, does that mean that the amount of E2 indicated by the lab is not really in the blood?
If someone is on HCG monotherapy, obviously they wouldn’t discontinue the HCG.
How is an estradiol interpreted when a patient is on HCG mono?
If an individual were on testosterone + HCG, had labs drawn (with no HCG the week of the draw) and had a result of say 50 (<29) and was symptomatic for high E2 (emotional lability) but subsequently switched to HCG mono and for arguments sake had the same E2 reading, would the expectation be that the person would still have the same emotional lability as when on test + hcg.
Or, because HCG can falsely elevate E2, might the person feel better with the indicated E2 of 50 than he did when on test?
If the person in the first example needed arimidex to feel well, is it possible that the hcg mono patient might do without it?
I’m interested in that as well. If someone is taking HCG EOD, why not just measure E2 the day before the shot? HC levels should be pretty stable on such a schedule, so I don’t see estrogen spiking that much.
That’s my understanding, I might be wrong here.
@gu3vara 837 wrote:
I’m interested in that as well. If someone is taking HCG EOD, why not just measure E2 the day before the shot? HC levels should be pretty stable on such a schedule, so I don’t see estrogen spiking that much.
That’s my understanding, I might be wrong here.
I’m curious as to whether “artificially elevated” can translate into a difference in symptomology for a given E2 result (b/w a test/hcg and hcg mono pt), and the related mechanism.
I heard similar thing with using transdermal DHEA and doing 24 urine test. Dr J says it make many elements artificially high in the analysis.
Why would I stop DHEA some days before testing, I will have no idea how much DHEA I’m absorbing?
I’d like to hear more from Dr. M on HCG and appropriate way of testing estrogens and testosterone, whether it’s from HCG monotherapy or not.
@gu3vara 840 wrote:
I heard similar thing with using transdermal DHEA and doing 24 urine test. Dr J says it make many elements artificially high in the analysis.
Why would I stop DHEA some days before testing, I will have no idea how much DHEA I’m absorbing?
I’d like to hear more from Dr. M on HCG and appropriate way of testing estrogens and testosterone, whether it’s from HCG monotherapy or not.
I believe transdermal DHEA can actually raise T levels, or at least moreso than oral DHEA.
@chaos 832 wrote:
Elsewhere, Dr. M stated that HCG is usually withheld the week someone draws labs because it can falsely elevate estrogen.
I do not understand the mechanism whereby the labs could be falsely elevated. Is it because HCG is cross reactive for estradiol as it can be for LH depending on the assay?
And when we say falsely elevated, does that mean that the amount of E2 indicated by the lab is not really in the blood?
If someone is on HCG monotherapy, obviously they wouldn’t discontinue the HCG.
How is an estradiol interpreted when a patient is on HCG mono?
If an individual were on testosterone + HCG, had labs drawn (with no HCG the week of the draw) and had a result of say 50 (<29) and was symptomatic for high E2 (emotional lability) but subsequently switched to HCG mono and for arguments sake had the same E2 reading, would the expectation be that the person would still have the same emotional lability as when on test + hcg.
Or, because HCG can falsely elevate E2, might the person feel better with the indicated E2 of 50 than he did when on test?
If the person in the first example needed arimidex to feel well, is it possible that the hcg mono patient might do without it?
I did not state that HCG should be withheld.
HCG doesn’t falsely elevated estrogen. It actually increases estradiol production. This is not “false”.
As I recall, another registered member noted his physician recommended withholding HCG prior to lab measurements.
My answer is to not withhold HCG. Rather, it is to time the lab for the trough level of testosterone. And if needed, do a lab to determine a peak value of testosterone. The estradiol that is present is due to HCG but that is taken into account. It is not a falsely elevated estradiol. By not withholding HCG, I see what a person actually experiences. This is the most important reason for not withholding HCG.
In my own protocol for testosterone replacement using testosterone cypionate, with HCG used cosmetically to maintain testicular size, I modified Dr. Crisler’s method by having HCG taken at the same time as the testosterone injection (with an additional dose between testosterone injections if the injections are once a week for testosterone). This modification is done for convenience. From my point of view, when testosterone is given at an appropriate weekly frequency (e.g. twice a week or more frequently for those with short-half lives for testosterone cypionate, weekly and longer for those with normal or longer half-lives), the need to boost testosterone with a small HCG injection is not necessary.
When not withholding HCG (my preference), it is then a matter of timing the date of the lab.
@DrMariano 1034 wrote:
I did not state that HCG should be withheld.
HCG doesn’t falsely elevated estrogen. It actually increases estradiol production. This is not “false”.
As I recall, another registered member noted his physician recommended withholding HCG prior to lab measurements.
My answer is to not withhold HCG. Rather, it is to time the lab for the trough level of testosterone. And if needed, do a lab to determine a peak value of testosterone. The estradiol that is present is due to HCG but that is taken into account. It is not a falsely elevated estradiol. By not withholding HCG, I see what a person actually experiences. This is the most important reason for not withholding HCG.
In my own protocol for testosterone replacement using testosterone cypionate, with HCG used cosmetically to maintain testicular size, I modified Dr. Crisler’s method by having HCG taken at the same time as the testosterone injection (with an additional dose between testosterone injections if the injections are once a week for testosterone). This modification is done for convenience. From my point of view, when testosterone is given at an appropriate weekly frequency (e.g. twice a week or more frequently for those with short-half lives for testosterone cypionate, weekly and longer for those with normal or longer half-lives), the need to boost testosterone with a small HCG injection is not necessary.
When not withholding HCG (my preference), it is then a matter of timing the date of the lab.
Sorry doc, I must’ve misunderstood another post. Might have even been another doctor the poster was referring to.
I notice you mention using HCG to maintain testicular size. Do you think it also maintains baseline function? I have recently switched doctors and my new guy wants me to take a break from TRT to get a new set of baseline labs. He did tell me i would probably crash, though he expected it to be less because I had been doing hcg.
@DrMariano 1034 wrote:
I did not state that HCG should be withheld.
HCG doesn’t falsely elevated estrogen. It actually increases estradiol production. This is not “false”.
As I recall, another registered member noted his physician recommended withholding HCG prior to lab measurements.
My answer is to not withhold HCG. Rather, it is to time the lab for the trough level of testosterone. And if needed, do a lab to determine a peak value of testosterone. The estradiol that is present is due to HCG but that is taken into account. It is not a falsely elevated estradiol. By not withholding HCG, I see what a person actually experiences. This is the most important reason for not withholding HCG.
In my own protocol for testosterone replacement using testosterone cypionate, with HCG used cosmetically to maintain testicular size, I modified Dr. Crisler’s method by having HCG taken at the same time as the testosterone injection (with an additional dose between testosterone injections if the injections are once a week for testosterone). This modification is done for convenience. From my point of view, when testosterone is given at an appropriate weekly frequency (e.g. twice a week or more frequently for those with short-half lives for testosterone cypionate, weekly and longer for those with normal or longer half-lives), the need to boost testosterone with a small HCG injection is not necessary.
When not withholding HCG (my preference), it is then a matter of timing the date of the lab.
Many people when they start TRT i see they start everything at once just to see what sticks then adjust from there rather then doing it in layers. I do agree that when TRT is administer Testosterone and e2 levels must be stabilized for a good length of time before HCG is introduced. When doing HCG day before the shots in my case really did not make that much differnce may be 2-3 points if that. I tested at 881 on the trough but with my shbg of 35 I can use alittle testosterone. I no longer test testosterone as it has been solid for past 3 years.
So in order to have stabilized estrodial is the most difficult thing I have to deal with.
Since lowering my dhea from 50 mgs to 30 mgs and keeping the adex the same this resulted in a dramatic drop of e2 to <3 (3-70) range. So now i know that once my dhea goes above 300 then the estrodial goes up significantly. I will sacrfice top end numbers to reduce the unneeded meds i have been taking for years.
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