Treatment options for Hypogonadism

Pretty impressive changes in T levels from hCG alone. Interestingly, you managed to increase total T while decreasing SHBG, for some really nice gains on the free T side. Conceivably, 5 beers the night before the blood draw might have depressed your levels a little, but probably not that much. (I have heard of folks trying to deliberately skew the test results through alcohol consumption, but I think they are talking about substantially higher consumption.)

Your free T is almost 7 times higher than mine, so it looks like you got a pretty good start on things even before exogenous T. Still, at the end of the day, you have to find the level that works for you. Maybe you’ll be like Sta-kool and see a response only at higher levels.

I’d be curious to hear how long Sta-kool had been on TRT before going to the mid 800 range, and how quickly symptoms relieved at that level.

I can maybe figure all that out, will take a little research.

Yeah, I was quite surprised myself, considering that I still feel pretty fucked up. I`ve been better the last days being off HCG.

I wonder if the high estradiol may be what have prevented me from feeling the full effects from the increased testosterone. I know that I can`t expect full effects of testosterone that fast, but I thought that I would at least experience some improvement.

Not quite sure how to proceed. I suppose I could try 250 IU 3X per week and see if that would be better and possibly lower E2. An AI would probably not be a bad idea either, but I don`t think I have access to that.

Regards,

Renholder

Sounds reasonable.

For what it`s worth, I have never been a high testosterone guy at all. Moderate at best, but probably average or slightly below. :)

Your E2 theory sounds plausible. I saw an article in the Journal of Endocrinology & Metabolism, 91 (9) 3324-3328 (2006), “In Men, Peripheral Estradiol Levels Directly Reflect the Action of Estrogens at the Hypothalmo~Pituitary Level to Inhibit Gonadotropin Secretion.” There, they supressed E2 levels in healthy males and applied various levels of estrogen to gauge the amount of exogenous E require to restore baseline T levels. Baseline E2 levels were reduced from 28 ng/dl +/- to around 13 ng/dl +/- before exogenous E. That resulted in increasing T from basline of around 503 ng/dl +/- to around 955 ng/dl +/-.

I’m curious if they ever measured your DHT levels. I remember reading somewhere that most body tissues (other than skeletal muscle) make use of DHT rather than testosterone itself. If that were true for the brain and something impaired normal rates of conversion of T to DHT, maybe you would not get cognitive/mood benefits until you reached higher T levels? (That said, I’ll bet there are dozens of interesting questions you could explore if you were on a quest to become a science project, rather than a quest to relieve symptoms. Going forward with Nebido might put you over the top quickly, leaving plenty of time to sort out other questions later, if need be.

Thanks for this and also for the prior information.

Actually, I never got DHT tested and it is not an option on the standard test sheet the government have issued here in Norway. It may be possible to test for it, but I do think it`s a special test.

So, what do you think?

Give Nebido a shot?

If I had the opportunity to get blood work done privately myself and also access to an AI like arimidex, I think I would try that route first. But, getting arimidex might not be easy and I dread calling my doctor one more time and having to explain him how to do his job. I also need to go by him every time I need blood work and I don`t think he would see the point in getting it done as frequently as I would.

From a practical perspective, I don`t see any problem with using Nebido. I would use HCG along with any way to maintain testicular function, but at significantly smaller doses. Maybe as little as 250 IE twice per week.

Another thing I`ve been thinking is that using HCG is very impractical when traveling. I suppose skipping HCG sporadically is not a big problem while on TRT, but imperative while on mono.

I think that combining Nebido with hCG sounds like the right plan for you.

I have to admit that I`m confused about what to do, but I`m leaning towards giving Nebido a trial.

I have received very different advice on this matter and I have been very confused, but I decided to try Nebido, although I could perhaps have given it a little more thought first.

So, today, I injected 4 ml of Nebido in my thigh. Inserting the needle was less painful than I had imagined, but the injection process was slightly painful. Yesterday, I injected my first shot of HCG since last Friday, but half the prior dose at 250 IU. I was feeling slightly more horny this morning, prior to the Nebido shot.

I will continue injecting 200-250 IU HCG Monday, Wednesday, Friday and if I feel good, I will inject my next shot of Nebido in 6 weeks. Then, I`ll see if I can get bloodwork done in 16 weeks, if I don`t see any reason to do it earlier. If I had a private lab I could use, I would have taken more tests, but I have to go past my doctor, so I`m not sure if I will bother.

If I suspect continued high E2 for some reason, I will call him and ask for an AI if I can`t get it anywhere else.

I hope you’ll keep us posted on your progress under the new regimen.

I’m still waiting to get my blood drawn. Since my sleep cycle is a little abnormal (and screwed up to boot), I’m supposed to shoot for the earliest blood draw I can get - which around here means 7:00 a.m. The big labs here have gone with automated everything, so I haven’t been able to get a human being, and the automated scheduler seems to have no 7:00 slots in the foreseeable future. I’m frustrated with the delay, so I think I’m going to try the “walk in” approach. I was fairly successful with that last year when I had regular lab work to monitor a blood thinner. I’m sure I can be the first one in the door, though I’ll still take a back seat to anyone with an appointment.

I will, meatbuilder.

FWIW, I don`t notice any difference yet, but it is a slow acting ester so it takes some time to kick in. On the other hand, my levels are already high without reaping any benefits, so I wonder if it may be elevated E2 that is blocking me from reaping the benefits. I will get blood work done in 4 weeks and then possibly see if I can convince my doctor to try an AI, if my E2 still is high.

Good luck on getting your blood work done. Abnormal sleep cycle? How so? This is one of the things that can affect your hormones, but I`m sure you already know what. :)

Even though Nebido is not an option here, I’m curious about how they get your dose right. My impression with shorter acting T is that there might be a period of dose adjustment. I assume that they aim for the lowest blood level they think reasonably might work, then calculate the TRT dose that would be expected to reach that point, and get fairly prompt lab work and patient feedback. When you get injection somewhere between 1 and 3 times a week, this seems relatively straightforward, but when doses are 6 weeks apart, it seems like this could take a really long time. Do they have some other better process for fine tuning dosing?

I was able to get a blood draw at 7:00 on Saturday, so I should have more info in 10 days or so. (Apparently Vitamin D takes a while, although it would be pretty surprising to me if I came up low on that one, given my sun exposure.)
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Since I normally get up at 4:00 a.m., the doctor thought my testosterone cycles might be earlier than normal. Plus, for the past couple of months, of months, I wake up every night some time between 11:30 and 1:30 or 2:00. Usually just for 15- 30 minutes, but enough to prevent long periods of uninterrupted sleep. (I’m sure that isn’t helping things on the T front, although I’ve also had symptoms for much longer than the current sleep cycle issues, so I’d be surprised if it accounts for everything.

I don`t think you will see that level of sophistication around here. The goal is simply to put yourself back in the normal range, which technically, I already was in. :)

FWIW, after 3 days, I still don`t notice nothing, although I feel better than while on HCG 500 IU 3X, but that improvement came about prior to the Nebido since I already took a break from HCG.

Some people I talked to were concerned about the low SHBG, thinking it could indicate both hypothyroidism and insulin resistance, so maybe this will not be as easy as I hoped.

It might be worth having your thyroid hormone levels checked out if things don’t turn around for you after a while on Nebido/hCG. I saw an article about different things that influence SHBG levels. Increasing T3 raised SHBG levels (both serum and intra-cellular if I understood it correctly).

It seems a little counterintuitive to me that your SHBG levels declined even as your testosterone levels were increasing. However, there are probably a large number of variables in play, so maybe an endocrinology consult would make sense if things resolve on your current regimen.