Treatment options for Hypogonadism

Thanks!

Ideally, I would have wanted to see a doctor that really knew what he was doing and where I did not have to do any research myself, but I don`t think he exists up here. The doctor said he had given HCG and clomiphene to earlier patients, but when he was about to prescribe it, he had to ask me about brand names, dosing and such and appeared a little surprised when he learned it was injections. I think it`s the first time he does it, but he wants it to appear otherwise.

Let`s hope things turn out well for you as well. :)

“The ONLY protocol that should be used is Dr. Shippen’s HCG protocol. Dr.
Shippen’s protocol calls for low dose shots (about 300 to 500 IU) at
bedtime, 2 to 5 times a week depending upon your responsiveness. This
protocol more closely mimics the body’s natural physiologic rhythm of LH
production.”

With 5 times per week, that is 2500 IU.

That would be a maximum and based on other sources I`ve come across, some place around 1500-2000 is ideal. Too large doses can cause leydig cell desenzitation over time and spike estrogen.

There is however more differing opinions with regards to injection frequency. I read that Dr Mariano prefers daily doses, but other places I read that because of the half-life of HCG, it is better to spread out the doses. At least every other day. Supposedly, that is less suppressive of the HPTA, since it allows the body to still produce some LH and FSH. It makes sense to me.

I think I will start out with 3 times per week like you, but possibly 500 IU per injection.

Thanks. :)

Renholder

Sounds like a great strategy.

Just to clarify my dosage, was so tired when I posted that I didn’t spell it out.

Vial is 10ml/10,000 USP units. I inject with a 1mL U-100 insulin syringe. The insulin syringe has tick marks from “10” to “100” units. I inject 25 units.

Thanks.

I`m having a real hard time getting this stuff right because the entire dose of 5000 IE is intended to be taken right away. It does not come with bacteriostatic water and thus is not meant for storage. I`ve been doing a lot of research on this the last days and it is not even possible to buy bacteriostatic water and sterile vials in this country such that I can mix it properly and store it.

My doctor said that there was no problem injecting 5000 IE weekly in one dose, which is obviously NOT true, so I don`t feel like calling out to him either since I don`t think he got any help to offer and will probably insist on taking 5000 IE.

On a side note, I`ve been feeling rather down the last days, but I`m not sure if it`s the HCG since I`ve been feeling rather down since I finally realized that I need some kind of treatment and actually have a problem. I guess I stopped resisting and trying to “feel better”.

I`ll just have to give it some time and see what happens. I read about a guy on another forum who noticed the effects first after three weeks.

Sounds complicated. Hope you can come up with a workable solution.

It was, but I think I`ve figured it out. :)

The literature from the manufacturer states that men may dose it at 1000 IU three times per week, but obviously the 5000 IE is meant for immediate use and not storage as it comes, so there is a contradiction there. I even called the manufacturer and they said I had to use it immediately and throw away the rest.

Anyway, I have finally gotten a hold of bacteriostatic water and sterile vials if they can only pass the customs, so I think I should be fine.

As for the effects of the HCG, I have not noticed anything yet after 10 days. Libido has been better this week, but not anything better than prior random periods above baseline. I think I may need more time, but I will get bloodwork done on the 18th. That should reveal if it is working or not. If it does not, I think I will try Nebido.

Mine come as a powder in it’s on vial, and a second vial containing the bacteriostatic water. I reconstitute it as soon as I get it and then store it in the fridge, where it stays good for the 90 days

So what form exactly are you receiving the 5000 IE in, I am a little confused?

One ampoule containing 1 ml of sterile natrium chloride water and one ampoule containing the powder. For all practical purposes it is meant for immediate use, considering that one can`t store it in ampoules anyway and since one really can`t use sterile natrium chloride water for long-term storage.

When I get bacteriostatic water, I will reconstitute it just like you do. :)

Thanks for the update. I’ve been wondering about your experience so far. From what I’ve read, its not uncommon for it to take several weeks after T levels are up to see noticeable changes in libido, and potentially longer still for other benefits of restored T levels. So, I wouldn’t be discouraged by ambiguous results after 10 days. If your blood work shows the hCG has elevated your T levels, I suppose you’ll stick with hCG, maybe tinker with dosing a little if you need a small additional boost, and give it more time? Good luck. I don’t know anything about your fallback plan, since don’t think Nebido is even available here. Do they use “old school” short acting T to figure out what dose it takes to produce T levels that work for you, before going to the long acting form?

While you’re getting blood work I’ll be seeing an endocrinologist. I’m mentally prepared not to get much by way of opinions/conclusions during this visit. More likely the endo can decide if my unusual profile (high FSH, normal LH, low free T) is reason for further tests (pituitary imaging?) I made sure the endo knows my original set of concerns, so if he could order additional lab work if he thinks my hypogonadism evaluation should include information on E2 or thyroid hormones. Then, maybe I can get down to the TRT question with either the endo or the urologist.

Seeking input/advice on a couple of questions.

1. How far does TRT typically suppress LH levels?

I’ve been trying to get more info on TRT and Alzheimers. My urologist does not seem to recognize any connection at all, but I think he is just not up on things because I have found a lot of research and clinical investigations in this area. Anyway, the initial stuff I read found connections between low T levels and elevated harmful beta amyloid proteins, and suggested T may have some neuro protective role. More recently I found articles indicating that LH may be a culprit (via some cell cycle mechanism that I don’t understand at all. These papers don’t dispute beneficial effects of T administration (at least in early stages), but they think reducing LH may be a key part of the mechanism for reducing neurotoxicity in the brain. Thus, I’m curious how much lower my LH levels might go under a TRT regimen that did not attempt to preserve LH.

2. I finally had a satisfactory outcome with a sample pack of Cialis. On the one hand, how great is that? On the other hand, I’m a little concerned that my urologist might say that if Cialis works, there is no reason to consider TRT. (Previously, he seemed interested in the efficacy of Cialis in deciding a course of treatment. In fairness, he didn’t have lab data at the time.) This seems backwards to me, but I.m curious what you would say if you got such a reaction.

Seeking input/advice on a couple of questions.

1. How far does TRT typically supress LH levels?

I’ve been trying to get more info on TRT and Alzheimers. My urologist does not seem to recognize any iconnection at all, but I think he is just not up on things because I have found a lot of research and clinical investigations in this area. Anyway, the initial stuff I read found connections between low T levels and elevated harmful beta amyloid proteins, and suggested T may have some neuro protective role. More recently I found articles indicating that LH may be a culprit (via some cell cycle mechanism that I don’t understand at all. These paoers don’t dispute beneficial effects of T administration (at least in early stages), but they think reducing LH may be a key part of the mechanism for reducing neurotoxicity in the brain. Thus, I’m curious how much lower my LH levels might go under a TRT regimen that did not attempt to preserve LH.

2. I finally had a satisfactory iutcome with a sample pack of Cialis. On the one hand, hiw great is that? On the other hand, I’m a little concerned that my urologist might say that if Cialis works, there is no reason to consider TRT. (Previously, he seemed interested in the efficacy of Cialis in deciding a couse of treatment. In fairness, he didn’t have lab data ar the timeThis seems backwards to me, but I.m curious what you wiuld say if you got such a reaction.

Damn this phone and/or its user!

Maybe because I am going though this with my brother in law and one of my good friends, I am feeling some frustration.

It is one thing to be well-educated and cautious, it is another thing to continually talk yourself out of a treatment that will improve your health, protect your body, restore your mental capacity and energy levels.

My brother in law was diagnosed with Low Testosterone at least two years ago. I think he has been suffering from it for longer than that. I do not know his free test numbers but his total test is 100 ng/dL

He is dead tired and fatigued. He is irritable and vicious. His judgement is very poor. He can’t make decisions. His state is affecting his relationship with his children. He’s depressed. He can’t deal with anything, because he is so fatigued.

I did convince him to see an endocrinologist, and the endo did an MRI. However he never made a follow-up appointment,

He called up his insurance company and was very outraged to hear there would be a co-pay on several of the HRT treatments.

Other people are telling him that “HRT causes cancer” or “You won’t be able to sleep if you are on HRT”.

So he is miserable, he knows why he is miserable, but he will not do anything about it.

Everytime I see him, he looks more and more physically deteriorated. I saw him this past weekend, and again told him he needs to get treatment. I suggested to him to make an appointment with his endo to talk about starting treatment. He paid lip service to it, I have no idea if he will follow up.

It is so painful for me watch him suffer. But I am doubting he will ever do anything about it.

As to my good friend, his total test was around 150 ng/dL. He did seek treatment a couple years ago. His GP prescribed androgen. But he did not go to any of the follow up treatments to get his blood work done. Consequently his doc refused to refill his prescription. He has a urologist he really like, I suggested he see the URO and have him take over. “That’s a great idea.”

And he didn’t do a damn thing.

So my friend went another year and a half untreated, again the symptoms getting worse and worse. Finally in the last several months, he returned to his GP and started on the androgel again. The other day he told me “I don’t think it is doing anything.” I asked if he had done any follow up lab work. “No.”

So the cycle starts again.

If I am projecting on you guys, I apologize.

Sta-kool: I can see how watching that would be frustrating — especially when you have first hand experience concerning what TRT can do for you. But trust me on this: of all my problems, talking myself out of TRT isn’t one of them. I REALLY want to give it a shot, for all the usual reasons plus the vague hope that I would feel like I’m doing everything in my power to reduce the Alzheimers risk present in my family.

I just sense - fairly or not that - there is a lot of resistance to prescribing TRT. I hope I’m wrong, but I feel like I need to go into appointments “loaded for bear,” but I actually feel like my knowledge is about a mm deep. Thanks probably to PE, I have experienced some mild but definite improvement in EQ lain the last week r two, and I’m hoping that won’t be held against me when I seek TRT.

Being educated and loaded for bear is a really good thing. I have learned the hard way.

Personally I don’t think there is a resistance to prescribing HRT. It has been around for ever, plenty of studies have been done about it. Some docs might be hesitant about treating you because if I remember your total test is within “normal range.” But to me it sounds like the doc you have chosen is not the type to treat lab numbers.

I did want to note that the first thing I felt when starting HRT was a HUGE libido burst. Urge to single-handedly repopulate the earth. I kid you not. Insane libido. Fun as hell, but this only lasted a few weeks and then settled down into my “old normal libido”, which is pretty high. This is pretty typical for guys starting.

Full effects of testosterone is likely to take even months from what I heard, which is part of the reason why I`m impatient to get started with exogenous testosterone if this does not work out. From what I`ve read though, the blood work should reveal if it is working or if there is potential for it to be successful, since my testes should be working at maximum capacity now. If there is only a slight difference or none at all, I don`t think it`s likely there will be in two months either.

Right now, I`m considering just calling my doctor on Friday and get started right away. I have a lot on my plate now and in the immediate future, so I don`t feel I have any more time to experiment. I could really need the boost.

I`m also not sure if there is any real benefit to not going on Nebido compared to monotherapy. HCG is still three shots per week, while Nebido is only every 10 weeks, so it does not really impact my lifestyle negatively. Also, I know that it works. Continuing to use HCG should keep my testes alive and fertile, so I don`t think that is a concern either. Possibly I could try to go off in the future some time under better conditions if bloodwork comes back and shows that HCG did have effects on it`s own.

As for Nebido, you first take one shot and then a new shot after 6 weeks during a loading phase. After that, you`re supposed to take the next shot after 10-14 weeks. I read about a guy who feel great on this treatment and better than on weekly shots. He takes his shot every 14 weeks. A lot of guys needs to take it sooner though, around week 9-10.

I was initially skeptical towards the drug, but there are some great reviews of it online, so I`m willing to try it out.

1. I don`t know for sure, but I think both exogenous testosterone and HCG are suppressive of your LH levels, so most likely they will be at rock bottom.

2. I think what matters is how you feel overall and what your blood work says. I assume it may be possible to have decent/good sexual function, while still having other symptoms of low testosterone. Libido/poor EQ is not the only thing I suffer from, but I also lack energy, I`m fatigued, lack mental clarity at times and motivation. So, while I would be supremely happy to fix my problems with libido and EQ, I would not be pleased if my other problems persisted.

If you are borderline low and actually feel decent, I don`t think I would jump on TRT immediately. People function differently on different levels.

How did the Cialis work btw? I tried that myself during a period where I did not really suspect low testosterone, but knew I had issues. After the 1st pill, I felt nothing. Continued taking small doses daily. Then I met a girl after a week or so. Did not take her to bed, but we made out heavily. My erection was so hard that it actually hurt. :)