stat1951 said:
Where can I find more information on the hCG stimulation test (or similar) that can be done to see if one's body can respond to stimulation for testosterone production?
I had a "situation" develop last June (2004) where I started experiencing some very severe anxiety and then went into a very sudden hypogonadal state. Erectile functioning and libido went from an 8.5 (on a ten scale) to a ZERO almost overnight. The specialists are still testing to try and find out what may have caused this problem - which is still on-going (by the way, the hypogonadism was just one of several serious symptoms that surfaced within a 2 - 3 week period). At one point, there was a belief that I had "Cushing's Disease" (in fact one endocrinologist diagnosed it very emphatically), but more advanced testing has since ruled out Cushings. Current testing is being directed toward the possibility of having a "Pheo tumor" (especially since a CT Scan last September found a small tumor inside my left adrenal gland - and my symptoms fit the various listings of Pheo tumor symptoms... with the exception that I have fluctuating BP rather than consistent high BP which is a "usual" symptom of Pheos, but it is conceded that mine is in an early stage apparently).
Anyway, I was put first on 2.5 grams AndroGel (by my initial PCP), then as an after thought was put on 5.0 grams AndroGel (with no testing other than total T and PSA). In late Sept (2004), I was put on 7.5 grams AndroGel (by my initial Endo who had me go off the AndroGel for almost 4 weeks and then re-test). I have since switched to a new Endo (at a major metro hospital). While he has re-tested my levels, he is - for now - satisfied with my T levels and the 7.6 grams AndroGel... and is concentrating on my "main problem". I have some serious hopes that this "main problem" is going to be a Pheo tumor and that surgical intervention would then take care of the chemically generated anxiety (long story but the Pheo tumor causes chronic secretion of adrenalin, etc.) and the various physical symptoms.
To cut to the chase: My hope is that a regimen of hCG (or similar) would cause the HPAT Axis to "re-set" and resurrect that natural production of T. So any information in that regard would be appreciated.
Also - in the meantime - not being satisfied with where I am at with the 7.5 grams dosing of AndroGel (Total T- 358 reference range of 220 1000, Free T - 112.8 - reference range of 40-240, Estradiol - 25 - reference range 0 60), are there any suppleemnts that can be taken to increase the Free T levels while on AndroGel? Was specifically thinking of something like 6-OXO or similar? Am already taking Zinc and DIM to counter aromatase factor to some extent. Wondered if rotating it with something stronger, such as 6-OXO might have benefit of lowering estradiol a little further while increasing Free T?
Thanks for any input.
P.S. Am a new poster, so if this should be primarily posted in a different section, please advise.
LRS
Hi LRS your levels are to low on 7.5 grams of AndroGel for me anyway when I was doing 10 grams my levels were at 600 and still to low for me.
I have a cut & paste from David Z.
Human Chorionic Gonadotrophin (HCG) is a hormone found in men and women. Women secrete large amounts of HCG during pregnancy and men secrete large amounts during puberty.
HCG is administered as a form of TRT. HCG is an alternative to standard TRT in men with low LH and FSH (i.e., secondary hypogonadism). To determine if you are a candidate for HCG you must have a blood test showing low T, LH and FSH. This blood test cannot be taken while you're on standard TRT because standard TRT shuts down LH and FSH production and thereby distorts the test results. Alternatively, a Clomid Stimulation Test can also demonstrate secondary hypogonadism (see separate posting on this topic).
Rather than shutting down your body's natural T production system (like standard TRT does), HCG stimulates it back towards normal function. Your body produces it's own T. I believe that HCG is vastly superior to standard forms of TRT for the following reasons:
1. Better mimics the body's own natural physiologic rhythm of T production.
2. Easier to maintain normal T levels when administered properly.
3. More physiologic T levels minimize excess estradiol production (i.e., reduces aromatization).
4. Maintains normal size of testicles (in contrast, standard TRT shrinks the testicles).
5. Stimulates sperm production (thereby increasing/restoring fertility). In contrast, standard TRT reduces, if not eliminates, sperm production thereby making you infertile.
6. Restores normal function to testicles - the benefits of normal testicular function are not fully known. In his book "Saw Palmetto: Nature's Prostate Healer", Ray Sahelian, M.D. says that the testicles and the prostate exchange enzymes. I don't know what purpose these enzymes serve, but I'd rather have them working than not working.
7. Restarts the pituitary/hypothalamus axis (see Medline article 4044781). My HCG dosage is very small (currently 480 IU per week). This means that my body is responding to HCG by producing more LH and FSH on the "off days." Some have claimed that HCG can restart your system completely so that you can get off the shots and your body will maintain on it's own. While, I've yet to hear of someone for whom this has actually happened, my HCG dosage has steadily declined over 3 years from 1000 IU to 480 IU per week. Also, I feel good about the fact that my pituitary/hypothalamus axis is being stimulated to return towards normal function.
The only disadvantage of HCG is that doctors are unaware of this excellent alternative.
Doctors are usually down on what they are not up on. If you ask about HCG, most doctors will give you a variety of lame, ill-conceived reasons for not prescribing HCG. These excuses all add up to the fact that they don't know how to administer it properly and don't want to take the time to learn. I wonder what percentage of doctors would take the time to learn about HCG if they were diagnosed with secondary hypogonadism?
Typical excuses for not prescribing HCG are (1) that the insurance company won't pay for it and (2) it's expensive. Both are absolutely untrue. As far as I know, all insurance companies pay for it (if the doctor clearly states in writing that it's for hypogonadism only) and it 's actually cheaper than standard forms of TRT.
The current guidelines of the American Association of Clinical Endocrinologists (AACE) indicate that HCG should only be prescribed when a man is interested in fertility. As a result, most doctors will not prescribe HCG unless you tell them you are currently trying to have children. The AACE guidelines can be found at:
www.aace.com/clin/guidelines/hypogonadism.pdf
These guidelines (written in 1996 and updated in 2002) are considered outdated by many practitioners with respect to HCG therapy for the following reasons:
1. The guidelines call for intramuscular HCG injections. Subcutaneous injections are much more convenient, much less painful and equally effective (see discussion below and/or just ask the many men who inject HCG subcutaneously or look at their blood test results).
2. The excessive HCG dosage levels suggested in the guidelines cause a variety of problems as discussed throughout this primer. In particular, excessive HCG dosages cause elevated estradiol (E2), which defeats many of the positive effects of increased T.
3. The guidelines cite expense and inconvenience as the reasons why one wouldn't use HCG otherwise. Aren't those my judgements to make? Of course they are! The funny thing is, if I were injecting 2000 to 6000 IU per week intramuscularly, I too would consider HCG therapy expensive and inconvenient, but also ineffective (due to E2 overload). Duh?! But instead, I inject 480 IU/week subcutaneously and find it to be inexpensive, convenient and highly effective.
Unfortunately, doctors are unwilling to stray too far from their professional guidelines. Also, they are unwilling to devote the amount of time to each patient required for effective HCG therapy monitoring and education. That's just human nature. But we're talking about our health and future here! Think for yourself and you will see the fallacies in these doctors' arguments against it.
Each day more and more doctors are becoming more and more aware of the benefits of HCG. In his landmark book, The Testosterone Syndrome, Dr. Eugene Shippen makes a strong case for HCG as an alternative to standard TRT in cases of secondary hypogonadism. This book is considered by many as the definitive book on TRT.
Unfortunately, the vast majority of doctors are woefully ignorant about the proper dosage for HCG. In fact, the AACE clinical guidelines call for HCG dosages of 1000 to 2000 IU, two or three times a week. Scientific studies have demonstrated that HCG dosage levels of about 5,000 IU per week or more administered long-term cause permanent damage to the testicles (see Medline articles 6210708 and 3583230). These studies have shown that such excessive HCG dosages taken long-term result in testicular desensitization (to future stimulation by LH or HCG). In other words, long-term, such excessive dosages of HCG will result in primary hypogonadism!
Also, the AACE guidelines call for intramuscular injections when scientific studies show that subcutaneous injections work equally as well (see Medline article 8075787). My experience as well as hundreds of other men's experience proves this point. Subcutaneous injections are much easier to administer and far less painful than intramuscular injections.
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.
Below is a copy of Dr. Eugene Shippen's HCG protocol that he emailed to me on 3/17/01. If you are interested in HCG therapy, I suggest that you show this protocol to your doctor. If your doctor has any questions, he/she should contact Dr. Shippen.
Prior to HCG therapy, Shippen gave me a Clomid Stimulation test to rule out any hypothalamus/pituitary issues such as tumors, etc. My response to this test was good. He then put me on Selegiline, which raised my T, but not enough for me.
HCG is available in shots only. It is self-administered at bedtime using the smallest of needles (0.5 cc, 30 gauge, 5/16"). Shots are simple and virtually painless.
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Chorionic Gonadotrophin Stimulation Test (males < 75 years old)*
Chorionic Gonadotrophin is presently available through most pharmacies or distributors as Profasi, Pregnyl or generic Chorionic Gonadotrophin 10,000 units per 10 cc vial. Various stimulation tests have been described, from high dose, short course testing to more normal physiologic doses over a longer time period. I have found that a typical treatment course for three weeks is best for determining those individuals who will respond well to this type of treatment. It is administered by injection 500 units (0.5 cc) SQ, Monday through Friday for three weeks. Teach patient to self administer with 50 Unit Insulin Syringes with 30 gauge needles in anterior thigh, seated with both hands free to perform the injection. Measure: Testosterone, total and free, plus E2 before starting CG and on the third Saturday AM after 3 weeks of stimulation (salivary testing may be more accurate for adjusting doses). Studies have shown that SQ is equal in efficacy to IM administration.
Results:
1. <20% rise suggests poor testicular reserve of leydig cell function (primary hypo-gonadism or eu-gonadotrophic hypo-gonadism indicating combined central and peripheral factors).
2. 20-50% increase indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.
3. > 50% increase suggests primarily centrally mediated depression of testicular function.
Options for treatment vary both with the response to CG and patient determined choices.
1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.
2. The area in between 20-50% will usually require CG boosting for a period of time, plus natural boosting or "partial" replacement options. I believe that full replacement with exogenous testosterone is always the last option in borderline cases since improvement over time may frequently occur as leydig cell regeneration may actually happen. Much of this is age dependent. Up to age 60, boosting is almost always successful. 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, AMI, obesity, alcohol, deficiency, etc.) This positive effect will not occur if suppressive therapy is instituted in the form of full replacement.
3. If there is an adequate response, >50% rise in testosterone, there is very good leydig cell reserve. Natural boosting or CG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response.
4. Chorionic Gonadotrophin can be self-administered and adjusted according to response. In younger, high output responders (T > 1100ng/dl), CG can be given every third or fourth day at bedtime or in the AM. This also minimizes estrogen conversion. In lower level responders(600-800ng/dl), or those with a higher E2 output associated with full dose CG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full Testosterone response. In these cases, the diluent is lowered to 7.5cc or even to 5 cc, which increases the CG concentration 1 - 2 X. This can be administered in variable doses 0.3 - 0.5cc given every 3rd day. Check salivary levels on the day of the next injection, but before the next injection to determine effectiveness and to adjust the dose accordingly. Keep in mind that later as leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.
5. Monitor both Testosterone and E2 levels to assess response to treatment after 2 - 3 weeks after change in dose of CG as well as periodic intervals during chronic administration. Sublingual testing is very easy and cost effective. It will also better reflect the true free levels of both estrogens and testosterone. (Pharmasan Labs 888-342-7272 is very good)
6. Adjustment of dosage is a result of symptomatic response and hormone level boosting. It is based on clinical judgement as much as actual hormone levels. Remember that "Normal" ranges are for populations, not individuals!
7. Except for reports of antibodies developing against CG (I have not seen this), there are no adverse effects of chronic CG administration. An additional benefit is the boosting of Growth Hormone output which has also been reported, either as a direct effect of CG or as an effect of increased levels of testosterone.
*Protocol adapted from "The Testosterone Syndrome" by Eugene Shippen, M. D. (M Evans and Co, NY 1998).
Posted on ASI with permission of Eugene Shippen, M. D.
- David
And this one on Clomid.
A Clomid stimulation test is a standard protocol that has been used by endocrinologists for years to test whether a man's hypogonadism is primary or secondary. If the test is successful (i.e., if your T rises significantly), that means that all of the organs in the feedback loop (the testicles, pituitary and hypothalamus) are healthy and functional, but for some unknown reason the system has gone dormant. A successful test result also means that you are a good candidate for HCG or Clomid, which in contrast to standard TRT, stimulate your body to produce its own T. See:
www.aace.com/clin/guidelines/hypogonadism.pdf
Clomid (Clomiphene Citrate) doesn't lower estrogen; it "blocks" it. Estrogen attaches to the receptors in the hypothalamus and that signals that there's enough T in your blood, so your body reduces its T production. Somehow the hypothalamus reacts to E as well as T. Clomid attaches to these receptors but doesn't act like E.
I did a Clomid stimulation test in November 1999. Dr. Shippen gave me 100 mg/day (one 50 mg tablet in the morning and one in the evening before bed) for a week. I took a blood test on the morning after the last day. My test was successful, in that, my T went from about 200 to 600.
Clomid is most often used to promote fertility in women. Therefore, if you research Clomid, the vast majority of the literature you find will discusses the use of Clomid by women rather than men. In fact, when I went to fill the prescription, the pharmacist was very leery and asked me a lot of questions before dispensing the drug.
- David
Phil
