HCG Only Protocol and Secondary Hypogonadism

[Kroms_laugh]

I've got secondary hypogonadism. Fertility is still a concern of mine. Is an hCG only protocol a good option in my case? I'm looking for people who've had experience with hCG only protocol that could share their experience. Is hCG more expensive than, say Test?

What does a typical hCG only protocol look like?

 

[earthdog]

I can't speak to the first part of your question, but I can help on the price question. This is assuming your insurance doesn't pay for anything. Going by prices from the pharmacy that Swale uses, generic hcg is $46 for 10,000 IU, which is a lot of hcg, but you can only keep it for 60 days once its reconstituted and then you have to throw it out. So, you'd be looking at $23 a month no matter how much you use. Test cyp is $110 for 10ml of 200mg/ml. So at 100mg a week, you'd have enough for 20 injections or about 5 months, or $22 a month. Now this pharmacy does not necessarily charge the going rate, I'm just using them as an example. You can probably get the meds cheaper if you shop around.

 

[Sonny]

The protocols for HCG are all over the map in terms of dosages and frequency.

Swale's approach is probably the least aggressive in terms of amount used and frequency of use. However, Swale's approach is extremely effective when "stacked" with Test Cyp/gel/cream/etc. The small dosages of HCG (250 iu 2x per week) plus the moderate dosage of Test (100mg/week) gave me super T levels. The addition of HCG to the existing Test Cyp caused serum T levels to jump by around 40%!

Dr Eugene Shippen wrote a big "how to" on administering TRT using HCG only. Some of what was written is available on SBI.

In short, it basically mentioned using high dosages of HCG (like 1000iu/day) for a week to determine your response to it. The amount of change in your blood levels became an indicator for how much/how frequently you used HCG and whether you also include Test or not.

The main risk with using too much HCG at once (based on feedback from Swale) is that it can elevate your E2. For that reason, I believe he recommends no more than 250-500 iu per day. If you need more, increase the number of days...not the number of iu.

Sonny

 

[SWALE]

I disagree with much of what Dr. Shippen has said about using HCG. He still uses too much, to start with. And he tries to arbitrarily assign dosages based upon some sort of percentage yield of T production. The problem with that is he doses the HCG QOD. Therefore blood androgen levels are constantly going up and down, also affected by widely varying LH production, AND inherent innaccuracies in lab testing. You just cannot arrive at hard-and-fast rules given all those confounders.

I spent about an hour with Dr. Shippen a year ago December. He's a really good guy, and I like him very much. However, he always is trying to convince other doctors that he has all these new, secret protocols, and tries to get you to pay to go to one of his seminars to discuss them. That did not impress me very much.

His introduction of Deprenyl is quite interesting, I must say.

Just yesterday one of his patients emailed me with some questions. I was kind of surprised at what this particular patient's regimen is.

He is to be respected as a true pioneer in TRT medicine, though.

 

[DavidZ]

I've got secondary hypogonadism. Fertility is still a concern of mine. Is an hCG only protocol a good option in my case?

That probably depends on how responsive you are to HCG. I currently take 205 IU HCG shots twice a week, which consistently gets my T into the upper normal range. I don't see how adding exogenous T would improve my protocol at this point.

If a weekly HCG dosage of about 1,000 to 1,500 IU gets your T into the upper normal range, you probably don't need to add exogenous T. If that dosage is not enough, then adding T would probably be a good idea.

What does a typical hCG only protocol look like?

Subcutaneous shots of 300 to 500 IU each, 2 or 3 times a week at bedtime.

 

[Sonny]

David:

Do you have any problems with insomnia as a result of taking HCG at night? I notice that on the days I take it, I feel like I drank jet fuel for breakfast. It really makes me feel alert/awake/wired up...but in a good way...not like revved up on caffeine.

On HCG, I have to work a bit at winding down at night. This was not the cause pre-HCG (when I was on Test Cyp only).

Sonny

 

[Kroms_laugh]

If I take HCG and Testosterone, will I still become infertile?

 

[DavidZ]

If I take HCG and Testosterone, will I still become infertile?

I don't think so. However, I suspect that an HCG only protocol would provide better fertility.

 

[davejohnson]

Subcutaneous shots of 300 to 500 IU each, 2 or 3 times a week at bedtime.

Why would it matter when HCG is injected?

 

[DavidZ]

Why would it matter when HCG is injected?

Men produce most of their T during sleep. Taking HCG at bedtime mimics the body's natural physiology, which is better for you and maximizes the body's response.

 

[SWALE]

I think the circadian rythm is much over-rated. Most of my guys take their HCG in the morning, and enjoy its subjective benefits all day long. Response to HCG will not mimic the circadian rythm, anyway. That is why it can be taken QOD.

 

[SWALE]

Appropriate TRT should not make a fertile man infertile.

 

[DavidZ]

I disagree with much of what Dr. Shippen has said about using HCG. He still uses too much, to start with.

The large initial dosages (about 2,500 IU/week for 2 or 3 weeks) is a stimulation test. These dosages are necessary, particularly with older men, because initial leydig cell response is often weak. It takes some time for leydig cell response to return to full capacity. The HCG shot dosage is then adjusted based on subsequent blood tests and clinical response.

And he tries to arbitrarily assign dosages based upon some sort of percentage yield of T production.

His algorithm is a tool to try to properly set the dosage after a stimulation test. Its an estimate that actually worked very well in my case. However, regular blood tests and clinical response determine the ongoing HCG dosage.

The problem with that is he doses the HCG QOD.

Skipping days between HCG shots is the way to go. There's a common misconception that HCG shuts down the h/p axis. While the increase in T that results from HCG does shut down the h/p axis as you would expect, HCG itself actually stimulates the h/p axis.

When a man is "responsive" to HCG, the response occurs in 2 ways - the testicles and the h/p axis. Medline article 4044781 documents HCG's "self-priming" effect on the h/p axis. This article indicates that an initial peak in T occurs 2 to 8 hours after an HCG shot and a second peak in T occurs 48 to 72 hours after the shot. The second peak is caused by LH production. In other words, HCG primes the pump (the h/p axis).

Therefore blood androgen levels are constantly going up and down, also affected by widely varying LH production, AND inherent inaccuracies in lab testing. You just cannot arrive at hard-and-fast rules given all those confounders.

Cant the same be said about your combo protocol? I understand that the HCG shots in your combo protocol are intended to fill in the low T point at the end of the week created by weekly T shots. But can you say with certainty that your combo protocol produces more level T than an HCG-only protocol?

I spent about an hour with Dr. Shippen a year ago December. He's a really good guy, and I like him very much.

Me, too.

However, he always is trying to convince other doctors that he has all these new, secret protocols, and tries to get you to pay to go to one of his seminars to discuss them. That did not impress me very much.

Thats understandable. But can you blame the guy for trying to make a buck?

His introduction of Deprenyl is quite interesting, I must say.

Its worked well for me so far.

Just yesterday one of his patients emailed me with some questions. I was kind of surprised at what this particular patient's regimen is.

What was the regimen?

He is to be respected as a true pioneer in TRT medicine, though.

For sure. His book is the bible for mens HRT. The field of mens HRT has change greatly since his book and probably much as a result of his book. And most of what he said is just as valid today as it was then.

 

[Kroms_laugh]

Thats understandable. But can you blame the guy for trying to make a buck?

This is the very reason, why I admire SWALE's work so much. All of my education on TRT has come from him and his boards exclusively... for free.

 

[DLMCBBB]

The large initial dosages (about 2,500 IU/week for 2 or 3 weeks) is a stimulation test. These dosages are necessary, particularly with older men, because initial leydig cell response is often weak. It takes some time for leydig cell response to return to full capacity. The HCG shot dosage is then adjusted based on subsequent blood tests and clinical response.
Skipping days between HCG shots is the way to go.

There's a common misconception that HCG shuts down the h/p axis. While the increase in T that results from HCG does shut down the h/p axis as you would expect, HCG itself actually stimulates the h/p axis.

When a man is "responsive" to HCG, the response occurs in 2 ways - the testicles and the h/p axis. Medline article 4044781 documents HCG's "self-priming" effect on the h/p axis. This article indicates that an initial peak in T occurs 2 to 8 hours after an HCG shot and a second peak in T occurs 48 to 72 hours after the shot. The second peak is caused by LH production. In other words, HCG primes the pump (the h/p axis).

Stimulates how? Production of GRH? Some of his protcols started again this misconception that guys can "bridge" between cycles with hCG. We all know now, there is no such thing as a bridge.

I dont see how hCG can stimulate GRH, leading to LH production? Can you please show us how this happens? Or does it stimulate the HP directly?

David I only see the abstract on the net, if you have it, can you post it to this board entirely, I would like to look at it more closely. I wonder if this had to do with its pharmokinetics.

Swale, what are your thoughts to that study?

David here is something else that I found:

Prolonged biphasic response of plasma testosterone to single intramuscular injections of human chorionic gonadotropin.

Padron RS, Wischusen J, Hudson B, Burger HG, de Kretser DM.

The response of plasma testosterone to varying doses of hCG (0--6000 IU) given as a single im injection has been evaluated in normal men. After an initial rise at 2 h, the levels of testosterone demonstrated a secondary rise, reaching a peak 48 h after the im injection. The magnitude of the response varied directly with the dose of hCG used, and at the highest dose (6000 IU) testosterone levels were still elevated 6 days after administration. Plasma estradiol levels showed a dose-dependent rise, with peak levels being attained 24 h after hCG. The prolonged response of plasma testosterone to a single injection of hCG should prompt a reevaluation of diagnostic and therapeutic regimens using this agent.

PMID: 7372789 [PubMed - indexed for MEDLINE]

AND


Testicular responsiveness to a single hCG dose in patients with testicular feminization.

Balducci R, Adamo MV, Mangiantini A, Municchi G, Toscano V.

Clinica Pediatrica 2nd University, La Sapienza, Rome, Italy.

The suggestion that androgens may regulate testosterone (T) production in rat Leydig cells by a receptor-mediated feed-back mechanism, led us to investigate whether in vivo the absence of testicular androgen receptors, as it occurs in testicular feminization (TF), may modify the characteristic testicular response observed in men and prepubertal children after a single dose of hCG. Subjects consist of: 1) six normal men, 2) two adult patients with the complete form of androgen insensitivity syndrome (TF), 3) 12 normal prepubertal boys, 4) one prepubertal boy with the same form of TF. Each subject received i.m. a single dose of hCG 3500 IU/m2 b.s. and blood samples were collected basally and 2, 4, 24, 48, 72 and 96 hours after the hormonal stimulus. Serum levels of T, 17 alpha hydroxyprogesterone (17OHP) and 17 beta estradiol (E2) were measured at each collection time. In normal men a significant increase in T (M +/- SE) was observed at 4 h (758.6 +/- 135 ng/dl, P less than 0.05) and a more significant increase at 48 h (1082 +/- 60.3 ng/dl, P less than 0.001). E2 and 17OHP peaked significantly at 24 h (81.5 +/- 9.6 pg/ml and 460.7 +/- 90.9 ng/dl respectively). This response pattern is characteristic of the testicular desensitization which occurs in normal man after a single hCG dose. The same response pattern has been observed in the two TF adult patients suggesting that human testicular desensitization in vivo does not depend on androgen receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

PMID: 2793066 [PubMed - indexed for MEDLINE]

 

[SWALE]

David--Welcome to the Forum!

I meant to get to this thread today, but instead watched my MSU Spartans beat Kentucky in a game played so well, and so valiantly, by both sides, it is a shame anyone had to walk away with a loss.

It will take me about half an hour to adequately answer your post. I'll try to get to it tomorrow (going to bed after a weekend business trip). Once I do, I am confident you will see that you have been badly misinformed. I say this because you are obviously very intelligent and well-read.

THIS is the kind of wonderful dialogue we really enjoy here.

 

[DavidZ]

David--Welcome to the Forum!

Thank you. It's nice to be here.

I meant to get to this thread today, but instead watched my MSU Spartans beat Kentucky in a game played so well, and so valiantly, by both sides, it is a shame anyone had to walk away with a loss.

It will take me about half an hour to adequately answer your post. I'll try to get to it tomorrow (going to bed after a weekend business trip). Once I do, I am confident you will see that you have been badly misinformed.

Great! I look forward to it. I'm always interested in learning new things.

THIS is the kind of wonderful dialogue we really enjoy here.

That's why I'm here.

 

[DLMCBBB]

When a man is "responsive" to HCG, the response occurs in 2 ways - the testicles and the h/p axis. Medline article 4044781 documents HCG's "self-priming" effect on the h/p axis. This article indicates that an initial peak in T occurs 2 to 8 hours after an HCG shot and a second peak in T occurs 48 to 72 hours after the shot. The second peak is caused by LH production. In other words, HCG primes the pump (the h/p axis).

Yes, im very interested also, to what swale has to offer. But David, I must say how can you say such things, when the study doesnt even extrapolate the things you bring up?

HH patients (hypogonadotropic hypogonadism), and T-G1 children (normal pre-pubertal), and two patients with the complete form of the androgen insensitivity syndrome, were the only test subjects in which the researches noticed that the early peak of T between the time interval of 2-7hr did not occur. And the second peak in T between the time interval of 48-72 hrs were attenuated as compared with pubertal boys, IOW, reduced.

If im not mistaken hCG is an LH analog, it mimicks its effects, especially in regards to leydig cell stimulation. So yes, the study does make sense, that prior exposure to LH, is a prerequisite for the early peak of the hCG-mediated biphasic testicular responce, ultimately leading to a rise in T. Which is why the researches stated that after the second dose of hCG (80 IU/kg) all groups had biphasic T responses, to varing degrees in magnitude.

The only priming I see, is the action of hCG on the testis. Swale in the past better helped us with describing the effect of a particular SERM (clomid), by analogy, "priming the pump", " if you don't use it, youll loose it". That priming he was talking about on the HP, is not the same in this study.

Dustin

 

[DavidZ]

Dustin,

The key conclusions that I reach from this (and other) studies are:

(1) HCG generates a biphasic T response. That means that (at least) 2 peaks in T are observed after an HCG shot. One that occurs 2-7 hours after the shot, and one that occurs 48-72 hours after the shot.

What causes a second peak? (My guess is that before you read this article you assumed that there was only one peak. Correct?)

While the abstract doesn't say what causes the second peak, my doctor (Dr. Shippen), told me that the second peak (of the "biphasic" response to an HCG shot) is caused by an LH burst produced by the H/P axis. In other words, the H/P axis responds to an HCG shot with an LH burst about 2 days later. Pretty interesting, eh?

(2) Men with secondary hypo don't respond well to their first HCG shot(s). In other words, it takes time for the Leydig cells to be restored their full capability.

 

[SWALE]

I do not believe what Dr. Shippen claims has ever been shown. At least, not to my knowledge. If it has, I would be VERY much interested in seeing it.

In fact, the well-known biphasic response has never been shown to occur at APPROPRIATE HCG dosages--only toxic ones. Again, this is to the best of my knowledge.

I would instead hazard a guess that the biphasic response is proof of LH receptor downregulation. And LH receptor downregulation has been well demonstrated.

Testicular response has long been recognized as the rate-limiting step in HPTA recovery.

Either way, you can only produce just so much testosterone, whether via LH, or HCG, stimulation. Going above the concentration required to do so makes no sense. It is not only wasteful; there are direct negative side effects as well. Because it also, and this is kind of surprising, does continue to increase estrogen levels (although T levels have maxed). Even worse, progesterone goes up, and this contributes to gynocomastia. And progesterone opposes the beneficial effects of DHT. DHT is responsible for "ALLTHINGSMALE".

I believe these points are part and parcel of why it is men who undergo TRT solely by HCG stimulation just do not report the subjective benefits of those who attain the same serum androgen concentrations test cyp or test gel patients do.

The best use of HCG in TRT, IMPO, is adjunctive to either test cyp or test transdermal--used to stabilize serum androgen levels, stave off testicular atrophy (the best it can), stimulate the P450scc enzyme, and lend the increased sense of well-being and libido HCG is so well known for. I know that the establishment (if there is one in this new field) largely disagrees with me on this, but let them prove me wrong, both in the science, and the excellent results I achieve in my patients with my protocols.

This is a smokin' hot thread.