FYI--Low Dose HCG maintains ITT

[kis55]

Found this on another board

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posted by jb at CEM


J Clin Endocrinol Metab. 2005 Feb 15; [Epub ahead of print] Related Articles, Links


LOW DOSE HUMAN CHORIONIC GONADOTROPIN MAINTAINS INTRATESTICULAR TESTOSTERONE IN NORMAL MEN WITH TESTOSTERONE INDUCED GONADOTROPIN SUPPRESSION.

Coviello AD, Matsumoto AM, Bremner WJ, Herbst KL, Amory JK, Anawalt BD, Sutton PR, Wright WW, Brown TR, Yan X, Zirkin BR, Jarow JP.

Center for Research in Reproduction and Contraception, Geriatric Research Education and Clinical Center, Veteran Affairs Puget Sound Health Care System (AMM), and Department of Medicine, University of Washington School of Medicine (ADC, WJB, JKA, BDA, PLS), Seattle, WA; Department of Medicine, Charles R. Drew University (KLH), Los Angeles, CA; Department of Urology, Johns Hopkins University School of Medicine (XY, JPJ), Baltimore, MD; Division of Reproductive Biology, Department of Biochemistry and Molecular Biology Johns Hopkins University School of Public Health (WWW, TRB, XY, BRZ, JPJ), Baltimore, MD.

In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T), suggesting that high ITT is needed relative to serum T for normal spermatogenesis in men. However, the quantitative relationship between ITT and spermatogenesis is not known. To begin to address this issue experimentally we sought to determine the dose response relationship between human chorionic gonadotropin (hCG) and ITT to determine the minimum dose needed to maintain ITT in the normal range. Twenty-nine men with normal reproductive physiology were randomized to receive 200 mg T enanthate (TE) weekly in combination with either saline placebo or hCG 125 IU, 250 IU, or 500 IU every other day for 3 weeks. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and the end of treatment. Baseline serum T (14.1 nmol/L) was 1.2% of ITT (1174 nmol/L). LH and FSH were profoundly suppressed to 5% and 3% of baseline respectively, and ITT was suppressed by 94% (1234 nmol/L to 72 nmol/L) in the TE/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Post-treatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression. Extensions of this study will allow determination of the ITT concentration threshold required to maintain spermatogenesis in man.

 

[mranak]

This study confirms what SWALE has already determined through real world experience administering HRT.

I'm really excited to read about the ITT situation. I hypothesized such a couple of months ago, because it seems logical after I read about a blood barrier in the testes through which serum testosterone cannot pass. This completely explains why hCG (mimicking LH) prevents testicular atrophy even though the testes are much more predominantly sertoli cells (FSH stimulated) than the leydig cells (LH stimulated). It seems clear, especially now, than the sertoli cells need both FSH (but not much) and testosterone, but serum testosterone is unable to get to the sertoli cells. But testosterone produced by the leydig cells is right there and available.

I guess that this is the study that the Endo over at Duke referred to in his letter to SWALE-follower.

Thanks for the post!

 

[Stez]

Does this mean we should take a low dose of HCG ED instead of doing twice a week shots?

 

[HeadDoc]

I think the more interesting question would be how to test the utility or harm of more frequent hcg injections that are a part of the trt protocol. Then there's the question of how to maximize the total and free test created with the test shot and the hcg without going into a superphysiological state.

 

[jboldman]

what if you went slightly higher than physiologic levels while maintaining E levels appropriately? Ever wonder how that would feel?

jb

 

[Stez]

I think going superphysiological has more harms than good, and the positive effects u feel wear off.

I'm sure there's a few people here who have done bodybuilding AAS cycles (i for one have). Currently im on HRT at top of the range after a shot, and i feel about as good as it gets.

 

[HeadDoc]

what if you went slightly higher than physiologic levels while maintaining E levels appropriately? Ever wonder how that would feel?

jb

been there when I first combined the test and 250 hcg. Happened on the second day also. Blood work during the second week confirmed what was going on. It was more than I was looking for in hrt. I sketched out my with my doc was changes I'd take and how to modify the protocol. That chart you posted a while back that demonstrated the daily test levels over the course of a weekly test cyp shot gave me an idea on how to redistribute the test, hcg, and arimidex.

Test cyp reaches its highest level of test on day 2. So arimidex is taken days 2,4,6. Test was cut to .8cc, hcg 100 iu is taken days 2,3,4,5,6.

Last blood work, taken on 5th day of this protocol after 8 weeks of use, showed everything nicely balanced without superphysiologic levels. Subjectively this works great for me.

 

[SWALE]

Think of how happy I was when this study came out.

jb--In some cases (on a case-by-case basis) I am willing to go a bit over the top for Bioavailable T. But I consider Total T as a practical ceiling for TRT titration. Generally guys will develop that burned-out, edgy feeling when they are above normal range, and that is no way ot live. It's like being "on" for years and years.

HeadDoc--Please elaborate on your first point. Your second point is indeed "The Art of TRT" (what I am going to call my book).

 

[HeadDoc]

Swale if you mean the comment about be superphysiologic---at 60, I have no desire to go thru my day in sexual overdrive. I enjoy the calm, euthymia, and focus of appropriate hrt. It allows me to be sexual on demand. It helps with consistent energy to workout with intensity and purpose. Further, the rest of executive brain functions are near optimum: the ability to shift thoughts, initiate new behaviors as needed, organize myself, organize my environment, self-monitor my behavior, possess adequate working memory, display and control a full range of affect. That rigidity of behavior that many younger people note when working with middle-aged co-workers, I now think of as decllinging hormon levels in middle age.

 

[Stez]

headdoc i also used 100iu hcg ED for a while.

Is this the way to go then? Swale? Anyone? My theory says yes, but I don't have the qualifications to back it up..

 

[HeadDoc]

headdoc i also used 100iu hcg ED for a while.

Is this the way to go then? Swale? Anyone? My theory says yes, but I don't have the qualifications to back it up..

I utilized this protocol in collaboration with my primary care doc. We review labs thoroughly and of course pay ample respect to how I feel. I bring the reprints. He has promised me to attend one of the 4AM weekend endo conferences in the future. He has been my doc for over 10 years. So I can have any theory I want--he owns the practice.

 

[pmgamer18]

Swale if you mean the comment about be superphysiologic---at 60, I have no desire to go thru my day in sexual overdrive. I enjoy the calm, euthymia, and focus of appropriate hrt. It allows me to be sexual on demand. It helps with consistent energy to workout with intensity and purpose. Further, the rest of executive brain functions are near optimum: the ability to shift thoughts, initiate new behaviors as needed, organize myself, organize my environment, self-monitor my behavior, possess adequate working memory, display and control a full range of affect. That rigidity of behavior that many younger people note when working with middle-aged co-workers, I now think of as decllinging hormon levels in middle age.

HeadDoc this is what I have been trying to get to for the last 21 yrs. I have been so housebound off and on for so long that now at 61 I am in bad shape. I have a lot of joint and muscle pain my back is bad from arthritis. I have started on 100 mg. shots every week and have been on them 5 weeks now and the pain is a lot better. I am over weight like a 100 lbs. and if I can't get some exercise I have a big problem getting some weight off. I am hoping to get my Dr. to let me try Hcg I am primary. I feel in the past to feel better I have been at the high end of my range about 800 to 1000. But doing Testim 10 g a day would only get me to 600 and I had a lot of pain doing this. So my Dr. would add shots to this the pain would go away but I never felt right. Last year we found out about high E2 and this has helped a lot. So this is were I am at I am taking Indolplex/DIM 1/2 a pill a day and on the 2nd. day after my shot I take if needed 1/4 of an arimidex. I get my blood tested next Tue. and see my Dr. the following week I have dropped off SWALE's articles on Hcg and hope it gets him on board. I live in Mi. and it would be hard for me to drive up to Lansing Mi. I take care of my mother in law she is 84 but if push comes to shove this is what I will have to do. I am tired of this long battle to feel better.
Phil

 

[HeadDoc]

I didn't mean to highjack this thread--here goes anyway. Contact Easter Seals or comparable group. Get a qualified sitter for granny for the day. Point your car to Lansing and see Swale. Or ask your PCP if s/he's open to a consult with Swale. Then you call Swale's office and make arrangements for the consult.

 

[SWALE]

It's all good, HeadDoc.

Have your Doc look me up at an A4M conferecne. I teach at most of them now. I was supposed to lecture at the May workshop, but with the London trip and my own MOA convention that month, just was not willing to pay to make money for others twice in one month.

 

[Stez]

Are you still coming to Australia, Swale?

If so, when and where, and where can i find details? I want to tell my doc.

 

[SWALE]

I haven't heard anything more about it, since Mr. Bill Anton brought it up in the Rumjungle at Mandalay Bay. He WAS quite "pissed" at the time, of note.

 

[Stez]

Bugger

 

[SWALE]

Maybe we should have our Aussie Bro's wage a huge email campaign to get me there. I would LOVE to see your country!

 

[jboldman]

i like headdoc's proactive approach, knows what he wants, and goes for it. Very lucky to have a doc wiling to work with you like that. I also like swale's open approach to this and his willingness to push the envelope.

jb

 

[SWALE]

Yes, jb, in today's medical environment, the patient MUST take charge of their own care. Doctor's are just too squeezed by the insurance companies, health management organizations and the trial lawyers to find the time to get on top of this stuff. Sad, sad, but true.