HCG - 1000IU too much?

Discussion in 'Men's Health Forum' started by HeavyJ, Jan 26, 2010.

  1. #1
    HeavyJ

    HeavyJ Member

    Is 1000 IU 3x a week for HRT (Secondary hypogonadism) too much?

    I was prescribed 5000IU 3x a week. These are Japanese protocols. I am self-injecting so I can reduce the dose. My test levels went from below average range into the upper 1/3 range. E2 is 78 but unfortunately there are no protocols in place to reduce E2 as of yet in Japan.
     
  2. #2
    cpeil2

    cpeil2 Junior Member


    It is difficult to say with certainty without knowing more about you and your condition, but it is likely too much as an HRT protocol. It may be possible for you to achieve a similar result without the sky-high E2 on 1000IU/wk, or less.
     
  3. #3
    HeavyJ

    HeavyJ Member

    31 years old. Diagnosed with low T a few years back. Had several tests done to rule out causes for the low T. hcg stimulation test showed my testes to be working.

    The protocols for testosterone injections are 1x every 2 weeks. I get 1 injection of 125 test depot but that didn't do much. HCG was introduced at 500IU twice a week. This month it's 1000IU 3x a week along with HMG for fertility reasons. Once my wife is pregnant, it's back to 500IU. However, during the lab tests for fertility my test levels where in the upper 1/3. LH and FSH were too low to count.

    I am allowed to control the amount of HCG going into my body and I would like to give my body as much test without my E2 going off the chart. I would hope that the fertility doctor figures something out (He hinted at looking into it).

    Anything else I should post?
     
  4. #4
    cpeil2

    cpeil2 Junior Member


    Whole different ball game since the hCG, in this case, is being used as a fertility drug rather than for HRT. It's out of my realm. Hopefully, someone more knowledgeable will chime in.
    Before the fertility treatment, though, your hCG dose was probably too high, given that it was an adjunct to the 125 mg. of T.
     
  5. #5
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    This is clearly for fertility. What was the result of the semen analysis? It is expected that the FSH and LH be abnormally low. By the way, spermatogenesis takes 70-100 days.
     
  6. #6
    HeavyJ

    HeavyJ Member

    Prior to the HMG being given to me, I was get 3 injections of 500IU per week for testosterone replacement therapy. The increase in hcg and addition of HMG was added when my sperm count was at 6.3 x 10 *6. (*means: to the power of).

    Japanese HRT is far behind what most of the modern world has going on. My endo doctor said he couldn't prescribe T shots more than 1x ever 2 weeks because beyond that goes beyond the protocols that are in place and insurance wouldn't cover it beyond that anyways. androgel doesn't exist in Japan as much as doctors would like to see it.

    Sucks that spermatogenesis takes so long. Are there times when this is faster?
     
  7. #7
    pmgamer18

    pmgamer18 Junior Member

    If your doing hcg for HRT to keep your testosterone levels up a lot of guys found doing 100 IU's everyday worked better this keeps you leveled and holds down estradiol levels. If you keep doing very high dose's of HCG it can in time desensitize your testis to it and you will become Primary.
     
  8. #8
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    There is not a single case in the literature of converting someone to primary hypogonadism by hCG administration. In fact, I challenge anyone to cite a study of hCG desensitization (humans) and further resulting in any adverse consequence. We are talking about human beings, not rats.
     
    Last edited: Jan 29, 2010
  9. #9
    HeadDoc

    HeadDoc Psychologist; Super Moderator


    for TRT purposes, what range of HCG doses have you recommended? While I realize that this may be a matter of clinical effects and blood work, what doses would be used on a weekly or more frequent protocol?
     
  10. #10
    pmgamer18

    pmgamer18 Junior Member

  11. #11
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Herein lies the rub! What is the purpose of the hCG administration: testes size, tweaking T level, maintaining testes function, etc. This question needs to be asked since the answer is different for each purpose.

    In my experience, the use of hCG usually falls into the category of testes size and HPTA restoration after stopping AAS. As far as tweaking, which is what I see described often appears to be focused on optimizing the T level on weekly TRT injection. I find this to be, for the most part, hocus-pocus - an attempt at some magical number of T. Why not just optimize the injection dose.schedule? [I have read on one site that hCG has CNS effects causing "euphoria" not yet described but occurs somewhere in the brain. Guess Who?]
     
  12. #12
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    For the 100th time, this is not a study on serum T production. Please, read the study. I have posted on this study many times. This is a study on ITT, a poor study. Do you even know that the subjects in the study are receiving TE 200 mg/week?

    What about the contention of hCG and primary hypogonadism? What does this article have to do with that? I am very willing to change my opinion if the evidence is put forward, not mumbo-jumbo parroting. I feel my obligation to posters is to state the evidence found within the peer reviewed literature. I am open to experiential opinion so long as it is consistent with science. If not, it might be a possible theory or pure BS. I call it as I see it.


    Coviello AD, Matsumoto AM, Bremner WJ, et al. Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression. J Clin Endocrinol Metab 2005;90(5):2595-602.

    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 determined the dose-response relationship between human chorionic gonadotropin (hCG) and ITT to ascertain 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 weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. Baseline serum T (14.1 nmol/liter) was 1.2% of ITT (1174 nmol/liter). LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94% (1234 to 72 nmol/liter) in the T enanthate/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Posttreatment 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.
     
    Last edited: Jan 31, 2010
  13. #13
    Andrew Androgen

    Andrew Androgen Junior Member

    Dr Scally, why do you think it is a poor study on ITT?
     
  14. #14
    HeavyJ

    HeavyJ Member

    I do appreciate everyones help on this.
     
  15. #15
    Andrew Androgen

    Andrew Androgen Junior Member

    Bump, why is it a poor study on ITT, Scally?
     
  16. #16
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    I saw your post. I will reply once convenient. I have posted on this study many times. Why don't you try reading my posts?

    One way not to get my response is to be annoying - try a PM. Here is a hint: NORMAL.
     
  17. #17
    Andrew Androgen

    Andrew Androgen Junior Member

    Yeah ok, no need to get your knickers in a knot pal!
     
    Last edited: Feb 4, 2010
  18. #18
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    In my opinion, the study, “Coviello AD et al., (2005), Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression, J Clin Endocrinol Metab. 2005 May;90(5):2595-602,” has a poor trial design and amounts to little new science.

    The purpose of the study is related to spermatogenesis. The abstract begins, ”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 determined the dose-response relationship between human chorionic gonadotropin (hcg) and ITT to ascertain the minimum dose needed to maintain ITT in the normal range.”

    The authors point out the most glaring problem with the study in these sentences. First, the study deals with spermatogenesis, but the study fails to include any results for spermatogenesis. It is impossible to relate any of their findings to spermatogenesis. They even discuss that spermatogenesis occurs in the face of altered, including low, ITT.

    Second, the study apparently hopes to extend our understanding of male contraception, thus the use of TE 200 mg/week. This is a common dose schedule in male contraceptive studies. The important and salient fact of male contraceptive studies is that despite high serum T levels (and corresponding low ITT) and low gonadotropin (FSH & LH) levels spermatogenesis still occurs.

    The study continues, “Experimental suppression of LH and FSH levels profoundly decreases testosterone production and dramatically reduces spermatogenesis in men.” The study did not include spermatogenesis and therefore impossible to draw any correlation with ITT, but also FSH and LH, the gonadotropins. In what is another blunder, the study used hCG. hCG is not a factor in male contraception! hCG possesses LH and FSH stimulating abilities. It will provide no information for male contraception, none.

    For a proper trial design see: “Page ST, Kalhorn TF, Bremner WJ, Anawalt BD, Matsumoto AM, Amory JK. Intratesticular Androgens and Spermatogenesis During Severe Gonadotropin Suppression Induced by Male Hormonal Contraceptive Treatment. J Androl 2007;28(5):734-41” and “Matthiesson KL, McLachlan RI, O'Donnell L, et al. The Relative Roles of Follicle-Stimulating Hormone and Luteinizing Hormone in Maintaining Spermatogonial Maturation and Spermiation in Normal Men. J Clin Endocrinol Metab 2006;91(10):3962-9.” Both studies include endpoints of spermatogenesis.

    So what did the study provide? This is what I find most comical. They took NORMAL males, including spermatogenesis and exposed them to TE to suppress LH, FSH, and ITT. Can anyone guess what will happen when administered hCG? Duh… The ITT increased. This is totally expected and provides nothing more to move forward the development of a male contraceptive. My own suspicion is that this study is part of a larger study that includes spermatogenesis endpoints. There is still the larger problem that hCG does not correlate to FSH and LH.


    Many posters have linked to the article as support for their mode of hCG administration in TRT. As I have said on multiple posts, this study deals with intratesticular testosterone (ITT) and nothing to say about serum T production or otherwise.

    The study does include a bar graph of serum T levels with hCG dosing. hCG was delivered SC EVERY OTHER DAY (EOD) for 3 wk: 0 (saline placebo), 125, 250, or 500 IU hCG. The placebo group served as the control group. The lowest hCG dose (125) group had serum T levels similar to those in the placebo group, whereas higher serum levels were achieved in the two highest hCG groups, 250 and 500 IU. The administration of hCG is EOD. If you are administering hCG less frequently it is expected the effect would be less.

    [​IMG]



    In “Matthiesson KL, McLachlan RI, O'Donnell L, et al. The Relative Roles of Follicle-Stimulating Hormone and Luteinizing Hormone in Maintaining Spermatogonial Maturation and Spermiation in Normal Men. J Clin Endocrinol Metab 2006;91(10):3962-9,” hCG was also included.

    Changes in serum T (A) levels in 18 men (n = 6/group) randomized to receive:
    1) T implant, 800 mg sc, + DMPA, 150 mg im once;
    2) T implant+DMPA+FSH, 300 IU sc twice weekly; or
    3) T implant+DMPA+hCG, 1000 IU sc twice weekly.
    Serum levels are shown at screening and then weekly thereafter. Data are shown as mean ? SEM, n = 6/group. Shaded areas represent normal reference intervals. No differences in T levels from baseline were determined in the T+DMPA group. Higher levels from baseline were found in the T+DMPA+FSH group, d 14–28 and 42 (P < 0.05), and the T+DMPA+hCG group, d 7–42 except on d 35 (P < 0.05).

    [​IMG]
     

    Attached Files:

    Last edited: Mar 18, 2013
    Millard Baker likes this.
  19. #19
    HeavyJ

    HeavyJ Member

    Can someone dummy down all this?

    The initial reason for taking hcg is because Japanese protocols on HRT only allow for 1 shot of T every 2 weeks. No androgel or anything of that nature available in Japan. hCG brought my T levels into the normal range and had me feeling normal.

    Now, hCG is part of a fertility treatment program I'm on. This is 1000iu 3x a week and 1 shot of HMG. I get my bi-monthly shot of T still...I feel best for the 3 days from when I take my T shot. I wish there were a different way to get my T levels normal without having the high E2. My fertility doctor didn't indicate any issues with the high E2 levels but said he would look into it.
     
  20. #20
    Michael Scally MD

    Michael Scally MD Doctor of Medicine

    From your posts, the treatment is to achieve pregnancy. By your accounts, the sperm account is 6X10^6. I would concentrate on the sperm count, not the T level.
     

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