HCG dosage/frequency? What should my next step be?

[BlueMetroid]

I just finished a one month trial of 25 mg of Clomid EOD and .5 mg of Arimidex x2 weekly. I was initially on just 50 mg of Clomid EOD only, but my doc halved my dose and added the Arimidex. My labs went from this....

Total testosterone: 545 ng/dL (250-1100 ng/dL reference range)
Free Testosterone: 83.4 pg/mL (35.0-155.0 pg/mL reference range)
LH: 5 (<=10 mIU/mL reference range)
FSH: 2 (<=18 mIU/mL reference range)
Estrogen (total): 148 pg/mL (40.0-115.0 pg/mL reference range)
Estradiol 26 ( <=47 pg/mL reference range)

To this...

Testosterone, Total Ultrasensitive 470 (250 - 1100 ng/dL reference range)
Testosterone, Free 77.1 (35.0 - 155.0 pg/mL)
Estradiol <20 (<=47 pg/mL reference range)

I tried to make it to 6 weeks on the Arimidex as my doctor wanted, but I felt so terrible that I could only hold out one month. I had insomnia, mood changes, intense itching all over my body, and dry skin. The only positive side effect the Arimidex had was a noticeable increase in erection quality and some extra libido. I had trouble interpreting my Estradiol score, but my guess is that it got hammered pretty low, which is why I felt so terrible.

I'm currently waiting one month to get baseline labs. No Clomid or Arimidex. I'm one week in, and starting to feel a big drop in libido, energy, brain fog, and erectile problems. My guess is that my T is dropping while I return to baseline levels (which for me are just a few points inside "normal" ranges). I'm not looking forward to 3 more weeks of this. Not at all.

I had a semen analysis done, as per board member LW64's advice. My Uro said my levels were great, which was a huge relief. Here they are...

Semen volume >=1.5 mL 5.0
Sperm Count >=15.00 Million/mL 60.00
Sperm, Total >=39.0 Million 300.0
Normal Forms >=4 % 23

What should my next step be?

Could I use HCG alone, rather than Test? If so, what is a good dose/frequency for someone my age (30) and size (6'4", 250 lbs)? I very much would like to keep my sperm count above, as my wife and I recently made the decision to start a family and will begin trying soon. I've mentioned it to my Uro, and she is open to the idea of HCG. If given a choice, I would rather go with that than Testosterone injections.

Also, it's a long shot, but would Clomid work again for me after giving it a break for a few months? I seriously doubt it, since I was only getting mediocre levels (and didn't feel good, either) on a whopping 50 mg of it. Would a dose increase work? To 75mg or 100 mg?

 

[foreveryoung]

What were your initial reasons and test results for going on hrt in the very first place?

 

[Michael Scally MD]

NOT TRT!!! LMAO

 

[BlueMetroid]

Back in late 2011 I had my Testosterone levels checked, and they were extremely low. And I felt it, too. After being on Clomid 50 mg EOD since the Fall of '12, I decided to get my levels checked this past Fall. They'd dropped significantly, and yet again, I felt it. So basically I want to feel better. When I first started Clomid my Total T was up to 745 and I felt great, but the Clomid at the 50 mg dose seems to have stopped working for me.

 

[foreveryoung]

I personally can't see feeling good on Clomid at all ever, that drug has bad side effects as well l dont know why some insist on flogging that dead horse

 

[LW64]

Your initial results with clomid were better than with the reduced dose and the AI. However, if you didn't feel well on 50 mg clomid eod and it was losing its effectiveness, then that negates the better lab results.

I would question the need for an AI on a lower dose of clomid as you will definitely make less T to be converted to E2; but that also appears to be water under the bridge...

If you're looking to be a dad any time soon, you do NOT use T. It is possible you'll be fortunate enough to maintain fertility, but if you're not then you will have wasted time because it will take time (AT LEAST four months, maybe more) to verify that your sperm count is back to normal even if, all the while, you may be trying successfully/unsuccessfully to get her pregnant. Not worth risking it, if you ask me. Even more importantly, your wife might bend a frying pan over your head if you do something that delays her getting pregnant.

Stop using clomid.

With HCG: try 700 IUs every three days. No AI. Get labs for Total T and E2 after 4 or 5 weeks and adjust the dose up or down based on the results and how you feel. After 4 months on HCG, have another semen analysis done for comparison with your baseline. IIRC, the typical weekly dose of HCG for fertility purposes is something like 2,000+ IUs, so you can increase it quite a bit more if you need to.

 

[BlueMetroid]

Your initial results with clomid were better than with the reduced dose and the AI. However, if you didn't feel well on 50 mg clomid eod and it was losing its effectiveness, then that negates the better lab results.

I would question the need for an AI on a lower dose of clomid as you will definitely make less T to be converted to E2; but that also appears to be water under the bridge...

If you're looking to be a dad any time soon, you do NOT use T. It is possible you'll be fortunate enough to maintain fertility, but if you're not then you will have wasted time because it will take time (AT LEAST four months, maybe more) to verify that your sperm count is back to normal even if, all the while, you may be trying successfully/unsuccessfully to get her pregnant. Not worth risking it, if you ask me. Even more importantly, your wife might bend a frying pan over your head if you do something that delays her getting pregnant.

Stop using clomid.

With HCG: try 700 IUs every three days. No AI. Get labs for Total T and E2 after 4 or 5 weeks and adjust the dose up or down based on the results and how you feel. After 4 months on HCG, have another semen analysis done for comparison with your baseline. IIRC, the typical weekly dose of HCG for fertility purposes is something like 2,000+ IUs, so you can increase it quite a bit more if you need to.

Thanks for the info, LW64! Very helpful.

I will suggest that dosage and frequency to my doctor. My insurance plan's standard protocol for men who are trying for kids is T with HCG, but I'll push my doc for strictly HCG. If my doc does go for it, I'm hoping they let me inject at home. With my current work schedule (I live at my job for 2.5 days and get my 40 hours in that time), I don't think I could make it into the doctor every 3 days for an injection. Is there a great benefit to smaller doses injected every few days, rather than a large dose injected, say, once a week? I'm betting there is.

If for some reason my doc doesn't approve this frequency and dosage, I believe a while back you mentioned that HCG was relatively affordable out of pocket, was that right? Also, is the dosage/frequency you mentioned fairly standard? My insurance has narrow minded doctors who rarely deviate from standard procedure, and I worry that they may not go for it.

My wife very much wants children, as do I, so I want to avoid that frying pan scenario

I read somewhere that Clomid improves sperm count...is it possible that my good levels are only due to that? I had no idea that it took 4 months for sperm to return to normal....very good to know. I will definitely steer clear of strict T for the foreseeable future. I agree, it's probably time to stop using the Clomid. It bought me a couple years, but it's run it's course. Are long term doses above 50 mg ever used? I read that it has some pretty bad side effects above that.

Thanks again for all the insight....

 

[LW64]

IMO, if 50 mg clomid doesn't help you, then its time to bag it.

Relatively speaking, there are no 'small' doses of HCG when you're taking it (mostly) for fertility reasons. You are now try to accomplish THREE things by taking it:

[1] Get/maintain a decent T level
[2] Get/maintain a decent sperm count
[3] Avoid getting too much E2

This means you want to avoid the (very typical) large doses fertility doctors like to prescribe but also take enough to keep your T level going. Twice a week injections help keep the e2 down but if you have to increase the dose, you may need an AI. In this case, I'm ok with that because it will not be forever. If you inject 3x/week, its just about guaranteed you'll need an AI.

It is very necessary to have semen analysis done 4 months (120 days) after starting HCG only because if your count is still low, it will be necessary to add in FSH. Then another semen analysis 4 months after that to see how its working...

Spermatogenesis takes about 120 days, so that time lag has to be built into any pregnancy planning if the sperm count is low. As I understand it, a count over 39 million has a 95 % chance of pregnancy over one year of trying, as long as the other sperm params (motility, morphology, etc.) are ok.

 

[BlueMetroid]

IMO, if 50 mg clomid doesn't help you, then its time to bag it.

Relatively speaking, there are no 'small' doses of HCG when you're taking it (mostly) for fertility reasons. You are now try to accomplish THREE things by taking it:

[1] Get/maintain a decent T level
[2] Get/maintain a decent sperm count
[3] Avoid getting too much E2

This means you want to avoid the (very typical) large doses fertility doctors like to prescribe but also take enough to keep your T level going. Twice a week injections help keep the e2 down but if you have to increase the dose, you may need an AI. In this case, I'm ok with that because it will not be forever. If you inject 3x/week, its just about guaranteed you'll need an AI.

It is very necessary to have semen analysis done 4 months (120 days) after starting HCG only because if your count is still low, it will be necessary to add in FSH. Then another semen analysis 4 months after that to see how its working...

Spermatogenesis takes about 120 days, so that time lag has to be built into any pregnancy planning if the sperm count is low. As I understand it, a count over 39 million has a 95 % chance of pregnancy over one year of trying, as long as the other sperm params (motility, morphology, etc.) are ok.

Thanks for all the info...I'm going to give my doctor time to do her own research, and then request this HCG regime...I've just got to hold out until I get my baseline labs done on the 17th, and my follow-up app that's on the 28th. I'll keep you posted, you've been a great help!

 

[LW64]

I'll bet money she'll want you to take 1,000 or more IUs, 3x/week.

 

[foreveryoung]

I would theorize that a natural low test level of 300 would be more desirable and feel better consistently than an long term Hcg induced test level of 600

 

[BlueMetroid]

You're probably right, LW64...like I said, my insurance company and their doctors are not known for deviating from standard methods in the least. I do have a very open minded doctor, however. So open minded that I'm shocked that she's with this insurance. She'll no doubt consult with other doctors in the company, but I'm hoping she will also take into account what sort of HCG protocol I want. We'll see. I will definitely let ya'll know.

foreveryoung...just out of curiosity, why is that?

 

[foreveryoung]

...

foreveryoung...just out of curiosity, why is that?

just because I don't think there are going to be a ton of benefits seen with that difference in testosterone, but what little benefits there are will be strongly outweighed by the problems that will result and the tinkering and hassle needed. There are benefits to a natural libido and function, so you would be giving those up, to raise testosterone a bit you might see some small benefits in some areas like exercise recovery but I think you will feel a lot of other disruptions that will interfere with feeling good day to day all day.

I could understand someone wanting to go on hcg for life if they are starting from a seriously damaged hpta, like major pituitary dysfunction, so they are working from a near zero natural testosterone level, but to go on an hcg long term protocol just to raise a perceived "low testosterone" condition (like the guys that come with normal but in the lower 1/4 of the typical lab ranges) will (IMHO) bring with it more problems and hassles than it will solve.