Archive for 'human chorionic gonadatropin'

Testosterone Restart Failure

Picture of Heart

I just wanted to get everyone up to date on a relatively new way to boost testosterone for hypogonadal males whose cause of low testosterone is not a diagnosed primary (testicular failure) or secondary (issue with hypothalamus or pituitary gland).  In short, medical professionals call such states idiopathic, meaning cause unknown.  For example, some men with low testosterone suffer from insulin resistance, which can lower SHBG to levels low enough that free testosterone increases above the normal range, causing the homeostatic state to finally settle into a low total testosterone state as the body dumps the excess free T.  However, I am not aware of any study which conclusively proves this point.  Therefore, as in my case, decreasing insulin resistance by diet, exercise, and in my case the use of the over-the-counter product Ortho Molecular CM Core.  The later supplement decreased my A1C from 6.8 to 5.1 in about 4 months – an amazing result.

I recently attempted this approach, a therapy which consists of low dose Clomid at 25mg/day for 6 weeks.  In the past, many attempted high dose Clomid of 100mg-150mg/day for a few weeks to a month.  Side effects with dosages this high rarely are well tolerated and include seeing “tracers”, loss of libido, and mood swings.

Clomid is actually a selective estrogen receptor modulator, or SERM.  The drug, available by prescription only, acts on some tissues as an estrogen and in others this SERM will block estrogen. In males estrogen is blocked or inhibited in the hypothalamus resulting in an interesting effect:  the stimulation of Gonadatropin Releasing Hormone (GnRH) which then stimulates the pituitary gland to kick up its production of LH (leutinizing hormone) in the pituitary.  LH then stimulates the Leydig cells in the testicles to pump out testosterone.

One other side effect of Clomid to keep in mind is that over the long term, and especially at higher dosages, the pituitary gland is desensitized to GnRH.  Therefore, a short run of low dose Clomid,if successful in increasing testosterone production, is best looked at as a way to kick start the hypothalamus and pituitary gland into successfully working at full potential.  Upon cessation however, if the cause of low testosterone is still unknown or unaddressed, testosterone levels often drop to pretreatment levels.

One study of 36 men with average total testosterone of 248 ng/dl, placed the subjects on 25 mg/day of Clomid.  After 4-6 weeks the men’s average testosterone was a hefty 610 ng/dl.  This is a nice boost indeed, especially for what is considered a relatively low dose of Clomid.

My recent foray into this treatment ended unsuccessfully.  Prior to treatment, I ceased all TRT for two weeks.  Total T plummeted to 70ng/dL.  After six weeks my levels stood at a paltry 195ng/dL.  However, in my particular case, due in part to the length of time on TRT – over 15 years – the testicular atrophy due to such long use may have been addressed – and in my particular case has successfully been addressed in the past – with high dosages of Human Chorionic Gonadatropin (HCG) injected subcutaneously into the stomach fat using insulin needles.  Doses of 1000-1500IU every other day for 20 days are usually enough to really kick in Leydig cell production of testosterone assuming no issue exists with the function of these cells. At these dosages the need to control the conversion of testosterone to Estradiol or E2 (a potent estrogen) is sometimes necessary.  This conversion process, known as aromatization, typically occurs in the liver and body fat surrounding internal organs – also known as adipose fat.  Small dosages of the aromatase inhibitor Arimidex at .05mg/day usually keeps this process under control, and such dosages can be provided in capsule form by a good compounding pharmacy.  The amount needed varies from person to person, with some requiring more, and many hyper-responders requiring less.

The six week program of Clomid did increase my LH and follicle stimulating hormone to the high end of normal and quite possibly I could have seen an increase in testosterone given more time.  However the concern of desensitizing my pituitary to GnRH lead to the cessation of the Clomid and restarting the Testim for TRT.

Other protocols exist and mileage will vary.  Some add in Tamoxifen, another SERM, to work with the Clomid and also help combat the desensitization of the pituitary gland to GnRH.  I have seen so many protocols out there I can only conclude that the best protocol likely varies depending on the person and the underlying cause of idiopathic hypogonadism.

Testosterone Renormalization Protocol Day 45

The results are in – my total testosterone is 265ng/dl. This is lower than I would have liked. I get tested again in 1 month. Two weeks of the orals clomiphene citrate and tamoxifen are left and then I take a two week break.

Depending on my next test results, I have a few options according to the Houston doctor who specializes in treating hypogonadism. I could just accept the new number, take another month of clomiphene and tamoxifen once per day as opposed to two and then re-measure after being off the orals for two weeks, or go back on Testim gel for 12-18 months and then repeat the protocol of HCG, clomiphene, and tamoxifen.

What my Houston doctor found amazing is that, when he did this, many of his patients with numbers similar to mine bounced back to 500ng/dl, which is exactly where I would like to be. I think I will be taking this approach if my results are not satisfactory in one month.

The protocol has certainly not been a failure. My original total testosterone was 185ng/dl and now I am sitting at 265ng/dl. I now understand the possible cause of my maximum heart rate drop. My maximum heart rate while on Testim gel (total testosterone around 700ng/dl) was around 182. When my testosterone bottomed out after the Testim cessation it was around 162. Now it is around 166. I believe testosterone to be the main cause of this result. The most testosterone receptor cells can be found in the brain and the heart, so it just makes sense to me. The real test will be if I go back on the Testim and my maximum heart rate increases to 182 bpm.

Testosterone Normalization Day 24

It is now day 24 of my testosterone normalization protocol. The HCG injections stopped at day 19. My total testosterone measured on January 2nd just prior to stopping the HCG injections was measured at 327 ng/dL. The range is about 250-850 ng/dL, so definately an improvement from my pre-protocol result of 187ng/dL. During this time I was also taking the orals clomiphene (50 mg twice a day) and tamoxifen (10 mg twice a day).

Im still on the orals and will get my total testosterone remeasured on January 22nd. My second month or orals has been ordered. The amount taken and dosage will not change. I am not sure what will be done after this.

If my total testosterone is not around 500mg/dL 1 month after stopping the orals, restarting the entire protocol is one option to push my values higher.

During my treatment I expereinced one day of high anxiety and one day of a mild depression. Testicular size, which shrunk after the HCG was stopped, has rebounded on the oral medications to a range of 5-7 cubic centimeters. The average male testicular size is 12 cubic centimeters. When I started the treatment, testicular size was less than 3 cubic centimeters.

I feel great, my confidence levels are boosted, and morning erections have returned. There is also a slow reversal of my erectile dysfunction issues.

I am lucky to have such a good doctor in Houston and here in Austin and a very understanding and supportive wife. I believe I am really making a good comeback. Of course, days will exist when things don’t look so rosy, but for now I am happy at this latest turn of events.

Keep on truking,

Gerald Merits

Testosterone Normalization Day 6

Sorry about the light posting; so much going on right now with holiday shopping, packing to visit relatives, and health related activities.

By the later, I refer to my testosterone normalization protocol. Lucky enough to locate a doctor in Houston and really lucky to find a doctor in Austin willing to work together, by day six I am noticing a difference. Without revealing too much, let’s just say things are a little different in the morning than they were just six days ago. Hopefully, all will go well and I will find myself with normal T-levels and no need for Testim.

Here is the protocol. I take Clomid (50 mg 2x/day), Tamoxifen (10mg 2x/day), and Human Chorionic Gonadatropin (HCG) hormone injections via a small insulin needle into my stomach every other day.

Each injection is around 1cc. Each 10,000IU of HCG powder was mixed by me with 5cc of clean water that comes in its own vial along with the powder in a separate vial. This allows for ten 1cc injections over twenty days. Normally used to aid women with fertility, HCG is similar to luteinizing hormone (LH), a hormone release by the pituatary gland in response to Gonadatropin Releasing Hormone (GnRH) from the hypothalmus. The male testes react to the presence of LH by increasing testosterone. If the testes do not react to LH, this leads to low testosterone levels and primary hypogonadism.

Nolvadex and Clomid act as anti-estogens and stop the negative feedback estrogen has on GnRH release from the hypothalmus. Should failure occur at the pituatary or hypothalmus level and the cause is discernible such as a pitutary growth, the result is secondary hypogandism. Sometimes no reason presents itself for hypogadism, in which case it’s classified as idiopathic.

My only concern is my knowledge of how Nolvadex (Tamoxifen) makes the pituatary gland receptors more sensitive to GnRH, while Clomid desenstizes the pituitary receptors. I just shot off an e-mail to the doctor in Houston asking for a reason behind the dual-therapy. I will keep the reader posted on the response.