Doc prescribed very high dose of HCG (ovitrelle)

[Cataceous]

Do you know what type of estradiol tests you've been getting? LC/MS (sensitive) or immunoassay (regular)? Your results seem a little funny to me, and in particular it's odd that you didn't get much extra with the hCG. But it's not necessarily meaningful.

Yes, DHEA is a precursor to the other sex hormones. But you're still looking for hints that something is wrong in that chain of metabolites. And if it's low for your age then supplementing is simple. Occasionally someone will claim to be helped by DHEA.

Similarly with progesterone, high or low levels may cause problems. And if low, an experiment with supplementation is easy.

[Tn198989]

I've been getting the regular one which is for women but they change the ref range. The other one is not available in my country. I've asked all over. It could be the e2 though.. After my first cycle I had the same problem for like 7-8 months after.. No libido ed, watery semen all of it.. And blood work seemed normal except from crashed e2 from previous arimidex use. Then I took clomid 50mg ed for a month and I saw improvement but not 100 percent. After that I waited for a month and had blood work done which showed e2 70.the doc II had back then told me to go another month of clomid along with aromasin and I recovered completely. Of course I tried that even after my second cycle but it didn't work. And I have dropped my e2 one time last summer to 29 with no improvement although I had very high shbg back then which could play a role. I am taking a aromasin now and there is some small improvement from last week. But to tell you the truth I don't even know what my e2 should be.. Some say 22 is optimal, others 20-30, others that high e2 is good if you have high testosterone. Can a 45 level be the cause (if it is accurate). And where should I drop it to.. As I said I crashed them once and it was the same as being high.

[Cataceous]

Given that you have experienced various levels of estradiol it seems less likely that it has much relevance to your problems.

[Tn198989]

Well it does have some effect. Back in January i was much better erection wise and i had e2 34pg/ml (now 45). But i still keep messing around with medication cause even then it wansn't 100%. But i think that the low ejaculation volume with normal testosterone and fsh levels has something to do with the ed problem. Something we are missing. And the hcg is improving the ejaculation at least. Thats why i want to keep taking it and maybe add some low dose nolva to keep lh/fsh from plummeting. Just in case its an issue with the intratesticular testosterone or something similar. Plus the testicle pain ever since i started hcg seems like something is happening. I dont know maybe its from the high hcg dose (which i lowered to 1000ius eod) or the testis are waking up after 2 years of producing low sperm. My doc measured the testicles and he said that they are small and barely make the normal range. Maybe its androgen receptor downregulation or damage although i read that its not likely cause i would have other symptoms like no gains in the gym, no body hair grow etc..Anyway thanks for your time and help. I'll post again if i figure it out

[Cataceous]

Personally I've found ejaculate volume was poor under TRT alone, better but so-so with hCG added to TRT, and practically normal with GnRH and enclomiphene added to TRT without hCG. This latter treatment raised LH and FSH from near zero to low-normal, both around 2 mIU/mL.

I'll mention this though it may not be at all related to your issues: I started experimenting a little with kisspeptin-10. An unexpected correlation is considerably more frequent and prominent nocturnal erections. Erections and libido are specifically mentioned in some of the literature on kisspeptin:

It is therefore possible, that other factors are also important in modulating libido that may include upstream kisspeptin signaling. Certainly, the expression pattern of kisspeptin and its cognate receptor in limbic and paralimbic structures would point towards this as well as the more recent studies identifying a role in sexual brain processing and erection generation. Further studies are required to determine if kisspeptin signaling could be exploited in future therapies for patients with sexual and emotional disorders.

[Ref]

I discuss kisspeptin a little more here. In considering your issue I wondered what kind of problem at the hypothalamus might still allow for normal GnRH and gonadotropin and testosterone levels. It may just be an outlandish hypothesis, but what if kisspeptin levels are diminished, not enough to reduce GnRH, but enough to cause these problems at other brain locations?

[Tn198989]

Never even heard of kisspeptin.. It could be.. I'll read about it. The only thing that gave me morning and nocturnal erection was proviron. which I took a couple of months ago to reduce shbg, which I did. full libido, all the time horny but could only get to 70% erection. . But I have never tried gnrh or tripto.. I don't know much about it.. Clomid on the other hand (enclomiphene not available) I have some experience.. It was what recovered me after my first cycle along aromasin and I had improved ejaculation volume with it but not normal.. Still watery and clear.. Just more than before.. On the first cycle I used low dose hcg throughout but at the second I didn't.. I think that's why it's taking so long. Even if the numbers say I have recovered. Cant take clomid now though cause it's causing me a weird chest pain every time I take it. I also switched from aromasin to arimidex cause although it's considered the best of the 2, aromasin doesn't seem to lower my e2 that much..been taking it for a week 25mg eod and no difference, and yesterday I took 0.5 arimidex and in 2 hours I felt a difference. Will taking 10mg of Nolva eod along the hcg keep my hope from shutting down??

[Cataceous]

There is some research showing that a SERM combined with hCG retained some HPTA activity. Unfortunately I don't recall the doses or duration of the trial. These could certainly influence the outcome.

[Tn198989]

Thinks are going from bad to worse unfortunately.. Two days ago I was frustrated about not feeling any difference from all the medication and took 0.5 arimidex (was already taking asin 25mg eod) . Boom after 3 hours raging libido. Ed not cured but better.

Then after two more hours panic attack, dehydrarion and peeing like crazy. Next day clicking knees and pain.   Libido dead. I should also mention that I have been taking daily cialys and viagra on an as needed basis. Still not much. I took some clomid to raise e2 ASAP and my hcg dose of 1000iu.

Anyway I decided to come off the hcg with a taper for two weeks and add clomid or Nolva to increase lh. I need your help with two things. First does clomid raise shbg by increasing e2 and you can control that with asin or another mechanism? Or should I go with Nolva, asin?

And second, since I can't seem to find what is going on with the basic bloodtest (lh, fsh, shbg, total t, e2, prolactin). Could you tell me everything that I should test (like dht, igf-1 etc) thanks

[Flyingfool]

TN1989

My observation and I could be wrong. Is that you are changing too many things, much too fast.

I understand the incredible frustration with lack of results. But with hormones, they are all so inter-related and sensitive, low and slow changes one at a time seems to be the best idea, but it can be painfully, frustratingly and glacially slow process.

[Cataceous]

Clomid probably raises SHBG in two ways, both related to estrogenic effects on the liver. First there's the direct increase in estradiol stimulated by higher testosterone and LH-stimulated intratesticular aromatization. Second, the zucomiphene isomer is estrogenic and probably acts directly on the liver. As an aside, I've been taking enclomiphene, the other isomer of Clomid, and have not seen a change in SHBG.

An aromatase inhibitor has no effect on zuclomiphene, limited effect on intratesticular aromatization, and a significant effect on other systemic aromatization.

Tamoxifen does not have an estrogenic component, but otherwise acts similarly to Clomid.

It wouldn't hurt to look at DHT, IGF-1, also progesterone and thyroid hormones (fT3, fT4, rT3) if you haven't already. I'm not expecting to see anything too out of line. There are way too many guys in this position, with good basic numbers but still having low libido and other problems. Unfortunately I don't think there are widely available tests for kisspeptin levels. Maybe in time more doctors will prescribe kisspeptin-10 as a stimulation test in cases where nothing else is obviously wrong.

[Tn198989]

TN1989

My observation and I could be wrong. Is that you are changing too many things, much too fast.

I understand the incredible frustration with lack of results. But with hormones, they are all so inter-related and sensitive, low and slow changes one at a time seems to be the best idea, but it can be painfully, frustratingly and glacially slow process.

You are right. I do. Its just so frustrating. It has severely affected my job performance and relationship with gf. And when your bloodwork seems ooptimal it is even harder to deal with. If i had low t it would be more simple. Try a couple of restarts and if they dont work go to trt. But as i said you are right and i need to deal with it more mature.

[Tn198989]

Clomid probably raises SHBG in two ways, both related to estrogenic effects on the liver. First there's the direct increase in estradiol stimulated by higher testosterone and LH-stimulated intratesticular aromatization. Second, the zucomiphene isomer is estrogenic and probably acts directly on the liver. As an aside, I've been taking enclomiphene, the other isomer of Clomid, and have not seen a change in SHBG.

An aromatase inhibitor has no effect on zuclomiphene, limited effect on intratesticular aromatization, and a significant effect on other systemic aromatization.

Tamoxifen does not have an estrogenic component, but otherwise acts similarly to Clomid.

It wouldn't hurt to look at DHT, IGF-1, also progesterone and thyroid hormones (fT3, fT4, rT3) if you haven't already. I'm not expecting to see anything too out of line. There are way too many guys in this position, with good basic numbers but still having low libido and other problems. Unfortunately I don't think there are widely available tests for kisspeptin levels. Maybe in time more doctors will prescribe kisspeptin-10 as a stimulation test in cases where nothing else is obviously wrong.

Yes but for some reason clomid raises ejaculation volume more than nolva. Anyway i'll do bloodwork tommorow (only e2) to see if i crashed them. And then nolva, or clomid with aromasin for 4 weeks (and maybe some proviron to keep gf happy). After that i'll wait for 4 more weeks and do bloodwork with all the extra you mentioned, plus free T no matter how inaccurate it may be. Do you know how long for hcg to clear my system cause in 2 weeks i am going on vacation with gf and i dont want to be crushed at that time. Should i keep taking it until then at lower dose along with a serm or it will have cleard my system before that if i stop now? I have taken about 13000 ius in total.

[Tn198989]

Since November 2018 only 2 things gave me brief relief from ed and low libido symptoms. Nolva when taken for 4 weeks at 10mg eod but it only lasted for a couple of days. I guess it either raised e2 after that or shbg. and the second is proviron a couple of months ago. So i think i should take these 2 for 4 weeks so that i can raise free t by increasing lh with nolva and keep shbg low with proviron. I know its a little suppresive but i dont think it will have that effect along with nolva. If and when i get that symptom releif i'll do a complete bloodwork to see what my labs are when i feel good.

[Cataceous]

If the half-life of hCG is about 36 hours then it takes maybe a week to ten days for it to be pretty thoroughly eliminated. This doesn't address lingering effects, which could last longer, particularly if there's been more HPTA suppression, which then takes time to reverse.

I think your plan is reasonable under the circumstances, but it's likely not directly addressing any underlying issues; it's mainly giving them more time to resolve naturally.

[Tn198989]

If the half-life of hCG is about 36 hours then it takes maybe a week to ten days for it to be pretty thoroughly eliminated. This doesn't address lingering effects, which could last longer, particularly if there's been more HPTA suppression, which then takes time to reverse.

I think your plan is reasonable under the circumstances, but it's likely not directly addressing any underlying issues; it's mainly giving them more time to resolve naturally.

Are you reffering to the nolva + proviron plan? Also do you actually think that if i drop everything and let my body heal on its own, eventually everything will be back to normal?