Doc prescribed very high dose of HCG (ovitrelle)

[Tn198989]

Hello again.. It's been 5 weeks since I stopped the clomid and I have an appointment to get bloodwork done.. Could you please tell me every thing I should ask.. The basics I always test are total t, e2, lh, fsh, prolactin, shbg
What else that could possibly help identify my issue?

Thanks in advance

[Cataceous]

I would add progesterone to the tests. Also, have you measured free T3 and free T4 recently?

[Tn198989]

Ok progesterone added.. No I haven't tested free t3, t4 ever. Not just recently.. Every endocrinologist  I saw only tested tsh ( in my latest blood work it was 1.91)

[Cataceous]

It is considered reasonable to check the underlying thyroid hormones at least one time when one is having problems. In addition to free T3 and free T4, reverse T3 may be worth looking at. Examples of a couple panels:
https://www.lifeextension.com/lab-testing/itemlc304131/thyroid-panel-tsh-t4-free-t4-free-t3-blood-test
https://www.lifeextension.com/lab-testing/itemlc100044/thyroid-panel-with-reverse-t3

[Tn198989]

Ok I will do them. If there's anything else I should test please let me know.. Also the only thing I found that can help with my situation is either viagra or cialis along with high dose maca. In case anyone is in a similar situation

[Tn198989]

Hello again,

So here is my latest bloodwork 6-7 weeks after last pct with clomid nolva..
Is there anything that could cause my symptoms (low libido, ed) based on this bloodwork or something that seems off?

(Τ3)  1.20 ng/mL 0.35 - 1.93

(Τ4) 6.09 μg/dL 4.87 - 11.72

Ε2 46 pg/mL 11 - 44

Total Testosterone 24.65 nmol/L : 1.63 - 34.00

SHBG 37.0 nmol/L 10.0 - 80.0

(FSH) 4.14 mIU/mL 0.95 - 11.95

(LH) 3.97 mIU/mL 0.57 - 12.07

(PRL) 5.73 ng/mL 3.46 - 19.40

Progesterone (PRG)  0.1 ng/mL 0.1 - 0.2

DHT 573.00 pg/mL 250.00 - 990.00

[Cataceous]

Overall pretty good looking numbers. Ideally you should have tested free T3 and free T4 instead of the totals. It's possible the highish estradiol and lowish progesterone are contributing to your problems. These hormones are supposed to balance each other, and yours could be out of whack. I think what I'd do if I had these numbers is try supplementing with a little progesterone and give it a couple months. I like to add progesterone to my injections, but most may prefer transdermal delivery. Among the topical preparations I prefer progesterone in coconut oil for its relative purity. It's easily obtained on Amazon. A reasonable starting dose is 5-10 mg. It can be applied to the scrotum for somewhat better absorption. Serum levels of progesterone and estradiol should be tested after a couple weeks to see if things are moving in the right direction. The dose can be adjusted up or down as needed.

If this trial didn't get anywhere, either subjectively or with respect to reducing estradiol, then I might consider trying some very low doses of anastrozole to at least get a sense of whether the estradiol level is actually a problem.

[Tn198989]

Thanks for the quick response..
I dont know much about progesterone.. What you suggest is a supplement or medication?.. Can it increase progesterone too much and if yes will it make symptoms worse..

I was thinking of trying a low dose of aromasin (I hear it's better at increasing free t, lowering shbg, better on the lipids than arimidex) but I don't know what dose.. 6.25 mg every 2 days?

I always add low dose serm with the aromasin cause that combo is the one that brought me back when I was in a similar situation 3 years ago. I also read that it can raise progesterone.

[Cataceous]

I tried the Progestelle brand topical progesterone. It seems to be characterized as a supplement. It worked fine for raising my serum levels.

It is possible to use too much, which could create other problems. However, there's probably a decent safety margin in the short term. I was initially using several times as much as my final dosing, without any obvious problems. The blood test isn't too expensive, so keeping serum levels in the normal range shouldn't be hard.

I consider AIs more of a last resort. I'd definitely try progesterone first. It is a natural aromatase inhibitor.

[Tn198989]

Hello again.
So I ordered progesterone and I am waiting for it. In the meantime I started aromasin 6.25 mg eod and on the first and second day my libido was higher with bouts of anxiety.. From the third day until today (6 day).my libido dropped significantly but I doubt I crashed my e2 with such a low dose so soon. Could it be that I function better with higher than normal e2 (46)? What do you think?

[Cataceous]

Estradiol is positively correlated with libido, though I'm sure there are limits. When I had a period of undetectable estradiol I also had undetectable libido. At the high end of the spectrum, excessive emotional responsiveness is the only symptom I've been sure about; I've had estradiol as high as 60 pg/mL and I can't say with certainty that it was hurting libido or sexual function. At those levels I had the sense that things weren't quite right, but nothing dramatic like intractable ED. It's possible that over time elevated estradiol contributes to a rise in prolactin, creating other issues.

[Tn198989]

When your e2 was 60pg/ml how high was your total t? Cause maybe it was a ratio thing. Anyway I ll keep taking the aromasin for another week at this dose and I will get blood work again.. Some people say that they get symptoms like mine when they have e2 above 40..does e2 have any effect or correlation with free testosterone??

[Cataceous]

I've had estradiol hit the 60s twice. The first time total testosterone was only about 725 ng/dL, and the second time it was 900. If there were going to be problems you'd assume they would be more likely with the lower reading. The E2/T ratio is over 0.8%, much higher than the typical 0.4-0.5%. Looking back I see the numbers alarmed me and I did start low doses of anastrozole. But I don't think the overall TRT experience changed much with that—though it did cut back on that emotional responsiveness.

Estradiol should be well correlated with free testosterone; it's the aromatization of free testosterone that creates estradiol.

[Tn198989]

So less aromatase (aromasin) more free t? I thought that the free t was what remained after the aromatization of total t to estrogen.. Maybe the lower libido is a result of the fluctuations of hormones cause I doubt I crashed my e2 or reduce even below 35pg/ml from 46 so fast.. Plus more free t should increase libido not drop it.. Thanks once again for your time

[Cataceous]

In guys on TRT the amount of aromatization has a trivial effect on testosterone levels. Estradiol is only running around 0.4% of total T. Furthermore, each 1 ng/dL of testosterone converts to 10 pg/mL of estradiol. So you can have have sky-high estradiol of 100 pg/mL and it only took 10 ng/dL of testosterone to get there.

It's a different story when your HPTA is working. Basically, testosterone production is regulated to achieve a fixed level of free estradiol. If the rate of aromatization decreases, such as through an aromatase inhibitor, then testosterone production is increased to maintain that desired level of free estradiol. So yes, you do get more free testosterone.

A speculative concern about aromatase inhibitors is the effect they have locally; that is, aromatase exists in areas such as the brain and vasculature. Is it possible that AI use leads to lower levels at these production sites, starving these tissues, even though total serum levels may seem ok? I don't think we know for sure.

The research on testosterone and libido shows that if you have normal testosterone then higher levels do not lead to further improvements. There's anecdotal evidence that sudden increases in testosterone help, but only temporarily.