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Swale's New HCG advice
In my paper "My Current Best Thoughts on How to Administer TRT for Men",
published in A4M?s 2004/5 Anti-Aging Clinical protocols, I introduced a new
protocol where small doses of Human Chorionic Gonadotrophin (HCG) are regularly
added to traditional TRT (either weekly IM testosterone cypionate or daily
cream/gel). The reasons and benefits of this protocol are as follows, along with
a new improvement I wish to share:
Any physician who administers TRT will, within the first few months of doing so,
field complaints from their patients because they are now experiencing troubling
testicular atrophy. Irrespective of the numerous and abundant benefits of TRT,
men never enjoy seeing their genitals shrinking! Testicular atrophy occurs
because the depressed LH level, secondary to the HPTA suppression TRT induces,
no longer supports them. It is well known that HCG "a Luteinizing Hormone (LH)
analog" will effectively, and dramatically, restore the testicles to previous
form and function. It accomplishes this due to shared moiety between the alpha
subunits of both hormones.
So, that satisfies an aesthetic consideration which should not be ignored. Now
let's delve into the pharmacodynamics of the TRT medications. For those
testosterone cypionate, the cypionate ester provides a 5-8 day half-life,
depending upon the specific metabolism, activity level, and overall health of
the patient. It is now well-established that appropriate TRT using IM injections
must be dosed at weekly intervals, in order to avoid seating the patient on a
hormonal, and emotional, roller coaster. Adding in some HCG toward the
end of the weekly "cycle" compensates for the drop in serum androgen levels by the
half-life of the cypionate ester. Certainly the body thrives on regularity, and
supplementing the TRT with endogenous testosterone production "at just the right
time" without inappropriately raising androgen OR estrogen (more on that
later)?approximates the excellent performance stability of transdermal
testosterone delivery systems for those who, for whatever reason or reasons,
prefer test cyp.
But there's another metabolic reason to employ this protocol. The P450 Side
Chain Cleavage enzyme, which converts CHOL into pregnenolone at the initiation
of all three metabolic pathways CHOL serves as precursor (the sex hormones,
glucocorticoids and mineralcorticoids), is actively stimulated, or depressed, by
LH concentrations. It is intuitively consistent that during conditions of
lowered testosterone levels, commensurate increases in LH production would serve
to stimulate this conversion from CHOL into these pathways, thereby feeding more
raw material for increased hormone production. And vice versa. Thus the addition
of HCG (which also stimulates the P450scc enzyme) helps restore a more natural
balance of the hormones within this pathway in patients who are entirely, or
even partially, HPTA-suppressed.
It is important that no more than 500IU of HCG be administered on any given day.
There is only just so much stimulation possible, and exceeding that not only is
wasteful, doing so has important negative consequences. Higher doses overly
stimulate testicular aromatase, which inappropriately raises estrogen levels,
and brings on the detrimental effects of same. It also causes Leydig cell
desentization to LH, and we are therefore inducing primary hypogonadism while
perhaps treating secondary hypogonadism. 250IU QD is an effective, and safe,
dose. After all, we are merely replacing that which is lost to inhibition.
In my previous report I recommended 250IU of HCG twice per week for all TRT
patients, taken the day of, along with the day before, the weekly test cyp
injection. After looking at countless lab printouts, listening to subjective
reports from patients, and learning more about HCG, I am now shifting that
regimen forward one day. In other words, my test cyp TRT patients now take their
HCG at 250IU two days before, as well as the day immediately previous to, their
IM shot. All administer their HCG subcutaneously, and dosage may be adjusted as
necessary (I have yet to see more than 350IU per dose required).
I made this change after realizing that the previous HCG protocol was boosting
serum testosterone levels too much, as the test cyp serum concentrations rise,
approaching its peak at roughly the 72 hour mark. The original goal of
supporting serum androgen levels with HCG had overshot its mark.
Those TRT patients who prefer a transdermal testosterone , or even testosterone
pellets (although I am not in favor of same), take their HCG every third day.
They shouldn't concern themselves with diminishing serum androgen levels from
their testosterone delivery system. These patients will, of course, notice an
increase in serum androgen levels above baseline.
While HCG, as sole TRT, is still considered treatment of choice for
hypogonadotrophic hypogonadism by many , my experience is that it just does not
bring the same subjective benefits as pure testosterone delivery systems do even
when similar serum androgen levels are produced from comparable baseline values.
However, supplementing the more ?traditional? TRT of transdermal, or injected,
testosterone with HCG stabilizes serum levels, prevents testicular atrophy,
helps rebalance expression of other hormones, and brings reports of greatly
increased sense of well-being and libido. My patients absolutely love it. As
time goes on, we are coming to appreciate HCG as a much more powerful--and
wonderful--hormone than previously given credit.
Copyright John Crisler, DO 2004. This article may, in its entirety or in part,
be reprinted and republished without permission, provided that credit is given
to its author, with copyright notice and 2. www.AllThingsMale.com clearly
displayed as source. Written permission from Dr. Crisler is required for all
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