Working HCG mono therapy but no libido or sex drive?!

[Aleeri]

Hey guys,
I am in need of some opinions on my results and current treatment. I am 28 years old and have been experiencing hormonal imbalance for the last few years. Took me a few years to understand what was going on.

Anyway I am currently seeing a good doctor who specialises in hormones. He currently has me on 25mg DHEA and 25mg Pregnenolone oral tablets. 2 UI HGH, 0.5mg Arimidex 3 times per week and 500 UI HCG 3 times per week.

Before treatment I had depression, weight loss, hairloss, no libido, no morning erections, difficulty maintaining erection, lack of energy etc. All the classic low T symptoms really.



Before I saw my current doctor this year I did a saliva test in September last year 2015, it showed Estrone 150 on a reference range of 25-55. Also my DHT and Androstenedione tested off the charts high. I was asked if I have used steroids, which I have not.

My current treatment plan outlined above has helped me regain energy, better sleep and improved mood and confidence. I now have morning erections every day and I have periods of good sexual activity. I feel about 40-50% better then before but far from good.


I took 5000 UI HCG shot once per week for 3 weeks before lowering dosage. I did not feel any improvements then. I then switched to 1500 UI IM and I almost got close to euphoria within 2 hours of the shot, felt better then I had done in years, but only lasted one day. Since then I have done 500 UI shots 3 times per week, I feel a difference on the days I take them.

Should I increase my dosage of HCG?


My problem now is that sometimes for periods I still struggle with maintaining erection (cialis helps and I take sometimes) but I still have very low libido. I just don’t want sex anymore, sometimes I have sex with my gf just for her pleasure which really feels f**ked up as a guy that should still have a raging libido in my age.



Can anybody shed some light what they think the issue might be of no libido? I mean I have tested 3 times reference range on DHT before and have side effects of high DHT like hairloss but still I have no libido, not horny at all like when I was younger.



I will be taking new labs in 2 weeks, but any second opinions are appreciated.


Labs from last year:


Hematology Panel, 12 Sep 2015 9:15 AM
· Facility: LIFELABS

Flag Results Reference Range
---- ------- ---------------
· WBC: A 3.2 giga/L (4.0 - 10.0) (Final)
· RBC: N 4.58 tera/L (4.20 - 5.40) (Final)
· Hemoglobin: N 134 g/l (133 - 165) (Final)
· Hematocrit: N 0.40 (0.38 - 0.50) (Final)
· MCV: N 86 fL (82 - 98) (Final)
· MCH: N 29.3 pg (27.5 - 33.5) (Final)
· MCHC: N 339 g/l (305 - 365) (Final)
· RDW: N 13.2 % (11.5 - 14.5) (Final)
· Platelet Count: N 250 giga/L (150 - 400) (Final)
· Neutrophils: A 1.4 giga/L (2.0 - 7.5) (Final)
· Lymphocytes: N 1.1 giga/L (1.0 - 4.0) (Final)
· Monocytes: N 0.6 giga/L (0.1 - 0.8) (Final)
· Eosinophils: N 0.1 giga/L (0.0 - 0.7) (Final)
· Basophils: N 0.0 giga/L (0.0 - 0.2) (Final)
· Granulocytes Immature: N 0.0 giga/L <0.2 (Final)


Iron / TIBC, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· Iron: N 10 umol/l (10 - 33) (Final)
· TIBC: N 50 umol/l (37 - 72) (Final)
· Iron Saturation: N 0.20 (0.20 - 0.55) (Final)


Vitamin B12, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· Vitamin B12: N 209 pmol/l (150 - 650) (Final)


Ferritin, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· Ferritin: N 53 ug/l (15 - 300) (Final)

TSH, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· TSH: N 1.2 mU/L (0.27 - 4.2) (Final)


Free T4, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· T4 Free (first: Free T4): N 14.8 pmol/l (10.5 - 20.0) (Final)


Free T3, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· T3 Free (first: Free T3): N 5.2 pmol/l (3.5 - 6.5) (Final)

Prolactin, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· Prolactin: N 5.5 ug/l <15 (Final)


________________________________________________________________________________________________________

From this year:

12 January 2016:

WBC 4.76 (4-11)
Neutrophil 35 (45-75)
Lymphocyte 42 (20-45)
Monocyte 18 (2-10)
Eosinophil 3 (4-6)
Basophil 2 (0-1)
RBC count 4.58 (4.5-6)
Hb 13.2 (14-18)
Hct 40 (41-51)
MCV 87.3 (80-98)
MCH 28.8 (27-32)
MCHC 33 (32-35)
RDW 13.4 (11.8-16.5)
Platelet count 231 (150-400)
RBC Morphology Normal

PSA 1.2 (0-4)
Free PSA 0.39
% Free PSA 32.5

Carrion Embryonic Antigen
CEA 2.2 (<4.6 non-smoker)
AFP 2.7 (0-7)



Total Testosterone 6.26 (2.8-8) ng/mL
SHBG 62 (10-60) nmol/L
Albumin 4.8 (3.5-5.2) g/dL
Free Testosterone 85 (90-300) pg/mL
% Free Testosterone 1.35 (2-4.8) % of Total
Bioavailable Testosterone 220 ng/dL
% Bioavailable Testosterone 35 % of Total

Estradiol 18.3 (25.8-60.7) pg/mL
FSH 6.1 (1.5-12.4) mIU/mL
LH 7.3 (1.7-8.6) mIU/mL


TSH 1.13 (0.27-4.2) uIU/mL
Free T3 3.69 (1.9-5.1) pg/mL
Free T4 1.68 (0.93-1.70) ng/dL

DHEA-S 294 (80-560) ug/dL
Cortisol 8.1 (6.24-18 morning) ug/dL


IGF-1 95 (81-424) ng/mL


Stopped all supplements I used myself after this lab. I was using Myokem Alphadex as anti estrogen so you will see at my next labs my estrogen went up. Doctor put me on DHEA 25mg, Pregnenolone 25mg, 1mg Melatonin per day.


________________________________________________________________________________________________________________________________


3 February 2016:


Estradiol: 49.9 (25.8-60.7) pg/mL
DHEA-S: 630 (80-560) ug/dL


After this labs we agree to continue DHEA, Pregnenolone and Melatonin. We also start HGH at 2 UI per day, building up dosage in two weeks.


_____________________________________________________________________________________________________________________________________________________


23 February 2016:


Estradiol: 34.9 (25.8-60.7) pg/mL
IGF-1: 164 (81-424)


Starting HCG 500 UI 3 times a week, and 0.5mg Arimidex 3 times a week.

 

[halfwit]

Your blood test results make little sense to me. You're taking a MASSIVE dose of HCG with adex, yet you have an extremely high LH and FSH along with a decent testosterone level. Something isn't right here as HCG is suppressive, and it doesn't show up on a panel.

Or was January before you started?

 

[Megatron28]

So what what your Total Testosterone at prior to any treatment? Is that the 6.26ng/ml?

 

[Megatron28]

Your blood test results make little sense to me. You're taking a MASSIVE dose of HCG with adex, yet you have an extremely high LH and FSH along with a decent testosterone level. Something isn't right here as HCG is suppressive, and it doesn't show up on a panel.

Or was January before you started?

It seems like he wasn't on hCG yet when he had his LH and FSH checked.

 

[halfwit]

It seems like he wasn't on hCG yet when he had his LH and FSH checked.

That's what I'm thinking, but as he stated it was early this year, and the results were from January - I was a bit confused. SHBG is really high too, which may be what's responsible for symptoms, even with a decent total testosterone.

 

[Aleeri]

Thanks for taking the time to read my thread, really appreciate it.

Yes I have no labs after I started HCG and Arimidex. Results from January is pre any treatment. I had to go work abroad for 2 months but I will get labs in 2 weeks. I will post them here when I do also.

The only labs I have is after I stop Alphadex and start with DHEA:

3 February 2016:
Estradiol: 49.9 (25.8-60.7) pg/mL
DHEA-S: 630 (80-560) ug/dL

So Estradiol went back up, DHEA within a better range now. Then I have after about 1 month on 2 UI HGH also:

23 February 2016:
Estradiol: 34.9 (25.8-60.7) pg/mL
IGF-1: 164 (81-424)

HGH back in a better range for my age. It's after this I have started HCG and Arimidex.

I know HCG has a tendency to bump up your estrogen quite a lot and I thought my large dosage of Arimidex was because of this? What Arimidex dosage would you recommend for 500 UI HCG 3 times a week?

I have had quite nice improvements on HCG and Arimidex, every day there is the day where I take the HCG shot and Arimidex I feel much better then the other days of the week. I have more energy, confidence, less stressed etc. But no increase in sex drive or libido and after 24-36 hours it seems to go back to normal.

My thought is that my issues and symptoms comes from low range of Free Testosterone. Since my total T is quite ok. And that must have to do with SHBG correct? How come this is so high for me and how do I lower it?

Also I am thinking that what if I am going to low in estrogen now because of high arimidex dosage, but I don't feel like it. I have no side effects from the medication and I still have strong morning erections each morning. I have been monitoring it as a sign of going to low if they disappear. I can masturbate, get an erection and orgasm also, I just don't feel like doing it much.

 

[Aleeri]

Ok guys I finally have an update with labs. This is after doing the following protocol for 2 months:

DHEA oral 12.5mg, Pregnenolone oral 25mg, HGH injections 2 IU before bed, HCG 500 IU x3 week, 0,5mg Arimidex x3 week

I skipped Arimidex 10 days counting up to lab, thought I had gone to low E from how I felt.

I took my last HCG injection 3 days prior to test.


Total Testosterone - 6.10 ng/mL - ref: 2.8-8 ng/mL
SHBG - 58.2 nmol/L - HIGH - ref: 10-60 nmol/L
Albumin - 4.6 g/dL - ref: 3.5-5.2 g/dL
Free Testosterone - 88 pg/mL - LOW - ref: 90-300 pg/mL
% Free Testosterone - 1.44 % of Total - LOW - ref: 2-4.8 % of Total
Bioavailable Testosterone - 219 ng/dL -
% Bioavailable Testosterone - 36% of Total -


Progesterone - 0.19 ng/mL - LOW - ref: 0.3 ng/mL (Men age 18-29)
Estradiol (Regular test, no access to ultra sensitive etc) - pg/mL - BORDERLINE LOW - ref: 25.8-60.7 pg/mL
FSH - 2.5 mIU/mL - ref: 1.5-12.4 mIU/mL
LH - 2.6 mIU/mL - ref: 1.7-8.6 mIU/mL


DHEA-S - 469 ug/dL - ref: 80-560 ug/dL
Cortisol (Serum, Morning-Noon) - 6.6 ug/dL (10:18am) - LOW - ref: 6.24-18 ug/dL Morning


IGF-1 - 159 ng/mL - ref: 81-424 ng/mL
Prolactin - 12.19 ng/mL - BORDERLINE HIGH? - ref: 4-15 ng/mL

Ferritin - 89 ng/mL - ref: 30-400 ng/mL
Vitamin B12 - 479.1 pg/mL - ref: 197-771 pg/mL
-

WBC - 4270 cells/mm^3 - LOW - ref: 5000 - 10000
Neutrophil - 54% Low - ref: 55 - 75
Lymphocyte - 35% - ref: 20 - 45 OR 20 - 35
Monocyte - 7% High - ref: 2 - 6
Eosinophil - 3% - ref: 1 - 3
Basophil - 1% - ref: 0 - 1
RBC count - 4.75 Mcells/mm^3 - ref: 4.5 - 6.0
Haemoglobin - 13.2 g/dL - LOW - ref: 14 - 18
Hematocrits - 41% - BORDERLINE LOW - ref: 41 - 51
MCV - 85.7 fL - ref: 80 - 98
MCH - 27.8 pg - ref: 27 - 32
MCHC - 32.4 g/dL - ref: 32 - 35
RDW - 13.2% - ref: 11.8 - 15.6
Platelet count - 234 - 10^3 cells/cu.mm. - ref: 150 - 400
RBC Morphology - Normal


25 - Hydroxy Vitamin D total - 85.80 ng/mL - ref: >= 30 ng/mL
Magnesium; Serum - 2.2 mg/dL - ref: 1.6 - 2.6 mg/dL
Sugar; Glucose NaF (Fasting) - 74 mg/dL - ref: 70 - 110 mg/dL
Zinc; Serum - 99 ug/dL - ref: 70 - 170 ug/dL
ACTH (EDTA) - 28.3 pg/mL - ref: 0 - 71 pg/mL
Urine iodine - 57.4 ug/L - LOW - ref: 90 - 230 ug/L

Cholesterol - 202 mg/dL - HIGH - ref: < 200
Triglyceride - 54 mg/dL - ref: < 150
HDL-Cholesterol - 46 mg/dL - LOW - ref: > 60
LDL-Cholesterol - 134 mg/dL - HIGH - ref: < 100

# Liver Function Test:
Total Protein - 6.8 g/dL - ref: 6.0 - 8.3
Albumin - 4.5 g/dL - ref: 3.5 - 5.0
Globulin - 2.3 g/dL - ref: 2.1 - 3.3
Albumin/Globulin - 1.9 - HIGH - ref: 1.0 - 1.8
Total Bilirubin - 0.9 mg/dL - ref: 0.2 - 1.2
Direct Bilirubin - 0.3 mg/dL - ref: 0.0 - 0.5
AST (SGOT) - 31 U/L - ref: 5 - 34
ALT (SGPT) - 24 U/L - ref: 0 - 55
Alkaline Phosphatase - 54 U/L - ref: 40 - 150

# Electrolyte:
Sodium - 137 mEq/L - ref: 135 - 150
Potassium - 4 mEq/L - ref: 3.5 - 5.5
Chloride - 104 mEq/L - ref: 95 - 110
Total CO2 - 27 mEq/L - ref: 22 - 30


My ideas and take aways are the following:

HCG does not do much for me other then give me temporary mood boost from LH receptor stimulation in the body. Does not affect my labs much other then raising prolactin? I am thinking I want to stop it, i.e. feels like a waste to continue.

Progesterone is LOW, adrenal fatigue? Probable reason to my low cortisol since lack of building blocks for cortisol? I bought a transdermal cream I want to try low dose.

Estradiol is borderline low now so was a good call to stop Arimidex. I don't feel I want to take an AI because of all these issues it presents with potential low E.

Ferritin move a tiny bit up but RBC not much. I am switching to another type of Iron Protein Plus from Life Extension, also adding Lactoferrin and Liposomal Vitamin C for absorption. Also adding Panax Notoginseng for increasing RBC.

Monocytes and Neutrophils seems to be out of range on this and past tests, low grade infection going on?

Iodine is LOW, this is a surprise. I am thinking that maybe I am hyporthyroid even though my thyroid panel always seems OK. Last time T4 was high so maybe conversion issue? I sure have all the symptoms of hypo including cold hands and feet, hair loss, dry hair and skin, fatigue etc.

Cholesterol is imbalanced because testosterone and iodine issues?

 

[Megatron28]

Why are you running all that stuff when your baseline labwork is more or less fine?

 

[Aleeri]

Why are you running all that stuff when your baseline labwork is more or less fine?

Check again and look at my free T, I am 28 years old and my total T might be good, but my free T makes me same as a hypgonal old man.

 

[Megatron28]

Check again and look at my free T, I am 28 years old and my total T might be good, but my free T makes me same as a hypgonal old man.

You are chasing your tail.

Look at your Bio-available Testosterone. It is in the upper end of the range. See the following ranges per the Mayo Clinic

TESTOSTERONE, BIOAVAILABLE
Males
< or =19 years: not established
20-29 years: 83-257 ng/dL
30-39 years: 72-235 ng/dL
40-49 years: 61-213 ng/dL
50-59 years: 50-190 ng/dL
60-69 years: 40-168 ng/dL
> or =70 years: not established

TTFB - Clinical: Testosterone, Total, Bioavailable, and Free, Serum

 

[Aleeri]

View attachment 564405

I am confused. Why would my labs and my doctor tell me I am LOW out of range if that was not the case? I feel like shit many days and I thought this was the reason.

Please see my attached lab scan.

 

[Megatron28]

View attachment 564405

I am confused. Why would my labs and my doctor tell me I am LOW out of range if that was not the case? I feel like shit many days and I thought this was the reason.

Please see my attached lab scan.

You do not have a testosterone problem. Your numbers are great for Natty. Whatever is causing your symptoms, it is not from low T.

 

[Aleeri]

You do not have a testosterone problem. Your numbers are great for Natty. Whatever is causing your symptoms, it is not from low T.

Thanks Megatron28 I really appreciate your input. I have posted on like 5 forums for help with my case and you are the first one to point this out, which is also surprising in itself.

So what about my free testosterone being low? like 1.44% when ref should be 2-4.4% of total? Doesn't this mean that I don't really have access to my T, ie it's not active? I always thought this was the most important.

You have any idea concerning my low IGF-1 before HGH treatment and low Progesterone and Iodine? Are these the likely culprits then?

 

[Megatron28]

Thanks Megatron28 I really appreciate your input. I have posted on like 5 forums for help with my case and you are the first one to point this out, which is also surprising in itself.

So what about my free testosterone being low? like 1.44% when ref should be 2-4.4% of total? Doesn't this mean that I don't really have access to my T, ie it's not active? I always thought this was the most important.

You have any idea concerning my low IGF-1 before HGH treatment and low Progesterone and Iodine? Are these the likely culprits then?

I would focus more on Bioavailable T. Free T is not the end all, be all. T bound to albumin is available to your target tissue.

I don't know on the rest. Iodine is easy though -- just get some salt with iodine in your diet.

 

[halfwit]

Free T is likely lower due to your SHBG being higher. I'm frankly surprised given the fact you're on an AI, which reduces SHBG considerably.

I personally do place more value on free T than bio T as bioavailable can change from free to bound at any given time. What do your FT3 numbers look like? There is a link with thyroid and SHBG production.

My main reasoning for looking at free T a little more in this context is the lower red blood cell and platelet generation. That to me says there is some sort of deficiency going on, although it could be dietary in nature (supplements cannot take the place of whole foods in this case), which is remedied easy enough.

 

[Aleeri]

Free T is likely lower due to your SHBG being higher. I'm frankly surprised given the fact you're on an AI, which reduces SHBG considerably.

I personally do place more value on free T than bio T as bioavailable can change from free to bound at any given time. What do your FT3 numbers look like? There is a link with thyroid and SHBG production.

My main reasoning for looking at free T a little more in this context is the lower red blood cell and platelet generation. That to me says there is some sort of deficiency going on, although it could be dietary in nature (supplements cannot take the place of whole foods in this case), which is remedied easy enough.

Yeah I stopped the AI now but looking at the labs pre AI, SHBG 62 nmol/L and after almost two months of Arimidex 0.5mg x3 week, SHBG 58.2 nmol/L. Not much different. I did however stop the AI 10 days prior to labs so maybe it was a bit lower then that. AI did not work out for me though since after a few weeks I started feeling bad, probably from low E. I think I felt the best with an E around 34.9 pg/mL.

I do follow a whole foods diet since 2 years back, I almost never eat junk food. No gluten, no lactose and also have started minimising grains last few months. The iodine is my fault though from only using sea salt in small amounts for a long time.

I have been using Endosurge (Divanil (Stinging Nettle)) for about 1.5 weeks now, there is a difference in how I feel. Less tired and better mood. I am however worried that I might be creating more problems lowering SHBG this way by freeing up DHT and estrogen also. My hair loss has been increasing since starting HCG 2 months ago, there is probably higher DHT levels going on.

 

[Aleeri]

And here is thyroid numbers also. I don't have from April but January I have and I had same issues then, high SHBG and low free T etc.

TSH, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· TSH: N 1.2 mU/L (0.27 - 4.2) (Final)


Free T4, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· T4 Free (first: Free T4): N 14.8 pmol/l (10.5 - 20.0) (Final)


Free T3, 12 Sep 2015 9:15 AM
Flag Results Reference Range
---- ------- ---------------
· T3 Free (first: Free T3): N 5.2 pmol/l (3.5 - 6.5) (Final)


***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;***8212;-

From this year:

12 January 2016:

TSH 1.13 (0.27-4.2) uIU/mL
Free T3 3.69 (1.9-5.1) pg/mL
Free T4 1.68 (0.93-1.70) ng/dL

 

[Aleeri]

Here is temperature from yesterday:

I woke up between 11:30am and 12pm:

**temp 12pm= 36.1 celsius (96.98 f)**
**temp 2pm=36.6 celsius**
**temp 5pm=36.7 celsius**

From what I understand anything below 97.3 f in the morning is likely signs of hypothyroidism. Considering my iodine is also low, I have symptoms and from what I understand labs can sometimes be normal even in these cases.

**Is it likely that I am hypothyroid?**

ncbi.nlm.nih.gov/pubmed/10518398
**Anemias are diagnosed in 20-60% patients with hypothyroidism**

njthyroidsolutions.com/understanding-thyroid-markers-and-panels

Although the human growth gene does not contain a thyroid hormone response, the thyroid does have influences on the synthesis of IGF-1 in the liver. **Adequate amounts of thyroid hormones are required for the healthy production of IGF-1. Anytime reduced IGF-1 markers are demonstrated, thyroid dysfunction must be ruled out. The reduced potential to synthesize IGF-1 may be partly due to the loss of anabolism in hypothyroidism.**

chriskresser.com/5-ways-that-stress-causes-hypothyroid-symptoms/

**Seems to be common with low cortisol from hypothyroid issues also or adrenal fatigue causing it in the first place.**

 

[halfwit]

Your conversion to free T3 is on the lower side for sure. The problem here is that you're subclinical in so many ways, that it makes treatment difficult from a physician's perspective as insurance wants to see numbers - not how you feel.

You can drop the stinging nettle, it's garbage.

In all honesty; if I were in your shoes, I'd look at TRT. I really don't like recommending this as you're so close to being in healthy ranges, but if you feel like crap - you feel like crap.

The only other aspect that I might look into would be checking the pituitary. Just to rule out any growths or abnormalities. If that's something you're not interested in, or it comes back clean - I'd probably start hormone replacement therapy.

Just be aware that this is potentially a lifetime commitment. Once you start, if you have second thoughts a year down the road, coming off may put you in a place worse than where you started.

I just see too many systems not functioning properly, and you've jumped through plenty of hoops as-is. I can only suggest this as a last resort that (in my experience) will likely fix everything that ails you.

 

[Aleeri]

Your conversion to free T3 is on the lower side for sure. The problem here is that you're subclinical in so many ways, that it makes treatment difficult from a physician's perspective as insurance wants to see numbers - not how you feel.

You can drop the stinging nettle, it's garbage.

In all honesty; if I were in your shoes, I'd look at TRT. I really don't like recommending this as you're so close to being in healthy ranges, but if you feel like crap - you feel like crap.

The only other aspect that I might look into would be checking the pituitary. Just to rule out any growths or abnormalities. If that's something you're not interested in, or it comes back clean - I'd probably start hormone replacement therapy.

Just be aware that this is potentially a lifetime commitment. Once you start, if you have second thoughts a year down the road, coming off may put you in a place worse than where you started.

I just see too many systems not functioning properly, and you've jumped through plenty of hoops as-is. I can only suggest this as a last resort that (in my experience) will likely fix everything that ails you.

Even the Divanil extract? I think that one might be a good one, I will be running it 4 weeks with labs before and after, starting in a week.

I agree with you, TRT would probably solve most of my problems. But the thing is that since it has potential to mess me up more if I want to get off it, I won't consider it until my situation is even worse then it is, need more then subclinical.

The reason primarily is that I travel all around the world for work, Canada, UK, Scandinavia, South East Asia - And I now live primarily in South East Asia. This makes treatment extremely difficult, planning with medications and bringing them to other countries. Getting proper blood tests in other countries etc. Just a real pain in the ass.

What I would like is a doctor who actually wants to find out what the causes are and how to fix it, not just treat symptoms. Funny enough this is about the hardest to find.