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Thread: HCG and it's Use in Functional Medicine!

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    Forum Legend UkrainianGuy's Avatar
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    Default HCG and it's Use in Functional Medicine!

    Regarding HCG and It’s Use in Functional Medicine

    Human Chorionic Gonadotrophin (HCG) is a hormone found in men and women. Women secrete large amounts of HCG during pregnancy and men secrete large amounts during puberty.

    HCG is administered as a form of TRT. HCG is an alternative to standard Testosterone Replacement Therapy in men with low LH and FSH (i.e., secondary hypo-gonadism). To determine if you are a candidate for HCG you must have a blood test showing low Testosterone, & Luteinizing Hormone. This blood test cannot be taken while you're on standard TRT because standard TRT shuts down LH and FSH production and thereby distorts the test results.

    Rather than shutting down your body's natural Testosterone production system (like standard TRT does), HCG stimulates it back towards normal function. Your body produces it's own Testosterone.

    Some scientists believe that HCG is vastly superior to standard forms of TRT for the following reasons:

    1. Better mimics the body's own natural physiologic rhythm of Testosterone production.

    2. Easier to maintain normal Testosterone levels when administered properly.

    3. More physiologic Testosterone levels minimize excess estradiol production (i.e., reduces aromatization associated with testosterone use).

    4. Maintains normal size of testicles (in contrast, standard Testosterone Replacement Therapy shrinks & shuts down the testicles). 5. Stimulates sperm production (thereby increasing/restoring fertility). In contrast, standard Testosterone Replacement Therapy reduces, if not eliminates, sperm production thereby making you infertile.

    6. Restores normal function to testicles

    7. Restarts the pituitary/hypothalamus axis (see Medline article 4044781). This means that my body is responding to HCG by producing more LH and FSH on the "off days." Some have claimed that HCG can restart your system completely; pituitary/hypothalamus axis is being stimulated to return towards normal function.

    The only disadvantage of HCG is that doctors are unaware of this excellent alternative.

    The current guidelines of the American Association of Clinical Endocrinologists (AACE) indicate that HCG should only be prescribed when a man is interested in fertility. As a result, most doctors will not prescribe HCG unless you tell them you are currently trying to have children. The AACE guidelines can be found at:

    www.aace.com/clin/guidelines/hypogonadism.pdf

    These guidelines (written in 1996 and updated in 2002) are considered outdated by many practitioners with respect to HCG therapy for the following reasons:

    1. The guidelines call for intramuscular HCG injections. Subcutaneous injections are much more convenient, much less painful and equally effective (see discussion below and/or just ask the many men who inject HCG subcutaneously or look at their blood test results).

    2. The excessive HCG dosage levels suggested in the guidelines cause a variety of problems. In particular, excessive HCG dosages cause elevated estradiol, which defeats many of the positive effects of increased Testosterone. Scientific studies have demonstrated that HCG dosage levels of about 5,000 IU per week or more administered long-term cause permanent damage to the testicles (see Medline articles 6210708 and 3583230). These studies have shown that such excessive HCG dosages taken long-term result in testicular desensitization (to future stimulation by LH or HCG). In other words, long-term, such excessive dosages of HCG will result in primary hypogonadism!

    Each day more and more doctors are becoming more and more aware of the benefits of HCG.

    *****************************

    Chorionic Gonadotropin Stimulation Test (males < 75 years old)*

    Chorionic Gonadotrophin is presently available through most pharmacies or distributors as Profasi, Pregnyl or generic Chorionic Gonadotrophin 10,000 units per 10 cc vial. Various stimulation tests have been described, from high dose, short course testing to more normal physiologic doses over a longer time period. A typical treatment course for three weeks is best for determining those individuals who will respond well to this type of treatment. It is administered by injection 500 units (0.5 cc) SQ, Monday through Friday for three weeks. Teach patient to self administer with 50 Unit Insulin Syringes with 30 gauge needles in anterior thigh, seated with both hands free to perform the injection. Measure: Testosterone, total and free, plus E2 before starting CG and on the third Saturday AM after 3 weeks of stimulation (salivary testing may be more accurate for adjusting doses). Studies have shown that SQ is equal in efficacy to IM administration.

    Results:

    1. <20% rise suggests poor testicular reserve of leydig cell function (primary hypo-gonadism or eu-gonadotrophic hypo-gonadism indicating combined central and peripheral factors).

    2. 20-50% increase indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.

    3. > 50% increase suggests primarily centrally mediated depression of testicular function.


    Options for treatment vary both with the response to CG and patient determined choices.

    1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.

    2. The area in between 20-50% will usually require CG boosting for a period of time, plus natural boosting or "partial" replacement options. Full replacement with exogenous testosterone is always the last option in borderline cases since improvement over time may frequently occur as leydig cell regeneration may actually happen. Much of this is age dependent. Up to age 60, boosting is almost always successful. 60-75 is variable, but will usually be clear by the results of the stimulation test. Also, disease related depression of testosterone output might be reversible with adequate treatment of the underlying process (depression, AMI, obesity, alcohol, deficiency, etc.) This positive effect will not occur if suppressive therapy is instituted in the form of full replacement.

    3. If there is an adequate response, >50% rise in testosterone, there is very good leydig cell reserve. Natural boosting or CG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response.

    4. Chorionic Gonadotrophin can be self-administered and adjusted according to response. In younger, high output responders (T > 1100ng/dl), CG can be given every third or fourth day at bedtime or in the AM. This also minimizes estrogen conversion. In lower level responders(600-800ng/dl), or those with a higher E2 output associated with full dose CG, 300-500 units can be given Mon-Wed-Fri. At times, sluggish responders may require a higher dose to achieve full Testosterone response. In these cases, the diluent is lowered to 7.5cc or even to 5 cc, which increases the CG concentration 1 ½ - 2 X. This can be administered in variable doses 0.3 - 0.5cc given every 3rd day. Check salivary levels on the day of the next injection, but before the next injection to determine effectiveness and to adjust the dose accordingly. Keep in mind that later as leydig cell restoration occurs, a reduction in dose or frequency of administration may be later needed.

    5. Monitor both Testosterone and E2 levels to assess response to treatment after 2 - 3 weeks after change in dose of CG as well as periodic intervals during chronic administration. Sublingual testing is very easy and cost effective. It will also better reflect the true free levels of both estrogens and testosterone. (Pharmasan Labs 888-342-7272 is very good)

    6. Adjustment of dosage is a result of symptomatic response and hormone level boosting. It is based on clinical judgement as much as actual hormone levels. Remember that "Normal" ranges are for populations, not individuals!

    7. Except for reports of antibodies developing against CG (I have not seen this), there are no adverse effects of chronic CG administration. An additional benefit is the boosting of Growth Hormone output which has also been reported, either as a direct effect of CG or as an effect of increased levels of testosterone.

    *Protocol adapted from "The Testosterone Syndrome" by Eugene Shippen, M. D. (M Evans and Co, NY 1998). Posted on ASI with permission of Eugene Shippen, M. D.

    ================

    And this one on Clomid.

    A Clomid stimulation test is a standard protocol that has been used by endocrinologists for years to test whether a man's hypogonadism is primary or secondary. If the test is successful (i.e., if your T rises significantly), that means that all of the organs in the feedback loop (the testicles, pituitary and hypothalamus) are healthy and functional, but for some unknown reason the system has gone dormant. A successful test result also means that you are a good candidate for HCG or Clomid, which in contrast to standard TRT, stimulate your body to produce its own T. See:

    www.aace.com/clin/guidelines/hypogonadism.pdf

    Clomid (Clomiphene Citrate) doesn't lower estrogen; it "blocks" it. Estrogen attaches to the receptors in the hypothalamus and that signals that there's enough T in your blood, so your body reduces its T production. Somehow the hypothalamus reacts to E as well as T. Clomid attaches to these receptors but doesn't act like E.

    Clomid is most often used to promote fertility in women. Therefore, if you research Clomid, the vast majority of the literature you find will discusses the use of Clomid by women rather than men.
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    Excellent post!
    It was good to see they recommend low dose administration. This supports Dr Crisler's protocol. He combines TRT with HCG. Here is the updated protocol.




    AN UPDATE TO THE CRISLER HCG PROTOCOL

    By John Crisler, DO




    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 employing injectable
    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 needn’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 www.AllThingsMale.com clearly displayed as source. Written permission from Dr. Crisler is required for all other uses.
    All posts are for entertainment and may contain fiction. Consult a doctor before using any medication.


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    These are both great articles. But even though these guys touch on the idea of attempting to mimic the body's own production of T with the use of HCG, I haven't seen anything with regard to the best time of day to administer HCG in order to achieve this.

    Any ideas?
    Last edited by FreakPeak; September 20th, 2008 at 01:35 AM. Reason: spelling

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    great info...many people dont bother with hcg but its an important part of your stack, especially if you stay on for long periods. I had both my kids on heavy cycles, and only because of hcg

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    Quote Originally Posted by FreakPeak View Post
    These are both great articles. But even though these guys touch on the idea of attempting to mimic the body's own production of T with the use of HCG, I haven't seen anything with regard to the best time of day to administer HCG in order to achieve this.

    Any ideas?
    HCG has a half life of about 1-2 days therefore the time of day it is administered really is not that critical however Dr. Crisler does make a point of administering it 24 and 48 hours before Testosterone administration. If taken IM the peak concentrations will be reached in about 6 hours and 16-20 hours after subcutaneous injection.
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    I was on 30mg of test cream a day for 5 months, got blood work done 3 days after discontinuing the cream:

    test: 254 (241-827)
    LH:2.8 (1.5-9.3)
    FSH:2.0 (1.4-18.1)

    Unfortunately my LH and FSH were not tested by the doc before going on testosterone cream, but my testosterone tested at 291 before.

    Are you guys saying I can't go on HCG? Or are you saying I shouldn't until I know my LH is truly low?

    How long do I need to stay off testosterone before I get LH tested to get a good reading?

    Is there any possibility that because I was doing so little testosterone, that my LH may not have been lowered by that, and it's just naturally low?
    I saw a woman wearing a sweatshirt with Guess? on it. I said, "Thyroid problem?" --ArnoldSchwarzenegger

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    Great info. Any benefit to adding HMG to HCG, or bumping with HMG mid cycle?

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    Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression
    Andrea D. Coviello, Alvin M. Matsumoto, William J. Bremner, Karen L. Herbst, John K. Amory, Bradley D. Anawalt, Paul R. Sutton, William W. Wright, Terry R. Brown, Xiaohua Yan, Barry R. Zirkin and Jonathan P. Jarow
    Center for Research in Reproduction and Contraception, Geriatric Research Education and Clinical Center, Veteran Affairs Puget Sound Health Care System (A.M.M.), and Department of Medicine, University of Washington School of Medicine (A.D.C., W.J.B., J.K.A., B.D.A., P.R.S.), Seattle, Washington 98195; Department of Medicine, Charles R. Drew University (K.L.H.), Los Angeles, California 90059; Department of Urology, Johns Hopkins University School of Medicine (X.Y., J.P.J.), Baltimore, Maryland 21287; and Division of Reproductive Biology, Department of Biochemistry and Molecular Biology Johns Hopkins University School of Public Health (W.W.W., T.R.B., X.Y., B.R.Z., J.P.J.), Baltimore, Maryland 21205

    Address all correspondence and requests for reprints to: Dr. Andrea D. Coviello, Feinberg School of Medicine, Northwestern University, Tarry 15-751, 303 East Chicago Avenue, Chicago, Illinois 60611-3008. E-mail: a-coviello@northwestern.edu.

    In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T), suggesting that high ITT is needed relative to serum T for normal spermatogenesis in men. However, the quantitative relationship between ITT and spermatogenesis is not known. To begin to address this issue experimentally, we determined the dose-response relationship between human chorionic gonadotropin (hCG) and ITT to ascertain the minimum dose needed to maintain ITT in the normal range. Twenty-nine men with normal reproductive physiology were randomized to receive 200 mg T enanthate weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. Baseline serum T (14.1 nmol/liter) was 1.2% of ITT (1174 nmol/liter). LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94% (1234 to 72 nmol/liter) in the T enanthate/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Posttreatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression. Extensions of this study will allow determination of the ITT concentration threshold required to maintain spermatogenesis in man.

    http://jcem.endojournals.org/cgi/con...ract/90/5/2595

    full study;
    http://jcem.endojournals.org/cgi/content/full/90/5/2595
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    Very interesting. So it looks like 500 IU every other day for 3 weeks is a good guideline.

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    Quote Originally Posted by Klaus Urine View Post
    Very interesting. So it looks like 500 IU every other day for 3 weeks is a good guideline.
    250-500iu eod should work. On cycle I like to stay in that range.
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    Quote Originally Posted by heavyiron View Post
    250-500iu eod should work. On cycle I like to stay in that range.
    Surely you don't run it the whole cycle, though (so you don't damage Leydig cells)?

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    Quote Originally Posted by Klaus Urine View Post
    Surely you don't run it the whole cycle, though (so you don't damage Leydig cells)?
    yes, doc prescribed. 1000iu a week taken in 250iu increments. I go a little higher at times when my test dose accidentally increases.
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    What about those poor Leydig cells? Have you no heart?

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    Well, show me the evidence of leydig death from HCG.=)
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  16. #16

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    Quote Originally Posted by heavyiron View Post
    Well, show me the evidence of leydig death from HCG.=)
    You don't buy it? I'm sure I've read that a few times. Can't think where.

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    RR stated that his endo told him. I have been unable to verify this with low dose HCG.
    All posts are for entertainment and may contain fiction. Consult a doctor before using any medication.


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