good read
Men produce less testosterone (T) as they get older. See the table of T levels for men by age group in the Appendix of this primer.
T is vitally important to a man's health. Low testosterone (i.e., hypogonadism) has been shown in scientific studies to lead to osteoporosis, atherosclerosis, high LDL (bad) cholesterol and diabetes. Also, hypogonadism leads to erectile dysfunction, loss of libido, lack of vitality, and depression. Read "The Testosterone Syndrome" by Eugene Shippen, MD. Also, see
Atherosclerosis, Prostate Health, Hormones, Diabetes, And More Health Concerns - Life Extension
Testing laboratories in the US specify a normal range for blood levels of T of about 300 to 1000 ng/dl. If your T measures below the bottom of the normal range, your doctor will almost certainly suggest that you start testosterone replacement therapy (
TRT). T is administered in a variety of ways including shots, patches, gels, pellets, creams, and lozenges. The goal of
TRT is generally to get your blood level of T into the upper half of the normal range.
Many doctors argue that the normal ranges used by testing laboratories are based on studies that include much older men and, therefore, are not appropriate for younger men. Further, many argue that hormone levels for older men should be restored to youthful levels in order to maintain optimum health. Therefore, many doctors today will begin
TRT if a man's T is below about 450.
The Leydig cells in the testicles produce almost all of a man's T (95%). The rest is produced by the adrenal glands. The amount of T produced by the testicles is regulated by the hypothalamus/pituitary axis located at the base of the brain. The receptors in the hypothalamus monitor the blood level of T and the pituitary produces Lutenizing Hormone (LH) and Follicle Stimulating Hormone (FSH) to signal the testicles to produce T and sperm, respectively.
When a man goes on
TRT, the hypothalamus/pituitary axis senses the T in the blood and stops producing LH and FSH, thereby, signaling the testicles to stop producing T. In other words,
TRT will completely shut down a man's T production. In order to raise the man's T level to the desired range, the
TRT program must constitute the man's entire T needs except for the small amount supplied by the adrenals. Therefore,
TRT is an all-or-nothing proposition. You can’t just add a little T.
Men convert a portion of their T to Estradiol (E2) via the action the aromatase enzyme. This process, known as aromatization, increases as men get older. Many doctors believe that excess E2 is related to hypogonadism and many other health problems including prostate problems. However, this topic is relatively new and not well known or understood.
Estrogen (E) means the family of female sex hormones including Estrone (E1), Estradiol (E2), and Estriol (E3). E2 is by far the most powerful of these hormones. As a result, Estradiol and Estrogen are often used interchangeably in the literature.
Men on
TRT tend to have elevated E2 levels, particularly men who take T via shots. Moderately high E2 levels cause a number of negative health effects in men. Very high E2 levels leads to gynocomastia (i.e., female-like breast development). Therefore, men on
TRT should have their levels of T and E2 monitored regularly. If E2 level is consistently high, an Estrogen management protocol should be adopted.
E2 is also vitally important to men's health including bone and muscle formation. Scientific studies have shown that men born without the gene to aromatize suffer from the same list of chronic diseases of old age as men with low T. Therefore, it appears that T and E work together as a team in men. Also, E2 is necessary for libido in men.
Men also convert a portion of their T to Dihydrotestosterone (
DHT) via the action the 5alpha reductase enzyme.
DHT is a very powerful form of T that doesn't convert to E2.
DHT cream is used as a form of
TRT predominantly in Europe, but hardly at all in the USA. Studies have shown that
DHT supplementation is safe and has a beneficial impact on prostate health and urinary function.
Chapter 2 – HCG and Dr. Shippen’s Protocol
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
TRT in men with low LH and FSH (i.e., secondary hypogonadism). To determine if you are a candidate for HCG you must have a blood
test showing low T, LH and FSH. 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. Alternatively, a Clomid Stimulation
Test can also demonstrate secondary hypogonadism (see Chapter 3).
Rather than shutting down your body's natural T production system (like standard
TRT does), HCG stimulates it back towards normal function. Your body produces it's own T. I 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 T production.
2. Easier to maintain normal T levels when administered properly.
3. More physiologic T levels minimize excess estradiol production (i.e., reduces aromatization).
4. Maintains normal size of testicles (in contrast, standard
TRT shrinks the testicles).
5. Stimulates sperm production (thereby increasing/restoring fertility). In contrast, standard
TRT reduces, if not eliminates, sperm production thereby making you infertile.
6. Restores normal function to testicles - the benefits of normal testicular function are not fully known. In his book "Saw Palmetto: Nature's Prostate Healer", Ray Sahelian, M.D. says that the testicles and the prostate exchange enzymes. I don't know what purpose these enzymes serve, but I'd rather have them working than not working.
The only disadvantage of HCG is that doctors are unaware of this excellent alternative.
Doctors are usually down on what they are not up on. If you ask about HCG, many doctors will give you a variety of lame, ill-conceived reasons for not prescribing HCG. These excuses all add up to the fact that they don't know how to administer it properly and don't want to take the time to learn. I wonder what percentage of doctors would take the time to learn about HCG if they were diagnosed with secondary hypogonadism?
Typical excuses for not prescribing HCG are (1) that the insurance company won't pay for it and (2) it's expensive. Both are absolutely false. Most insurance companies pay for it (if the doctor clearly states in writing that it's for hypogonadism only) and it 's cheaper than most standard forms of
TRT.
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 as discussed throughout this primer. In particular, excessive HCG dosages cause elevated estradiol (E2), which defeats many of the positive effects of increased T.
3. The guidelines cite expense and inconvenience as the reasons why one wouldn't use HCG otherwise. Aren't those my judgements to make? Of course they are! The funny thing is, if I were injecting 2000 to 6000 IU per week intramuscularly, I too would consider HCG therapy expensive and inconvenient, but also ineffective (due to E2 overload). Duh?! But instead, I inject 410 IU/week subcutaneously and find it to be inexpensive, convenient and highly effective.
Unfortunately, doctors are unwilling to stray too far from their professional guidelines. Also, they are unwilling to devote the amount of time to each patient required for effective HCG therapy monitoring and education. That's just human nature. But we're talking about our health and future here! Think for yourself and you will see the fallacies in these doctors' arguments against it.
Each day more and more doctors are becoming more and more aware of the benefits of HCG. In his landmark book, The Testosterone Syndrome, Dr. Eugene Shippen makes a strong case for HCG as an alternative to standard
TRT in cases of secondary hypogonadism. This book is considered by many as the definitive book on
TRT.
Unfortunately, the vast majority of doctors are woefully ignorant about the proper dosage for HCG. In fact, the AACE clinical guidelines call for HCG dosages of 1000 to 2000 IU, two or three times a week. 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!
Also, the AACE guidelines call for intramuscular injections when scientific studies show that subcutaneous injections work equally as well (see Medline article 8075787). My experience as well as hundreds of other men's experience proves this point. Subcutaneous injections are much easier to administer and far less painful than intramuscular injections.
I use and recommend Dr. Shippen's HCG protocol. Dr. Shippen's protocol calls for low dose shots (about 300 to 500 IU) at bedtime, 2 to 5 times a week depending upon your responsiveness. This protocol more closely mimics the body's natural physiologic rhythm of LH production. (Note: Effective April, 2005 I switched to nightly HCG shots of 65 IU/night)
Below is a copy of Dr. Eugene Shippen's HCG protocol that he emailed to me on 3/17/01. If you are interested in HCG therapy, I suggest that you show this protocol to your doctor. If your doctor has any questions, he/she should contact Dr. Shippen.
Prior to HCG therapy, Shippen gave me a Clomid Stimulation
test to rule out any hypothalamus/pituitary issues such as tumors, etc. My response to this
test was good. He then put me on Selegiline, which raised my T, but not enough for me.
HCG is available in shots only. It is self-administered at bedtime using the smallest of needles (0.5 cc, 31 gauge, 5/16"). Shots are simple and virtually painless.
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Dr. Shippen’s HCG Protocol (circa March 2001)
Chorionic Gonadotrophin 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. I have found that 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. I believe that 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).
Reprinted with permission from Eugene Shippen, M. D.
Are there guys on TRT whitout E2control? 
Linear Mode
