ED + Libido issues on HCG monotherapy, desperate for help. Bloodwork included.

[LostInTRT]

Hey everyone, looking for input from people with experience on HCG monotherapy or similar protocols.

Background: 31 year old male, healthy, fit, good diet, exercise regularly, sauna. No prior ED issues, could get and maintain erections for sex without any issues before starting.

Protocol: HCG monotherapy, started a few months ago. Original goal was improving mood and libido which were low. Have tried different doses, currently on 3 x 500 IU per week.

Bloodwork at trough (just before injection):

• Current testosterone: 19 nmol/l / 548 ng/dl
  • Baseline testosterone: 13 nmol/l / 375 ng/dl
• Current estradiol: 136 pmol/l / 37 pg/ml
  • Baseline estradiol: ~50 pmol/l / ~14 pg/ml (nearly 3x increase)
• SHBG: 25 nmol/l
• Prolactin: not yet tested

Current issues since starting HCG:

• Unable to maintain erections for sex despite mental desire (tried with different girls, told them I had issues, they were really understanding so the anxiety I had left disappeared after that. Still having issues though.
• Tadalafil (15mg) largely ineffective (before HCG I could get insane hard on 2.5-5mg Cialis). Even Viagra didnt do anything last time. Like, nothing.
• Precum present without erection during arousal — never experienced this before HCG
• Morning wood weak and only partial (50%) only there with tadalafil assistance
• Original goals of improved mood and libido not achieved, only achieved more energy and muscle mass
• Mood swings

Key observations:

• Testosterone increased ~46% from baseline
• Estradiol increased ~170% from baseline
• Good circulation, healthy lifestyle rules out vascular causes
• Seeing endocrinologist Monday, but I don't have mucht faith in his expertise. He only looks at the testosterone value and said: you're test is good so it's mental.

This issue is ruining my dating life/potential for a relationship, even though the girls are very understanding. I've read a lot of stuff on T:E2 ratio, elevated estrogen levels, dampened dopamine response from the HCG etc. It's a giant rabbit hole. I'm desperate, looking for some expertise and someone with experience.

Hope someone can save me out if this situation, thank you very much in advance.

Please let me know if there's any more information needed (have some more bloodwork available).

 

[Guided_by_Voices]

It sounds like HCG may not be for you. The rise in E2 really stands out but other factors could be involved as well since it tends to shut down natural LH. Is there a reason you didn't try Clomid or Enclomiphene monotherapy first? Stopping the HCG sounds like the next step. Other things can damage mood/libido such as low thyroid (which can be the case with "normal" bloodwork}, nutrient deficiencies such as low Salt, and other things like some sort of chronic infection or mold exposure. You might want to consult with a good holistic/integrative doc.

 

[LostInTRT]

It sounds like HCG may not be for you. The rise in E2 really stands out but other factors could be involved as well since it tends to shut down natural LH. Is there a reason you didn't try Clomid or Enclomiphene monotherapy first? Stopping the HCG sounds like the next step. Other things can damage mood/libido such as low thyroid (which can be the case with "normal" bloodwork}, nutrient deficiencies such as low Salt, and other things like some sort of chronic infection or mold exposure. You might want to consult with a good holistic/integrative doc.

Thank you for your reply.

No specific reason, my doctor recommended starting with HCG mono. Especially because I am a borderline low-normal testosteron case. All other bloodwork like soidum, thyroid etc are fine. I have done a complete panel. Maybe a bit on the borderline low-normal range for iron, but nothing major..

 

[Cataceous]

Another option is fast-acting testosterone, such as nasal gels or buccal troches. They're not particularly convenient, but they're useful for seeing what higher testosterone feels like without as much hormonal / fertility disruption as with other methods, including hCG monotherapy. Natesto is the well-known testosterone nasal gel brand. Empower Pharmacy compounds a version that is less expensive. Empower also makes troches in various doses.

I continue to believe that fast-acting testosterone should be the front-line treatment for hypogonadism. Even if you can't stay with it you'll gain valuable information from a trial. In particular you'll see if higher testosterone is actually helpful. If it is then you'll have a reference point if you move on to other forms of TRT, which allows you to recognize side effects related to excessive dosing or HPTA shutdown.

 

[Systemlord]

You could try cycling hCG and still receive benefits.

 

[billsman]

One thing to keep in mind is that if you add an AI, it can easily crash E2. In my experience, training AI's is challenging.