Mr Ontario
19-09-2008, 06:57 PM
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. 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). 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.
I did a Clomid stimulation test in November 1999. Dr. Shippen gave me 100 mg/day (one 50 mg tablet in the morning and one in the evening before bed) for a week. I took a blood test on the morning after the last day. My test was successful, in that, my T went from about 200 to 600.
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. In fact, when I went to fill the prescription, the pharmacist was very leery and asked me a lot of questions before dispensing the drug.
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. 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). 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.
I did a Clomid stimulation test in November 1999. Dr. Shippen gave me 100 mg/day (one 50 mg tablet in the morning and one in the evening before bed) for a week. I took a blood test on the morning after the last day. My test was successful, in that, my T went from about 200 to 600.
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. In fact, when I went to fill the prescription, the pharmacist was very leery and asked me a lot of questions before dispensing the drug.