A Primer on HCG and Dr. Shippen's HCG Protocol (2 of 7)

[Guest guest]

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

separate posting on this topic).

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.

7. Restarts the pituitary/hypothalamus axis (see Medline article

4044781). My HCG dosage is very small (currently 660 IU per week).

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 so that you can get off the shots and your body will

maintain on it's own. However, I've yet to hear of someone for whom

this

has actually happened. Nonetheless, I feel good about the fact that

my

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.

Doctors are usually down on what they are not up on. If you ask about

HCG, most 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

untrue. As far as I know, all insurance companies pay for it (if the

doctor clearly states in writing that it's for hypogonadism only) and

it

's actually cheaper than 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 considered outdated by many

practitioners) 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!

Unfortunately, doctors are unwilling to stray too far from their

professional guidelines. 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 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 prove this point. Subcutaneous injections

are

much easier to administer and far less painful than intramuscular

injections.

The ONLY protocol that should be used is 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.

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, 30 gauge, 5/16 " ). Shots are

simple and virtually painless.

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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 and Co, NY 1998).

Posted on ASI with permission of Eugene Shippen, M. D.

-

If the only tool you have is a hammer, you tend to see every problem

as

a nail. - A. Maslow

davidzolt@...

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