ASIH & Regaining Fertility

[enrod]

Hello all!

Long time competitor in BB and currently trying to conceive. I’m doing self-administered therapy, post self administered years of ped use leading to what I believe is secondary hypogonadism (was fertile before use). This therapy consists of:
1500iu HCG MWF
50iu HMG TTHSa
50iu rFSH TTHSa
25mg Enclomiphene ED

I had an SA done about 6-8 weeks ago, and it came back with signs of oligospermia (<9M motile). I recently had blood test results back on my hormone panel - without surprise my test is in the gutter and my estrogen was through the roof:




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I’m not sure where I am currently with my sperm levels, but I can tell you I feel awful. I’ve read that coming off test is not necessarily required to regain fertility, but I’ve managed 4-5 months so far and my symptoms are not improving. I’m practically a walking anxiety attack. Should I restart a low dose trt or would that hinder my progress? Has anyone else had a similar experience, or advice?

 

[madman]

Hello all!

Long time competitor in BB and currently trying to conceive. I’m doing self-administered therapy, post self administered years of ped use leading to what I believe is secondary hypogonadism (was fertile before use). This therapy consists of:
1500iu HCG MWF
50iu HMG TTHSa
50iu rFSH TTHSa
25mg Enclomiphene ED

I had an SA done about 6-8 weeks ago, and it came back with signs of oligospermia (<9M motile). I recently had blood test results back on my hormone panel - without surprise my test is in the gutter and my estrogen was through the roof:




image801×183 34.1 KB


image783×410 57.3 KB


I’m not sure where I am currently with my sperm levels, but I can tell you I feel awful. I’ve read that coming off test is not necessarily required to regain fertility, but I’ve managed 4-5 months so far and my symptoms are not improving. I’m practically a walking anxiety attack. Should I restart a low dose trt or would that hinder my progress? Has anyone else had a similar experience, or advice?

Welcome to Nelson's domain!

Yes, one can remain fertile when using exogenous T but your chances may be better coming off temporarily.

Your starting protocol is overkill (hCG + EC + FSH + hMG)

The dose /injection frequency of hCG may be too low.

No need to throw in the FSH or hMG off the hop and you could leave out the hMG if you are already using hCG + FSH.

If one is going to stop TRT/AAS then the basic starting protocol would be hCG and clomid.

I would give it 3 months before getting another SA done let alone labs for FSH, LH, T/FT, and estradiol.

If you are still struggling at the 3-month mark on the current protocol you can drop the clomid and add in FSH at a minimum starting dose of 75 IU EOD.

If you are going to stay on TRT/AAS then hCG or hCG + clomid would be used or you can go with hCG + FSH off the hop.




*If the patient desires to maintain fertility at the outset, then a baseline semen analysis should be obtained and a decision made as to the timing of the desired pregnancy. For patients who desire a pregnancy within 6 months, TST should be discontinued immediately and therapy initiated with 3000 IU hCG every other day, with or without 25 mg daily clomiphene citrate, and a semen analysis obtained every 2 months. If semen parameters do not improve sufficiently and FSH remains suppressed, rhFSH at 75 IU every other day may be added with discontinuation of clomiphene citrate. If the patient and his partner anticipate the desired pregnancy in 6–12 months, TST may be started or continued with 500 IU hCG given every other day with or without clomiphene citrate at the aforementioned dose. For those patients desiring pregnancy in greater than 1 year, we recommend the patient cycles off TST every 6 months with a 4-week treatment cycle of 3000 IU hCG every other day.




Look over post #5 (link below) numerous threads to chew on!

Fertility maintenance or restoration in men before, during, and after TRT or AAS

Fertility Preservation in Hypogonadal Men (2018) Robert J. Carrasquillo and Ranjith Ramasamy Introduction Testicular failure is defined as the impairment or loss of both the endocrine functions of the testis (production of testosterone, or T) and exocrine function (production of...

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[madman]

T + hCG + rFSH

Continuous Testosterone Therapy with Recombinant FSH & HCG Improves Semen Parameters - Excel Male TRT Forum

Continuous Testosterone Therapy with Recombinant FSH & HCG Improves Semen Parameters: A Pilot Study (2022) THakky, HShirazi, MChristensen, APastuszak Introduction Male hypogonadism is characterized by inadequate production of Testosterone (T) and a deficiency in spermatogenesis. The main...

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FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate

024 Dual Therapy with rFSH and HCG Results in a Significantly Shorter Time to Return of Spermatogenesis than Combination HCG and Clomiphene (2021) K. Campbell, J. Sullivan, R. Valero Carrion, J. Kraus, B. Stocks, A. Lawrence, L. Lipshultz Introduction: The use of testosterone replacement...

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