Fertility help...again

[Hopeful1]

I wrote about my husband being on T and HCG about a year ago and you guys were very helpful, so I am seeking your advice again. When we finally found a urologist that would prescribe fsh, I got pregnant 5 weeks after he started the fsh injections along with T and hcg (previously had 0 count). Unfortunately, due to complications from a genetic test, i lost the baby at 16 weeks along.

Since October, he is now currently doing his weekly T shot, hcg and fsh EOD and supposed to take 1mg anastrozole daily and 10mg of tamaxofin 2 times a day (he was on all of this when I got pregnant). We normally check his sperm at home with a microscope and the past few months the sperm looked like a pretty decent amount. We just checked several times the past week and a half since we haven't checked for some time and I have not conceived again and have noticed a big decrease in the amount of sperm we saw.

Do you guys think it has something to do with him taking the anastrozole and tamoxifen? The urologist gave him that protocol with the intentions of him dropping the T, but he continued the T. Since tamoxifen is a SERM and he is on T, does tamoxifen even help?

We are at a loss of what to do now. Any advice you guys can give me would be greatly appreciated!

 

[swoops36]

1mg anastrozole daily is A LOT. Estrogen is required to make sperm:

Estrogen Linked To Sperm Count, Male Fertility

Testosterone may be the hormone that makes the man, but it is estrogen the so-called ³female² hormone that gives sperm its reproductive punch, a team of researchers report in Thursday¹s (Dec. 4) issue of the journal Nature. Estrogen is vital to male fertility specifically to sperm count.

www.eurekalert.org

Dial that back, then check again? Just a thought, I have no experience with fertility on TRT

 

[Hopeful1]

1mg anastrozole daily is A LOT. Estrogen is required to make sperm:

Estrogen Linked To Sperm Count, Male Fertility

Testosterone may be the hormone that makes the man, but it is estrogen the so-called ³female² hormone that gives sperm its reproductive punch, a team of researchers report in Thursday¹s (Dec. 4) issue of the journal Nature. Estrogen is vital to male fertility specifically to sperm count.

www.eurekalert.org

Dial that back, then check again? Just a thought, I have no experience with fertility on TRT

Thank you for that information. Do you think he should cut the anastrozole out all together or maybe take it 1 or 2 days a week like I see some of the other guys on here doing?

 

[fifty]

See post #4

The real answer if fertility is your prime directive may be to ditch testosterone for the time being. Then you have clomid as a real option.

When HCG is Added to TRT

Hey, I have been reading threads thru out the years since I've been on TRT. I appreciate everyone's advice and stories of their own. However, I haven't seen a question like mine. I have three children and after my youngest was born, 4 years ago, I began to experience low T symptoms. After blood...

www.excelmale.com

 

[Hopeful1]

See post #4

The real answer if fertility is your prime directive may be to ditch testosterone for the time being. Then you have clomid as a real option.

When HCG is Added to TRT

Hey, I have been reading threads thru out the years since I've been on TRT. I appreciate everyone's advice and stories of their own. However, I haven't seen a question like mine. I have three children and after my youngest was born, 4 years ago, I began to experience low T symptoms. After blood...

www.excelmale.com

Thank you! I actually read that yesterday while digging through this forum looking for answers.

He did tell me he was off the T for maybe 3 weeks and just started taking it again last week. His sex drive completely tanked pretty quickly and he was tired. He also started taking the anastrozole daily where as before he was taking it only several days of the week, not sure if any of this makes a difference. He has been consistently taking taking the hcg and fsh (75iu) EOD since the middle of October.

He doesn't want to come off the T because of quality of life, plus we got pregnant 5 weeks after he added the fsh last time.

Maybe instead of taking the 1mg of anastrozole daily he could drop it down to .5mg on his T day and then the other .5mg 3 days later and see if that helps? What do you guys think?

 

[Vince]

What's his estradiol levels at?

 

[Vince]

By blocking these estrogen receptors, these drugs stop estrogen from joining to the cancer cells, and the cells stop growing. Both drugs are taken daily as a pill. Tamoxifen is the best studied hormone drug for breast cancer in men and is most often used first.Apr 27, 2018

American Cancer Society › cancer
Hormone Therapy for Breast Cancer in Men - American Cancer Society

 

[Hopeful1]

What's his estradiol levels at?

I'm not sure what his estradiol levels are at, I cant imagine they would be very high since he has been taking the anastrozole daily for the past several weeks.

He was supposed to have a blood drawl a few weeks ago, but because of COVID, the doctor canceled non essential appointments.

 

[Sean Mosher]

We kind of need his entire protocol, exactly what he's taking and how often, but that much Anastrozole and Tamoxifen is destroying him.
We can confidently say that much.

Most recent labwork would help too.

 

[Hopeful1]

We kind of need his entire protocol, exactly what he's taking and how often, but that much Anastrozole and Tamoxifen is destroying him.
We can confidently say that much.

Most recent labwork would help too.

-He takes 1.0 Test Cyp on Mondays
-FSH 75 iu EOD
-HCG EOD, I cant remember the dose, but he goes through a 10,000iu bottle in roughly a week and a half, I know on the syringe he draws it up to 1 and half.
-10 mg tamaxofin 2 times daily
-1mg anastrozole daily

I will see if he has his most recent blood work.

I guess we could try dropping the anastrozole and tamoxifen and see what happens? I feel as if he's got so much crap in his system with everything maybe just going simple and doing T+hcg+fsh is the way to go? I know that protocol has worked well for @Sides and @HealthMan ...

I obviously have no clue about this stuff and you guys have been such a great help to me through all of this...much better than any doctor has been.

 

[gaz7718]

As you may have read on here I took hmg and hcg EOD without the tamoxifen or Anastrozole and wife was pregnant after about 8 weeks. TRT remained throughout.
Without blood work it would be educated guesswork but removal of anything that isn’t directly supporting the pregnancy goal must be the priority. For me coming off TRT would have been the last resort.
good luck with getting yourselves sorted
Btw - you didn’t indicate your hcg dose. 500iu or more?

 

[Cataceous]

For most guys, exogenous testosterone negates the desired effects of SERMs and AIs on the HPTA. Refer to this illustration:


What is desired is to stimulate natural LH and FSH production. SERMs such as tamoxifen block the negative feedback of estradiol at both the hypothalamus and pituitary. An AI like anastrozole does something similar by reducing the total amount of estradiol. The problem is that there's also negative feedback by testosterone at the hypothalamus. This limits the necessary GnRH output, which in turn stops production of LH and FSH. If your husband is highly motivated then it is possible to bypass the hypothalamus by injecting GnRH directly. But it requires frequent administration or an infusion pump. It's unclear if this would significantly improve fertility. The large doses of hCG are already equivalent to massive amounts of LH. So it's a question of whether adding native FSH to the modest injected doses would help. In the end it might be easier to bite the bullet and stop everything except a SERM, which typically provides the best fertility.

Per Dr. Saya:

A *very* generalized ranking of relative fertilities (with top being most fertile):​

​

1. Clomid/SERM treatment​

2(A). HCG + HMG (or lyophilized FSH)​

2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.​

3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)​

3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)​

4. TRT/AAS with no concurrent HCG.​

 

[Vince]

Before You Post About Estradiol or Anastrozole- READ THIS FIRST

Estradiol (E2) frightens a lot of men with low T or on TRT. It’s perceived - all too often - as an almost wicked hormone, lurking, waiting to undermine a patient’s TRT protocol. Guys fear it will rob them of their erections and sex drive and cause them to grow breasts. Estradiol is a necessary...

www.excelmale.com

 

[Hopeful1]

As you may have read on here I took hmg and hcg EOD without the tamoxifen or Anastrozole and wife was pregnant after about 8 weeks. TRT remained throughout.
Without blood work it would be educated guesswork but removal of anything that isn’t directly supporting the pregnancy goal must be the priority. For me coming off TRT would have been the last resort.
good luck with getting yourselves sorted
Btw - you didn’t indicate your hcg dose. 500iu or more?

@gaz7718 I'm pretty sure hcg dose is 500
@catathank you for that, it helped me visualize how everything works
@vincmakes complete sense, also I apologize if I violated any forum rules.

When we had the consultation with the urologist last May, she prescribed all of that stuff with the intentions of him slowly coming off the T injections. When I got pregnant, he was still injecting. So this time around we figured we would do what worked before, but now I'm thinking it's best just to stick to the T+hcg+fsh alone and see if things improve.

 

[Sean Mosher]

Echo much of what was said above.
So it looks like 200mg of Test a week, 75 IU's of FSH EOD.
If he's going through a 10,000 IU bottle of hCG in two weeks with EOD shots, that sounds about or aound 1500 IU's of hCG EOD which is a considerable amount as well.
I believe most of the Lippshulz studies posted here on the sight are are 1500 IU's of hCG 3 times a week to maintain fertility.
That might be something to talk with the doctor about changing and then possibly splitting that Testosterone injection into 2 injections per week (if that helps him).
Less of an estrogen peak when splitting the dose.
And I don't know what to say about the Estrogen blocking doses.
Please read the studies everyone posted above about the need for the aromisation process to occur.
He would probably need to taper the Anastrozole down in a reasonable way to the point to where he may not need it at all.
Right now I don't see how his estradiol isn't zero which is bad news both short term and long term.
Not even sure why the Tamoxifen is in there.
If he dropped the anastrozole completely then maybe it might be beneficial.
I can think of only one other doctor here recently that's even prescribed it to be honest.

 

[Hopeful1]

Echo much of what was said above.
So it looks like 200mg of Test a week, 75 IU's of FSH EOD.
If he's going through a 10,000 IU bottle of hCG in two weeks with EOD shots, that sounds about or aound 1500 IU's of hCG EOD which is a considerable amount as well.
I believe most of the Lippshulz studies posted here on the sight are are 1500 IU's of hCG 3 times a week to maintain fertility.
That might be something to talk with the doctor about changing and then possibly splitting that Testosterone injection into 2 injections per week (if that helps him).
Less of an estrogen peak when splitting the dose.
And I don't know what to say about the Estrogen blocking doses.
Please read the studies everyone posted above about the need for the aromisation process to occur.
He would probably need to taper the Anastrozole down in a reasonable way to the point to where he may not need it at all.
Right now I don't see how his estradiol isn't zero which is bad news both short term and long term.
Not even sure why the Tamoxifen is in there.
If he dropped the anastrozole completely then maybe it might be beneficial.
I can think of only one other doctor here recently that's even prescribed it to be honest.

When we originally started this fertility journey about 2 and a half years ago, he was just doing the T+ hcg EOD. He was on that for a year and had a SA done which came back as 0. So the hcg was not enough to maintain fertility.
I've read through all the studies everyone has posted, such a big help and a bunch of info!
I was thinking the same about the estradiol, I will have him taper down. I wasn't sure what the purpose of the tamaxofin was for, I think the doc just threw everything she could at him.

 

[Sean Mosher]

When we originally started this fertility journey about 2 and a half years ago, he was just doing the T+ hcg EOD. He was on that for a year and had a SA done which came back as 0. So the hcg was not enough to maintain fertility.
I've read through all the studies everyone has posted, such a big help and a bunch of info!
I was thinking the same about the estradiol, I will have him taper down. I wasn't sure what the purpose of the tamaxofin was for, I think the doc just threw everything she could at him.

That sounds like a good plan.
Keep us posted!

 

[Sides]

As I've written before, I am certainly no expert, but I can tell you what worked for me.

I am now 52 years old and I have been on testosterone for over 28 years now.

When my wife and I decided to try for another child, my sperm count was zero. At the end of my 11-month program, my sperm count was 31 million and fertilized 17 out of my wife's 20 viable eggs during our IVF procedure.

I stayed on test the entire time, added HCG and eventually HMG and FSH. Those are the things that I felt made a positive difference.

My doctor added Clomid and Letrozole, just as your doctor has added Nolvadex and Arimidex. But all the Clomid ever did was raise my SHBG very high, it never raised my FSH levels, which never went up until I added HMG and FSH into my program. And adding the aromatase inhibitor (Letrozole, Arimidex) just crushed my estrogen to undetectable levels and made me miserable.

If I had to do it all over again, I would keep it simple:

Test 200mg per week or whatever your TRT amount is
HCG 500iu every other day
HMG or FSH 30-60iu every day, or 75-150iu every other day, which has been used in most studies

In the end it all worked out for us. Our baby girl is now over 5 months old, happy and healthy and a delight in every way, even with all the poopy diapers LOL. I hope that you have the same joy in your lives soon.

 

[Sean Mosher]

That seems very reasonable and obviously it worked.
Thanks for sharing!

 

[Hopeful1]

As I've written before, I am certainly no expert, but I can tell you what worked for me.

I am now 52 years old and I have been on testosterone for over 28 years now.

When my wife and I decided to try for another child, my sperm count was zero. At the end of my 11-month program, my sperm count was 31 million and fertilized 17 out of my wife's 20 viable eggs during our IVF procedure.

I stayed on test the entire time, added HCG and eventually HMG and FSH. Those are the things that I felt made a positive difference.

My doctor added Clomid and Letrozole, just as your doctor has added Nolvadex and Arimidex. But all the Clomid ever did was raise my SHBG very high, it never raised my FSH levels, which never went up until I added HMG and FSH into my program. And adding the aromatase inhibitor (Letrozole, Arimidex) just crushed my estrogen to undetectable levels and made me miserable.

If I had to do it all over again, I would keep it simple:

Test 200mg per week or whatever your TRT amount is
HCG 500iu every other day
HMG or FSH 30-60iu every day, or 75-150iu every other day, which has been used in most studies

In the end it all worked out for us. Our baby girl is now over 5 months old, happy and healthy and a delight in every way, even with all the poopy diapers LOL. I hope that you have the same joy in your lives soon.

Thanks! @Sides

That's what we are doing now keeping it simple, Test+hcg+fsh. He has not taken the tamaxofin or anastrozole in almost a week. Hopefully he feels better without those 2 meds and maybe an improvement in the sperm count. Just cant understand the all the sudden decline in the count when he has been doing that previous protocol with the tamaxofin and anastrozole since October.

Congrats on the baby!