Fertility help!!

[Nelson Vergel]

hCG by itself is usually not effective to improve sperm count since it shuts down HPTA and may not generate enough intratesticular testosterone (ITT).

Using TRT plus 500 IU HCG three times per week works in 2/3 of men.

hCG + FSH works even better.

Empower Pharmacy has a good price on FSH (but your husband needs a prescription)

Semen analysis results after adding FSH to TRT and hCG

Fertility Restored While on TRT

I would also get on 300 mg per day of Coenzyme Q10.

Top Supplements That Improve Sperm Quality

He needs a better doctor.

 

[Nelson Vergel]

There's a few studies that show a benefit to taking HGH or IGF-1 to help with fertility, both in animals and humans, and in both males and females. You can Google "growth hormone male fertility" and you will see studies like these:

The link between IGF-1 and fertility is weak. I would spend that money on FSH + HCG instead.

 

[Hopeful1]

hCG by itself is usually not effective to improve sperm count since it shuts down HPTA and may not generate enough intratesticular testosterone (ITT).

Using TRT plus 500 IU HCG three times per week works in 2/3 of men.

hCG + FSH works even better.

Empower Pharmacy has a good price on FSH (but your husband needs a prescription)

Semen analysis results after adding FSH to TRT and hCG

Fertility Restored While on TRT

I would also get on 300 mg per day of Coenzyme Q10.

Top Supplements That Improve Sperm Quality

He needs a better doctor.

I agree he needs a better doctor...

 

[Hopeful1]

I need your help again guys...
So I have an appointment next week with a different reproductive endocrinologist. I want to see if he will prescribe my husband fsh while he continues test plus hcg. I want to go into this appointment armed with knowledge, so my question is how do I plead my case for him dropping the clomid and adding in the fsh? From what I gather from this forum, the clomid will not have any effect on the lh and fsh due to the hpta being shut down due to the test, which makes the clomid pretty much useless for sperm regeneration while on the test...am I correct?
I'm hoping they wont say come completely off the test bc I know he will feel like crap, plus the toll it will take on his libido. Hopefully they will do a semen analysis too so we can see what if any count he has since being on his current protocol of test+hcg+clomid.

 

[Hopeful1]

UPDATE:

Semen analysis after adding hcg mwf since July came back at 0.

However, he was able to talk with the doc that gives him his test shot and he finally agreed to order him the fsh! He did mention it will be expensive, so we are waiting to hear how much. I did tell him to check Empower Pharmacy though...

Fingers crossed the test+hcg+fsh works

 

[Sides]

UPDATE:

Semen analysis after adding hcg mwf since July came back at 0.

However, he was able to talk with the doc that gives him his test shot and he finally agreed to order him the fsh! He did mention it will be expensive, so we are waiting to hear how much. I did tell him to check Empower Pharmacy though...

Fingers crossed the test+hcg+fsh works

Tough news with the HCG and zero sperm count, but the FSH will do the trick if anything will.

If the doctor prescribes the FSH through Empower Pharmacy, it will only cost $325 for 1200iu, so that is definitely the most reasonably priced FSH anywhere in America. It worked for me, and I've been on test for 27 years now, so I believe it will work for your husband as well.

Test + HCG + FSH and you've got all the bases covered. That will work if anything will.

Best wishes for you and your husband!

 

[lt84]

I know this is an old post, but do you have an update? We are in a very similar situation. Had a baby naturally in Dec. 16 and hubby got diagnosed with low T in Jan. 2019. They put him on 100mg test cyp per week, 800IU HCG per week, 50 mg of Clomid daily, plus .3 mg of anastrazole daily. He had no baseline SA, but his sex drive was so bad in Jan. that we weren't even able to try to conceive at that point. A home sperm test showed low, but that's all we went by. He had an SA last week and came back with zero count.

He's off the test completely now and doctor has moved him to just clomid 25mg/day. Repeat SA in 2 months. I'm totally taking your suggestion of getting a microscope to check for swimmers in the meantime.

How are you guys doing now?

UPDATE:

Semen analysis after adding hcg mwf since July came back at 0.

However, he was able to talk with the doc that gives him his test shot and he finally agreed to order him the fsh! He did mention it will be expensive, so we are waiting to hear how much. I did tell him to check Empower Pharmacy though...

Fingers crossed the test+hcg+fsh works

 

[Hopeful1]

I know this is an old post, but do you have an update? We are in a very similar situation. Had a baby naturally in Dec. 16 and hubby got diagnosed with low T in Jan. 2019. They put him on 100mg test cyp per week, 800IU HCG per week, 50 mg of Clomid daily, plus .3 mg of anastrazole daily. He had no baseline SA, but his sex drive was so bad in Jan. that we weren't even able to try to conceive at that point. A home sperm test showed low, but that's all we went by. He had an SA last week and came back with zero count.

He's off the test completely now and doctor has moved him to just clomid 25mg/day. Repeat SA in 2 months. I'm totally taking your suggestion of getting a microscope to check for swimmers in the meantime.

How are you guys doing now?

@It84

We went to a urologist the 1st week of May who specializes in Male fertility and is supposed to know about TRT too. At the time of our consultation, he was on test, hcg, and clomid since July of 2018. His SA this past March showed 0 sperm on that regime. This urologist told him he needs to come off the test, do a stronger dose of hcg EOD, 75iu of fsh every day, and she put him on Tamoxifen 10mg twice a day, and Anastrozole 1mg once a day. We were supposed to have a follow up appointment with the urologist this past week, but due to not being able to get enough hcg to administer the higher dosage in order for him to wean off the test, we had to move the appointment to sometime in July.

Prior to adding the fsh, when we looked under the microscope, we saw literally 1 or 2 twitching sperm, but since adding the fsh approximately 4 weeks ago, we were able to see at least 20 sperm on the slide, I know it's not a lot, but its definitely an improvement. I'm hoping by the time we go to this next urologist appointment, she let's him do a SA so we can see where we are sperm count wise.

As for the microscope thing, I got the idea from the babycenter boards for vasectomy reversals. That's actually how a lot of those couples track the progress of sperm returning after their procedures. They also give directions on how to go about looking for them under the microscope. I got a cheap kids one from Amazon and was under 12 bucks and was able to see them on the highest magnification.

I will update once we have our next urologist appointment in a couple weeks. Also, please dont hesitate to message me if you need any help on scoping.

 

[HealthMan]

@It84

We went to a urologist the 1st week of May who specializes in Male fertility and is supposed to know about TRT too. At the time of our consultation, he was on test, hcg, and clomid since July of 2018. His SA this past March showed 0 sperm on that regime. This urologist told him he needs to come off the test, do a stronger dose of hcg EOD, 75iu of fsh every day, and she put him on Tamoxifen 10mg twice a day, and Anastrozole 1mg once a day. We were supposed to have a follow up appointment with the urologist this past week, but due to not being able to get enough hcg to administer the higher dosage in order for him to wean off the test, we had to move the appointment to sometime in July.

Prior to adding the fsh, when we looked under the microscope, we saw literally 1 or 2 twitching sperm, but since adding the fsh approximately 4 weeks ago, we were able to see at least 20 sperm on the slide, I know it's not a lot, but its definitely an improvement. I'm hoping by the time we go to this next urologist appointment, she let's him do a SA so we can see where we are sperm count wise.

As for the microscope thing, I got the idea from the babycenter boards for vasectomy reversals. That's actually how a lot of those couples track the progress of sperm returning after their procedures. They also give directions on how to go about looking for them under the microscope. I got a cheap kids one from Amazon and was under 12 bucks and was able to see them on the highest magnification.

I will update once we have our next urologist appointment in a couple weeks. Also, please dont hesitate to message me if you need any help on scoping.

1mg anastrozole a day is CRAZY! Run from this doctor

 

[Cataceous]

1mg anastrozole a day is CRAZY! Run from this doctor

This is the dose given to breast cancer patients to make their estradiol as low as possible. Giving the doctor the benefit of the doubt, maybe she's hoping that strong estradiol suppression will provide additional HPTA stimulation. But it's not worth it, as guys need some estradiol. Without it, libido may suffer, and over time bone mineral density will be degraded.

 

[HealthMan]

This is the dose given to breast cancer patients to make their estradiol as low as possible. Giving the doctor the benefit of the doubt, maybe he's hoping that strong estradiol suppression will provide additional HPTA stimulation. But it's not worth it, as guys need some estradiol. Without it, libido may suffer, and over time bone mineral density will be degraded.

He is prescribing 20mg tamoxifen a day which should be enough to stimulate HPTA. Don’t think this doctor is adding the 1mg anastrozole for that purpose it seems like she has no clue how to manage estradiol. Plus she is using HCG which shuts down the HPTA (hopefully the doctor is just using HCG to help the restart since testosterone is no longer being administered)

 

[Cataceous]

He is prescribing 20mg tamoxifen a day which should be enough to stimulate HPTA. Don’t think this doctor is adding the 1mg anastrozole for that purpose it seems like she has no clue how to manage estradiol. Plus she is using HCG which shuts down the HPTA (hopefully the doctor is just using HCG to help the restart since testosterone is no longer being administered)

Regardless of her intent I think we agree that this is a dubious protocol. @lt84 described similar weirdness with a SERM + hCG + AI + TRT. So it seems like some doctors just want to throw everything at the problem, while ignoring the counterproductive effects.

 

[Hopeful1]

1mg anastrozole a day is CRAZY! Run from this doctor

Ugh! Now I want to scream lol. I thought we found a doc who knew what they were doing. At least on a positive note, she did prescribe us the fsh. If I'm remembering correctly, I thought she prescribed the anastrozole for gynecomastia, not 100% sure. I just looked for his most recent blood work and saw his estradiol from May prior to starting the tamoxifen, anastrozole, and fsh was at 59.9 with a reference interval of 25.8 - 60.7. I was actually wondering if that dose of anastrozole was a bit much considering I have seen guys on this board using something like .5, but not a daily dose.

So is it dangerous for him to be taking the prescribed dose of anastrozole?

I thought we were heading in the right direction, now I'm not so sure. This is so frustrating.

 

[fifty]

He’ll live. It’s not dangerous short term. Dr. Crisler had me on 1mg anastrozole every other day back in like ‘05 for like 4-6 weeks. I was fine and he was a hero doctor on these boards.

 

[HealthMan]

Ugh! Now I want to scream lol. I thought we found a doc who knew what they were doing. At least on a positive note, she did prescribe us the fsh. If I'm remembering correctly, I thought she prescribed the anastrozole for gynecomastia, not 100% sure. I just looked for his most recent blood work and saw his estradiol from May prior to starting the tamoxifen, anastrozole, and fsh was at 59.9 with a reference interval of 25.8 - 60.7. I was actually wondering if that dose of anastrozole was a bit much considering I have seen guys on this board using something like .5, but not a daily dose.

So is it dangerous for him to be taking the prescribed dose of anastrozole?

I thought we were heading in the right direction, now I'm not so sure. This is so frustrating.

Long term can be detrimental for his health for sure. If the main goal here os fertility i would drop everything and just use clomid. Or have the doctor prescribe TRT + HCG + FSH. Clomid alone would be the cheapest and most effective way to get fertility back but he might not feel nearly as good as compared to TRT + HCG + FSH.
Have a conversation with his doctor. Most doctors are not willing to prescribe anything. At least she is. Maybe an educated conversation is all you guys need to sort things out.

 

[HealthMan]

Regardless of her intent I think we agree that this is a dubious protocol. @lt84 described similar weirdness with a SERM + hCG + AI + TRT. So it seems like some doctors just want to throw everything at the problem, while ignoring the counterproductive effects.

So sad how many clueless doctors are out there

 

[HealthMan]

Ugh! Now I want to scream lol. I thought we found a doc who knew what they were doing. At least on a positive note, she did prescribe us the fsh. If I'm remembering correctly, I thought she prescribed the anastrozole for gynecomastia, not 100% sure. I just looked for his most recent blood work and saw his estradiol from May prior to starting the tamoxifen, anastrozole, and fsh was at 59.9 with a reference interval of 25.8 - 60.7. I was actually wondering if that dose of anastrozole was a bit much considering I have seen guys on this board using something like .5, but not a daily dose.

So is it dangerous for him to be taking the prescribed dose of anastrozole?

I thought we were heading in the right direction, now I'm not so sure. This is so frustrating.

If he has gynecomastia tamoxifen alone should help. No need to bring down his estradiol to zero. If tamoxifen doesn’t work after 2-3 months then consider anastrozole. Usually tamoxifen works really well for lump gyno that is recent.

 

[Hopeful1]

If he has gynecomastia tamoxifen alone should help. No need to bring down his estradiol to zero. If tamoxifen doesn’t work after 2-3 months then consider anastrozole. Usually tamoxifen works really well for lump gyno that is recent.

Thanks Healthman. I was wondering if he really needed the tamoxifen and anastrozole. I figured the doc would want him to come off test, but assumed he would just be on hcg and fsh to bring back the swimmers. It doesn't look like he has gyno, so I was a little confused on the addition of the tamoxifen and anastrozole. His next appointment can't come soon enough.

 

[HealthMan]

HCG after stopping TRT is a bridge for HPTA recovery. After stopping TRT a SERM like clomid or tamoxifen won’t work right away (exogenous testosterone is still in his system) so HCG will keep his testicles producing testosterone. After a few weeks doctor should drop HCG and just keep a SERM and anastrozole it he has estradiol issues. Remember that HCG suppresses the HPTA like testosterone does. So it should only be used short term in a restart. If that is the doctor objective then fine. But given he is using FSH as well I doubt this is what he is planning. Again. For fertility clomid alone is best and cheapest

 

[Hopeful1]

HCG after stopping TRT is a bridge for HPTA recovery. After stopping TRT a SERM like clomid or tamoxifen won’t work right away (exogenous testosterone is still in his system) so HCG will keep his testicles producing testosterone. After a few weeks doctor should drop HCG and just keep a SERM and anastrozole it he has estradiol issues. Remember that HCG suppresses the HPTA like testosterone does. So it should only be used short term in a restart. If that is the doctor objective then fine. But given he is using FSH as well I doubt this is what he is planning. Again. For fertility clomid alone is best and cheapest

My understanding was she was trying to get his test levels up using the hcg along with all the other meds and drop test in order to bring fertility back up. She said with this regimen she can get his test levels up as if he were actually taking test while bringing fertility back. So from what I understand, I dont think she intends to drop the hcg.