Fertility: Sperm count up after adding HCG to TRT

[HealthMan]

Maybe Dr Saya might shed some light on this topic. My understanding is that both LH and FSH are necessary for spermatogenesis. LH via stimulating testosterone production in the Leydig cells (intratesticular testosterone levels are important for spermatogenesis) and FSH directly stimulating spermatogenesis in the sartori cells. HCG is a LH analog and is able to stimulate LH receptors then taking care of part of the equation. Most of times HCG alone is able to maintain fertility in men on TRT but at higher dosages (possibly because of the weak FSH analog effect of HCG that is only significant in higher dosages?). In that case using lower dosages of HCG that are capable of maintaining intratesticular levels of testosterone (around 300IU EOD or 500IU 2x week) and supplementing with FSH one should be able to achieve optimal sperm count and quality while on trt right?
I am asking this because HCG has a very stimulatory effect on me at higher dosages (most likely because of it similar structure to TSH) and I was contemplating using a lower HCG dosage and adding FSH. Thoughts?

 

[Dr Justin Saya MD]

Maybe Dr Saya might shed some light on this topic. My understanding is that both LH and FSH are necessary for spermatogenesis. LH via stimulating testosterone production in the Leydig cells (intratesticular testosterone levels are important for spermatogenesis) and FSH directly stimulating spermatogenesis in the sartori cells. HCG is a LH analog and is able to stimulate LH receptors then taking care of part of the equation. Most of times HCG alone is able to maintain fertility in men on TRT but at higher dosages (possibly because of the weak FSH analog effect of HCG that is only significant in higher dosages?). In that case using lower dosages of HCG that are capable of maintaining intratesticular levels of testosterone (around 300IU EOD or 500IU 2x week) and supplementing with FSH one should be able to achieve optimal sperm count and quality while on trt right?
I am asking this because HCG has a very stimulatory effect on me at higher dosages (most likely because of it similar structure to TSH) and I was contemplating using a lower HCG dosage and adding FSH. Thoughts?

Healthman - yes adding FSH along with HCG will typically result in better spermatogenesis, but at a cost ($$). Lyophilized FSH is available and I do prescribe it in certain fertility circumstances. We can consider this for you if the cost isn't prohibitive. My office can get you the exact pharmacy figures for cost if you call.

 

[HanOng]

Congrats HealthMan! Glad to know of the positive results, I am 6 weeks into my protocol and encouraged by your experience.

 

[HealthMan]

Healthman - yes adding FSH along with HCG will typically result in better spermatogenesis, but at a cost ($$). Lyophilized FSH is available and I do prescribe it in certain fertility circumstances. We can consider this for you if the cost isn't prohibitive. My office can get you the exact pharmacy figures for cost if you call.

Thanks Dr Saya! I will contact the office!

 

[HealthMan]

Congrats HealthMan! Glad to know of the positive results, I am 6 weeks into my protocol and encouraged by your experience.

Great! What is your protocol?

 

[HealthMan]

5 months after increasing HCG dosage to 500IU 3x a week and sperm count still very low 3mm/ml. Interesting enough HCG 500IU 2x vs 3x a week yielded same results. Maybe this a question for Dr Saya. Adding 50IU FSH 3x a week with HCG 500IU 3x a week (or FSH 75IU 2x a week with HCG 500IU 2x a week given there seems to be no difference between the 2 HCG protocols) might help bring fertility back to normal levels?
At FSH 150IU/week it wont break the bank if it is effective

 

[Dr Justin Saya MD]

5 months after increasing HCG dosage to 500IU 3x a week and sperm count still very low 3mm/ml. Interesting enough HCG 500IU 2x vs 3x a week yielded same results. Maybe this a question for Dr Saya. Adding 50IU FSH 3x a week with HCG 500IU 3x a week (or FSH 75IU 2x a week with HCG 500IU 2x a week given there seems to be no difference between the 2 HCG protocols) might help bring fertility back to normal levels?
At FSH 150IU/week it wont break the bank if it is effective

Yes, as I believe mentioned elsewhere, adding lyophilized FSH is the next step up for fertility purposes (alternatively D/C TRT and take Clomid).

 

[HealthMan]

Yes, as I believe mentioned elsewhere, adding lyophilized FSH is the next step up for fertility purposes (alternatively D/C TRT and take Clomid).

Thanks Dr Saya! In your opinion is HMG any better than rFSH while used in conjunction with HCG to restore or maitain fertility while on TRT when HCG alone is not enough?

 

[Dr Justin Saya MD]

Thanks Dr Saya! In your opinion is HMG any better than rFSH while used in conjunction with HCG to restore or maitain fertility while on TRT when HCG alone is not enough?

Lyophilized FSH (when used with concurrent HCG) should be physiologically equivalent to HMG although I'm not aware of any direct comparative studies. Lyophilized FSH is also more easily attainable (through select compounding pharmacies).

 

[HealthMan]

Lyophilized FSH (when used with concurrent HCG) should be physiologically equivalent to HMG although I'm not aware of any direct comparative studies. Lyophilized FSH is also more easily attainable (through select compounding pharmacies).

Dr Saya,

Maybe you can help clarify this. The attached article says that men with hypogonadotropic hypogonadism already taking HCG and adding FSH to their regimen can stop FSH once satisfactory sperm concentration is reached and spermatogenesis may be maintained with hCG alone. How is that possible? Also is there a difference between someone that started TRT using HCG and someone that only added HCG a few months later (my case) in terms of recovering fertility with the use of HCG alone while staying on TRT? In Dr Lipshultz experiment with low dose HCG to maintain fertility all the subjects started using HCG and testosterone at the same time. So looks like there is a difference between maintaining vs recovering fertility with the use of HCG. If yes what would be the mechanism responsible for that?

"In patients with acquired HGH, normal spermatogenesis can usually be restored by treatment with exogenous gonadotropins or GnRH. Human chorionic gonadotropin (hCG) therapy, which contains LH-like activity, is the most commonly used treatment in HGH for economic and compliance reasons (Conte et al 1990; Shin and Honig 2002). Human menopausal gonadotropin (hMG), which contains both FSH and LH, also has been used for replacement therapy in these patients. Normally, the treatment involves the subcutaneous administration of hCG 1500–3000 IU three times per week (March and Isidori 2002). However, congenital causes frequently require the addition of follicle-stimulating hormone (FSH). In these cases, after approximately 3 months of hCG therapy, intramuscular injections of FSH at dose of 37.5 to 75 IU are added three times per week. FSH is available in a recombinant form as well as in a highly purified urinary form. Serum testosterone levels and seminal analysis are followed during treatment. On average, it takes approximately 6 to 9 months before spermatozoa appear in the ejaculate (Haidl 2002). However, this period can be much longer (March and Isidori 2002). Once sperm concentrations reach satisfactory levels, FSH can be suspended, and spermatogenesis may be maintained with hCG alone (Siddiq and Sigman 2002)"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721319/#!po=12.6263

 

[Dr Justin Saya MD]

Dr Saya,

Maybe you can help clarify this. The attached article says that men with hypogonadotropic hypogonadism already taking HCG and adding FSH to their regimen can stop FSH once satisfactory sperm concentration is reached and spermatogenesis may be maintained with hCG alone. How is that possible? Also is there a difference between someone that started TRT using HCG and someone that only added HCG a few months later (my case) in terms of recovering fertility with the use of HCG alone while staying on TRT? In Dr Lipshultz experiment with low dose HCG to maintain fertility all the subjects started using HCG and testosterone at the same time. So looks like there is a difference between maintaining vs recovering fertility with the use of HCG. If yes what would be the mechanism responsible for that?

"In patients with acquired HGH, normal spermatogenesis can usually be restored by treatment with exogenous gonadotropins or GnRH. Human chorionic gonadotropin (hCG) therapy, which contains LH-like activity, is the most commonly used treatment in HGH for economic and compliance reasons (Conte et al 1990; Shin and Honig 2002). Human menopausal gonadotropin (hMG), which contains both FSH and LH, also has been used for replacement therapy in these patients. Normally, the treatment involves the subcutaneous administration of hCG 1500–3000 IU three times per week (March and Isidori 2002). However, congenital causes frequently require the addition of follicle-stimulating hormone (FSH). In these cases, after approximately 3 months of hCG therapy, intramuscular injections of FSH at dose of 37.5 to 75 IU are added three times per week. FSH is available in a recombinant form as well as in a highly purified urinary form. Serum testosterone levels and seminal analysis are followed during treatment. On average, it takes approximately 6 to 9 months before spermatozoa appear in the ejaculate (Haidl 2002). However, this period can be much longer (March and Isidori 2002). Once sperm concentrations reach satisfactory levels, FSH can be suspended, and spermatogenesis may be maintained with hCG alone (Siddiq and Sigman 2002)"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721319/#!po=12.6263

To your first question - I wouldn't be able to validate the efficacy of stopping FSH once adequate spermatogenesis is established in favor of HCG only. I would presume the fertility parameters would trend back down to the HCG-only levels at that time, which wouldn't be ideal in those cases where the progression is made to add FSH as the presumption there is that the fertility parameters were not ideal with HCG only (or else the progression to add FSH wouldn't have been necessary to begin with).

To your second question - I've seen nothing to suggest (in clinical practice) a significant deviation in results between beginning HCG at the onset of TRT vs beginning at some point thereafter (when factoring relative age into consideration). However, as you state, I'm also not aware of any data directly comparing the two scenarios. The most important factor, IMO, for response to HCG is the degree of primary hypogonadism present (at any time HCG is incorporated).

 

[HealthMan]

Thanks for taking the time to answer my questions Dr Saya!

 

[HealthMan]

Update: I will be adding FSH to my protocol next week. I am planning to have sperm analysis done once a month and post the results here. Wish me luck!

 

[HanOng]

Gentlemen, having been on my protocol for nearly 7 months, I got my wife pregnant!!!!!

Thanks everyone for the advice and encouragement!

 

[Rjsnuruf]

Gentlemen, having been on my protocol for nearly 7 months, I got my wife pregnant!!!!!

Thanks everyone for the advice and encouragement!

Thats great news!, Did you add FSH to your protocol?

How much did you use of FSH week and for how long?

 

[HanOng]

Thanks Rjsnuruf!

There wasn't a need to intro FSH to my protocol.

I was on pretty high dose HCG-monotherapy (1500iu every alternate days) for nearly 7months.

 

[HealthMan]

Thanks Rjsnuruf!

There wasn't a need to intro FSH to my protocol.

I was on pretty high dose HCG-monotherapy (1500iu every alternate days) for nearly 7months.

Great news! Did you ever get a sperm analysis done? If yes what were the results?

 

[HanOng]

I did one previously in May and another this morning to freeze and store my semen.

The report for May was pathetic but doctor said was good enough to freeze. I can't recall the detailed results but was something like:-

Volume: 1.1ml
Count: 4 million
Motility: 8%

Shall await this morning's report for a better gauge of my progress.

 

[HanOng]

My results for yesterday's analysis is out; not much of an improvement despite a further 3 months of HCG injections.

Nonetheless, one of them sperms got my wife pregnant so i am a happy man!

 

[nurselyfe]

how long did you do 1,500 IU every other day for? Were you on testosterone as well?