How to Improve Sperm Quality, LH, FSH and Testosterone in Infertile Men

Improving Testosterone, LH, FSH and Sperm Quality in Men Who Stopped TRT or Anabolic Steroids? Main Therapies.

Note: AI's are not recommended due to extreme decreases in estradiol that may have negative health consequences in men.

hCG plus FSH doses used in several studies:

Reference:

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

The use of hormone stimulation in male infertility - Excel Male TRT Forum

The use of hormone stimulation in male infertility (2023) Daniel Foran, Runzhi Chen, Channa N. Jayasena, Suks Minhas and Tharu Tharakan Abstract Infertility affects 15% of couples worldwide and in approximately 50% of cases, the cause is secondary to an abnormality of the sperm. However...

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Semen Analysis Optimum Parameters - Excel Male TRT Forum

Here is a sample semen analysis report (optimum ranges) that I was able to obtain from a friend. Infertility testing: In an evaluation of a man's fertility, each aspect of the semen analysis is considered, as well as the findings as a whole. Semen from a man can vary widely from sample to...

www.excelmale.com

 

Dr. Lipshultz keeps his patients on HCG year-round in order to retain fertility. Personally I never use more than 150 units EOD (just personally can't handle it). His suggestion before coming off of T is to do a semen analysis to determine the health of your sperm and whether or not coming off T is necessary. If coming off T is necessary after a semen analysis has demonstrated less than optimal sperm quality even while taking low-dose HCG with T, then he suggests coming off T and doing the following protocol (basically what you just read in the study i sent you).

"As a rule, all men who are actively trying for a pregnancy should immediately stop taking testosterone or AAS. This may include men taking non-prescribed AAS or men receiving TTh for an established history of hypogonadism. These men should instead start a regimen consisting of 3,000 IU HCG intramuscular or subcutaneous every other day [18]. CC 25 to 50 mg PO (per os, by mouth) daily should also be incorporated to help promote FSH production and pituitary function [69]. During this time, repeat SA's should be obtained every 2 to 3 months along with serum labs [70]. A detailed treatment algorithm is provided in Fig. 1. Men with oligospermia should be offered cryopreservation when appropriate while men with persistent azoospermia despite treatment and no prior history of fertility or sperm on SA should have genetic studies performed to rule-out an easily diagnosable pre-existing etiology. If pregnancy is not achieved with neither FSH levels or SA parameters showing improvement, clomiphene should be discontinued and recombinant FSH 75 to 150 IU every other day should be added [18]. If this fails, testicular sperm retrieval with possible microdissection should be offered in conjunction with in-vitro fertilization as a final chance for biologic paternity. Once pregnancy has been achieved, a discussion regarding the reinitiation of TTh can be had with special consideration to future fertility goals."

Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery

So that would look like:
(1) Conduct Semen Analysis, the start:
3000 IU HCG EOD
25-50 mg Clomid ED
(2) After 2-3 months, conduct second semen analysis:
IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD

***Dr. Lipshultz also advises that if E2 becomes an issue, which it likely will at this dosage, arimidex with be necessary to add in.

I was not suggesting that you do not need to get off Testosterone. I was saying that frontline treatment by Dr. Lipshultz is to stay on HCG @ 500 IU EOD to maintain fertility. However, if you are unable to achieve/maintain fertility and want to conceive a child, then the previously mentioned protocol is the way to go.

Good god that protocol sounds like pure misery.

 

Is HMG and FSH the same or interchangeable?

 

It terms of desired result that was my understanding and went with hmg due to cost and availability

 

3000 IU HCG EOD
25-50 mg Clomid ED
(2) After 2-3 months, conduct second semen analysis:
IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD

This is close to what I proposed at the thread start albeit skipping the clomid option and trying a lesser dose of hcg whilst remaining on TRT.

Ive moved to EOD hcg now to align with EOD hmg, so it just about the right (minimum) hcg dose to achieve desired result with minimal side issues. 500 iu is the safest dose but it is enough to restore fertility

 

Good god that protocol sounds like pure misery.

I agree. 3000 units of HCG EOD plus Clomid would be an emotional nightmare for me. If I absolutely had to get off T to restore fertilty, I would bump this down to 1000 units EOD and skip past Clomid and go right to FSH.

 

3000 IU HCG EOD
25-50 mg Clomid ED
(2) After 2-3 months, conduct second semen analysis:
IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD

This is close to what I proposed at the thread start albeit skipping the clomid option and trying a lesser dose of hcg whilst remaining on TRT.

Ive moved to EOD hcg now to align with EOD hmg, so it just about the right (minimum) hcg dose to achieve desired result with minimal side issues. 500 iu is the safest dose but it is enough to restore fertility

I don't disagree at all. Sounds like a good plan.

 

3000 IU HCG EOD
25-50 mg Clomid ED
(2) After 2-3 months, conduct second semen analysis:
IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD

This is close to what I proposed at the thread start albeit skipping the clomid option and trying a lesser dose of hcg whilst remaining on TRT.

Ive moved to EOD hcg now to align with EOD hmg, so it just about the right (minimum) hcg dose to achieve desired result with minimal side issues. 500 iu is the safest dose but it is enough to restore fertility

Wanted to share this excerpt from an interview with Dr. Lipshultz:

-Strategy for clinicians

To maintain fertility in men with hypogonadism prescribed testosterone, Lipshultz said, clinicians should first insist on a semen analysis before beginning testosterone treatment.

“Patients need to realize that 2% of all men are sterile,” Lipshultz said. “We need to know where the individual is before we introduce testosterone because our endpoint may not be able to be any better than pre-treatment level.”

If the man desires a future pregnancy, the clinician should prescribe hCG concurrent with testosterone therapy, typically at 500 U subcutaneous three times per week or 1,500 U once weekly if the patient wishes only to prevent testicular atrophy. The patient should cycle off of testosterone twice yearly, at a rate of 3,000 U three times per week for 4 weeks, adding 25 mg daily clomiphene therapy during that period, Lipshultz said. However, for men desiring a pregnancy, 3,000 U hCG three times per week should be prescribed in addition to clomiphene therapy. Clinicians should check the patient’s follicle-stimulating hormone (FSH) level and conduct a semen analysis after 4 months for men desiring pregnancy; if the FSH level is not sufficiently elevated, the clinician should discontinue clomiphene and instead introduce FSH concurrent with the hCG, he said.

Low-dose hCG can prevent sterility in men prescribed testosterone Page 2

The article itself is a good read.

 

Hi, everyone... I've been posting to this thread for probably six months now. I'd like some guidance as I have another update and would like an opinion before we have a follow up appointment next week.

Hubby started on HCG monotherapy (1500IU/3Xweek) in July. He had a follow up SA and bloodwork in late September and his SA results showed 4 million/ml with low morph and motility. Testosterone was 368.

Andrologist upped his HCG to 2000 IU/3X week and added Clomid 50 mg/every other day. He spent about two weeks on the Clomid but felt crappy, so she decided he could discontinue that.

So after four months of 2000IU/3X week on HCG, he had more follow up bloodwork and an SA. Bloodwork showed a total test of 260 and with LH at 1.1 and FSH at .6. His SA was still super low at 13 million/ml and still crappy morph and motility.

We've been trying for a baby for nearly 2 years now. Hubby is frustrated and we need to figure something out. We had a baby naturally only three years ago, so we know his body is able... we are just trying to figure this out.

Hoping you experts can help answer a few questions for me.

1. Why would his test DROP that much on a higher HCG dose? He said he feels decent (still lacks libido though), so we were both extremely surprised by this number.

2. Would adding the Clomid back help? He said he will do it if this will help his test and SA parameters.

3. Based on his bloodwork, would adding FSH or HMG give him the boost in sperm that he's looking for? At this point we would just like to regain enough to be able to be IUI candidates because at this point natural conception is pretty much impossible.

Any takeaways from this? I want more info for this appointment. We have spent way too much time on treatments that just aren't working and he's getting depressed about his infertility. Let me know if you all have any suggestions. TIA.

****ETA**** I should add that we have been tracking his sperm under our own microscope at home, so we can kind of see when he has influxes in count or even major issues with motility. I can see plenty of free swimmers, but I knew his count was still low (although I didn't realize it was only 13 million/ml-- i was thinking 25-30 million based on past observations). I haven't noticed any major differences in count between November and now. It has been very steady and doesn't seem to be improving anymore.

 

The research I read from this forum all points towards the addition of FSH or HMG being the most productive combination with HCG. I believe the only reason for suggesting clomid first is one of cost, unless there’s any other evidence I’ve missed.

 

Hi, everyone... I've been posting to this thread for probably six months now. I'd like some guidance as I have another update and would like an opinion before we have a follow up appointment next week.

Hubby started on HCG monotherapy (1500IU/3Xweek) in July. He had a follow up SA and bloodwork in late September and his SA results showed 4 million/ml with low morph and motility. Testosterone was 368.

Andrologist upped his HCG to 2000 IU/3X week and added Clomid 50 mg/every other day. He spent about two weeks on the Clomid but felt crappy, so she decided he could discontinue that.

So after four months of 2000IU/3X week on HCG, he had more follow up bloodwork and an SA. Bloodwork showed a total test of 260 and with LH at 1.1 and FSH at .6. His SA was still super low at 13 million/ml and still crappy morph and motility.

We've been trying for a baby for nearly 2 years now. Hubby is frustrated and we need to figure something out. We had a baby naturally only three years ago, so we know his body is able... we are just trying to figure this out.

Hoping you experts can help answer a few questions for me.

1. Why would his test DROP that much on a higher HCG dose? He said he feels decent (still lacks libido though), so we were both extremely surprised by this number.

2. Would adding the Clomid back help? He said he will do it if this will help his test and SA parameters.

3. Based on his bloodwork, would adding FSH or HMG give him the boost in sperm that he's looking for? At this point we would just like to regain enough to be able to be IUI candidates because at this point natural conception is pretty much impossible.

Any takeaways from this? I want more info for this appointment. We have spent way too much time on treatments that just aren't working and he's getting depressed about his infertility. Let me know if you all have any suggestions. TIA.

****ETA**** I should add that we have been tracking his sperm under our own microscope at home, so we can kind of see when he has influxes in count or even major issues with motility. I can see plenty of free swimmers, but I knew his count was still low (although I didn't realize it was only 13 million/ml-- i was thinking 25-30 million based on past observations). I haven't noticed any major differences in count between November and now. It has been very steady and doesn't seem to be improving anymore.

Here is my take on what has happened with your husband:

1. Why would his test DROP that much on a higher HCG dose? He said he feels decent (still lacks libido though), so we were both extremely surprised by this number.
This could be due to any number of things. (1) Timing of the assay (2) Desensitization of the LH receptors due to the dosage (3) E2 increase due to dosage increase (4) Sleep/diet/exercise/stress

2. Would adding the Clomid back help? He said he will do it if this will help his test and SA parameters.
If he felt bad on Clomid, as many men report that they do, then starting Clomid back would simply reduce quality of life while potentially adding to his sperm production. However, there is a better option (FSH or HMG).

3. Based on his bloodwork, would adding FSH or HMG give him the boost in sperm that he's looking for? At this point we would just like to regain enough to be able to be IUI candidates because at this point natural conception is pretty much impossible.
Adding FSH, according to Dr. Larry Lipschultz at the Baylor College of Medicine (one of the leading urologists in the US), is advisable at this point.

https://www.healio.com/endocrinolog...erility-in-men-prescribed-testosterone?page=2

-Strategy for clinicians (Excerpt from Dr. Larry Lipshultz)

To maintain fertility in men with hypogonadism prescribed testosterone, Lipshultz said, clinicians should first insist on a semen analysis before beginning testosterone treatment.

“Patients need to realize that 2% of all men are sterile,” Lipshultz said. “We need to know where the individual is before we introduce testosterone because our endpoint may not be able to be any better than pre-treatment level.”

If the man desires a future pregnancy, the clinician should prescribe hCG concurrent with testosterone therapy, typically at 500 U subcutaneous three times per week or 1,500 U once weekly if the patient wishes only to prevent testicular atrophy. The patient should cycle off of testosterone twice yearly, at a rate of 3,000 U three times per week for 4 weeks, adding 25 mg daily clomiphene therapy during that period, Lipshultz said. However, for men desiring a pregnancy, 3,000 U hCG three times per week should be prescribed in addition to clomiphene therapy. Clinicians should check the patient’s follicle-stimulating hormone (FSH) level and conduct a semen analysis after 4 months for men desiring pregnancy; if the FSH level is not sufficiently elevated, the clinician should discontinue clomiphene and instead introduce FSH concurrent with the hCG, he said.

 

Thanks, both of you.

I have been pushing for FSH for six months and his doctor won't prescribe. She said she'd "consider it" if he was still low once his test levels came back up. We are point blank asking for it this time. I want him to be able to get back on test so we can put an end to this baby stuff. I'm also about to turn 36 so we don't have long to wait. We are both tired of waiting for FSH so if she won't prescribe, we will probably end up leaving and going to Defy or ordering it ourselves from overseas. I don't know why she is so against him using it (cost aside). Sigh.

Thanks, guys.

 

It’s a risk buying through your own sources. Will they deliver? Is the content of the vial precisely what it is claimed to be?
But for cost and expediency I took that risk but tried to mitigate where I could by using suppliers with a track record and using a commercial platform and credit card that affords some protection.

 

HCG, HMG (mixed FSH and LH), and FSH worked for me, and restored my fertility after 27 years on testosterone and other anabolic steroids. My wife is currently pregnant, and our baby girl is due to be born on November 29. And I am 51 years old, and have been using test for more than half my life. It worked for me, and will work for most men, barring any pre-existing fertility issues.

I just saw this post! Congratulations! May I ask how old your wife is??? I just had my first, a daughter at 46. My wife is 41.

 

Be aware of this. Deadline for comments Feb 15, 2020

Your Access to More Economical hCG and FSH May End- Send Comments to the FDA

 

Be aware of this. Deadline for comments Feb 15, 2020

Your Access to More Economical hCG and FSH May End- Send Comments to the FDA

 

Holy crap. How did I not know about this? I am now officially stressed as hell. I wish I had heard about this sooner. I left a comment.

Be aware of this. Deadline for comments Feb 15, 2020

Your Access to More Economical hCG and FSH May End- Send Comments to the FDA

 

Here is my take on what has happened with your husband:

1. Why would his test DROP that much on a higher HCG dose? He said he feels decent (still lacks libido though), so we were both extremely surprised by this number.
This could be due to any number of things. (1) Timing of the assay (2) Desensitization of the LH receptors due to the dosage (3) E2 increase due to dosage increase (4) Sleep/diet/exercise/stress

@DS3 (or anyone who is knowledgeable), i just now had time to go over the parts of this post that I’d missed during the month or two I was off and am left with a burning question:

If LH receptors have been desensitized, is there a way to cycle them so that they turn back on? I just did a “DIY semen analysis” tonight and I am confident that along with hubby’s falling test numbers, his sperm count is falling as well. Two months ago i absolutely saw more than i currently see. Two months ago we took a “home” semen analysis that tells you if you have 20 million/ml or more (WHO standard lower reference range of normal) and he got a positive result. Something is going on and I’m now suspecting desensitization.

Is there any way to combat this? And if This IS the case, i worry that adding an additional 3000 units of HCG a week could just make it worse, even with adding FSH as well.

What’s the best way to cycle and give those LH receptors a break?! Can this be fixed? And if it IS LH desensitization, would adding FSH to the increased HCG (3000 units 2x week combined with 75 units of FSH 3x a week) still help?
I’m convinced something is going on here as I’ve seen his count decline over the last six weeks.

 

I admit, I have dabbled in the under ground labs for test ect but I have never seen anything for UG fsh. I’m I interested where you’re getting the fsh Bc it is getting very pricey for me. Even going through empower

 

Just an update on my protocol. In month 2 of taking hcg EOD 500iu with hmg 75iu my wife has become pregnant. Previously without the hmg we had been trying for 1 year.

 

Wow. Congrats. I Have yet to be that fortunate