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

[lt84]

Just want to say thanks Sides for your opinion and advice. We will give the HCG + Clomid a go for awhile. He went from 0 - 4 mil/ml in two months on HCG, so hopefully it'll continue rising. Even at .20/unit, FSH would probably be $400 a month or so for us... so we will give this a whirl for now.

 

[Sides]

Sides - your advice and insight in this thread is on point. If remaining on TRT, then HCG + FSH would be more effective than HCG + clomid (due to the competing negative feedback from TRT). If OFF of TRT, then clomid is typically quite effective from a fertility perspective.

Thanks, Dr Saya, I appreciate the comment and insight. You managed to say in two concise sentences what I was trying to express in several rambling paragraphs LOL.

 

[Sides]

Just want to say thanks Sides for your opinion and advice. We will give the HCG + Clomid a go for awhile. He went from 0 - 4 mil/ml in two months on HCG, so hopefully it'll continue rising. Even at .20/unit, FSH would probably be $400 a month or so for us... so we will give this a whirl for now.

lt84, I completely understand. Especially when it comes to trying to have a baby, we all have to budget our money and other resources as effectively as possible. Clomid is cheap while FSH is still relatively expensive, so I understand why you would want to give it a chance to work first. I am 51 and my wife is 42, so we were in a rush to have our baby as soon as possible, and would do anything to make that possible.

And of course, once the baby comes that is only the beginning of the expenses, so you have to budget your money as best you can. Here I am taking a break from trying to put together our new changing table and crib, and then there will be the stroller to buy, and the breast pump, and diapers...and eventually college someday. The expenses of having a child will never end...but still I am grateful for the chance to have our baby.

 

[lt84]

lt84, I completely understand. Especially when it comes to trying to have a baby, we all have to budget our money and other resources as effectively as possible. Clomid is cheap while FSH is still relatively expensive, so I understand why you would want to give it a chance to work first. I am 51 and my wife is 42, so we were in a rush to have our baby as soon as possible, and would do anything to make that possible.

I wish you the best of luck in your parenting journey! We have an (almost) three year old together and I have an (almost) 16 year old from my prior marriage, and to say it is life changing doesn't even begin to hit the tip of the iceberg. They get more expensive as they get older too. Oh my oh my... it sure is fun, though-- and the time flies. Oh, and in case you didn't know, your health insurance should foot the breast pump cost. Every little bit helps! Breastfeeding alone will save you guys massive $$$.

I am 35 and hubby is 41, so we are definitely in a hurry too-- but since we conceived naturally only three years ago and he was only on testosterone for a little while, we are hoping for a faster recovery. If his numbers aren't up to sufficient levels within the next 4-6 months or so, we will definitely try the FSH for sure. She did up his HCG to 2000IU 3x/week in addition to adding Clomid, so we are hoping this really helps. Fingers crossed.

Thank you so much for all the info and good luck to you and your wife on your impending bundle of joy! <3

 

[lt84]

Sides - your advice and insight in this thread is on point. If remaining on TRT, then HCG + FSH would be more effective than HCG + clomid (due to the competing negative feedback from TRT). If OFF of TRT, then clomid is typically quite effective from a fertility perspective.

Thank you SO much for you input, Dr. Saya. Husband is off T right now and was on it for less than a year, so this makes me have a good degree of confidence moving forward with the HCG+Clomid protocol.

Sides and Juice aren't joking when they say there is better info available here than there is at my fertility doctor's office-- and we are using the "world renowned" Cleveland Clinic. I cannot express enough gratitude for the information I've received on this site. Thank you.

 

[Sides]

Sides and Juice aren't joking when they say there is better info available here than there is at my fertility doctor's office-- and we are using the "world renowned" Cleveland Clinic. I cannot express enough gratitude for the information I've received on this site. Thank you.

For better or worse, that's definitely true. My fertility doctor is well-known and respected locally, and was recommended to us by our IVF clinic...and yet neither he nor the doctor at the IVF clinic knew a damn thing about helping men who are on testosterone regain fertility and conceive a child. I researched everything online and was constantly aggravating him by printing out and bringing him studies I found...and he still wouldn't prescribe me HMG or FSH, and had no idea that Empower Pharmacy had low-cost FSH available until I printed out the information from this site and Empower's website, and brought it to him. That's not to say my doctor is a bad guy, but that most doctors and even fertility clinics know nothing about helping men who have been on testosterone.

There is much better information here, and I am grateful for that.

 

[gaz7718]

Hi, I’m new to the forum having discovered it a few months back. I’m from the UK where it seems we are still catching up with the thinking in the US.

I am very grateful for any wisdom this forum can offer on the challenge I face and hopefully can add to the rich information already here.

I started TRT 1 year ago and although had initial guidance from a private trt business, eventually I decided to buy what I needed and monitor my health as a much cheaper way to achieve the same end result. My T and free T were in the lower quarter of the target range. To accompany the use of injectable testosterone I used 500iu of HCG every 3 days on the same day as the T injection of 60mg.

It was a bit of a balancing act over the past year to try and get everything right from a blood test perspective and still there’s some fine tuning, but this process is made harder through the availability of HCG, having started with pregnyl and then being forced to move to a hcg from drs labs, which I remain sceptical how reliable it is. T levels are in the top quartile and so is free t.

unfortunately after several months of trying for a baby we remain without a positive result and having took a fertility test recently (home version) it confirmed my suspicions that my sperm count is not in a good state. I will take a further test, but all indicators are suggesting the hcg wasn’t effective at maintaining fertility. Tescticals seem a little smaller compared to prior trt but nothing significant on this front.

Anyway, the above is the background.

If we assume I am right and fertility needs addressing it looks from the evidence posted here the quickest and most reliable recovery is higher doses of hcg and fsh. I notice the doses are pretty sizeable which presents a number of concerns:

1. Where in the world can you get reliable sources of hcg and fsh that ship to UK without prescription?
2. The costs appear sizeable. I mean seriously sizeable! Thousands over a 3-6 months. Am I correct here or am I missing something?
3. Given I started trt 1 year ago and have used hcg throughout would you subjectively believe clomid and higher dose hcg might be as effective and clearly much more affordable? I’m 47 and want my wife to be pregnant within 6 months
4. Are there any protocols anyone would recommend as having the least adverse side effects? I thought high doses of hcg can screw up your HPA axis?
5. Any other recommended directions I should take?
My preference is not to stop trt itself as this would carry pretty scary implications as I am an avid health and fitness freak and really don’t like the prospect of low t for several months.

Thanks for any feedback in advance

 

[Nelson Vergel]

If we assume I am right and fertility needs addressing it looks from the evidence posted here the quickest and most reliable recovery is higher doses of hcg and fsh. I notice the doses are pretty sizeable which presents a number of concerns:

1. Where in the world can you get reliable sources of hcg and fsh that ship to UK without prescription?
2. The costs appear sizeable. I mean seriously sizeable! Thousands over a 3-6 months. Am I correct here or am I missing something?
3. Given I started trt 1 year ago and have used hcg throughout would you subjectively believe clomid and higher dose hcg might be as effective and clearly much more affordable? I’m 47 and want my wife to be pregnant within 6 months
4. Are there any protocols anyone would recommend as having the least adverse side effects? I thought high doses of hcg can screw up your HPA axis?
5. Any other recommended directions I should take?
My preference is not to stop trt itself as this would carry pretty scary implications as I am an avid health and fitness freak and really don’t like the prospect of low t for several months.

Thanks for any feedback in advance

Men in the UK have a lot of access issues.

I would stick with clomiphene first at 25 mg per day (no TRT). Check your sperm count after 8 weeks and see where you are.

Contact this clinic since they may be able to help: Testosterone Replacement Therapy (TRT/HRT) Services - Balance My Hormones

 

[gaz7718]

Thanks Vince. I’m really not keen to just drop the trt as I’m seriously into my gym stuff and the drop in t levels will be something I’d much prefer to avoid. If there’s no other option then so be it but I’m hoping for another option.

 

[gaz7718]

Just thought I’d update on my journey on thus topic

Have been on 500iu of hcg every 3 days and additionally hmg 75iu EOD whilst remaining on TRT and 90mg of deca weekly for joints primarily.

perhaps somewhat optimistically was hoping to get the wife pregnant in month one of this new protocol but hasn’t achieved that result yet and didn’t conduct a new fertility test.

So I realise I was probably a little underdosed for a recovery protocol so was intending to up the hcg to 1500iu every 3 days and continue with the hmg at 75iu EOD. TRT to continue as is. I will also conduct a fertility test mid way through month 2 to verify that I have the desired result in my sperm.

Any thoughts / experiences to help validate or refine this proposed protocol?

Another option is to increase hmg to 150iu but that is the more expensive option and would add circa £200 to the monthly protocol cost.

 

[DS3]

Just thought I’d update on my journey on thus topic

Have been on 500iu of hcg every 3 days and additionally hmg 75iu EOD whilst remaining on TRT and 90mg of deca weekly for joints primarily.

perhaps somewhat optimistically was hoping to get the wife pregnant in month one of this new protocol but hasn’t achieved that result yet and didn’t conduct a new fertility test.

So I realise I was probably a little underdosed for a recovery protocol so was intending to up the hcg to 1500iu every 3 days and continue with the hmg at 75iu EOD. TRT to continue as is. I will also conduct a fertility test mid way through month 2 to verify that I have the desired result in my sperm.

Any thoughts / experiences to help validate or refine this proposed protocol?

Another option is to increase hmg to 150iu but that is the more expensive option and would add circa £200 to the monthly protocol cost.

Dr. Larry Lipshultz at the Baylor College of Medicine advises to take 500 units of HCG EOD for a minimum of 3 months before expecting to achieve much in the way of fertility. One month is certainly not enough time. I personally have gone from completely sterile to getting my wife pregnant in a 4 week period of time with 500 units of HCG EOD, but that is not necessarily a normal response. HMG can definitely increase fertility, but again, you haven't really given the fertility medication time to work.

Also, good news for you. Dr. Lipshultz does make his patients get off of T in order to regain fertility. A good HCG protocol (500 units EOD) and time (3-6 months) should get you into a fertile state.

 

[DS3]

Dr. Larry Lipshultz at the Baylor College of Medicine advises to take 500 units of HCG EOD for a minimum of 3 months before expecting to achieve much in the way of fertility. One month is certainly not enough time. I personally have gone from completely sterile to getting my wife pregnant in a 4 week period of time with 500 units of HCG EOD, but that is not necessarily a normal response. HMG can definitely increase fertility, but again, you haven't really given the fertility medication time to work.

Also, good news for you. Dr. Lipshultz does make his patients get off of T in order to regain fertility. A good HCG protocol (500 units EOD) and time (3-6 months) should get you into a fertile state.

BTW, I know what Dr. Lipshultz does because I am a patient of his and speak with him regularly about this.

 

[gaz7718]

That’s interesting as the studies published in this thread all indicated using a restorative dose of 1500mg and greater.

bear in mind I was using 500iu every 3 days during my TRT programme for the last year and it didn’t maintain my fertility.

I thought the half life of hcg was approx 3 days so very interested in the rationale for EOD.

Thank you for sharing, it has opened up some further questions apart from the time point. Patience is of course vital, but in limited supply when you are already over 1 year down the road of hoping each month.

 

[DS3]

Preserving fertility in the hypogonadal patient: an update

Here is the study Dr. Lipshultz published regarding the preservation of fertility with HCG. The issue with taking 1500 units of HCG 3 times per week is the possibility of desensitizing the LH receptors in your testicles, subsequently possibly reducing your overall response to HCG. Additionally, that high of a dosage will undoubtedly cause estrogen issues. Older ideologies of taking that high of a dosage of HCG are fading from the medical community.

 

[DS3]

That’s interesting as the studies published in this thread all indicated using a restorative dose of 1500mg and greater.

bear in mind I was using 500iu every 3 days during my TRT programme for the last year and it didn’t maintain my fertility.

I thought the half life of hcg was approx 3 days so very interested in the rationale for EOD.

Thank you for sharing, it has opened up some further questions apart from the time point. Patience is of course vital, but in limited supply when you are already over 1 year down the road of hoping each month.

I should state that I meant that high of a dosage increases the possibility Leydig cell desensitization, not LH receptor.

 

[DS3]

Good to know. Most fertility doctors would make you stop TRT if you use FSH (or hMG)

Dr. Larry Lipshultz does not require that you get off. And he reports they have yet to be unable to help a man regain fertility unless they are primary.

 

[gaz7718]

Many thanks. I was aware of the desensitisation risk, although was unaware of the advantage of EOD dosing of HCG. This would also be more cost effective, albeit secondary to the main purpose.

 

[gaz7718]

Preserving fertility in the hypogonadal patient: an update

Here is the study Dr. Lipshultz published regarding the preservation of fertility with HCG. The issue with taking 1500 units of HCG 3 times per week is the possibility of desensitizing the LH receptors in your testicles, subsequently possibly reducing your overall response to HCG. Additionally, that high of a dosage will undoubtedly cause estrogen issues. Older ideologies of taking that high of a dosage of HCG are fading from the medical community.

This report was very informative, but was not conclusive about dosages required to return to fertility when combining hcg and hmg. It did however refer to the use of 1500iu and 3000iu of hcg in certain cases. It also suggests coming off TRT, which presents further issues if that isn’t your intention

 

[DS3]

This report was very informative, but was not conclusive about dosages required to return to fertility when combining hcg and hmg. It did however refer to the use of 1500iu and 3000iu of hcg in certain cases. It also suggests coming off TRT, which presents further issues if that isn’t your intention

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.

 

[djjaxs007]

Sides - your advice and insight in this thread is on point. If remaining on TRT, then HCG + FSH would be more effective than HCG + clomid (due to the competing negative feedback from TRT). If OFF of TRT, then clomid is typically quite effective from a fertility perspective.

Trying to decide between adding FSH to current Test + HCG protocol or come off TRT and attempt "restart" for fertility reasons. Was on clomid for 1.5 years and although numbers ok on paper I felt like crap and progressively got worse. Was trying to conceive so put up with it until the vision side effects got too severe, floaters, plus zero libido didn't help. Decision was made to move to TRT 4 months ago and hope HCG would maintain sperm enough to conceive. Currently on 80mg Test C E3.5D, 500IU HCG 3 x week and .125 AI 2 x week and feeling good. Had full labs and SA pre-TRT and 3.5 months into treatment.

Pre-TRT (taking clomid 12.5mg EOD)
SA sperm concentration 120 M
Test Total 950 ng/dL
Test Free 75 pg/mL
E2 US 25 lc/ms
SHBG 150
LH 7.0

3.5 Months into TRT
SA sperm concentration 02 M
Test Total 990 ng/dL
Test Free 136 pg/mL
E2 US 26 lc/ms
SHBG 75
LH <0.02
FSH <0.8

Since fertility is priority doc wants me to stop TRT and go back to clomid until baby which I'm dreading. Vision still a mess and SHBG (although still high and has a long way to go) has been cut in half since starting TRT. I suggested tamoxifen to doc if I go this route but he felt I needed to use clomid for first two months which I don't agree with. Any reason why tamoxifen would not make sense if I go this route?

Ideally, I'd like to continue TRT protocol and add FSH, heck even stop TRT and add FSH w hcg. I've seen all the studies and am optimistic this would be enough or am I missing something? Just don't want to go back to clomid. Sure that would be quickest way back but for me it got really bad.