Now on TRT plus HCG to preserve fertility

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Update Paco ?

I’m now 5 weeks and a couple days in to the new regimen at 200 mg testosterone cypionate plus 500 IU of HCG 3 times per week and 12.5 mg clomid per day. I can’t yet say that I feel a whole lot better, consistently. I’ve had some better days and my libido seems to be slightly improved, but nothing really notable has happened with my low mood, inconsistent energy and concentration, and poor libido. Oh, and I seem to be having more trouble sleeping all the way through the night, and nighttime and morning wood has been reduced in recent weeks. All that said, maybe it’s still too soon to assess??

I was scheduled to see Dr. Lipshultz again next Monday, but I had to reschedule. Sadly, the next opening on his schedule isn’t until May 28[SUP]th[/SUP], more than 3 months since my last visit.

Of course, I haven’t done any bloodwork yet to confirm this, but I’m guessing my dose of testosterone is a bit too high and also that the low dose clomid may be limiting the subjective benefits of treatment. However, as I may have mentioned earlier in this thread, before starting TRT, I found that 12.5 mg/day of clomid had no significant negative or positive effects (although it did increase free T and total T significantly), so it seems doubtful that it would be a problem now, but I’m really not sure.

Given that it will be another 7 weeks until I see Dr. Lipshultz and I don’t feel much better now, I’m thinking of changing my regimen a bit at the 6 week or 7 week mark. I’d like to know what others think of trying 75 mg test cypionate twice a week together with the 500 IUs of HCG three times a week plus 12.5 mg clomid per day. In a few weeks, I might also drop the clomid as I’m not yet convinced that is a necessary component of maintaining my fertility.

Looking forward to hearing others’ thoughts.
 
Defy Medical TRT clinic doctor
I bet your total testosterone blood level is above 1300 ng/dL with that program.

It would be interesting to see what Dr Lipshults or Jason Kovack would think about dropping the clomiphene and leaving you on TRT+ HCG.

Too bad they do not seem to use the ultrasensitive estradiol test there since they use an in-house UT one instead. I am looking forward to your follow up tests. By the way, you can have labs done this month if they allow you. That way you would have numbers to discuss on May 28th.

Question: Do they provide patient support via email or do you have to wait til you see him next? Why are you not on low dose Cialis?
 
Paco, I might consider dropping the clomid. I think it takes at least a couple of months for it to mostly wash out of your system. At least you could see now if there was any subjective difference after awhile, rather than waiting until the end of May and potentially having Dr. L suggest it. Seems like test cyp and hcg is pretty common together for guys to report feeling good subjectively. If you are doing 200 test cyp and week now, why drop it to 2x75? Why not 2x100 without the clomid?
 
I bet your total testosterone blood level is above 1300 ng/dL with that program.

It would be interesting to see what Dr Lipshults or Jason Kovack would think about dropping the clomiphene and leaving you on TRT+ HCG.

Too bad they do not seem to use the ultrasensitive estradiol test there since they use an in-house UT one instead. I am looking forward to your follow up tests. By the way, you can have labs done this month if they allow you. That way you would have numbers to discuss on May 28th.

Question: Do they provide patient support via email or do you have to wait til you see him next? Why are you not on low dose Cialis?

Thanks for replying to this, Nelson. I'm doubtful that Dr. Lipshultz's office will facilitate blood work before I see him again. Each time I've seen them, I do the lab work after my consult with him at his office, so we haven't really used blood work to help decide next steps (at least not yet). And, I had suspected that they were not using a sensitive assay for estradiol as you suggested.

So, I'm thinking of getting some basic bloodwork such as total testosterone and free testosterone via Labcorp through Life Extension Foundation before changing anything. I am not sure whether it's worthwhile (or worth the money) to get the sensitive estradiol test at the same time, given that I'm currently on clomiphene and I keep hearing that can confuse interpretation of the results. Is that still believed to be true?

I have not been very pleased with the responsiveness of his staff. They have a patient portal where you can supposedly communicate with them, but nobody looks at it or replies to even the simplest requests. Also, it can take days and a lot of pestering for his nurse to return calls (to her credit, she seems overwhelmed and overworked), even relatively urgent ones such as when you need a Rx refill or insurance has changed and you need to get a prior authorization for a new version of testosterone. I have eaten some extra costs because of these delays and felt like a bit of an annoyance when I was calling for several days at a time with no response. So, they generally seem inclined to only provide attention and care when you visit the office. All that said, Dr. Lipshultz gave me his card and assured me I could email him with basic questions and updates. I tried that today, emailing him my progress (or lack thereof) to date and my proposed changes so we'll see if I hear back soon.

Regarding Cialis, that's another variable that I may consider in the future, but i'd prefer to change as few things as possible at a time.
 
Paco, I might consider dropping the clomid. I think it takes at least a couple of months for it to mostly wash out of your system. At least you could see now if there was any subjective difference after awhile, rather than waiting until the end of May and potentially having Dr. L suggest it. Seems like test cyp and hcg is pretty common together for guys to report feeling good subjectively. If you are doing 200 test cyp and week now, why drop it to 2x75? Why not 2x100 without the clomid?

Thanks for the ideas! I'm up in the air about exactly what to try next, but I'm thinking that the dose of testosterone is probably too high either way, so that seems like an obvious place to make changes. Also, I gathered that Lipshultz has me on clomiphene to promote fertility, which is a very important component of my treatment, so I don't want to abandon that too hastily.
 
From everything I've seen, you can't get an accurate E2 reading while on clomid, although if you test E2 multiple times on clomid I suppose the results may be relative to each other (I think Defy uses this method). Regarding the non-response of the doctor and/or staff, that can be tricky. My endo has the same or similar proprietary portal system through which I am supposed to communicate. It is slow, complicated, probably expensive, and worthless for any sort of modern day quick communication. It may be good for them to provide a funnel for all the patients, but it is horrible for timely communication and follow up. So I ignore it. When I want to communicate with them, I send a........get ready......fax (hello 1980s :) Once I know the fax has been received, I then call the nurse's line and leave a message, telling them of the fax, and asking them to read the specifics. If I don't get a response within a day, then I call again, and usually that will draw a response from the nurse. I also schedule my appointment through the nurse, even though I am supposed to use the portal, which gives you no flexibility as you have to enter your best guess for an appointment and hope they have an opening or they call you back eventually. Weird. I'm hoping maybe your email to Dr. L. will work as well. My wife did have an eye doctor who communicated great by email, but he is the exception. He was busier than anyone, yet took time to research and reply. Very professional, and showed he actually cared.
 
Can someone please remind me of the optimal time to have my blood work done? I plan to have my blood drawn Monday morning, fasted, just before my next scheduled shot of testosterone. I also do one of my three weekly injections of HCG MOnday mornings, so I'm assuming I should still do that before my blood draw?
 
Paco

You got it right. HCG right after the blood draw, though.

As weeks go by, those that inject testosterone and HCG twice a week tend to have stable blood T levels and the timing of blood draw becomes less important.
 
Love this thread! Very helpful and insightful guys! Thanks heaps.... :)

Quick question - does Clomiphine lower the conversion of testosterone to estrogen?
 
I'm glad to hear it's been helpful, Randy. In regards to clomiphene, it is not an aromatase inhibitor like anastrozole. In "secondary" hypogonadal men, clomiphene acts on estrogen receptors in the pituitary, resulting in increased testosterone and preservation or enhancement of fertility, from increased LH and FSH. In my experience, it has been effective for fertility purposes, but provided little subjective benefit in regards to increased testosterone levels.

http://thinksteroids.com/steroid-profiles/clomid/
 
Ok, cool. What does did you take to maintain fertility? Is it possible that it's use while already on TRT can help restore fertility?
 
HCG can maintain fertility in men using testosterone

The study attached to this post from Lipshultz' team in Houston showed that it is possible to maintain and restore fertility while on testosterone.
 

Attachments

  • Concomitant IM HCG preserves spermatogenesis in men undergoing TRT (2).pdf
    75.3 KB · Views: 657
Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of
Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island




Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin. Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formu- lation. No patient became azoospermic during concomitant testosterone replace- ment and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.
 
Ive tried the Clomid stim challenge (7 days at 100mg per day).

-Free T and Total T doubled
-FSH and LH more than doubled
-SHBG spiked 15 units (due to the cis/trans config of the drug and its estrogen agonist capabilities).

-not as tired at night, but nothing to write home about.
-Bloodshot eyes
-Gained 8 pounds in a week

Good for testing the axis, for me it wouldnt be a long term low dose treatment option. Ive read other protocols that compounded clomid+arimidex, havent heard any feedback though.
 
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