Regaining Fertility; TRT+HCG+FSH

[Mr S]

luckyg,

That's very unfortunate you had that experience with the andrologist. Believe me, I understand your frustration. It is very difficult to find an open-minded fertility specialist, or a doctor in general, who is willing to embrace ideas and approaches outside of the norm and off the beaten path.

All you can do is use their assistance and experience for what it is worth, and go outside of that on your own to get you to where you want to be.

In my own case, my fertility doctor would prescribe me HCG, but not HMG or, initially, FSH. I had to source black-market HMG (Menopur and Merional) on my own for most of my protocol, and then he finally agreed to prescribe me FSH at the very end. You will probably have to go the same route and procure your own HMG.

HMG is mixed FSH and LH, it contains both usually in equal concentrations (150iu FSH and 150iu LH per vial, for instance.)

In your case, you will be using it for it's FSH. The extra LH you will have to take into account when deciding how much HCG to use, as you will need to use HCG as your analogue for LH. HMG on it's own doesn't have enough LH to provide high enough levels of intra-testicular testosterone, so you will need both HMG and HCG for optimal fertility.

In the article that Focus already gave you:

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

You can read this section on the importance of having both HCG and either FSH or HMG to provide optimal fertility:

"FSH given alone or in combination with testosterone has proven unsuccessful at inducing spermatogenesis or maintaining spermatogenesis in those previously induced with hCG/FSH (hCG 1500 IU and HMG 150 IU both subcutaneous and 3 times per week), confirming the need for maintenance of elevated ITT.46 However, long-term use of hCG alone can induce spermatogenesis in up to 70% of patients, with a greater effect seen in men with initial testis length >4 cm, but further improvement is appreciated with the addition of FSH (HMG) suggesting a timelier recovery with both gonadotropins."

You can look at Table 1 to see approximate levels of FSH or HMG along with HCG that have restored fertility for men in our situation.

Best of luck to you. HCG and HMG worked well for me for most of my fertility protocol, before my doctor agreed to prescribe me FSH. As long as you are getting your FSH and LH (or HCG), you are getting everything you need to successfully produce sperm.

Cheers,

Sides

I have a question concerning HCG and you seem well versed in matters related to this hormone. If you come off TRT and inject HCG to reverse testicular atrophy, once the atrophy is resolved and you stop HCG, will the atrophy come back? Can HCG cause any testicular atrophy as well?

 

[eli0228]

I order my HCG and FSH from India way cheaper 10 vials of HCG 5,000ui and 12 vials of FSH 150ui for $225.00 the 12 vials of FSH is for 3months Supply

 

[Sides]

I have a question concerning HCG and you seem well versed in matters related to this hormone. If you come off TRT and inject HCG to reverse testicular atrophy, once the atrophy is resolved and you stop HCG, will the atrophy come back? Can HCG cause any testicular atrophy as well?

Mr S, thanks for the compliment. The lessons I've learned have been over the course of using testosterone and studying it for over 27 years; I am happy if my experiences can help anybody else in their journey.

To answer your question, if you come off TRT and use HCG to reverse testicular atrophy, your testicles should regain some of their former size. HMG or FSH should help further in that regard, as HCG will stimulate the Leydig cells while FSH will stimulate the Sertoli cells of the testicles.

Having regained the size of the testicles, if you stop using HCG and go back on TRT by itself, then the testicles will atrophy again. If you stop using HCG and don't go back on TRT, then the testicles may not atrophy if your HPTA and endogenous hormones have recovered enough to maintain the testicles size on their own. So it all depends on how well your own endogenous hormones recover, which will also depend on genetics and how long you've been on exogenous testosterone.

HCG on it's own should not cause the testicles to atrophy; in fact it should help keep the testicles "plumped up" for as long as you are on HCG.

From my own perspective, after being on testosterone for 27 years, as a former girlfriend put it, I have "a lot of meat but not much potatoes" LOL. Even after using HCG, my testicles are not as big as they were, although my urologist said that my testicles are much bigger than he would have expected for a man who has been on testosterone for so long. Genetics plays a big part in that; some guys on test see their testicles shrivel to raisins, while it doesn't seem to effect other guys so much. But using HCG (and HMG and FSH) can only help to increase the size of the testicles.

 

[Sides]

I order my HCG and FSH from India way cheaper 10 vials of HCG 5,000ui and 12 vials of FSH 150ui for $225.00 the 12 vials of FSH is for 3months Supply

eli0228, please share your source for cheap HCG and FSH if you've found a reliable source. The best way is always if guys can get HCG and FSH prescribed by their own doctors, but of course as many of us have found, many doctors won't prescribe HCG, HMG, FSH, or other fertility meds for men, and of course insurance will rarely pay for them. So unfortunately we are forced to find sources for these hormones on our own.

 

[Mr S]

Mr S, thanks for the compliment. The lessons I've learned have been over the course of using testosterone and studying it for over 27 years; I am happy if my experiences can help anybody else in their journey.

To answer your question, if you come off TRT and use HCG to reverse testicular atrophy, your testicles should regain some of their former size. HMG or FSH should help further in that regard, as HCG will stimulate the Leydig cells while FSH will stimulate the Sertoli cells of the testicles.

Having regained the size of the testicles, if you stop using HCG and go back on TRT by itself, then the testicles will atrophy again. If you stop using HCG and don't go back on TRT, then the testicles may not atrophy if your HPTA and endogenous hormones have recovered enough to maintain the testicles size on their own. So it all depends on how well your own endogenous hormones recover, which will also depend on genetics and how long you've been on exogenous testosterone.

HCG on it's own should not cause the testicles to atrophy; in fact it should help keep the testicles "plumped up" for as long as you are on HCG.

From my own perspective, after being on testosterone for 27 years, as a former girlfriend put it, I have "a lot of meat but not much potatoes" LOL. Even after using HCG, my testicles are not as big as they were, although my urologist said that my testicles are much bigger than he would have expected for a man who has been on testosterone for so long. Genetics plays a big part in that; some guys on test see their testicles shrivel to raisins, while it doesn't seem to effect other guys so much. But using HCG (and HMG and FSH) can only help to increase the size of the testicles.

Thank you for the thorough answer to my question. It’s very clear to me now how the whole thing works. You certainly have 27 years of experience and knowledge including being yourself the subject of experimentation. My journey has recently began and I’m hoping that whatever happens I don’t get the raisins LOL. Thank you for sharing.

 

[Buster33]

@eli0228 where are you getting fsh at that price?

 

[luckyg]

Regarding using HMG as the source for FSH to regain spermatogenesis, can someone help me out with a couple of questions please . I'm struggling to wrap my head around it.

In the attached dosage guidleines and based on the great advice here so far, I started yesterday by adding 75iu HMG EOD to my existing 1 year history protocol of 500iu HCG EOD on top of my 5 year history protocol of 100mg T once per week.

Question
1) Should I amend the quantity of 500iu HCG EOD downwards, to take into consideration the extra LH taken seperately EOD? Is there any reason to do this or am I fine just sticking with the 500iu HCG plus LH? if there is nothing to be worried about then I would rather stick to the 500iu HCG for simplicity.

Very grateful to have found HMG on my own and I am looking forward to going back to the fertility clinic and showing off my sperm results (hopefully in 3 months time) to the andrologist who refused to give me fsh!! Maybe she can learn a thing or two from the experience

Thanks to everyone who has helped on these forums.

 

[Sides]

I don't think there is any reason to amend your 500iu HCG downwards when you add in your HMG. The half life after injection of the LH in HMG is very short, compared with the much longer half life of HCG (anywhere from 24 to 36 hours, depending on the size of the dose injected.) That's part of the advantage of HCG over just injecting LH, that it works for much longer in the body, negating the need for frequent injections.

A review of luteinising hormone and human chorionic gonadotropin when used in assisted reproductive technology

As the table you attached to your reply indicates, HCG is usually injected 2-3 times per week, while HMG or FSH is injected daily or every other day.

I think you are on the right track and will have good results to show to your andrologist in a few months!

Cheers and good luck,

Sides

 

[luckyg]

Thanks @Sides for your input again.

 

[ozraelised]

I order my HCG and FSH from India way cheaper 10 vials of HCG 5,000ui and 12 vials of FSH 150ui for $225.00 the 12 vials of FSH is for 3months Supply

Are you able to share where from India?
can you explain why you also take FSH ? this is something that I didnt hear before

 

[Juice7]

Thanks to everyone sharing their experience in this thread, it’s been the most informative thread for TRT and Fertility I have found on the net so far.

I’m from New Zealand where sourcing anything trt related is incredibly hard and expensive

A couple of options I have done for those of you looking for cheaper sourcing

- Ali Baba sells HCG 10 x 5,000iu vials for around $100 USD. I’ve tested both times I’ve orderes and they have come up positive on an HCG Test kit. You can never be 100% sure they are correctly dosed though. Also The HMG I’ve sourced was a Chinese brand called Renjian which looked legit.

- the IndiaMART app offers countless Indian pharmacies that sell HCG and HMG for around $5-10 a vial. These look legit with brand names you can research independently
As well if needed they offer generic SERMs etc (price list example attached)

I’m starting my fertility journey soon so once again thanks to everyone sharing their experiences here.

 

[Etownone]

Wow...

These forums are a life saver.
I have literally been going out of my mind thinking I've made myself infertile due to trt for many years. And I want to have another Kid.

Now I see, there is hope.

 

[Juice7]

For the guys that have managed to regain fertility, what were your testicle sizes before the fertility protocol and how big did they get when you conceived?
Mine have shrunken quite a bit despite using HCG and am a bit anxious that this could hinder my fertility

 

[Jayyy]

I see the prices have increased slightly since I bought FSH from Empower this autumn, when I got a 1,200iu vial for $325. Probably reflects the increased demand as more people become aware that they are offering FSH. Nevertheless, those are still fantastic prices, and Empower really does take care of you.

By comparison, when I had to buy Gonal-F (FSH) for my wife's IVF procedure in October, a 900iu pen cost me $714, and that was with a huge discount from the fertility pharmacy. If you look up the prices for Gonal-F 900iu pens using GoodRx or a similar site, you will see that the 900iu pens often cost $2000 or more. So for Empower to offer FSH at such a low price is really an amazing bargain.

I think your adjusted program looks great, and the longer you can run it, the better results you will have as your body gets used to producing sperm again. For me, it was an eleven month process, but then I had been shut down for 27 years. Hopefully you will get back on line, up and running quicker than I did.

Hi Sides,

An idea would be to make testosterone + HCG + FSH an standard protocol for young men on TRT. That way they could possibly keep prices low by increasing volume of sales.

Hello Folks,
Thanks for your contribution to this forum and helping lot of people who are in need of help.
I am just thinking to start TRT along with HCG. I do have low sperm count to begin with so thats the reason i dint start trt for long time as i was worried that my sperm count will become 0. But now i am willing to take risk after reading lot of post that i am getting some confident. So my question is, Can i just use TRT and HCG combination to maintain my fertility. Does FSH necessary, I mean, i will take it if i dont see any improvement but to begin with what do you guys suggest. I already have low sperm count so just wondering what is your thoughts on this? Also, I am from canada. Do u know any place in usa where i can get online consultation bcas its getting hard to get prescription in canada.

 

[cigpk]

@Jayyy in my mid twenties I got on trt + hcg. Almost 3 years later my sperm count was above average and all parameters were healthy

 

[Jayyy]

@Jayyy in my mid twenties I got on trt + hcg. Almost 3 years later my sperm count was above average and all parameters were healthy

Cool. tats what i wanted to know but couple of people are using FSH too, So just want to know the exact reason behind it. For sperm production, we need FSH hormone, i dont know how HCG will cause sperm production as it mimics LH hormone.

 

[HealthMan]

Cool. tats what i wanted to know but couple of people are using FSH too, So just want to know the exact reason behind it. For sperm production, we need FSH hormone, i dont know how HCG will cause sperm production as it mimics LH hormone.

My sperm on TRT + HCG was close to zero. Before TRT over 100mm. Adding FSH solved the problem

 

[Jayyy]

My sperm on TRT + HCG was close to zero. Before TRT over 100mm. Adding FSH solved the problem

So, you think, TRT and FSH is enough to maintain fertility. We need either hcg or fsh to maintain fertility right?

 

[Sides]

So, you think, TRT and FSH is enough to maintain fertility. We need either hcg or fsh to maintain fertility right?

TRT and FSH by itself is NOT enough to maintain fertility. You need HCG to maintain high levels of intra-testicular testosterone. Use all three for maximum fertility, TRT + HCG + FSH.

Quoted from the following study:

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


"FSH given alone or in combination with testosterone has proven unsuccessful at inducing spermatogenesis or maintaining spermatogenesis in those previously induced with hCG/FSH (hCG 1500 IU and HMG 150 IU both subcutaneous and 3 times per week), confirming the need for maintenance of elevated ITT.46 However, long-term use of hCG alone can induce spermatogenesis in up to 70% of patients, with a greater effect seen in men with initial testis length >4 cm, but further improvement is appreciated with the addition of FSH (HMG) suggesting a timelier recovery with both gonadotropins.47 The success of inducing spermatogenesis with a combination of hCG and FSH is supported by several studies (Table 1).41,42,45,48,49,50,51,52,53 "

 

[Jayyy]

TRT and FSH by itself is NOT enough to maintain fertility. You need HCG to maintain high levels of intra-testicular testosterone. Use all three for maximum fertility, TRT + HCG + FSH.

Quoted from the following study:

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


"FSH given alone or in combination with testosterone has proven unsuccessful at inducing spermatogenesis or maintaining spermatogenesis in those previously induced with hCG/FSH (hCG 1500 IU and HMG 150 IU both subcutaneous and 3 times per week), confirming the need for maintenance of elevated ITT.46 However, long-term use of hCG alone can induce spermatogenesis in up to 70% of patients, with a greater effect seen in men with initial testis length >4 cm, but further improvement is appreciated with the addition of FSH (HMG) suggesting a timelier recovery with both gonadotropins.47 The success of inducing spermatogenesis with a combination of hCG and FSH is supported by several studies (Table 1).41,42,45,48,49,50,51,52,53 "

Thanks for the reference. Yes, i read the article. I couldnt read the whole article as i got tired Yes it seems like to be effectively increase sperm count in men with hypogonadism, its better to use the combination of 3.
Also, I am plannig to start this new trt+hcg+fsh protocol and wondering if anybody knows what is the safe dosage? Since i am not going through doctor. I was about to create a thread for the fertility protocal for this combination along with time of the week to take the dosage. Do u know what is the right dosage?