TRT - Trying to Conceive and Looking for Direction

[brian.coggins1969]

High BMI is associated with fertility issues and other obvious health related issues as well as low T in men, etc. Improve your nutrition, get some regular exercise, throw in some key supplements, and one, or both of you, may see a radical improvement in fertility and of course over all health.

People often don't wanna hear that, and look for a magic pill/shot from a doctor. Not directed at you, just a general statement of fact;

TBI is associated with major disruption of hormones in men, something very few docs currently aware of and could certainly be a major part of your issue:

https://www.excelmale.com/forum/showthread.php?9774-TBI-and-PTSD-what-s-the-connection&highlight=TBI

TBI is the cause of my issues. My diagnosis is Post TBI hypothalamic pituitary dysfunction. My BMI was around 20-21 prior to my accident. After my accident no amount of exercise could keep the weight off. I was a logger at the time running chokers in the brush so I was running up and down hills with 80+ pounds of cable on a regular basis and still gaining weight at a rapid rate. Now I drive truck so I definitely don't get as much physical activity as I should, but we are working on that. It's just hard to get the motivation when low T is a factor, as I'm sure you know. Plus my heart health is a major issue now that I have packed on all this weight. My cholesterol and triglycerides are through the roof. We have started with daily walks, it sounds small but considering I have been sitting in a truck every day for the last year it's actually a good start for now.

I take no offense to you bringing up weight being a possible issue, as it was the first thing I thought too.

We eat very healthy, rarely eat processed foods, my wife gardens and organically grows most of our fruits and vegetables. Our main issue was that she used to use too much butter and high fats in things but since my diagnosis that has stopped and we now eat less red meats and more chicken and fish to try and help with my heart health, and of course lots of fiber.

My wife is always working out, and the diagnostics we were given definitely prove her fertility issues are not at all related to health. And I was in great health the first 4 years of us trying to start a family, it wasn't until after my accident that my health declined.

I'm not sure how much you have heard of with female infertility so these conditions may mean nothing but she has PCOS, endometriosis, LUFS, and an MTHF A1298C Homozygous gene mutation. She is considered pre-diabetic so we have always been good with diet and she always keeps up an exercise. Basically what her condition means is she doesn't ovulate on her own, and in the rare instance that she does the egg doesn't release from her ovary and it generally forms a cyst then she ends up in the ER for 3 days or so. Sometimes they have to do surgery or a draining process, and her gene mutation usually causes recurrent miscarriages. We have been actively thinking about surrogacy due to all her issues. She has been pregnant twice with fertility medications but both ended in a miscarriage at about 6 weeks. I'm not sure if my low testosterone could have had an impact on her losing the pregnancies though. The thought has definitely crossed my mind.

 

[brian.coggins1969]

Yes I do realize there is only one appropriate test, that's why I said I think the Doctor ran the wrong one. But he is running it again after 4 weeks of HCG treatment. Granted we don't have a base line to go off of, but we will see if my E2 is elevated soon.

 

[brian.coggins1969]

You came to the right place. Don't be surprised at all if even the specialist looks at you like you're crazy when you attempt to discuss some of this with them. So, be prepared for that.

That's good to know, thank you for the heads up. We deal with a lot of doctors looking at us like we are crazy when we have gone in for my wife's fertility issues. And she is very well read in hormonal issues because of dealing with infertility. It took her 9 doctors to get a diagnosis when we first started trying and couldn't get her pregnant. And it was another 4 doctors, 2 surgeries, and god only knows how many trips to the ER before we found out she had a gene mutation and endometriosis. It's really awful that we have to take such control over our health care because most doctors don't see the whole picture.

 

[Will Brink]

That's good to know, thank you for the heads up. We deal with a lot of doctors looking at us like we are crazy when we have gone in for my wife's fertility issues. And she is very well read in hormonal issues because of dealing with infertility. It took her 9 doctors to get a diagnosis when we first started trying and couldn't get her pregnant. And it was another 4 doctors, 2 surgeries, and god only knows how many trips to the ER before we found out she had a gene mutation and endometriosis. It's really awful that we have to take such control over our health care because most doctors don't see the whole picture.

Good luck!

 

[Dr Justin Saya MD]

HCG cream, sublingual, oral, etc are all bunk. The ONLY way to effectively use HCG is via injection (IM or SQ).

 

[brian.coggins1969]

HCG cream, sublingual, oral, etc are all bunk. The ONLY way to effectively use HCG is via injection (IM or SQ).

That's kind of what I have been finding.

It seems most doctors don't really know what they are talking about these days.

We just got done with our appointment with our reproductive endocrinologist. He basically said that there isn't an efficient way to combine meds with TRT to keep my body producing sperm. He said there's a chance that my sperm count won't be completely depleted with TRT.... but it will likely at least be slightly more compromised.

My wife and I are working on coming to terms with we will likely never conceive a child the "traditional" way, and IVF will more than likely be our route to a family. Which is unfortunate because it isn't covered under our insurance so we are looking at a few years before we are ready to make that big purchase.

Thanks again guys for all your input. Guess I will be calling my doctor for some better longer lasting testosterone injections.

 

[CoastWatcher]

That's kind of what I have been finding.

It seems most doctors don't really know what they are talking about these days.

We just got done with our appointment with our reproductive endocrinologist. He basically said that there isn't an efficient way to combine meds with TRT to keep my body producing sperm. He said there's a chance that my sperm count won't be completely depleted with TRT.... but it will likely at least be slightly more compromised.

My wife and I are working on coming to terms with we will likely never conceive a child the "traditional" way, and IVF will more than likely be our route to a family. Which is unfortunate because it isn't covered under our insurance so we are looking at a few years before we are ready to make that big purchase.

Thanks again guys for all your input. Guess I will be calling my doctor for some better longer lasting testosterone injections.

What at does he mean by "efficient" and what does he mean by "longer lasting" injection? While there are no absolutes, TRT and HCG when taken together have a very good record of maintaining testicular vitality. We have seen it here in the Forum, men reporting success at fathering a child, and we've had material posted about the studies indicating that it is not as dire a picture as you have had described. This isn't an Internet myth - there is a reason it's discussed here.

What was said about HCG and testosterone? It's a lot cheaper than IVF, and what have you got to lose?

 

[Will Brink]

That's kind of what I have been finding.

It seems most doctors don't really know what they are talking about these days.

We just got done with our appointment with our reproductive endocrinologist. He basically said that there isn't an efficient way to combine meds with TRT to keep my body producing sperm. He said there's a chance that my sperm count won't be completely depleted with TRT.... but it will likely at least be slightly more compromised.

My wife and I are working on coming to terms with we will likely never conceive a child the "traditional" way, and IVF will more than likely be our route to a family. Which is unfortunate because it isn't covered under our insurance so we are looking at a few years before we are ready to make that big purchase.

Thanks again guys for all your input. Guess I will be calling my doctor for some better longer lasting testosterone injections.

False. See article I linked in #8 and the many threads here covering that issue. He/she is simply not up to date on the topic.

 

[brian.coggins1969]

What at does he mean by "efficient" and what does he mean by "longer lasting" injection? While there are no absolutes, TRT and HCG when taken together have a very good record of maintaining testicular vitality. We have seen it here in the Forum, men reporting success at fathering a child, and we've had material posted about the studies indicating that it is not as dire a picture as you have had described. This isn't an Internet myth - there is a reason it's discussed here.

What was said about HCG and testosterone? It's a lot cheaper than IVF, and what have you got to lose?

I'm not really sure what he meant by efficient, it sounds like what he was implying is that HCG combined with TRT doesn't always work and isn't a long term solution because many men become resistant to the HCG. And longer lasting yes, the injection since I am using the cream right now and a short lasting testosterone that requires injections every 3 to 4 days. I wanted to get on something that I don't have to use as frequently. If I were to start the HCG injections with the TRT I am using now I would end up feeling like a pin cushion. And in all honesty... I don't even know what type of TRT is the typical protocol. I don't know how often or how much of what kind of testosterone is commonly given, I don't know what dose of injectable HCG at what frequency is most commonly used to maintain testicular health.

I want to walk into my doctor and request HCG injections instead of cream and a testosterone injection that lasts longer than 3 days. But I am not sure which medication, at what dose is the best so for all I know what he recommends may not be the right combination. Obviously he hasn't proven to be very knowledgeable considering he prescribed HCG cream ONLY at first. Thinking this would do the trick. But given that we live pretty much in the middle of no where it is difficult to see another doctor without taking a day off of work and driving several hours. And I cannot take time off work this time of year.

 

[brian.coggins1969]

False. See article I linked in #8 and the many threads here covering that issue. He/she is simply not up to date on the topic.

In that link it talks a lot about restarting sperm production in men that were on TRT. What we are trying to do is prevent his sperm count from declining at all. Am I missing something?

I haven't been able to find something that says "if you use HCG and Testosterone replacement therapy it is likely that your sperm count won't drop" I know that nothing will say it "will" work. But I haven't really found anyone going into TRT while trying to start a family and using TRT and HCG to keep sperm production going, especially when it comes to long term use.

 

[Will Brink]

In that link it talks a lot about restarting sperm production in men that were on TRT. What we are trying to do is prevent his sperm count from declining at all. Am I missing something?

I haven't been able to find something that says "if you use HCG and Testosterone replacement therapy it is likely that your sperm count won't drop" I know that nothing will say it "will" work. But I haven't really found anyone going into TRT while trying to start a family and using TRT and HCG to keep sperm production going, especially when it comes to long term use.

Part II covers T + HCG and male fertility. Proper use of HCG, Clomid. etc can res establish fertility in most men who have been on TRT alone and or maintain it in those on TRT. As, variables apply and there will be varying degrees of success/inter-individual differences, but Id try all options before ever going to IVF which besides being incredibly costly, can comes with it's own issues.

Part II HERE

 

[Dr Justin Saya MD]

I quite literally just finished my last follow-up consult of the day with a longterm patient whom expressed his sincerest gratitude that his wife is now pregnant. He has been on longterm TRT with a more fertility directed HCG dosing of 400iu TIW...I receive pregnancy updates of this nature on virtually a weekly basis.

 

[CoastWatcher]

Well, you can find plenty of excuses to not undertake this effort - and that's your privilege. Or, you can engage Dr. Saya and Defy Medical. It doesn't matter where you live, he can treat you remotely. He's one of the leading androgen specialists in North America (he won't say that, but I will and I'm not one his patients, I live in Canada). He has responded to this thread, plug his name into the search function and read some of his other posts.

It's your call.

 

[brian.coggins1969]

Part II covers T + HCG and male fertility. Proper use of HCG, Clomid. etc can res establish fertility in most men who have been on TRT alone and or maintain it in those on TRT. As, variables apply and there will be varying degrees of success/inter-individual differences, but Id try all options before ever going to IVF which besides being incredibly costly, can comes with it's own issues.

Part II HERE

Thank you, I must have missed this. I am going to bring this forward to my doctor and see if I can get follow up semen analysis done.

 

[brian.coggins1969]

I am by no means trying to make excuses. There is just a lot of information flying around and it's a lot to take in and sift through. I hear one thing from one doctor and a completely different thing from another. I am looking into seeing Dr. Saya now.

I do appreciate all of the brutal honesty with everything, and all of the guidance.

 

[CoastWatcher]

Thank you, I must have missed this. I am going to bring this forward to my doctor and see if I can get follow up semen analysis done.

You are finding that you must be your own advocate in matters of health. It's sad, but true - despite designations and certifications, many doctors you'll consult in this field are not broadly knowledgeable. There is a sad lack of awareness on the part of many physicians about the male hormonal system. That's why a site like this exists.

 

[brian.coggins1969]

My wife is 26, I am 25. Yes it is the HCG cream.

We just received follow up blood work results.

Testosterone has actually decreased from the last draw.

1st Draw VS 2nd Draw
Total Testosteron: 1st - 273.6 ... 2nd - 241.5
FSH: 1st - 3.8 - No change
LH: 1st - 4.4 ... 2nd - 6 (I know HCG is what is increasing this)
SHBG: 1st - 24 ... 2nd - 27.7
Free Testosterone: 1st - 77.8 ... 2nd - 58

Why would my testosterone decrease when my LH is increasing? I honestly don't understand.

The doctor failed to pull estradiol AGAIN! I ordered a specific lab test only for estradiol today... should have results in a week. This is frustrating.

Is it possible that instead of my testosterone increasing that my estrogen is?
I have been having some mood swings lately... and I am getting a lot of acne.

 

[Dr Justin Saya MD]

My wife is 26, I am 25. Yes it is the HCG cream.

We just received follow up blood work results.

Testosterone has actually decreased from the last draw.

1st Draw VS 2nd Draw
Total Testosteron: 1st - 273.6 ... 2nd - 241.5
FSH: 1st - 3.8 - No change
LH: 1st - 4.4 ... 2nd - 6 (I know HCG is what is increasing this)
SHBG: 1st - 24 ... 2nd - 27.7
Free Testosterone: 1st - 77.8 ... 2nd - 58

Why would my testosterone decrease when my LH is increasing? I honestly don't understand.

The doctor failed to pull estradiol AGAIN! I ordered a specific lab test only for estradiol today... should have results in a week. This is frustrating.

Is it possible that instead of my testosterone increasing that my estrogen is?
I have been having some mood swings lately... and I am getting a lot of acne.

The HCG cream is NOT increasing LH. The change in those levels is just normal variation you are seeing. HCG cream doesn't work (first of all) and HCG that DOES work (injectable) actually LOWERS endogenous LH levels. I know this sounds counterintuitive, but HCG mimics LH (it is an analog), but at the same time suppresses endogenous LH production.

Bottom line, you are wasting your and your wife's (and yet unborn child's) time and resources with the HCG cream.

 

[brian.coggins1969]

I completely agree that we are wasting our time with the cream. But... for the sake of humoring our doctor... we gave it a chance.
Today we have another appointment and we have every intention of pushing for HCG injections, instead of the cream.

Thank you for clarifying the LH portion, I wasn't aware of that.
I am very frustrated at this point.

Do you know anything about the SHBG levels? I know this can impact fertility but I don't know to what extent. From what I have read it is common to have low SHBG when estrogen is elevated, but I am not sure if that is 100% accurate information.

It's frustrating that that my levels dropped rather than increased.

 

[Dr Justin Saya MD]

I completely agree that we are wasting our time with the cream. But... for the sake of humoring our doctor... we gave it a chance.
Today we have another appointment and we have every intention of pushing for HCG injections, instead of the cream.

Thank you for clarifying the LH portion, I wasn't aware of that.
I am very frustrated at this point.

Do you know anything about the SHBG levels? I know this can impact fertility but I don't know to what extent. From what I have read it is common to have low SHBG when estrogen is elevated, but I am not sure if that is 100% accurate information.

It's frustrating that that my levels dropped rather than increased.

Your current SHBG level is of no concern currently with your fertility and it is highly unlikely your estrogen is elevated based on where your current T levels are.

You shouldn't be frustrated as you already know the problem (and the solution) - you're taking a bunk product.