T Nation

Change in TRT When Trying to Have Kids?


#1

A little background first: I've been on TRT since late 2010, and I've gone through a few doctors until I found a decent one in early 2013. I had a thread on that, but it's gotten too large so I am starting a new one.

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/33_yo_hypogonadic_looking_for_good_trt_dr?id=5556564&pageNo=0

You can read back if you like, but I'm going to give a short summary here:

Cause of low testosterone (<300 TT) - unknown. Regrettably, LH, FSH and other parameters not tested until after starting TRT. Low T manifested in ED & low libido symptoms, went through a carousel of doctors until I found a good one who prescribes me compounded T creams plus HCG to maintain the boys. He also tested everything else under the sun, CBC, physical exam, heart EKG, thyroid, adrenals, etc... and everything came back just fine except my lipid panel, which isn't as optimal as it should be (HDL is excellent, but LDL is also high, Triglycerides normal).

Settled on TRT regimen as follows - 100 mg T cream ED, 250 IU HCG EOD. No interest in bodybuilding, sole goal of TRT is to increase libido and maintain solid erections. TT went up to +500 after a few months but E2 too low at <10 with no AI. Libido comes and goes, some improvement in erections. Currently not taking an AI, will test E2 first week of April.

Now, my wife and I are thinking about having kids. We are preparing for a pregnancy later in this year. I do NOT want to get off testosterone. I am a wreck without it, so I must stay on testosterone.

So my question is, do I continue taking HCG? Or should I switch to Nolvadex? When I start trying to conceive, or should I start a few months before? For how long? Or is Clomid better? If one MUST stay on TRT while trying to get a girl pregnant, how do the parameters and dosing of TRT change?


KSman is Here
KSman is Here
KSman is Here
#2

If you have been on HCG the whole time, you should still be where you were before starting TRT (if not above). Keep everything the same. If you are having doubts about your viability, go have a semen analysis done.

I just had one done and came back with good results - in fact, above average levels. I’ve been on TRT for a couple of years now, maybe longer and I didn’t have HCG the whole time - my first doc wouldn’t prescribe it. So I basically did a mild T only cycle without and PCT before I found my current doctor.


#3

If you stay on TRT do not start taking Novla or Clomid. Just continue taking the HCG.


#4

I did not know this, so as long as HCG was started with TRT, fertility should be fine? My doc said when it was time to have kids, if I was having issues I would just need to back off the T for a while. He was not sure, but thought after a few years on TRT I would probably not be able to have kids while still on, but it would be fine just by backing off. I also read about guys doing HMG (I think that was it but not certain), clomid, and HCG in some sort of cocktail fashion to get the fishes swimming again if you wanted to have a kid.


#5

[quote]bluecollarjock wrote:
I did not know this, so as long as HCG was started with TRT, fertility should be fine? My doc said when it was time to have kids, if I was having issues I would just need to back off the T for a while. He was not sure, but thought after a few years on TRT I would probably not be able to have kids while still on, but it would be fine just by backing off. I also read about guys doing HMG (I think that was it but not certain), clomid, and HCG in some sort of cocktail fashion to get the fishes swimming again if you wanted to have a kid. [/quote]

Everyone is different but not HCG does not quarantee fertility at all. My bro got his wife pregnant while on testosterone but other people have 0 sperm count and need to discountinue.

Do a sperm analysis and you will know.
Jon


#6

[quote]bluecollarjock wrote:
I did not know this, so as long as HCG was started with TRT, fertility should be fine? [/quote]

Well I started TRT without HCG, went on for two years, then I stopped for 6 months (nolvadex-only PCT). When I restarted TRT last year, I got on HCG the same time.

I’ll request a sperm analysis next time I see the doc.

Isn’t HMG ridiculously expensive?


#7

From my understanding, HMG is pretty expensive. You may have done some damage being on the T for that long without hcg. How did your testes do? I imagine you had some atrophy, did they come back after PCT and how are they now?


#8

HMG or Clomid until she’s pregnant and then just discontinue. No need to mess with your TRT protocol.


#9

[quote]catfish74 wrote:
From my understanding, HMG is pretty expensive. You may have done some damage being on the T for that long without hcg. How did your testes do? I imagine you had some atrophy, did they come back after PCT and how are they now?[/quote]

When I was on Testim without HCG (beginning of TRT) one of my nuts partially atrophied. Strangely, the other nut stayed the same or got bigger.

PCT, yes my nuts regained size and firmness. Back on TRT now with HCG, my nuts remain firm and they hang well. Normal size.


#10

[quote]brentf13 wrote:
HMG or Clomid until she’s pregnant and then just discontinue. No need to mess with your TRT protocol. [/quote]

My understanding from this forum is that you don’t take clomid (or nolvadex) and HCG at the same time, right? I could just switch to clomid until she’s pregnant, then go back on HCG and/or discontinue.


#11

Yep you got it. Substitute climid for HCG and then switch back. Pretty simple.


#12

Update:

Current labs:

TT 392 (348-1197)
FT 9.7 (8.7-25.1)
E2 13.3 (7.6-42.6)
DHEA 229 (160-449)

TSH 2.97 (0.4-4.0)
RT3 14.9 (9.2-24.1)
FT3 3.4 (2.0-4.4)
FT4 1.36 (0.82-1.77)

I’m now switching to clomid 25mg ED + T cream 50 mg ED. Stopping HCG for now. Retest in 2 months. We’ll see if that’ll shake up the middling results I’ve been getting from my current TRT protocol.


#13

You may be a poor responder/absorber to the cream. Injections may suit you better, and no chance of that getting transferred to your girl. I’d recommend a semen analysis as mentioned before I started with chlomid, the sides can be pretty bad. YMMV.


#14

Got new labs after 7 weeks on Clomid 25 mg ED along with T-cream 50 mg ED, and WHOA! Seeing numbers beyond those I’ve been aspiring for!!

TT: 962 ng/dl (348-1197)
FT: 28.7 pg/ml (8.7-25.1) High
E2: 41.9 pg/ml (7.6-42.6)
DHT: 171 ng/dl (30-85) off the charts High

Now for FSH and LH, I know we don’t usually test those while on TRT, but this is to see my response to clomid for fertility purposes…

FSH: 4.6 (1.5-12.4) mIU/ml
LH: 9.1 (1.7-8.6) mIU/ml High

Looking good! But I’m hoping high LH or DHT is not a bad thing…

How do I feel? Marginal to maybe moderate improvement in libido and temperament, high E2 needs to be managed. But there’s no way my doctor is going to prescribe anastrozole, he’s too conservative. I may try Chrysin with bioperene, although people around here don’t think highly of any natural AIs, but these may be my only choice. I could order liquidex, but I’m hesitant to order powerful drugs online without a prescription without really knowing the source…

Any thoughts?


#15

Too much clomid. E2 is high and this can be from too much LH receptor stimulation. In that situation, anastrozole cannot reduct T–>E2 inside the tests and E2 can be uncontrollable. [Too much hCG does the same and you can see why hCG+AI would be asking for trouble.]

E2=42 would make most guys have major problems and reduced TRT effects. Your moderate libido is typical for these E2 levels. Ditto mood. [And perhaps you have clomid sides.]

Cut clomid dose in half and see where E2 goes from there. No AI Rx involved to try this.

Note to others: Some guys have bad side effects from Clomid. Nolvadex can do everything that that clomid does, but does not have the server estrogenic sides that some get.


#16

Thanks KSman, I’ll cut clomid in half, going to 12.5 mg ED. Will ask for a retest in 2 months. Oddly enough, I’m not having the estrogen sides that other guys describe… no signs of gyno, etc. I was having joint pains with low E2 (under 10), but that went away.


#17

How do you taper off a SERM like Clomid? I’m continuing to do TRT, but want to know how to taper a SERM safely so I don’t crash. Is there a good tapering schedule?

Right now I’m on 12.5 mg Clomid ED, I originally started with 25 mg ED but cut that in half when my TT & E2 levels came back high.


#18

The goal is to transition slowly so the HPTA can stand on its own. Typically SERM’s increase E2, all the more when SERM dose is too high with more LH than the testes can manage, and elevated E2 can cause a ‘rebound’ shutdown of the HPTA. To avoid that you should be using anastrozole [or other AI ] when on the SERM to manage E2 near E2=22pg/ml. Then taper the AI as you taper off of the SERM. Note that you want to taper AI to track serum T levels and that is mostly unknowable. It take time for serum SERM levels to drop and it takes time for serum AI levels to drop. So they may track each other OK and you can reduce AI at the same time that you reduce SERM.

You are looking to taper SERM towards zero. But you are looking to taper anastrozole to 0.5mg/week and you will cruise on that for a few weeks to keep E2 from interfering with the HPTA.

So no hard and fast rules and all of this gets complicated with a large number of details that are driven by testicular health and the hypothalamus-pituitary interactions.

Some other thoughts:

  • if hCG does not lead to useful T levels, you are not going anywhere, primary hypogonadism
  • if SERM does not lead to decent LH levels, you are not going anywhere
  • if SERM creates decent LH but T does not get decent, primary hypogonadism

When you use hCG or SERM, the testes will take time to recover form and function in response to the hCG or induced LH. You need to let the testes recover before you attempt to get the HPTA to stand on its own two feet/testes.


#19

Recent labs, still on 12.5 mg Clomid taken orally and 50 mg T ED applied via compounded cream:

TT: 534 ng/dl (348-1197)
FT: 7.7 pg/ml (8.7-25.1) Low
E2: 15.3 pg/ml (7.6-42.6)
DHT: 101 ng/dl (30-85) High, but lower than before
FSH: 2.7 (1.5-12.4) mIU/ml
LH: 4.4 (1.7-8.6) mIU/ml

As expected, my TT, E2, FSH, and LH dropped after I cut my clomid dosage in half. Note that I have NOT been taking any kind of AI, natural or Rx… so I’m a bit surprised my E2 dropped from 42 all the way down to 15 just by cutting my clomid in half.

Also surprised at my Free T number, it’s so low! No wonder my libido vanished after cutting clomid by half (although the past few days, it has been coming back a little bit). I think I have high SHBG because that would explain normal TT with very low FT.

What should I do now? Should I up my clomid to 18.75 mg ED (by taking alternating doses of 25 mg one day, 12.5 mg the next, and so on)?? Or should I just apply more T cream, like 75-100 mg ED instead of just 50?

Or should I just go back to the doctor and see what he thinks? I feel like I’m trying to hit a moving target.


#20

Has your doc had you do a semen analysis? What were the results?