T Nation

Fertility Preservation


Hi everyone. First time poster, long-time lurker here. So, I started TRT about 2 years ago (age 21 now) and after a few months got a sperm count done and it was at or near zero. Not good for my future as I want kids, so my doc put me on hCG and FSH with anastrozole to keep the E2 levels down. My regimen is 750 iu hCG every day and 75 iu FSH 3x / week. 1 mg anastrozole every day.

The problem here is that I can’t get my E2 levels under control. My T levels get to around 900 and then E2 is in the 80-90 range. Far too high. The way I see it, I have 2 options,

  1. Take more anastrozole and keep with my current regimen. If this is safe, this would be ideal in my opinion because I’m used to this and I also would be preserving my fertility and not dealing with atrophy.

Is taking more than 1 mg of anastrozole per day dangerous? From what I understand, even taking 1 mg every day is a rather high amount, but my body seems to be extremely resistant to it.

  1. Go on Testosterone + hCG. This is option two, for if I just can’t get my E2 levels in check / upping anastrozole is too dangerous. Would this preserve fertility for later on? I wouldn’t be taking the FSH anymore and I’m wondering if the testes can somehow “forget” how to make sperm if I don’t use the FSH for years until I want to have kids.

Thanks, everyone!

p.s. kind of off-topic, but: what other tests should I have done here besides testosterone and E2? People have been recommending Thyroid hormones, HGH, and cholesterol. Any other hormones?


See the 2nd post in the sticky in this forum:


  • advice for new guys
  • protocol for injections
  • things that damage your hormones

Your dose of hCG is way too high. 250iu SC EOD is a replacement dose for LH.
The high dose is driving high T–>E2 inside the testes.
T levels inside the testes can be ~80 times serum levels.
Anastrozole is a competitive drug that cannot compete inside the testes.
More anastrozole will not work!
This is not described in medical literature. But any doctor who thinks about the basics should see this problem. But doctors are not trained in deductive reasoning and critical thought.
High hCG doses risk desensitization of LH receptors!

1mg anastrozole per day is insane. Most do very well with 1mg anastrozole per week in divided doses.
Serum anastrozole levels need to match serum FT and weakly bound T levels [bio-T].

You are seeking knowledge. You can easily acquire more knowledge and practical knowledge by reading the links suggested. You can also look at the the other linked threads as well. Please read carefully. You cab print some info for your doctor who will have his eyes opened.

Suggested protocol:
50mg T injected twice a week [100mg/week total]
0.5mg anastrozole at time of injection
250iu hCG SC EOD at time of T injection.

If you reduce hCG, lingering anastrozole in your system may crash E2 and you would not feel well. So you have to get a plan that avoids this. You might want to reduce both in steps. Both drugs have half lives that are roughly similar ~ 36 hours.

You should easily be able to make huge improvements in how you feel.

Nolvadex can be used, 10-20mg EOD get your pituitary producing its own LH/FSH. One can be mostly on hCG, a natural human hormone, then switch to Nolvadex for a tune up for a while. Do not do hCG and a SERM at the same time. Both Nolvadex and Clomid are SERMs and work mostly the same. I suggest Nolvadex because Clomid can make some guys feel horrible. Docs like Clomid and they do not understand the problem with Clomid because this problem is not in medical literatures.

You did not discuss your T dosing.
You can self inject T with 0.5ml 1/2" #29 insulin syringes. ~$14 per 100 at USA Walmart - Relion house brand [made by BD]. You can inject SC or IM on upper legs, or SC in belly fat. 100% absorbed either way. SC avoids decades of muscle damage. Do what feels comfortable.


Thanks for the reply, KSman. I did not discuss my T dosing because I am on only hCG, no T. My doctor does not subscribe to the desensitization school of thought.

So, testosterone is injectable subcutaneously? Because that’s the way my hCG is (self) injected and what I am used to, so it would be ideal. I’ve heard also that propionate is the way to go

Again, thank you for the response.

What you did not answer, however, is whether fertility would be preserved if I were to stop with the FSH. I wouldn’t be taking the FSH anymore and I’m wondering if the testes can somehow “forget” how to make sperm if I don’t use the FSH for years until I want to have kids.


Yes, your testes may be damaged.

Your doc does not believe … but your high dose hCG is not sustainable because of your E2 problem.

Injected T is way more cost effective than hCG !!!

If you inject twice a week, it does not matter what T ester you use. So get whatever is considered basic where you are. T cypionate is “generic” in USA, T enanthate [aka ethanate] is more common elsewhere. Don’t get steered by what you find in body building or steroid forums. When ester groups are removed from T esters, you get bio-identical testosterone.

You problem was TRT without 250iu hCG EOD, your testes became small and may be damaged. You need to do a sperm count soon and see if you are getting any action. Your testes need to recover size and firmness, was well as function. That can take some time. When guys are on T+hCG, fertility is not at absolute risk. I discussed how you can use SERMs above to enhance things.

Do the reading, much of this is there and more.


Ok, but you still haven’t answered my question; when you say my testes may be damaged, is that when I’m on just TRT + hCG or if I continue to take hCG alone in these doses.

I’ve already tried the SERMs, it’s a no go where they are concerned, they don’t help in any way. My pituitary is just shot, I need to get my T replaced.

So if my fertility is at risk, then what would be the best way to preserve it??? Should I switch to TRT + hCG 250 iu EOD? What about the FSH I’m currently using? Maybe TRT + hCG + FSH? Or just TRT + FSH?

I’ve looked at everything you’ve provided to me, but I can’t find any documentation on fertility, which is a huge concern for me.

Thanks for taking the time, but I still need answers.


I was under the impression that you were on TRT for a long time without hCG. That can lead to damage.
If your pituitary cannot make any LH, damage may be from that.

When you took a SERM, did you have LH/FSH tested at that time?

T+hCG prevents most damage. T+hCG+FSH would be better.

Many do fine with T+hCG

BTW, when hCG increases T, LH/FSH go down or zero out…