T Nation

Fertility Regimen - Low T, Low Sperm, Otherwise Normal


#1

Good evening ladies and gents.

I’m gonna jump right in. I’m here for advice on lab-work combined with symptoms, in an effort to figure out the best fertility regimen so that eventually I can go on Dr. prescribed TRT without adding extra obstacles to pregnancy. But first, some background…

I’m 29 years old, living in the northeast US. I’m fairly active, with workouts ranging from 1.0-1.5 hours per day 5-6 days per week. I’m 6’1, 200lbs, with decent body composition (by no means fat, nor jacked for that matter). I watch my diet and consume as little sugar as possible, eat organic when I can, supplement my diet with a multi-vitamin, B-Complex, Vitamin D, Zinc, and powdered vitamin C (1g) and drink enough water for two humans. I do have a history of epidydimitis of the left testicle (the larger one, strangely), and a ‘‘level 1 vericocele’’ which I have deemed insignificant.

I work full time as a police officer in a busy city… I like to think I’m stress free, but when considering chemical stress (cortisol, etc), I’m going through adrenaline dumps multiple times every day. Otherwise, I’m financially stable, happily married, and generally quite pleased with life as it is.

When my problems became recognized:

My wife and I attempted conception for approximately one year without success. At this point, she went through all sorts of fertility testing though a recognized IVF clinic, at the end of which, the doctors told her she’s so fertile she should be the next Virgin Mary (okay, a bit of an exaggeration, but she ain’t the issue). That’s when I realized the math wasn’t adding up, and I was the issue.

A semen analysis of 4.4 million total, in addition to 1.1 million motile, and 0% morphology lead to blood labs. They are as follows;

Total Testosterone: 264 (348-1000)

Free Testosterone: 6.6 (9.3-26.5)

LH: 3.22 mIU/mL (1.8-12.0)

FSH: 7.04 mIU/mL (1.5-12.4)

TSH: 1.210 uIU/mL (0.450-4.500)

E2/Estradiol (sensitive): 38 pg/mL (10-40)

Prolactin: 11.4 ng/mL (4.0-15.2)

Okay so plot twist, these labs were taken at approximately noon, so not optimal for T, but probably not far off, either. I did a follow up with my primary, who conducted a second set of labs approximately two weeks later at the proper time (right at 0800)… Only LabCorp dropped the ball and lost most of my blood, somehow. But I got results for Total Testosterone (350) and PSA (0.36 ng/mL (0.00-4.00)). I also did a follow-up semen analysis two months later, which came back at 26 million total, 13 million motile, still 0% morphology. What I changed: No long johns at work, no heated seats cooking my testes, 3000mg vitamin C per day, 100mg zinc per day. A pretty good boost, still low.

Doc wanted me on Clomid, which isn’t going to happen. Can’t have visual disturbances in my line of work, as rare as they may be. So I did about 50 hours of google research… This forum, a dozen others, medical journals and documents, fertility forums, etc etc…

What I came up with:

Rather than stimulate my pituitary with Clomid to produce LH/FSH naturally, I’ll supplement with HCG and HMG, if necessary.

I riled up a prescription for HCG/Pregnyl, dosed at 1500iu/2 days per week. I’ve taken the liberty of using 500iu/EOD to prevent spikes and lows, over stim of the leydigs, and over aromitization of E2. HMG/rFSH are not covered by insurance, but I have a script…

I have read a ton of articles which contradict each other on whether or not that dose of HCG will shut down the pituitary and thus stop FSH, meaning less sperm. On that note, I have also read FSH is only necessary for initial spermatogenisis, and once started (which mine is, if I have sperm…) is no longer necessary to be maintained by further FSH stimulation. So is FSH really necessary? I don’t know… But it can’t hurt.

I will get labs in one month post HCG treatment (I started yesterday), and if FSH is low or low-normal, I will probably start HMG 75iu EOD, off days of HCG just to be sure FSH is there.

Also considered super low dose Clomid (12.5mg/day) in addition to HCG 500iu/EOD, keeping the pituitary somewhat alive and producing FSH, while getting plenty of LH/LH analog, however the general consensus seems to be that Clomid with HCG is useless.

Some guys have great luck with just HCG alone (TRT), some don’t, so I know it varies from person to person… But does this plan make sense?

Thank you guys in advance and sorry to make your eyes sore with the above essay lol


#2

You can also look into Nolva rather than chlomid…it is a SERM like chlomid, without the associated sides.


#3

Thanks for the reply Catfish!

I thought the same thing and did look into Nolva, as well as Tomoxifin, which seem relatively safe at low doses… But if you google them in regards to visual side effects, you’ll find a ton of forums where people have experienced some bad sides. Again I think it is dose dependent and probably depends on the person too (pre existing pituitary adenoma, etc).

With that said, it seems like they’re not nearly as effective as Clomid, for whatever reason…

No experience with hCG and hMG/rFSH?


#4

HCG is part of my TRT protocol. I use 250iu twice weekly, on injection days. I certainly feel better with it in the mix. With the exception of a couple of months at the start years ago, I’ve always used HCG. I’ve been on TRT for probably 7 years at this point.

I’ve had several semen analysis tests done, and they all came back “normal”. We’ve been struggling with fertility for several years. We have had a couple of miscarriages, one after an IUI and then one naturally. We’re not sure what the issue is, and neither are the doctors since we both test “normal” on all the regular tests. After a visit to a fertility specialist, they recommended IVF with genetic testing. At this point, that is cost-prohibitive.


#5

Some do 12.5mg EOD. Some/few feel like crap with clomid, Nolvadex does not have that issue.

With the SERM you will make roughly similar amounts of LH/FSH. Add hCG to the LH and that is too much of a load on the LH receptors! E2 can get out of control.

E2=38 is horrible. E2 is from FT–>E2 and FT is very low. E2 is probably high because E2 is not getting cleared properly in the liver. Some meds, Rx or OTC can interfere with E2 clearance by imposing loads on the same enzyme pathways that clear E2. Anastrozole .25mg twice a week might be helpful, then do E2 labs in two weeks. Further info in the stickies.

Elevated E2 reduces LH/FSH and thus reduces T levels. Reducing E2 alone would be helpful to some degree. Your FSH was not low. LH unknown as it changes a lot from hour to hour with a short half-life. FSH with its longer half-life is often a better indicator of LH status than LH itself.

AST/ALT can point out some liver issues. You need to lay off training and not have any DOMS as this alone can affect AST/ALT.

Sperm production needs high intratesticular T levels from effects of LH and FSH present.

Your high hCG dose is unwise.

100mg zinc is too much and can induce deficiencies in other minerals, copper seems to be the most quoted.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#6

Thank you for your detailed response! A lot of information here I did not receive during my research. I have read a couple stickies tonight, the rest will have to be at a later time. Meanwhile…

For now, SERM’s are out for me based on my concerns with vision… If other treatment options fail, it may have a place on the table, in which case I will start with 12.5 EOD (I already have Clomid, so I may as well try it if it comes to that).

It makes sense that if E2 is high and TT is low that perhaps my liver has a role in E2 elimination… I don’t believe I have ever had liver tests done, which I will request to our fertility doctor (we have an appointment tomorrow morning). Also, I do not currently take any Rx, with the exception of hCG, and no OTC except occasional ibuprofen.

If FSH is a better indicator of LH, and my levels are presumably good based on that FSH number, why would sperm be low? I would imagine lower ITT… But ITT shouldn’t be low if LH is normal, correct? I have had no significant trauma to my testes with the exception of the aforementioned epidydimitis.

You make a good point with the use of an AI… With estrogen being the negative feedback on the pituitary, it would make sense that less E2 = more LH and FSH, but from my reading it doesn’t seem that E2 of 38 would be high enough to be prohibiting my TT from being optimal, as it should for my age. Would you agree, or do you think an AI would be sufficient to restore normal TT/FT and sperm? Based on the information above and without liver tests done, is there anything that stands out?

I’ll cut the zinc in half… 50mg seems to be the average supplement dose. Without cutting pills, that’s the smallest I have seen locally.

Reading one of the stickies, it seems that 250iu hCG EOD is typical, at least for guys on TRT (I am not). Is that a more reasonable dose? Would that be closer to what a typical man of my age produces naturally in terms of LH?

I will begin monitoring body temperature and review the thyroid sticky thoroughly… Currently my supplemented salt is not iodized, but I’m a salt fiend and through other foods (cooking, my sunflower seed addiction at work, etc) I would imagine I’m taking in plenty of iodized salt.

Catfish: Thanks for the reply! Very interesting that you are able to maintain normal semen analysis tests with what I imagine is little to no FSH. Perhaps keeping ITT alive is responsible?


#7

My guess is the LH via the hcg is keeping things going. I’ve got a thread on here somewhere that details my case. Of interest perhaps - I quit my test injections back in January in an attempt to restart my HPTA. (This was an attempt to eliminate TRT as a culprit in our fertility struggles regardless of semen analysis testing.) I finished off my remaining hcg, then did the nolva restart as mentioned in the sticky. Had my labs done and they were abysmal (total test was 100ish after several months) and I felt like crap the entire time. The wife did get pregnant but we lost it fairly early, perhaps 4-6 weeks in.
I resumed my test injections and my current plan is to alternate nolva and hcg, just to get some FSH flowing every now and again. I’m currently on nolva, but will probably switch over to hcg around the first of the year.


#8

Let me tell you…i.have been on tastosterone and other anabolics for 6 years blast cruise …did not come off however after 2nd year on it i took up HCG 250iu twice per week…did not come.off HCG
In time for planing for a child i upped my HCG to 500iu twice per week
Boom wife pregnant and now 4.month old beautiful baby girl.

My other mate…same thing…HCG and pregnant.

So.really HCG is the way to go. Or at least its not going to be the contributor to low sperm count.
It is given to increase sperm

I also heard proviron helps but not sure abiut science behind it


#9

@houseoferebus35 - That’s crazy… 6 years of straight anabolics and hCG got you back on the fertility track? That’s incredible. And congratulations! Thank you for the reply. I’ll have to look into proviron, I have not heard of that.

@catfish74 - I’m not great with computers but I’ll have to search for your thread… I’m interested in your case. I’m sorry to hear about the loss… I had the same thing happen back in January before I was aware of my fertility issues. I suppose the good news is our bodies are capable of what we need them to do, even if they’re not great at doing it right now.

For what it’s worth, my 500iu hCG regimin (now 250iu daily) has been keeping my pituitary from shutting down completely. At least for now… Still producing LH and FSH within normal (not optimal) range. Details in the next post with recent labs.


#10

Approximately one week into my regimen and I have gotten two sets of labwork from two different doctors offices at their request(s). Also, different labs… First is LabCorp, second is a hospital lab. There is approximately 24 hours time difference between lab sets one and two.

First set taken (10:30am) is as follows:

Total Testosterone: 552 (264-916) +202 —> Same lab as previous, changed the range.

Free Testosterone: 20.1 (9.3-26.5) +13.5

LH: 1.84 (1.8-12.0) -1.38

FSH: 3.78 (1.5-12.4) -3.26

TSH: 1.830 (0.450-4.500) +0.62

E2/Estradiol (sensitive): 45 (10-40) +7

Prolactin:

Second set taken (11:00am) is as follows:

Total Testosterone: 542 (264-916) +192

Free Testosterone: 18.4 (9.3-26.5) +11.8

LH and FSH not tested

TSH: 1.090 (0.450-4.500) -0.120

E2/Estradiol: 15 (10-40) -23

Prolactin: 11.8 NG/ML (4.0-15.2) +0.4

Cortisol: 9.4 UG/DL (6.0-18.4)

IGF-1: 213 NG/ML (98-282)

AST: 20 U/L (0-40)

ALT: 22 U/L (0-41)

I am pleased with the free testosterone numbers being significantly higher than baseline in such short period of time. I am also pleased and quite surprised that my pituitary has not been shut off completely by the hCG… Suppressed nonetheless, and perhaps I am going towards complete shutdown. Time will tell. Second set of labs was taken after preliminary physical examination by a new Endocrinologist, including palpation of my thyroid (understandably not ideal per the thyroid sticky, but it’s a factor I need to mention). Estradiol results have me concerned due to the fact that there is a 30 point difference between 24 hours time period without the use of any AI’s or additional meds (except hCG). I tend to believe 45 is accurate since baseline was 38, adding hCG and increasing testosterone should raise estradiol, not lower it for no reason… Chalking this up to a lab error, for now. I have Aromasin, but am now hesitant to use it because labs don’t match up and I don’t want to risk tanking my estrogen.

@KSman - Thoughts/suggestions since your previous post?


#11

Yes mate HCG is the king for balls hehe


#12

Also curious if hCG normally increases testosterone by the numbers I have posted above in such short time (one week). Called my Dr. today to get new syringes prescribed and inquire about E2, and he commented that he has no idea how my testosterone numbers are this high after a short course of hCG.

I mean, it makes sense to me… I feel like the increase is normal for someone with fully functioning testicles. But I’d like your thoughts as well.


#13

One thing to keep in mind is that your T numbers can swing by quite a bit day to day, even hour to hour.

So you’re just on hcg mono-therapy at present? I’d wait another couple of weeks and retest if you can.


#14

@catfish74 Yeah it’s pretty much hCG monotherapy with the intent of an additional purpose (fertility). Just a higher dose I suppose… Still not as high as two docs wanted me (3x what I’m doing).

Rumor has it, 8am-11am for young-middle age males is peak time of day for Testosterone regardless of sleep schedule, and it goes down from there. Testosterone has it’s own circadian rhythm, so the blood work above should be accurate… But I’m doing another semen analysis tomorrow in addition to blood work, so we’ll see. I’ll post those numbers as well. I should be getting regular blood work throughout this, shall I say, experiment.

I will post every set of labs I have until success is seen, or I end up going with IUI/IVF after an undetermined period of failure. I’ve read too many forums and threads of people starting treatments and not following up with reports of success or failure.


#15

Yeah please keep us updated! I hope things work out for you, I know it’s tough.


#16

Had blood and semen tested today, results not in yet but when I went to check I realized Prolactin somehow swooped under my radar from my last group, first set of labs… Didn’t even see it there…

Prolactin from last group of labs, first set: 21.3 NG/ML (4.0-15.2) + 9.9

… Wth?!

First concern is holy hell, that’s super high. Second concern is that it differs greatly from my second set of labs taken just 24 hours later. Does prolactin fluctuate enough for that to be possible? Real suspicious that Estridiol has the same trend between the last two labs.

I was under the impression hCG did not affect prolactin, especially in that short of a time frame? Is this false?


#17

HCG should not affect prolactin no…


#18

Hcg Can increase test of course!!!


#19

Okay folks, so some of the lab results are in and to my surprise, they’re not good. I am now exactly 3 weeks (21 days) into hCG. Current stats…

Semen Analysis:

3.6 million total count (40 million minimum normal) (-22.4 million from last)

0.4 million motility (11%) (50% minimum normal) (-12.6 million from last)

0% morphology (4% normal, Tygerberg Strict) (no change from last)

4.0ml total volume (Unsure of normal range, but I know 4 is slightly above) (no change from last)

Some blood labs came back but there’s a delay with the holiday weekend in store. What I have right now…

Total Testosterone: 438 (348-1000)

Free Testosterone: 16.3 (9.3-26.5)

LH: 0.12 mIU/mL (1.8-12.0)

FSH: 0.24 mIU/mL (1.5-12.4)

TSH: 1.700 uIU/mL (0.450-4.500)

E2/Estradiol: 41 pg/mL (10-40)

These results, for me, are highly discouraging. Sperm counts, total and motile, are at an all time low. Testosterone, although fluctuating with many factors, is still low and just over 100 points lower than when I tested a few days into treatment.

It seems testosterone responded quickly and rapidly, but then fell off. Free test numbers are 2 points lower but in the area of the last test.

LH and FSH fell to sub 1.0 numbers, so my assumption that the pituitary was in the midst of shutting down was correct.

TSH is also higher than I would like. I have not taken the time to test morning/night temperatures, but did start daily supplementation of iodine (100%dv, with selenium).

I’m pretty much lost at this point on how to proceed. I’m not sure if I will continue treatment or not. It seems reasonable to say that hCG has unexpectedly damaged fertility rather than assisted, and hopefully only in temporary terms.

These results thus far contradict every piece of information I have read about hCG’s use in treating low sperm count in men with similar issues as mine. I have not been able to find one testimony where hCG decreases sperm count…

Open to any thoughts/suggestions/comments… Thanks guys.


#20

Your LH and FSH results are alarming, usually when LH and FSH are low T is also low. I wonder if your T levels have yet to start dropping, you might have just caught your pituitary shutting down and to possible expect a crash of your T levels. I’ve seen before where HCG works for a time and for whatever reason it just stops working after awhile.