From what you say, he has made a mess of things.
What has happened to the side and firmness of his testes?
How have they been hanging, or is scrotum pulled up tight.
From what you said, I assume that he was not using hCG those 10 years.
He does not need to stop using T, you do need to preserve libido.
Many here on TRT have been making babies, mostly using hCG all of the time as all TRT guys should, but some have used hCG to recover, but that only acts on LH receptors. Some planned to switch from hCG to SERM, but got a pregnancy first.
Did he use anastrozole to manage E2 levels?
250iu hCG SC EOD is a replacement dose for LH hormone. High doses can lead to uncontrollable E2 levels.
Never use a SERM [clomid, nolvadex] at same time as hCG or high doses of either as this overloads the LH receptors and risks desensitization of the receptors.
Get him back on T.
Clomid should cause his pituitary to generate LH and FSH. This is better than hCG as FSH is important for sperm production. He can take 25mg every other day, sometimes that is too much and E2 gets high. Some guys feel like crap with clomid, other fine. If he has used before - you know. Nolvadex never does that.
The testes take time to recover form and function. Observe changes to size, firmness and how they hang.
On Clomid or Nolvadex, do these labs:
- if LH/FSH are there, it is working, numbers should be 4,5,6 avoid high range
TT, FT will be high, no need to test
SHBG will be useful.
In time, if not pregnant, have a semen analysis done.
All of what we know about TRT is in the stickies and applies to him for general health, mood, energy and libido.
Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
- advice for new guys
- 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.