T Nation

HRT Questions: Sperm/Getting Pregnant

Hello all - thank you for taking a look at this post. Sorry in advance that it’s lengthy. I’m confused about things and the three doctors I’ve seen all seem to simply confuse me more.

This site has been invaluable in educating me about a variety of health related issues. I’m in my late 30’s and recently (approximately 4 -5 months ago) began testosterone therapy. First, with a low dose of Androgel, which I then stopped, and now, with 20 mg/ml daily cream provided by an anti-aging guy (who works for one of my clients). As such, my actual steady usage of the 20 mg/ml testosterone cream PLUS Anastrazole .5mg 3x per week has been about 3 months. Basically, I started half-assed with the androgel, stopped for a few weeks when I was sick, and have really been serious for 3 months - that’s the time all my gains have been made as well.

For a few years I had let myself go and, at 6’, reached 240 with 31% body fat (and, perhaps worth mentioning, I was boozing it up like a lunatic as well). Now, I have that down to just under 18% and I’m still going hard. I haven’t weighed myself in ages, but believe I’m about 220 - 225 - I stopped weighing myself because it was depressing - my belt kept going down, my pants no longer fit, people were commenting - but my weight wasn’t going down enough on the scale! My brain just didn’t believe that I could be putting on muscle while losing fat… even though I’ve been working out like a fiend (love it), both cardio and weights, and feel absolutely fantastic. I eat very well now (mainly vegetarian plus protein powder) and stopped with the booze.

I had also allowed my blood profile to go to hell. Since dropping a bunch of weight, gaining muscle, and losing body fat, I have improved my blood levels, though cholesterol is still too high. (I believe that my next test, in a couple weeks, will show that it’s improved further, especially since I now take a number of supplements like niacin, omegas, plant sterols, etc.)

5 months ago when things started:

Total cholesterol: 259
LDL: 172
HDL: 38
Triglycerides: 242
Total Testosterone: 2.41
FSH: 4.0
Testosterone Free: 9.3
PSA: .4
LH: 2.5 (super low)

Blood pressure was high as well.

Most recently, 2 months ago:

Total cholesterol: 222
HDL: 38
LDL: 171
Triglycerides: 117
Estradiol: 33 (this is when I started Anastrozole)
Testosterone, Serum: 254
Testosterone Free: 267
IGF-1: 267

My blood pressure is now a little elevated, but vastly improved.

Again, my cholesterol has improved, but isn’t great - working on it. Also interesting is that the most recent testosterone numbers were still low - I assume this is because I was tested at 7am, BEFORE my morning (first of two) application of testosterone cream? Still weird to me - like my testicles are more like drying raisins.

At any rate, here are the questions I have. First, why do you think my LH would be so low, but not my FSH? Why is it so low at all, especially since I’m still in my thirties? Is this suggestive of a pituitary issue? Second, and of great importance, my wife and I would like to have our second child - but I really, really don’t want to get off the test - I feel so much better. My personal trainer seems to know 10x more than any of the doctors I’ve gone too, and he said I should continue with the test (though he thinks I should get injections instead) and add HCG. My one doctor (who I don’t have much faith in) says I should get off the testosterone cream and SWITCH TO the HCG. That worries me because the testosterone is working! Then I’ve read about HMG. Would that be better? I’ve also read that it could take 3 - 6 months to get sperm production back up - assuming it’s down, which I imagine it is. That’s a real bummer - we’d like to get pregnant asap!

A couple more things - my testicles have definitely shrunk. I don’t care - in that I don’t really know how big they were before - but I can tell because they much more often creep up into that cavity as oppose to just hang down. That used to happen once in a blue moon - now it happens all the time.

Also, one thing worth mentioning - I never went to the doctor looking for HRT or talking about HRT issues. Instead, I was doing the oncology and hemotology thing - that has been resolved - no problems - but through it all, this low testosterone came up. And then I learned about the symptoms and said â??damn, I have every one of thoseâ??. And, well, the rest brings me here.

Regarding sex drive - there are times when it’s AMAZING and OUTRAGEOUS now - HOWEVER, something has changed a bit in the last, say, month to six weeks - it was UNBELIEVABLE - now it’s not nearly so much. Still 10x better than before (nonexistent) - but not as great as at the beginning. Could the addition of the arimidex be impacting things? I believe the timing is just right.

That leads me to my last question - because there was one other thing that seems kind of right with the timing. I decided to try a cycle of anavar - and got off it (40 mg a day) after two weeks because it made me feel short of breath - primarily when doing cardio (which we do hard - really hard) - and it made me very uncomfortable. Could that be impacting the sex drive? Right now, I’m on day two of trying it again - but at a reduced dose (starting at 20mg a day) - and IMMEDIATELY today - very early on, with pulse rate very low and not even breaking a sweat - I felt that shortness of breath - kind of like someone was sitting on my chest and I just couldn’t get a deep breath. I’ve ready EVERYTHING online about this and can’t find any good information. Is this a central nervous system issue? I drink a ton of coffee - I read somewhere that someone tried combating a similar feeling by reducing caffeine intake. Any thoughts? I’d like to know that it’s not some kind of awful pulmonary issue that’s leading me to my immediate death.

Anyway, if you’re still reading and have something to add I’m very grateful. I would love any input - especially because it’s become clear to me that the doctors I see - and try to rely on - clearly don’t make many efforts to stay abreast of things or attain knowledge the way you guys do.


I figured it might be worth adding a few more things… for instance, for the few year period (about three) that I was super out of shape, I was drinking pretty heavily. I tried a number of times to ‘get into shape’ - and remember thinking it seemed IMPOSSIBLE. I never wanted to acknowledge or even say that, though, because we so often hear the complaints: “I can’t lose weight because my glands are bad, or my hormones are wrong, or this, or that, or whatever…”

Well the funny thing is that it’s like my metabolism has kicked into super gear or something. Fat - especially in my gut where the majority of it was residing - is more or less melting away. Granted, I’m working out like a maniac - but before - even when I went through periods where I’d work out like a maniac - I had tremendous difficulty losing anything. It seemed nearly impossible. I have been reading that low T (and other associated issues) play a role in that - especially as it relates to the bad gut fat.

The only remaining thing that still really, really sucks is that I can’t sleep - period. The test has helped - it’s not AS awful as before - but it’s still awful.

Please use the edit button and edit-in the units and ranges for your lab numbers. I am have trouble making sense of some of the numbers.

TRT shuts down the HPTA and LH should be very low. FSH should be too. LH is released in pulses and has a short half life. So the numbers are not very useful. FSH has a longer half live and is a better indicator of pituitary output.

Low LH is making your testes shrink and the scrotum to contract. You need hCG for that. HMG is inappropriate from a cost point of view.

When guys start TRT libido can spike, but that is mostly transient. Compounding the decline is increasing E2 levels.

Read the ‘protocol for injections’ sticky and the book that I keep recommending.

You need a high potentency B vitamin and mineral supplement to increase HDL, 3-5 grams of fish oil and 6-8,000iu vit-D3 as small oil caps.

What is your iodine intake. Kosher salt and sea salt do not contain useful amounts of iodine. You need iodized salt and salt water fish. Seaweed is good.

Where are you getting B vitamins from veges!!!

How many mg’s of T are you applying as the cream???

You need to increase anastrozole dose by a factor of 33/22. That seems like a very large amount. Still need to know what your T levels really are. You may be converting too much T–>E in your skin. If so, injections would be better.

Clip your scrotum hair short and apply some T cream there and a tiny amount to your penis. Do not transfer large amounts to your wife. 20% is really too strong for this part. Do not apply cream to chest and shoulders, inner arms only for better absorption. Smaller surface areas will mean less T–>E in the skin.

OTC and/or Rx drugs may be increasing your E2 levels by reducing E2 clearance.

I can certainly understand your concerns about fertility/HRT. Let me offer some encouragement by saying that I have been on HRT for over a year and my wife and I are expecting our first child. HCG is an absolute necessity for keeping your nuts from shriveling and keeping you fertile. HMG would be better, but it is REALLY expensive.

FWIW, an HRT guy on another board got his sperm tested prior to starting HCG and after HCG. His count went from 800K to 15 million! If I recall, they are expecting soon as well. Good luck.

Not sure if that was me but I have not had luck yet but without HCG my count was 880k and after HCG it was just over 15 million. We just got her completely cleared of any issues last week…