Hi guys - first post, but have been reading the boards for the last few days. We are trying to have a baby as we are both 38+. I was on testosterone for 3 years 100mg a week and felt pretty good. I lost over 40lbs in this time as well. I had testicle shrinkage and when I got my sperm tested in December my sperm count was not high enough to even register.
I stopped taking test and my doc moved me to 50mg of Clomid a day to try and regain fertility. I took the Clomid for 2.5 months and on my next sperm test my count was up to 205 million total w/ grade 4 forward progression and all of the other bells and whistles. I was so happy that I had not done permanent damage as we’d really like to have a child.
My doc suggested I stop the Clomid after this to see if I successfully restarted my system. I spent 2.5 months off Clomid before getting another hormone panel done. I have managed to keep the weight off in this time, but have been feeling pretty down… calm, but down. Libido is basically non-existent.
Results:
FSH 2.3 (1.5-12.4)
Prolactin 9.1 (4.0-15.2)
TSH 1.89 (0.178-4.530)
Vitamin D 50.2 (32-100)
LH 1.9 (1.7-8.6)
Albumin 4.2 (3.5-5.2)
Total Test 277 (249-836)
Free Test 55.8 (30-150)
SHBG 32 (10-57)
I was hoping for some better results…
Our main goal right now is fertility for at least the next year (or hopefully shorter if it works).
Questions:
Did I make a mistake by coming off the Clomid? Doc didn’t seem to concerned now that testicles are working again. They are still very full after stopping everything (not sure if that even means anything)
Doc offered me this option to try and get me feeling better and retain my fertility:
1000iu 3 times a week + Anastrozole .5mg once a week
Does this sound like a good option to maintain fertility and bump my test? Clomid did not have much effect on my total testosterone at that dosage. It was 380 around the time I stopped taking it.
I appreciate any help since I have not used any of the HCG yet.
Sorry I’m a little lost because it’s late here. From what I understand you have a good sperm count now. So why not start your trt again with hcg to keep your balls working and producing sperm? That would keep your fertility while on test. You could also freeze sperm. It would be impregnating your wife in a different way but still would obviously work. Those are 2 option that get you back on test and feeling better. There are probably more options but those 2 seem the simplest.
Experienced TRT doctors incorporate TRT together with HCG to keep the testicles functioning and to remain fertile. TSH may indicate an iodine deficiency, one way to check is measure body temperatures using an oral glass thermometer. If you have trouble reaching 97.7 upon waking and 98.6 in the afternoon then iodine could improve your chances of reaching normal temperatures.
I’m a little confused. What do you want to accomplish? Is your primary goal fertility? Are you trying to balance TRT and fertility?
If your goal is fertility than it appears Clomid worked perfectly as it dramatically boosted your sperm count. Why worry about a restart at all? Why not focus on having a baby while your counts are high, then transition back to your prior protocol?
Clomid and HCG are totally different vehicles but they share a common goal in protecting fertility by stimulating LH. In terms of fertility I’m not certain one is better than the other. Also, you can use one or the other while on T and possibly have the best of both worlds.
Fertility is the main goal, but I have been feeling worse and worse mentally. TRT allowed me to get off of the antidepressant I had been taking since I was 22 years old. I do not want to go back there, so if there is a no real impact on fertility if I include HCG with the Test then I think I should go that way. I just wanted some kind of reassurance I guess.
I kept holding out hope that my system would function on it’s own after the clomid, but I guess it is time to put that to bed.
Do you know how effective HCG is at maintaining fertility in the long run (5+ years)?
I know docs use it to maintain fertility, but I have not found much research that says much more than it helps. A percent of men on trt that were able to maintain fertility after 5 years would be a useful stat.
Interesting they’ve found HCG+SERM to be a viable and successful option for fertility. I’m done with kids, but have always read here that you couldn’t mix the two.
Fertility preservation and recovery would make for a pretty informative sticky. Links to the available studies, a summary of stats (% of men after 1, 5, 10 years of TRT who maintained it with certain protocols), most effective protocols (for fertility).
At least for me fertility is the main concern with TRT.
As more studies comes out, it would be great to have a concise place for it. With the awesome contributors here the BS would be eliminated.
That is too much hCG and you can expect high T–>E2 inside the testes and anastrozole does not work there. What? Your doctor does not understand that? Almost none do.
T+hCG supports sperm production as well as hCG mono.
T+clomid would work better because of FSH.
You can do the first and switch to second to get ready to conceive.
Your T levels are too low. You need more T to support strong libido.
TSH should be near 1.0
We do not see that guys with TSH as high as yours having decent energy levels and mood. Eval overall thyroid function via oral body temperatures, see below. Do not think that this is trivial.
Your thyroid cannot work right when iodine deficient. Have you been using iodized salt or vitamins listing iodine+selenium?
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.
That paper suggests high dose hCG and hCG+Clomid. The paper is blind to the expected high E2 levels that will result from that. This is sub-optimization and will lead to may E2 related mood, energy and libido problems.
You can mix the two and get expected problems from high E2 levels and the problem that anastrozole cannot control intratesticular T–>E2. That study is not looking at the need for a proper balance of hormones.
All that is needed is TRT with 250iu hCG subq EOD. Many here have made babies on that protocol. And with anastrozole, they can have decent E2 levels and maintain an interest in sex.
Nothing is needed other than what has been recommended here for years. We do not need more half-baked studies. That study does quote from a 2005 study that is the foundation for 250iu subq EOD, not new information.
We have not seen any problems. 250iu hCG subq EOD supports the LH receptor activation level of younger normal males. I problems occur the issue would most likely be a problem in the testes, not the hCG. We have a few who are hCG intolerance for reasons not understood and SERMs is then an option.
Hi - thank you for the reply. I have a thermometer on order and no I do not take Selenium or Iodine at the moment. The salt I use is not iodized and I have been eating less and less red meat. Is it possible the thyroid could be the issue here causing the low test or is that just another thing on top of the low test to deal with?
I found my labs from late 2013 when this all started and I had a full Thyroid Panel:
TSH - 0.979 (0.270-4.200) **so this has gone up since TRT began
Cortisol - 1.2 (PM 0.6-2.8)
T4 - 7.4 (4.5-12.0)
T4 free - 1.2 (0.8-2.6)
ACTH - 12 (10-60)
I was thinking about just going back on Clomid at a lower dose (around 12.5mg daily) since I didn’t really notice any sides until we get this pregnancy thing figured out or I bank some sperm.
I had some Hematocrit issues will on Test alone so I am kind of worried about combining it with HCG.