T Nation

TRT Fertility Help

As some of you know, I’ve been on TRT for several years. I have my doses for test (175mg/week), adex (0.25mg EOD), and HcG (250IU E3D) dialed in via labs. We are now trying to get pregnant again (trying for 3rd) but to no avail for over 8 months. I presumably conceived at least one of my children while hypogonadal (pre TRT). I learned that about 10% of pregnancies were conceptions with a low sperm count.

I added clomid, 50mg ED, to the mix. My question is if any members are on TRT AND trying to conceive or know someone who is, what worked for you? I read about HmG being a more powerful sperm producer but it must be cycled carefully. Is there any other compounds or protocols someone had success with?

BTW, my wife is around 30 with regular menses.

Thank you for any help.


Are you feeling well with clomid?
Were you feeling well before?

DO NOT TAKE clomid+hCG! Take one or the other. You may reduce receptor sensitivity in the testes.

That may be too much clomid, check E2 levels. AI may not be able to control E2.

Clomid or nolvadex should get the job done. Check with LH/FSH lab work. If LH/FSH are encouraging, do a semen analysis.

Other factors:

  • adequate cholesterol numbers
  • EFA’s
  • diet and supplements

Interesting… I have read in several threads elsewhere plus researching some medical advice that said HcG plus clomid was okay. From your response it sounds like they work in a similar pathway and too much can down-regulate receptors just like too much test for long periods of time? I thought HcG was mimicking FSH and clomid helps the pituitary secrete LH. Is this reasoning sound?

I have felt great before the Clomid and about the same now. The TRT has completely changed my life; I’m back to feeling good. Also, I noticed a bit more semen volume on the clomid + HcG… to me this suggests both may be helping, no?

As I mentioned in my post, I have all parameters dialed in. My E2 is usually around the mid 20’s, although I mixed up my dose and it dropped to 6 for a few months, but I corrected that.

I’m a holistic nutrition/wellness professional so EFA’s, supps such as minerals (I used chelated forms) are all in check and have been for years. My total cholesterol is always “great.” Though there is little clinical relevance for total cholesterol. My LDL and HDL are both around 60, total being around 130-140. I have never taken a statin, nor will ever, so these are just my natural numbers. What issues, re fertility, could be caused by low cholesterol? The only way to increase serum cholesterol would be from a dietary source such as fatty beef since my liver is at homeostasis.

You also said Clomid or Nolva will help but just before you stated not to do the SERM with the HcG… so, would you suggest dropping the HcG over the SERM?


BUMP - still looking for anyone’s personal experience(s) and if HmG is worth the cost ($50/shot!!!).


Not familiar with LDL+HDL total, perhaps you can help me and perhaps the following does not apply.

Cholesterol is too low, that needs to be fixed. Total cholesterol 160 and lower is associated with increased all-cause mortality. Cholesterol is essential to life, you just do not want it getting past the blood vessel endothelial cells. Cholesterol is the foundation for production of pregnenolone, progesterone, DHEA, T, E2 and cortisol type hormones; as well as vit-D3 which when converted to the active vit-D25 is a true steroid hormone that gets transported to cell nuclei where gene expression is affected.

Study this: http://en.wikipedia.org/wiki/Steroid_hormone

Cholesterol is not “great”, more like “lethal”. Ideal total cholesterol is thought to be near 180.

With increased animal fat, the liver will produce more cholesterol in response, above the cholesterol that comes with the animal fats. Most cholesterol is made in the liver, not dietary, but production can be in response to diet. When men loose DHEA, pregnenolone and T as they age, total cholesterol increases. When these men go on TRT, total cholesterol often falls significantly [with HDL not dropping]. So one can state that the body might be making more cholesterol in an attempt to foster greater steroid hormone production. Note that TRT without hCG leads to the testes shutting down, removing some progesterone and pregnenolone production, and then DHEA can follow pregnenolone down. TRT also increases/restores [some] insulin sensitivity and can lower blood pressure by correcting arterial wall muscle tone.


hCG activates LH receptors, some but small/little cross over FSH action, OK for fertility for some, but not good enough for those with some sperm count issues.

You have it figured out.
Both SERM and hCG lead to LH receptor activation. Too much of a good thing can desensitize the LH receptors. Then you are screwed. High dose hCG or high dose SERM can do the same thing. Combining hCG and SERM can be too much as well. IF one took smaller doses of hCG and SERM combined, that might be useful. I also suggest hCG with occasional switches to Nolvadex to keep things going.

For TRT, you need to look at low sustainable doses. Do some docs prescribe high dose hCG, yes, but bad news for long term use. So some docs prescribe hCG+SERM for fertility? That may be needed to get a pregnancy, but dangerous long term as it could reduce fertility [and T levels for those who are trying a HPTA restart.]

hCG has a ‘lobe’ that is exactly the same as the active lobe of LH. [not FSH!]

Both clomid and nolvadex are effective. Clomid has horrible estrogenic sides for some.

"That may be too much clomid, check E2 levels. AI may not be able to control E2. " E2 management is mission critical.

Do you have E2, TT, FT labs?

What is your iodine source?

Please send picture of wife ;}