T Nation

TRT Fertility Questions


#1

Hello All- a little background I have been married for 1 year and I am in my late 20’s. My husband is older by about two decades. He has been on TRT for about 6 or 7 years now. He said when he initially saw a Dr it was because he was depressed and had low energy and the Dr told him you have low T. So that is how the diagnosis was made. Im guessing it wasnt a real RE doctor or urologist. Probably just a primary care. He put him on 200mg cyponiate every 3 weeks. He has been on this dose ever since. I dont know if a person is supposed to stay on the same dose for years. Assuming we want to have kids now (we dont) but lets just pretend we do…What is the course of action to take. I know if you have been on TRT for years you probably have low sperm count or no sperm count. We have not yet tried to get pregnant. Meaning we did not systematically calculate ovulation and plan it and monitor everything. We have not pursued pregnancy yet. But I do have one clue that says something. We have been having unprotected sex for the past year. No pregnancy occured. This leads me to believe he 100% has a Fertility issue. I am just predicting here. Nothing has been proven yet, but come on! Its obvious LoL. Maybe we should actually try to monitor ovulation and do all the stuff needed but we havent yet. Maybe I am wrong but science says 9 times outta 10 if you are on TRT it is extremely difficult to achieve pregnancy. If you are a man on TRT and got your girl pregnant you are an anomaly. Anyway I have heard various options for TRT patients:

option 1: Some men say they went off TRT completley and took clomid, HCG, HMG etc etc…and that helped their sperm regain itself which helped the sperm numbers go up which helped them conceive via normal conception or IUI or invitro or whatever.

option 2: others say they continued TRT and also added HCG or HMG etc …

My question is if we do option 1 and my husband does go off TRT isnt he going to experience bad side effects like decreased libido, ED, low energy, etc…So then should he continue taking TRT while adding in another horomone (i.e: HCG etc…) Unfortunatley he never took HCG while remaining on TRT. I have heard you should take HCG while on TRT but too bad he was never informed of this.

Keep in mind my husband has not had his testosterone retested again since 6-7 years. Nor has he had a semen analysis. We dont know anything at this point about his testosterone/sperm health. He has been on a dose of 200mg cyponiate every 3 weeks for the past 6 to 7 years. Some say this dose is old school and should be more like 200mg every week. Ill never know the truth since he hasnt been tested in years. He did do a routine physical two years ago that captured testosterone as part of the test. His testosterone was 100 and his FSH/LH was <0.3 (1.4-18.1) and LH was <0.1 (1.5-9.3). I dont know what these numbers mean but I do know when he had his blood drawn he was on the last couple days of his cycle so it was expected to show low levels. The doctor was a primary care not an endo nor a urologist nor an andrologist just a freaking primary care since it was just a routine physical. The doctor did tell my husband his levels were low and my husband said yea I know they are low I am taking injections. So that was that. This was not the same doctor who he saw 6-7 years ago for the injections.

What is the first step now? Is it for him to do another testosterone evaluation by an RE and to know the real levels, the real sperm count, the real everything and then move forward?

When time comes and I decide I do want a kid should he just go off TRT completley or combine it with another hormone? I just dont want him to go through bad side effects if he goes off it. Thanks All!


#2

Hes definitelty nearly infertile. Theres been new birth control for men which is essentially testosterone which shuts down the testes. He should try injecting 250 ius of hcg EOD. His testes may have atrophied past regeneration so to speak. If hcg (which mimics LH - leutinizing hormone) doesn’t reactivate his testes then a restart with clomid/nolva if successful wouldnt either, which would begin producing true leutinizing hormone which signals the testes leydig cells which in turn are responsible for spermatogenesis.His pituitary gland sees the high T levels and his body stops producing follicle stimulating hormone(FSH) and leutenizing hormone (LH). Men on trt are always near zero for that reason. hMG or Human Menopausal Gonadotropin is more effective than hcg because it contains both FSH and lh and is also much more expensive.

Is happy with how he’s been feeling? His “protocol” is pretty terrible. Most men inject once per week, twice per week or every other day. Many take hcg and also an aromatase inhibitor if their e2 gets too high.


#3

He feels fine. He is still on his TRT regimen. He has been on this dosage for all these years. I feel like you cannot stay on this dose for years. You have to go get rechecked every 3 months 6 months 1 year or whatever. He has a pretty built body and is vegetarian. He takes all the vitamis needed (zinc, carnitine, arginine, maca, boron, super B etc…etc…) I think maybe this time he should see an actual reproductive urologist or endo who specializes in this stuff. Not just a regular doc. I know the results are going to say his sperm is shit. I just know it. Its very obvious. The question is would HCG regenerate his production and allow him to produce normal levels that lead to conception. Do men usually take HCG along with TRT or do they have to quit TRT as a whole and take HCG by itself?


#4

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

He should be self-injecting T twice a week with hCG and anastrozole. Details in the stickies.

hCG will recover form and function as much as that can happen. But FSH will also help. He could take Nolvadex 20mg EOD [no hCG] then check LH/FSH later to see if his pituitary is in the game. Avoid Clomid as it makes some/few guys feel horrible.

Get a semen analysis to look for swimmers.
If hit testes have become very small, its not a good situation.

Getting Vit-D3?


#5

“Injecting T twice a week with HCG”…Well he injects T every 3 weeks. So we already know he is doing it wrong, since you suggest twice a week. It boggles my mind that he has been on this dose for all these years. He never saw any other doctor to do a recheck or anything.

I need to have him see the proper doctor to do a full ass panel. He also needs to do a semen analysis because I am torturing myself every day trying to predict his results.

I felt really depressed these past few days. I get these emotional phases where I think about his protocol with TRT then I forget about it and time goes on, then, something else happens and triggers it in me again. This time the trigger happened a few days ago when he told me his boss’s wife is pregnant. I just felt sad… like what if we can never have a kid…Not that I want one now and we havent tried…but what if I do later on and we cant, all because TRT destroyed his fertility…Why do docs prescribe TRT if it screws fertility. dumb question i know lol. Nobody ever told him about HCG maybe its too late now. He is 50 and his testicles are a little on the deflated side lol. I wish I knew him during the time he was prescribed this to tell him not to take these T injections. But I dont know the truth yet…no testing has happened…dunno his sperm count, motility, morphology and all that jazz…but we all know it prob gonna be very low or zero or maybe 1 sperm thats still alive LoL. Yes he takes Vit d3.


#6

As you will see in the stickies, there is a large number of issues to deal with. The suggested protocol addresses most. But in your situation, fertility is not a preservation concern but a recovery attempt.

I was thinking last night that injecting T every three weeks may have allowed the pituitary to fire up to some degree that might have been beneficial.

Self inject T 50mg SC or IM twice a week with insulin syringes
0.5mg anastrozole at time of injections, as needed to get near E2=22pg/ml
250iu hCG SC EOD
Swap hCG for Nolvadex 20mg EOD 1 week a month

or stay on Nolvadex for a while checking LH/FSH
If LH/FSH does not get off the floor, give up on that as pituitary is not in the game.

Urologists and endocrinologists are typically horrible at TRT and do and say stupid things. You two can easily learn from the stickies and know more than almost all most doctors. Docs do things that amount to malpractice all of the time. Critical thinking and analytical thought does not seem to be needed to practice medicine. So doctors have been and will be your biggest problem and there is a sticky for that.

Please note the references to iodine, thyroid and body temperatures in the stickies. Those address issues mission critical to energy levels.


#7

I take 100 mg T and 3000 IU HCG per week. I’ve gotten my wife pregnant three times with that HCG dose.


#8

I agree that there’s hope, although I believe your situation is different. It doesn’t sound like the OP’s husband has ever taken hCG or anything to stimulate his testes in the years he’s been on.

That being said, ksman also makes a valid point about the injection every 3 weeks actually being a benefit from a fertility standpoint.

You’ve been given some good options. The “easiest”/least complicated is for him to 1. inject 250 iu’s of hCG every other day. Next easiest is 2. Nolvadex 20 mg EOD for a few weeks while checking LH/FSH. Next would be 3. hCG 250 iu’s EOD and then 1 week per month have him not inject the hCG in placec of Nolvadex 20mg EOD.

These three should not be done together but stand alone.

Worst case scenario if his pituitary doesn’t “fire up” from the Nolvadex and increase his FSH and LH, there’s also hMG or Human Menopausal Gonadotropin which contains both FSH and LH.


#9

Just to clarify. One can do hCG or Nolvadex while still injecting T.

hCG and LH have two peptide lobe structures and one lobe of each activates LH receptors. hCG has a weak effect on FSH receptors. Most guys on TRT with T+hCG seem to preserve fertility but there are always some who are excepts or have other issues. SERMs [Nolvadex/Clomid] releasing FSH have a strong effect on sperm production. In this case, reliance on hCG alone may not be enough. If semen analysis shows some swimmers Nolvadex can only make thing better.

I think that the suggested protocol would make a substantial improvement in quality of life: energy, mood, initiative and libido.


#10

I went for over ten years of TRT with HCG. It does the trick for me.

AIs are not a necessity for all. I’ve never taken one and feel fine.


#11

That’s a god awful dose. T cyp is generally prescribed for 100 mg per week, which is what I’ve been using for bout four years. Before that, I was on gels for 10 grams per week. Clearly that doc doesn’t know what he’s doing.

Yes, one can stay on same dose for years if all is well.

I don’t want to sound like a wiseass but did you two ever think of the genius idea of getting a semen analysis done, rather than hoping and hoping that unprotected sex will yield the desired result: a kid?

But yes, he is likely shut down, as are nearly all TRT patients.

Regarding option one, of course you can use only climbed or HCG at high doses, with no T. I took high dose of HCG for a few months but felt like crap on it and it did not sustain normal T vaues for me, even with a whopping dose of 9,000 IU per week. Some men even need 10,000 IU for normal T values and fertility when taking HCG alone. And again, some men can stay on that dose for years with no ill effects.

As stated before, I am on option two. At first my urologist prescribed 100 mg T with added 500 IU HCG twice per week. That didn’t do the trick for fertility. When he increased the regiment to 100 mg T with 1000 IU HCG three times per week (3000 IU total per week), my sperm count increased sevenfold! And it’s likely higher now. After two miscarriages we are now expecting our first kid this summer!

Question 1’s answer: Yes, that can happen, if he does not respond to the mono therapy as desired.

Again, T and HCG work together, as it does for me and many others.

200 mg T every week is way too much for most men. Most men can archive a mid to high normal range of T with 100 mg per week of T cyp or 10 grams of gel a day.

It does not matter when those FSH or LH numbers were taken. It’s not like they recover by the end of his three week gap between injections. He is shut down with those numbers. And you will continue to go on speculation until you actually get him to start taking semen analyses.

First step: Stop going to a PCP and get him to a urologist with a fellowship in andrology. Yes, get sperm count and go to a doc who knows what the heck he is doing with TRT and fertility. Where are you located?

When time comes: I’d say try mono therapy with HCG. If that does not sustain normal T values, go ahead and do T and HCG.

BUT… this is just talk over the net, and we are not doctors. A qualified doc will know all the best steps to take, not us!


#12

A.) So I looked at the T-vial and it says “inject 1.5ml=(300mg) intramusculary every 3 weeks as directed.” I dont know if this is a correct dose to give someone, but thats what hes been taking for this whole time. Whether this is wrong or right I dont know. You guys know better than me.

B.) We were not having unprotected sex in hopes of a child. I guess in my mind I didnt want to go on birth control due to side effects of the pill (i.e: weight gain, depression, mood swings etc.) so I thought having low T is a good form of contraception lol, since having low T means its very hard to conceive. Extremely hard according to all these forums. So far no pregnancy has happened and I dont think it will since you are all saying his factory is shut down hehe. I watched “the great sperm race” on Youtube. That short documentary showed how difficult it was sperm to reach the egg and fertilize it.

All the obstacles and barriers they had to go through with a normal sperm count. The doctor on the documentary (Dr. Joanna Ellington) said she wanted to see how many sperm were in her fallopian tubes after sex. So the day before her surgery (tubes tied) she had sex with her husband. Then the day of surgery she asked her surgeon to remove her tubes and allow her to look at them to see how many sperm were in there. She said only 20 sperm were there (fallopian tubes) out of the millions and millions ejaculated.

So if a man with normal count, healthy etc…shoots millions of sperm in and out of those millions only 20 made it to the tubes then imagine a man with low T or low sperm count. Yes I know it takes only 1 for pregnancy. And I do know many men out there were able to procreate with a very low count. Just sayin’…

C.) The sad part in all of this is that the whole reason why he was given these injections is because one day when he went into the docs office and said he was feeling a little depressed from work or something the doc was like you prob have low T. Hence the era of injections began lol.The million dollar question is does depression cause low T or does low T cause depression?

If a man is depressed or has low energy or loses his apetite over a breakup or over work related issues why the hell do doctors prescribe T as if it is an anti depressant LoL. I know T-shots help with libido, energy, etc…but damn I didnt know t-shots are supposed to be taken forever to cure a temporary depression that a person gets over in time. Its sad when you have to resort to a forum for your answers instead of trusting doctors.

D.) For all the guys who said HCG helped them conceive thanks for giving a little bit of hope. I read other forums and websites where many other women/men said HCG, clomid or HMG, nolvadex, fertileaid, etc…helped with conception and their husbands count. Its nice to know that there exists some hope out there.

We are not ready for children now, but when we do get ready should:

  1. He start the HCG protocol near the time we would like to conceive or

  2. Should he begin using it now?

3.) Is the doctor supposed to be a urologist with a speciality in andrology? Or is it supposed to be a reproductive endocrinologist? Can you give me hints on how to identify a good doc.

4.) I heard there are differing testosterone blood tests and methods (ECLIA method, LC/MS method, Equilibrium Ultrafiltration etc…) Which do you suggest?

Thanks for the guidance!


#13

Did you read what I said above? 100 mg per week is the standard dose, and it works for most. 300 mg every third week or 200 mg every other week are outdated ways of taking this. Again, a doc like that, I would not go to.

It is highly likely your man is infertile. Again, he should get the semen analysis, which he will have to get anyway to see if a fertility drug is working or not.

Depression does not cause low T, but low T (hypogonadism) does cause depression. Did this genius doc even have his T value taken in the first place? Did he even make a diagnosis?

T should not be given as an anti-depressant considering it is not an anti-depressant drug.

Contrary to many people’s beliefs, TRT doesn’t turn men into the most virile beasts around and I’ve been damn depressed while on TRT with normal T values.

As said, nolvadex isn’t even needed in many cases. Neither is arimidex. I have not once needed or taken an AI in fifteen years of TRT.

  1. No! He will likely need to start HCG six months to a year before. This stuff doesn’t work overnight and might take some adjustments in dosing. I started eight months before the first pregnancy.

  2. Refer to 1 above considering the length of time it takes. So yes, he should start now. But that would also actually take going to a competent doctor and getting the prescription for HCG.

  3. Perhaps I am biased but I believe the best bet is a urologist with a fellowship in andrology, like my doctor. Hints: Does the doctor deal with fertility? Look at his CV! Where did he go to school? Did he do any research regarding fertility and TRT? My doc has several research papers in Pub Med.

Does he have any testimonials on his website regarding conception? As silly as it seems, does he have a collage of babies and families and thank you cards sitting in his office?

  1. Doesn’t matter, so long as he is in mid to high normal range consistently and feels good.

The ball doesn’t start rolling until there’s a competent doc in the picture.


#14

This thread is getting too fuzzy.

hCG is typically a life long thing, you can’t let the boys shrink then expect them to wake up on command.
Nolvadex is probably an essential part of fertility recovery if you are going to get serious about this.

Another issue is whether hubby is on-board with any of this. When you see what goes on in other threads here, you see guys who were dissatisfied with their QOL and/or doctors who then had the initiative to get on the WWW and land here. Your husband needs to participate with this process.

Your situation is quite unique. My wife is 19 years younger, so I can appreciate some of the variables. In our case, I take the lead on female hormone and related issues.

Doctors are mostly idiots who lack analytical thought and critical thinking. Guys need to read the stickies and manage aspects of their hormone care, passive only creates victims. Taking about how one doctor fails really does not solve anything, reading the finding a TRT doc sticky may be useful if you two cannot get that doc on board to changes. You can always find anastrozole and Nolvadex as “research chemicals” if forced into that; hCG is not quite so available.


#15

If you do TRT and HCG together and it works fine do you need to add Nolva and anastrozole to your regimen also?

I dunno why he needs anastroz. he doesnt have gyno or the breast issue.

Whats the link to the sticky that highlights the purpose, amount, combination etc… of each of these chemicals (nolva, anastroz, HCG, clomid etc…)


#16

Hello everyone first time posting. Started TRT about 6 weeks ago. Really worried about minting fertility. Anyone know a knowledge doctor in San Diego. I’m feelingredients good and want to stay on TRT. But need to maintain fertility for future attempts at getting pregnant.


#17

WOW man great TESTIMONY by increasing to 3000 IU HCG a week, pretty MADNESS though just for getting pregnant in the sense,the Aromatization from all that HCG must of sent your (E2) up to the roof, you must been of been popping 1MG Arimidex (Anastrozole) every 2 days out 7 days a week so like 2mg a week for all that E2.

Curious to know if both your nipples got super sensitive on that dose. CONGRATULATIONS on Baby dude.

I want a child with my Wife now, been trying 2 years straight but, 1 & half of that i was LOW T from TESTES injury however had okay FSH/LH level. I went onto TRT i have been now on 5 Months (2 months on TEST compounded cream 6 times day i felt like shit no energy it failed for me) then Injections, EVERYTHING improved.

I started out on TEST E (Enanthate) first for just over 1 month 40 days. No A.I needed NO high E2 at all SOLID Erections great mind was doing just 120mg total per week TEST E. comfortable protocol 60mg each shot twice weekly to make the 120mg. Now i am on SUSTANON as i couldn’t afford the TEST enanthate not been able to score GOOD JOB so paying for 2nd best. I am getting more E2 on SUSTANON surprising it’s not too bad on 200MG Sustanon a week. why you may ask i do this much i since changed to 150mg Sustanon a week.

because 200MG Sustanon brought my (E2) up to 39.5 pg/ml which isn’t that bad but too me bad enough because erections were getting SOFTIER Floppy end. my weight is lower 160lbs 5ft 9 lower body fat but not super lean. Now my point is 5 Months Shutdown TRT (TEST cream 2 months and injections 3 months) i have taken Bugger ALL HCG only experimented with it for about 1 week. I also think because i was running 200MG sustanon for like 2 months in a row almost. that it did Shrink my balls a bit more. but they still Good size. I going for SPERM Anaylysis next week after 2 years married no KID. Do you think 5 months of TRT (2 month cream/3month Shots) would make it too ZERO that quick or possible i have some left there? My plan is if it is HORRIBLE news all around.

I am going solely on HMG at 1500-2000 IU a week. Also will this cause more (E2) Aromatization than HCG? is it less ESTROGENIC than HCG exactly the same? because if my Sperm counts is near 0 i want to get on eventually 400 IU every 2 days of HMG(MENOPUR) https://www.medicines.org.uk/emc/files/pil.1294.pdf

I also will take pretty HUGE doses of Folic acid/Zinc to make them stronger all round, BLACK maca helps too. What you reckon can Higher dose TRT 200mg SUST for 8 weeks straight Obliterate my Sperm counts? or maybe the results will find something? the color of it looks OKAY but i don’t think that makes much difference. My age is above 30 but under 35. Does this go in my favor too just purely on Test?


#18

Thank you.

Even on HCG mono therapy of 9,000 IU per week I never had symptoms of high estradiol. If I recall correctly, the highest my estrogen got was 50-plus, and I didn’t feel any symptoms.

There is no published literature in the medical community showing that relatively high doses of HCG cause leydig cell shutdown and many men do not have one symptom from it.

I have never used Arimidex or any other anti-estrogen drug in all my years of using TRT.

What country are you in? In the USA, testosterone cypionate is dirt cheap. I buy mine for 120 bucks per 10 mg vial.

150 mg per week of any TRT is likely too much.

This is double the usual TRT dose.

ALL TRT doses will cause testicular atrophy.

One week on HCG after being shutdown for years will do nothing! My doctor advises patients to use clomid or HCG six to twelve months before getting the hopes up of having a kid.

I have never heard of a zero sperm count, but I am not a doc, but it is highly likely you have nowhere near the count required for a pregnancy.

You can afford this but you can’t afford testosterone enanthate?

I am unfamiliar with HMG and I do not believe that HCG inherently causes high estradiol levels.

As said above, standard TRT can lessen fertility.

You just said you use 150 mg per week. Why will you be using 200 mg? At some dose, it is no longer TRT but simply overuse of medication.

200 mg IS overuse of medication.

I doubt there has ever been a case of an infertile man having abnormally colored semen.

What do you mean by this question?


#19

Thanks @Brickhead Bro for your break down of questions, i thought it was pretty professional bro yes i enjoyed your great responses bro.

I like to ask out of curiosity did the TRT aspect of Lowering your HDL Value scare you by any chance, without much Supplements at all did it go down much prior to TRT your HDL or increase in LDL also score, many men have this General consensus Worry about that as of course related to our cardiovascular system & everyone has a different one.

Did you immediately jump on any Fish oil 2-4grams daily, Niacin(Niacinamide) or red rice yeast or any of the following three cholesterol boosting supplements.

just wondering that was my only worry too. having Cholesterol done this week, as i had requested it through my local M.D


#20

I’ve never paid any attention on worry on any of that and I’ve also not experienced one negative side effect of TRT. I only SUSPECT TRT made me hairier, darkened my hair, and caused hair recession. But that is only speculation.

I’ve also never gotten on the TRT Bionic Man/Cyborg Project in which one becomes a health-performance-well-being madman!