T Nation

TRT Prescribed - Infertility Concerns

Hi everybody,

Some quick stats: male, 27 y.o., 6’1 height, 175 lb weight, skinny with around 20% bodyfat I think.

3 weeks ago I was diagnosed with venous leakage and low T – blood tests came a little below 200ng/dl. Doc said it was extremely low for my age. But didn’t conduct any other studies.

I was prescribed with t shots of 300 mg/week for 6 months. Doctor said it “might” affect my sperm production, but that I would recover it after the treatment. Before this I didn’t have any sperm production issues (quantity and motility values were way beyond normal ranges), but since my wife and I might want to look for kids in the near future, I am really concerned about the impact that this may have.

Any experiences or suggestions? Is 300 mg too much?

I read that complementing with HCG might help preserve sperm production during the treatment. My doc said it wasn’t necessary. I will see another doctor (fertility specialist) to check for his opinion. In any event, can HCG be bought without a prescription?

Btw I’ve been feeling really good this last weeks. Quite alert throughout the day. Quite horny, too. Began strength training (SS protocol) a couple of months ago and gains have continued.


  • I went through a full Accutane cycle at around 15/16 y.o. Acne was on steroids and any other treatments had proven unsuccessful. I was not informed about any long term effects it might had.
  • I went through about a 6-12 months Finasteride cycle at around 20 y.o. Genetic hair loss began early, slowly but consistently at around 15 y.o. Didn’t notice major libido changes, but ultimately abandoned. Hair loss has continued but slower that I initially expected.

UPDATE 9-23-2014

  • I had a left test varicocele detected and treated (varicoceleoctomy) in July 2012.

You should have had LH/FSH tested before TRT. Your low T is a symptom and that doc did not do the diagnostics.

That dose of T is insane.

Please read the advice for new guys sticky.

I agree with everything that KSman said. If I were you, I’d find another doctor.

300mg/wk is a ridiculous TRT dose, especially without anything to keep your E2 in check.

HCG is absolutely beneficial for keeping the testes functions properly too. There are many fathers on TRT who can attest to that.

Thanks KSMan and AlwaysUp for your quick reply. I will read the advice for new guys sticky, and I will look for another doctor.

Do you think I should stop TRT altogether for now until I get another doc’s opinion and implement a TRT HCG protocol if necessary?

Also, having had 300mg/week three times now, should I worry about any long-term effects? Anything else I could do immediately to prevent it? First time I messed with hormones, so I’m pretty concerned.

If you are self injecting, you can change to twice a week now if you have enough syringes. In many US States, you can get insulin syringes without a Rx

UPDATE 9/11/14:

So I went today to another doc (urologist):

  • said 300mg/week was way too much and T shots not advisable if I wanted to get my wife pregnant
  • didn’t say a word about TRT HCG
  • suggested that I stopped with T shots and go with Clomid 50mg daily
  • ordered blood test: LH, total T, prolactin, FSH, estradiol, CMP, CBC, Lipid panel ($560!, arguably covered by insurance)
  • ordered scrotal ultrasound ($500!, arguably covered by insurance), I assume to diagnose the causes of low T
  • ordered complete semen analysis (not covered by insurance), to check the effects that T shots so far may have had on semen

So, what do you think? Does it make sense to replace T shots now with Clomid to preserve fertility?

PS: I have yet another appointment scheduled with one of the physicians that (suppossedly) work with Dr. Larry Lipshultz in Houston, TX (who I know that works with TRT HCG), but it is within a month. Appointments with Dr. Lipshultz were too far away in time.

I’ll let the experts here offer the best advice, but here is what I would do if I were you.

I’d reduce your current T injections to 100mg EW and wait until your appointment with the Dr. who works with Dr. Lipshultz to make any other changes. I’m guessing that he will get you set up with a good TRT protocol that includes hCG and an AI if you need it. If he works with Dr. Lipshultz, he’s likely got a good understanding of TRT.

Thank you AlwaysUp. I think it makes sense to me not to go off TRT right now having the prospect of seeing a more knowledgeable doc in 3 weeks.

KSman, any thoughts?

Here’s a contrary opinion. Why give up on your own nuts so fast? You’re only 27. Just think what will happen if HCG becomes too hard to get in a few years? You’ll have 1/2 sized sterile nuts for life. If the T supply gets cut off by the lawyers, you’ll be a eunuch. No offense to eunuchs intended.

A low dose serm might be all you need to raise your T levels into the upper range and it has a chance of restoring your own natural T production. Not everyone has adverse effects from clomid, but even if you do, you could try Nolvadex or even Enclomiphene which will hopefully be approved for long term use next year.

Listen to your urologist but make sure he lowers the dose after a month or so. Only go on TRT as a last resort.

hCG is an injected Rx hormone


We do not know if he is primary or secondary. If primary, hCG and SERM’s will not work well. LH/FSH prior to TRT was missed. Mal-practice in my opinion. I agree with your points concerning his age.

Thanks Freddy and KSman for your views. About 3-4 months ago I had a sperm test done and it was perfect. Had a couple more in the last years and same good results. Would that imply that I am secondary (from what I’ve learned, primary would have prevented normal spermatogenesis)?

Sorry for the urgency guys but tomorrow is my next shot so I have to come up with a decision today.

My initial impulse is, if something was done wrong, stop it altogether–unless there is an overriding reason not to. I assume that by now I have stopped producing T and sperm, so stopping T shots would make me feel like crap until I start producing again, and it would take 3-6 months to resume normal sperm production, if not more. I must note that before treatment I was not feeling crappy, only normal-to-low libido and certain cases of ED (venous leakage diagnosed), which was what moved me to consult in the first place.

What other reason, apart from Clomid’s reduced efficacy in case I’m primary–and its eventual sides if I’m one of those guys–, weighs in favor of keeping up with T shots?

You can ask for Clomid or Nolvadex and see what that does for you. If it works, you were secondary. Then you can see how you feel and could attempt a restart later. If T and LH/FSH labs while on the SERM is poor, the top end of your HPTA is not working and you will need to inject.

In some cases SERM’s overcome secondary. But that will not work if the pituitary or hypothalamus are not playing the game.

You can avoid potential clomid sides with nolvadex. You do not want high doses. Try 10mg/day, then 20mg/day if needed. Monitor E2 and use AI if needed.

Thanks KSman and the rest of you guys for your help. This forum has been incredibly helpful in only a couple of days of having discovered it. I will keep you posted. I think I will try Clomid or Nolvadex while monitoring E2.

UPDATE 9/15/14

So I started Clomid on Saturday. Reduced the dose to 25 mg for now. Probably tomorrow will have my blood/semen tested. No noticeable effects for now. Good mood, energy


  • I went through a full Accutane cycle at around 15/16 y.o. Acne was on steroids and any other treatments had proven unsuccessful. I was not informed about any long term effects it might had.
  • I went through about a 6-12 months Finasteride cycle at around 20 y.o. Genetic hair loss began early, slowly but consistently at around 15 y.o. Didn’t notice major libido changes, but ultimately abandoned. Hair loss has continued but slower that I initially expected.

Do you think this may have had an impact on my current low T?

We have seen guys here and elsewhere who have had permanent HPTA damage from Finasteride and other 5-alpha reductase inhibitors. Does the time frame fit. Some guys in that age range simply have unexplained HPTA failures. Typically when the hair loss drugs are involved, they know about the effect very soon.

venous leakage: suggest Cialis/tadalafil “every day” and see if that helps.

Thanks, KSman. Too bad for the Finasteride effect, but it is too late to lament. Tks for the advice on taladafil; I had already began trying it to great results!

UPDATE 09/18/14:

  • began taking 25 mg ED (half of my urologist prescribed dose) on Saturday.
  • 6 days now. I’ve been feeling really good in terms of energy, mood and general libido.
  • I’ve noticed that my testes shrinked a little (before I began Clomid and stopped the Tshots).
  • I’ve noticed my face got quite oily.
  • I’ve also noticed some general itching on the chest and arms, especially when lying on my bed. It began before I began Clomid and has continued up to today. Any ideas if I should worry about this? I don’t find any reddening or other things on my skin, it just itches from time to time.

I will have my blood tested probably tomorrow.

I think you’re on the right track taking the Clomid, however the only issue i see is if you get the BW now - you won’t know what the effects are from - whether it’s residual from the T shots or the Clomid. Honestly I’d say wait another month or two and repeat blood work then you know for sure it’s the Clomid that’s taking effect, then u can try getting off the Clomid and re testing and seeing if your HTPA restarted.

TRT can cause some skin changes and the effects at first may calm down in time. I found that TRT greatly increased my skin cell turnover, which has always been very high. So you can expect some changes. For older guys, skin can rejuvenate as collagen structures in the skin are restored. Skin then becomes thicker and more elastic. At your age, you will see less of this.