T and HCG, fertility and semen analysis

Hi all, 33 y/o Male currently under Dr. Saya's care. I am currently on T Cyp 50mg 2 x week, HCG 500 IU 3 x week, and anastrozole .15mg 3 x week.

Just did bloodwork after 3 months of being on this regimen, everything looks good except LH and FSH.

LH - .1
FSH - <.2
E Sensitive - 20.8
Total T - 1292
Free T - 32.2
SHBG - 38.3


I am concerned that the HCG is not helping me maintain fertility. My wife and I will be looking at getting pregnant early next year so this will be my focus in the next 6-8 months or so. Reading all the research, I was very optimistic that I could remain fertile while on TRT. Dr. Saya suggested a semen analysis after 3 months of this regimen, but with fertility hormones this supressed...is it even worth spending the money? Is spermatogenisis even possible at these levels? I dont like Clomid therapy but will do it if need be. I've had fertility success (proven by semen analysis) with it in the past but I've never felt very good on it. Same low libido symptoms on the 50mg EOD protocol in the past with previous urologist.
Does anyone have any thoughts or guidance? Obviously the fertility concern is pretty stressful but I know it will require patience so I'm trying to address it sooner than later. appreciate the input in advance.

When you are taking Test, LH and FSH will be suppressed (because the HPTA having been susppressed by the exogenous Test,) but that does not reflect at all on your fertility so semen test is the only way to know if you are fertile or not.

What Tom said; and having counseling men on TRT for almost a decade now I can't even begin to tell you how many men on TRT got their women prego. As long as you're on HCG your chances of getting pregnant are very very good.

IMO, save your money on the test and start getting to work on that baby

Gene/Tom, Thanks! My simple mind rationalized that if hormones were low then no sperm would be made. I thought LH would spike on HCG. I clearly have a lot to learn in this lifelong journey. Well, you have eased my stress. I will schedule that analysis! Gene, I'm waiting until I totally forget the first 6 months from the first child.

Mikeyp6679 said:

Gene/Tom, Thanks! My simple mind rationalized that if hormones were low then no sperm would be made. I thought LH would spike on HCG. I clearly have a lot to learn in this lifelong journey. Well, you have eased my stress. I will schedule that analysis! Gene, I'm waiting until I totally forget the first 6 months from the first child.

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Hi Mikey - HCG mimics LH, but does NOT increase LH or show up on lab test as LH (this is why I generally don't even check LH/FSH for a male on TRT - this may have been a typo by my staff on lab order unless you requested LH/FSH specifically). Only way in this scenario to truly (objectively) assess fertility is via semen analysis.

Dr Justin Saya said:

Hi Mikey - HCG mimics LH, but does NOT increase LH or show up on lab test as LH (this is why I generally don't even check LH/FSH for a male on TRT - this may have been a typo by my staff on lab order unless you requested LH/FSH specifically). Only way in this scenario to truly (objectively) assess fertility is via semen analysis.

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Thanks, Dr. Saya. And here I thought it was a mistake to not include so I had the office include at my request. Well thanks guys, now I know. I'm anxious to see semen analysis results.