New to TRT, Going with Defy... Protocol thoughts?

Hey guys, newbie here. So glad to have found this site and I want to say thanks to Nelson and the old pros who provide such a great resource for information.

So I kept hearing about the symptoms of low testosterone and decided I'd like to get tested. Male, late 30s, diet and exercise are pretty good (though could be better). I didn't even bother trying to go through my PCP, just ordered through DiscountedLabs.com. Total testosterone: 297 ng/dL (264 - 916) and Free Testosterone 8.3 pg/mL (8.7 - 25.1). I've read that you want the percent of free/total testosterone to be above 2.0 ... well if I did the math right I'm at 0.28%.

Again despite the low numbers I'm not even going to try to go through my PCP. Based off what I've read so far it seems like a waste of time and also that I'd be much better off working with a doc who has expertise in this field, so I'm in the process of setting up a telemedicine consult with Defy Medical. Got a physical exam done locally and ordered a whole bunch of labs.

Would appreciate some input from you experienced guys about what kind of protocol to discuss with Dr. Saya. Fertility is a concern of mine so originally I was thinking I should try clomiphene and/or HCG monotherapy at first, with an AI if needed to manage E2 (as recommended for younger guys in Jay Campbell's book). I figured if testosterone was low, sperm count would probably also be low, so I should try to avoid making it any lower.

Well, the picture looks different after I got my semen analysis results. This may be a first for ExcelMale because I didn't find anything like this when I searched. My test results indicate Polyzoospermia, which is basically a ridiculously high sperm count. Normal range is 15 - 150 million sperm/mL of semen. Mine was 550 million/mL! Motility and morphology were within normal ranges. I was pretty shocked at this. Apparently though, excessively high sperm counts are actually not great and once they get too high fertility starts to decrease, for reasons that are unclear.

That being said, I'm now thinking maybe I should skip the clomiphene and start right out with testosterone and HCG. This will lower my sperm count but based on the results of that semen analysis, a reduction in my sperm count would actually increase my fertility.

What do you guys think? I will of course be getting future semen analysis tests to monitor the situation, along with bloodwork. Thanks.

I feel like Patrick Swayze in "Ghost," I can see everyone else but nobody can see me... Nobody has any thoughts? Ok how about a general question then -- the main reason for going with clomiphene over exogenous testosterone is due to fertility concerns, right?

Hi Kirk, It is the holiday weekend and to be honest I think you are asking questions most here won't have experience in.
Your best bet is to talk to Dr Saya. No one here wants to give you advice and you end up sterile.

That said welcome.

We beleive HCG will (should) preserve your fertility though we gettin very little discussion on fertility and sperm counts as most of us are well past wanting (more) kids.

Kirk I think your free T % is more like 2.8. At a 300 level T 2% of that would be 6. In any event you will be in good care with Defy. Be sure and have them include thyroid testing as well. Symptoms mimic each other in many ways. Good luck and welcome.

Here's a really good thread by Healthman, Semen analysis results after adding FSH to TRT and hCG.

https://www.excelmale.com/forum/sho...lysis-results-after-adding-FSH-to-TRT-and-hCG

1Draw said:

Kirk I think your free T % is more like 2.8. At a 300 level T 2% of that would be 6. In any event you will be in good care with Defy. Be sure and have them include thyroid testing as well. Symptoms mimic each other in many ways. Good luck and welcome.

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Oh, yeah is it just a ratio of one number over the other? If that's the way it's done then you're right it's 2.8%. But the units on the two numbers are different... ng/dL vs. pg/mL... so I thought they needed to be converted into the same units which is how I got 0.28%. Thanks.

FeelingLost said:

No one here wants to give you advice and you end up sterile.

That said welcome.

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Ah the subject matter gave people pause I guess. Yeah I'm not too worried, I plan to stay on top of it from the get go. Anyhow thanks, glad to have found this place.

user_joe said:

I know my wife and I together were super fertile when I certainly had low T. It's complicated. ... PM me if you are near Texas.

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Yeah it is complicated lol. Weird thing is my FSH was low too. All this stuff is complex but interesting and important I think. Nope not close to TX thanks though.

Vince Carter said:

...very little discussion on fertility and sperm counts as most of us are well past wanting (more) kids.

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One less variable you have to take into account then eh... well I feel pretty confident I can manage it especially since I'm paying attention to it from the very beginning even before starting any kind of treatment.

Vince said:

Here's a really good thread by Healthman, Semen analysis results after adding FSH to TRT and hCG.

https://www.excelmale.com/forum/sho...lysis-results-after-adding-FSH-to-TRT-and-hCG

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Yep that is a good thread. He's sort of coming at it from the opposite side of things from my situation, but who knows, maybe the lab messed up my test. Future testing will shed more light. Thanks.

I had a sperm count of 135 million around the time I was tested for having low testosterone. All the sperm was normal. After the wife eventually got pregnant. I was shocked thinking my low test was gonna mean low fertility.

Nate1278 said:

I was shocked thinking my low test was gonna mean low fertility.

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Ah good so maybe the lab didn't mess up my test after all lol

To update this in case anyone is interested, they want me to try clomiphene at first because of my age. So I said ok, let's give it a try. Hopefully it will work well for me in releiving low-T symptoms and I won't have any of the vision problems that I've heard about. At some point down the road I'll do another semen analysis and if the count is too high then I may need to switch to test + HCG, but I guess I'll burn that bridge when I come to it.

I'm thinking the same thing. I want to maybe try hcg first just to see if they raises my levels. I keep hearing people saying that clomid can make you feel miserable. Not sure.