Considering TRT + HCG after orchiectomy, chemo & recovering fertility

[rdrg-queiroz]

Hey everyone,

I'm looking for some advice and shared experiences from this community as I'm facing a decision about my hormonal health.

Background: I'm 21 and a testicular cancer survivor. The treatment involved chemotherapy last year, which, as a side effect, resulted in azoospermia. After a long road, I'm grateful to say that my natural fertility has returned, and preserving this is my absolute top priority. I do have sperm banked from before treatment as a safety net, but my strong preference is to maintain my own function if at all possible.

The other major consequence of the treatment was secondary hypogonadism. While the remaining testicle is functioning, LH stimulation is low. My journey to fix this started with Clomid, but the side effects were severe for me: complete emotional blunting and zero libido, so I had to stop. I then switched to HCG monotherapy, which has been an improvement. My current protocol is 2000 IU every three days.

While the HCG got my T levels off the floor (around 450 ng/dL), I still feel far from optimal. The symptoms of low T are all there: low libido, lack of drive and confidence, and finding it very difficult to gain muscle or recover from workouts. It's just not where I want to be.

This has led me to strongly consider moving to a TRT + HCG protocol. The goal would be to get my testosterone to a more stable and optimal level to actually resolve my symptoms, while having HCG as a maintenance dose to keep the testicles active. My huge hesitation is, of course, the risk to my fertility.

So I'm reaching out to you all for some input:

Has anyone here gone down a similar path, especially starting TRT after having recovered fertility post-chemotherapy? I'm trying to understand the chances of maintaining fertility on a TRT + HCG protocol in a case like mine.

Also, are there any specific protocols, dosages, or strategies that are considered "best practice" for someone in my unique situation, where preserving fertility is the number one concern?

Any personal stories or insights would be incredibly valuable as I weigh this decision. Thanks for taking the time to read.

 

[Cataceous]

Since fertility is a key concern, I'll start with a ranking by Dr. Saya from Defy Medical:

A *very* generalized ranking of relative fertilities (with top being most fertile):​

• 1. Clomid/SERM treatment
• 2(A). HCG + HMG (or lyophilized FSH)
• 2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.
• 3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)
• 3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)
• 4. TRT/AAS with no concurrent HCG.

It sounds like you've ruled out SERMs, although you could give enclomiphene a try, as it should have a somewhat better side effects profile than Clomid.

Adding in FSH/hMG would be a good option, but the cost might be prohibitive.

There's a new fertility-preserving option in the form of fast-acting testosterone. One example is testosterone nasal gel, e.g. Natesto. I was just debating where it would fall in the list. I'm thinking around 3. Each dose would put your testosterone way above the current 450 ng/dL, but for a limited time. The fallback to low levels between doses is what keeps your HPTA functioning and preserving of fertility. Putting this stuff up your nose indefinitely isn't for everyone. But if you try it and have good results then you could experiment with other types of fast-acting testosterone. Certain oral forms and buccal forms look promising. Injectable forms are possible, but so far unproven.