Effect of Combined Low Dose hCG, FSH and Testosterone therapy versus Conventional High Dose hCG and FSH on Spermatogenesis and Biomarkers in Men

[Nelson Vergel]

HIGHLIGHTS​

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  a rational approach for inducing fertility in male CHH patients is to initiate combination therapy targeting FSH within the range of 4-8 units/L, hCG with a prime focus on achieving target AMH levels (<6·9 ng/ml) and exogenous T to target normal T levels.
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  our study demonstrates the potential value of monitoring AMH and inh B levels as proxy indicators for the likelihood of spermatogenesis.
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  Younger age, longer treatment duration, and greater reduction in AMH from baseline were identified as factors predicting successful spermatogenesis.
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  The available data do not indicate that prior T treatment has any adverse effect.

Abstract​

Objective​

In male Congenital hypogonadotropic hypogonadism(CHH), it was observed that lower dose human gonadotropic hormone(hCG) can maintain normal intratesticular testosterone(ITT) levels. We propose this study to compare the Low-Dose hCG, follicle stimulating hormone(FSH), and Testosterone(T) [LFT Regimen] to conventional treatment to induce virilization and fertility.

Design​

This open-label randomized pilot study was conducted from June 2020 to December 2021.

Subjects and outcome measures​

CHH were randomly assigned to either the LFT regimen (Group A)-low-dose hCG (500U thrice per week), FSH(150U thrice per week) and T(100mg biweekly) or conventional therapy(GroupB) with high hCG dose(2000U thrice per week) and the same FSH dose. The hCG dosage was titrated to reduce Anti-mullerian hormone(AMH) by 50% and normalization of plasma T in groups A and B, respectively. The primary objective was to compare the percentage of individuals who achieved spermatogenesis between the two groups.

Results​

Out of 30 patients, 23(76·7%) subjects achieved spermatogenesis, and the median time was 12(9-14·9)months. There was no difference in achieving spermatogenesis between the two groups (64·3%vs87·5%,p=0·204), and even the median time for spermatogenesis was similar (15monthsvs12months,p=0·248). Both groups had non-significant median plasma AMH at spermatogenesis,[6·6ng/ml(3·3-9·76) vs 4·41ng/ml(2·3-6·47),p=0·298]. Similarly, the median plasma Inhibin B at spermatogenesis between groups were comparable[152·4pg/ml(101·7-198·0)vs149·1pg/ml(128·7-237·3),p=0·488].

Conclusions​

A reasonable approach to induce fertility in male CHH is to initiate combination therapy using FSH, low-dose hCG targeting AMH <6·9 ng/ml, along with T to achieve normal range. Monitoring AMH could serve as a proxy indicator of spermatogenesis.

Effect of Combined Low Dose Human Gonadotropic Hormone , Follicle Stimulating Hormone, and Testosterone Therapy (LFT Regimen) Versus Conventional High Dose Human Gonadotropic Hormone and Follicle Stimulating Hormone on Spermatogenesis and Biomarkers

In male congenital hypogonadotropic hypogonadism (CHH), it was observed that lower dose human gonadotropic hormone (hCG) can maintain normal intratest…

www.sciencedirect.com

 

[jc2c]

@Nelson Vergel Thanks for the post. Six months after adding FSH to TRT+hCG, my sperm concentration went from 0.55 M/mL to 2.3 M/mL. Do you think that's good progress?

 

[Nelson Vergel]

Do you think that's good progress?

Sorry for the late reply (I am traveling).

Do you have a sperm report like this one?

Semen Analysis Optimum Parameters

Here is a sample semen analysis report (optimum ranges) that I was able to obtain from a friend. Infertility testing: In an evaluation of a man's fertility, each aspect of the semen analysis is considered, as well as the findings as a whole. Semen from a man can vary widely from sample to...

www.excelmale.com

 

[Forty2]

@Nelson Vergel Thanks for the post. Six months after adding FSH to TRT+hCG, my sperm concentration went from 0.55 M/mL to 2.3 M/mL. Do you think that's good progress?

How much FSH are you taking and have you felt any different from it?

 

[jc2c]

Sorry for the late reply (I am traveling).

Do you have a sperm report like this one?

Semen Analysis Optimum Parameters

Here is a sample semen analysis report (optimum ranges) that I was able to obtain from a friend. Infertility testing: In an evaluation of a man's fertility, each aspect of the semen analysis is considered, as well as the findings as a whole. Semen from a man can vary widely from sample to...

www.excelmale.com

Yes, I posted it a while back and you commented on it. Main concern is am I making decent progress? I got an order for AMH after reading the paper you linked to. I thought about also ordering Inhibin B but I'm not sure what I'd do with the results. The paper was less clear on how to act on Inhibin B results (vs. AMH it had a clear protocol). Here's my post with my semen analyses: FSH+hCG+TRT Semen Analysis

 

[jc2c]

How much FSH are you taking and have you felt any different from it?

Originally 75 IU 3x/week. Upped it to 150 IU 3x/week. I feel like I got a libido boost and volume of ejaculate increased. Nothing too crazy. Not as much of a libido boost as when I added hCG back in the day but not negligible either.