Failed PCT - Getting Off TRT for Fertility Purposes

[rimseb]

Hey guys,

I’ll try to keep this short not to overwhelm with a lot of info. I can add more if anyone asks otherwise it would be a wall of text.

I started TRT in July 2019 because of low T ( varying from lowest 2.1 to 4.1 ng / ml the highest tested during the course of 3 years ) and low libido / ED / lack of energy.

Before getting on it, I did a sperm freeze ( 21 million ) since I want to have kids in the future.

Started at 100mg / week just T enanthate. Symptoms improved mostly apart from ED which was better but not totally cured.

Fast forward, I changed doctors since the one following me was unavailable and I found a very good doctor in Greece specialising in TRT ( and being on it himself for years ).

When he saw the semen analysis of the frozen sample he said it wasn’t optimal so suggested we add HCG to the protocol to raise it and do a better freeze. He saw a previous one from a couple years ago which was at 65 million so thought we should be able to reach that.

In the next three months we tweaked it constantly by increasing HCG up to 1500 IU 3x a week plus later for one month adding HMG 75IU 3x a week in addition to zinc / proviron and dhea.

After 3 months the best we could get was 11 million ( still not enough ). So then I made the decision to try to get off TRT for a while till I get a decent sample frozen and then back on it for life.

At that point we started the following protocol:

After the last T shot, for the first two weeks , 1500 IU HCG 3x a week and 75IU HMG.
The third and forth week, 25mg Clomid along with 10mg Nolvadex every day.

So after one month I went in and did the hormones lab tests and spermiogram again. While the spermiogram improved ( 14 mill compared to 11 mill two weeks before ) the HPTA recovery was pretty bad , posting numbers below :

Needless to say with a total T of 1.1 I feel like shit but still down to sacrifice a few months of misery is there is any chance of fertility recovering and test going up by a bit.

My doctor suggested if I want to keep trying, I should switch now for the next 2 weeks to clomid alone EOD 25mgs, add proviron 50mg / day. Re-test in 2 weeks and act based on results.

So what do you think of the protocol so far and from your experience, is there any real chance of recovery.

Thanks!

 

[bochinit]

Are you trying to have kids?

 

[rimseb]

Are you trying to have kids?

Not right now, I'm trying to get some piece of mind by having a proper semen sample frozen.

 

[Cataceous]

Seems like a decent protocol and the gonadotropins are somewhat typical for a month of recovery, though T does seem low. Still, it's worth going at least another couple months to see if there are further improvements. Proviron seems questionable, though will make you feel better.

 

[gaz7718]

I was wondering whether you gave the HMG enough time. If I read correctly you only used HMG for one month with HCG and at the bottom of the dose range of successful studies which went on for a number of months.
I had positive results with EOD HMG and HCG and it was in month 3 of this protocol that my wife became pregnant.

 

[bochinit]

Not right now, I'm trying to get some piece of mind by having a proper semen sample frozen.

(My opinion) does not need to be much worried about it, I really think we can have kids on trt.

 

[rimseb]

Seems like a decent protocol and the gonadotropins are somewhat typical for a month of recovery, though T does seem low. Still, it's worth going at least another couple months to see if there are further improvements. Proviron seems questionable, though will make you feel better.

Yeah I agree. I think the low response in T is because of too much HCG was used and the LH receptors are desensitised right now. Before TRT I tried a Clomid protocol starting at 50mg EOD and tapering to every two days the second month and every three days the third. The results which I will post below were very different ( much better ) back then.

My plan for now is try to give it some more time if the situation will still be manageable in terms of symptoms.
One of the main reasons I got on TRT was libido and ED which TRT didn't totally solve, but again, that might have been due to mixing too many things ( Test, HCG, HMG, Proviron).

 

[rimseb]

I was wondering whether you gave the HMG enough time. If I read correctly you only used HMG for one month with HCG and at the bottom of the dose range of successful studies which went on for a number of months.
I had positive results with EOD HMG and HCG and it was in month 3 of this protocol that my wife became pregnant.

Yeah that's also something that I was wondering. I guess my doctor was just concerned of receptor desensitization so I said let's give the restart a try and later on can add HCG+HMG without TRT to boost things further.

@gaz7718 Can you please post the protocol you followed and what the semen parameters were before and after. It would be greatly appreciated!

 

[Chroniclowe]

Hey guys,

I’ll try to keep this short not to overwhelm with a lot of info. I can add more if anyone asks otherwise it would be a wall of text.

I started TRT in July 2019 because of low T ( varying from lowest 2.1 to 4.1 ng / ml the highest tested during the course of 3 years ) and low libido / ED / lack of energy.

Before getting on it, I did a sperm freeze ( 21 million ) since I want to have kids in the future.

Started at 100mg / week just T enanthate. Symptoms improved mostly apart from ED which was better but not totally cured.

Fast forward, I changed doctors since the one following me was unavailable and I found a very good doctor in Greece specialising in TRT ( and being on it himself for years ).

When he saw the semen analysis of the frozen sample he said it wasn’t optimal so suggested we add HCG to the protocol to raise it and do a better freeze. He saw a previous one from a couple years ago which was at 65 million so thought we should be able to reach that.

In the next three months we tweaked it constantly by increasing HCG up to 1500 IU 3x a week plus later for one month adding HMG 75IU 3x a week in addition to zinc / proviron and dhea.

After 3 months the best we could get was 11 million ( still not enough ). So then I made the decision to try to get off TRT for a while till I get a decent sample frozen and then back on it for life.

At that point we started the following protocol:

After the last T shot, for the first two weeks , 1500 IU HCG 3x a week and 75IU HMG.
The third and forth week, 25mg Clomid along with 10mg Nolvadex every day.

So after one month I went in and did the hormones lab tests and spermiogram again. While the spermiogram improved ( 14 mill compared to 11 mill two weeks before ) the HPTA recovery was pretty bad , posting numbers below :

View attachment 9454

Needless to say with a total T of 1.1 I feel like shit but still down to sacrifice a few months of misery is there is any chance of fertility recovering and test going up by a bit.

My doctor suggested if I want to keep trying, I should switch now for the next 2 weeks to clomid alone EOD 25mgs, add proviron 50mg / day. Re-test in 2 weeks and act based on results.

So what do you think of the protocol so far and from your experience, is there any real chance of recovery.

Thanks!

Are you from greece? Are there still proviron available? And have you heard dave palumbo fertility protocol? Clomid 50mg day, hcg 2000iu eod, fsh/hmg 75iu ed for 3-months if i remember right. With this protocol plenty of people has usually got them wife pregnant in 3-months. Despite they have run trt or gear for decades. I would look that if you want to get your sperm count up fast and jump back on your trt. Im gonna do it when its my time to have a kids.

 

[rimseb]

Are you from greece? Are there still proviron available? And have you heard dave palumbo fertility protocol? Clomid 50mg day, hcg 2000iu eod, fsh/hmg 75iu ed for 3-months if i remember right. With this protocol plenty of people has usually got them wife pregnant in 3-months. Despite they have run trt or gear for decades. I would look that if you want to get your sperm count up fast and jump back on your trt. Im gonna do it when its my time to have a kids.

No I'm not from Greece but my doc told me you can find Proviron there.

Thanks for the protocol, it looks solid!

 

[ajax31]

This won't make me popular around here, but, if I were you, I would consider adding a low-dose AI to your proposed clomiphene trial.

World J Mens Health. 2020 Feb 24. doi: 10.5534/wjmh.190160. [Epub ahead of print]
Obesity and Baseline Estradiol Levels Are Independent Predictors for Initiation of Anastrozole in Hypogonadal Men on Clomiphene Citrate.
Keihani S1, Alder NJ2, Cheng PJ2, Stoddard GJ3, Pastuszak AW2, Hotaling JM2.
Author information

Abstract
PURPOSE:
To assess the conversion rate from clomiphene citrate (CC) monotherapy to combination CC+anastrozole (AZ) therapy in hypogonadal men and the predictors associated with the initiation of AZ.
MATERIALS AND METHODS:
A retrospective review of records from hypogonadal men treated with CC in a single fertility center was performed from 2013 to 2018. Patient age, body mass index (BMI), blood pressure, and reproductive hormones were obtained at baseline. Obesity was defined as BMI≥30 kg/m². Cox proportional hazards models were used to identify predictors of switching to combination CC+AZ therapy.
RESULTS:
A total of 318 men on CC were included. Median (interquartile range) age was 34 years (30-39 years) and patients were followed for a median of 9 months (4-17 months). Of these, 97 (30.5%) were started on CC+AZ therapy. These patients had higher baseline BMI and estradiol, which in multivariable regression were significant predictors for switching to CC+AZ therapy. A threshold of 18.5 pg/mL for baseline estradiol provided the highest accuracy for predicting the addition of AZ after adjusting for baseline BMI and total testosterone levels.
CONCLUSIONS:
In our practice, following CC monotherapy, 30% of men were initiated on CC+AZ. Obesity (BMI≥30 kg/m²) and baseline estradiol ≥18.5 pg/mL can predict the conversion to combination therapy with addition of AZ. This information can be used to counsel patients and also help to identify patients who can be started on combination therapy upfront.
Copyright © 2020 Korean Society for Sexual Medicine and Andrology.
KEYWORDS:
Anastrozole; Clomiphene; Hypogonadism; Infertility, male; Testosterone

 

[gaz7718]

[/QUOTE]

basically 1500iu HCG and 75iu HMG EOD and tapered HCG down after a few weeks to 1000iu and then 500iu and maintained HMG at same level. TRT continued throughout including low dose deca at 90mg a week.

don’t have semen analysis but had been trying to make wife pregnant for nearly 1 year without success and towards the end of this time had a home kit confirming that my count was very low. About 5 weeks into the new protocol I retested and fertility was confirmed and about a month after wife became pregnant.

i am still taking the HMG as I have 5 months supply and am happy with how it makes me feel in terms of libido and sex life generally.

 

[rimseb]

basically 1500iu HCG and 75iu HMG EOD and tapered HCG down after a few weeks to 1000iu and then 500iu and maintained HMG at same level. TRT continued throughout including low dose deca at 90mg a week.

don’t have semen analysis but had been trying to make wife pregnant for nearly 1 year without success and towards the end of this time had a home kit confirming that my count was very low. About 5 weeks into the new protocol I retested and fertility was confirmed and about a month after wife became pregnant.

i am still taking the HMG as I have 5 months supply and am happy with how it makes me feel in terms of libido and sex life generally.

Thanks for the reply! Posts like this one give me hope that things can be fixed.

 

[Chroniclowe]

basically 1500iu HCG and 75iu HMG EOD and tapered HCG down after a few weeks to 1000iu and then 500iu and maintained HMG at same level. TRT continued throughout including low dose deca at 90mg a week.

don’t have semen analysis but had been trying to make wife pregnant for nearly 1 year without success and towards the end of this time had a home kit confirming that my count was very low. About 5 weeks into the new protocol I retested and fertility was confirmed and about a month after wife became pregnant.

i am still taking the HMG as I have 5 months supply and am happy with how it makes me feel in terms of libido and sex life generally.
[/QUOTE]
@gaz7718
Never heard anyone that got libido increase from hmg, as it mainly stimulates spermatogenesis. Do you got significant libido boost from it? Or just a little bit?

 

[rimseb]

Ok another update after two weeks.

The last two weeks ( week 5 and 6 ) I went from 25 clomid 10 nolva ED to just 25 clomid EOD.

While the sperm analysis went down from 14 mill to 10 mill ( I guess because of stopping HMG and HCG plus two weeks is too soon anyway) hormones look a bit better. Should I tapper down clomid to once every three days and see if the restart worked to keep at least decent levels of T?

Thanks

 

[Cataceous]

Maybe I'm being overly optimistic, but your current trajectory makes it look as though you could see further improvements at the current dose, and possibly at least maintain at a somewhat lower dose. If you're looking to maximize fertility shouldn't you stay with the current dose?

 

[rimseb]

Maybe I'm being overly optimistic, but you current trajectory makes it look as though you could see further improvements at the current dose, and possibly at least maintain at a somewhat lower dose. If you're looking to maximize fertility shouldn't you stay with the current dose?

Yes that's my plan, maybe lower it a bit and see how it goes from there.
Will discuss also with my doc today and see what he thinks.

 

[rimseb]

Another update. Now I've to decide between these two possible options how to continue ( after talking with my doctor ) :

1 - Drop Clomid and everything else and see how the HPTA stands on it's own and if it can recover. Do labs in two weeks and move from there.

2- Try to boost the sperm production by taking 150IU HCG a day and 75IU 3x / week for two months, along with 800 IU vit E and 50 grams Zinc

Thoughts?

 

[Cataceous]

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.

HCG Monotherapy to Clomid Ratio For Fertility

HCG Monotherapy to Clomid Ratio For Fertility

www.peaktestosterone.com

 

[rimseb]

Thanks for the reply @Cataceous.

Continuing with Clomid doesn't sounds bad. The only objection my doctor had is that it's not good using it for too long because it will spike estrogen really high.