Nelson Vergel
Founder, ExcelMale.com
One of the most significant yet frequently overlooked consequences of testosterone replacement therapy is its profound suppressive effect on male fertility. When exogenous testosterone enters the bloodstream, it triggers negative feedback on the hypothalamic-pituitary-gonadal (HPG) axis, shutting down the body's production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Without LH to stimulate Leydig cells, intratesticular testosterone plummets by up to 94%—and without adequate intratesticular testosterone, spermatogenesis grinds to a halt.
The clinical reality is stark: men on TRT can become azoospermic (zero sperm) within 10 weeks of starting therapy, and up to 10% may remain permanently infertile even after discontinuation. For younger men on TRT who desire future fertility—a population that has grown dramatically as testosterone prescriptions have increased 58% among men aged 35-44—this represents a critical gap in patient education and clinical care.
This comprehensive guide examines the evidence-based strategies for preserving fertility while on TRT, recovering spermatogenesis after testosterone-induced azoospermia, and selecting the optimal protocol based on individual circumstances and fertility goals.
When exogenous testosterone is administered, the brain senses adequate (or supraphysiologic) testosterone levels and responds by suppressing GnRH release. This cascades to reduced LH and FSH secretion, which in turn causes Leydig cell quiescence and declining ITT. A landmark study by Coviello et al. demonstrated that men receiving 200mg testosterone enanthate weekly experienced a 94% reduction in ITT within just three weeks when no protective measures were employed.
The severity and permanence of suppression depends on several factors: the dose and duration of testosterone use, the specific formulation (longer-acting preparations like testosterone undecanoate are more suppressive), individual variation in HPG axis sensitivity, and whether any fertility-preserving interventions are employed. Men who use anabolic-androgenic steroids (AAS) at supraphysiologic doses face even more profound and prolonged suppression.
hCG Dose-Response for Intratesticular Testosterone Preservation
Based on this data, most fertility specialists recommend 500 IU hCG every other day (approximately 1,500 IU weekly) as the standard co-administration protocol for men on TRT who wish to preserve fertility. This dose maintains ITT above baseline levels while on exogenous testosterone.
A retrospective study by Hsieh et al. confirmed the clinical relevance of this approach: 26 hypogonadal men on TRT who received concurrent hCG 500 IU every other day showed no difference in semen volume, sperm density, or motility after one year of treatment, and none became azoospermic. This represents a dramatic departure from the expected outcome of TRT-only regimens.
Active intervention with gonadotropins dramatically accelerates recovery. A groundbreaking 2024 study from Baylor College of Medicine (Stocks et al., published in Fertility and Sterility) evaluated a "reboot" protocol using 3,000 IU hCG plus 75 IU FSH, both administered three times weekly, in 77 men with testosterone-induced azoospermia or severe oligospermia.
Concurrent TRT Allowed: Remarkably, there was no significant difference in recovery rates between men who discontinued testosterone during the reboot (74% improved) and those who remained on concurrent TRT during hCG/FSH therapy (74% improved). This finding challenges the traditional dogma that exogenous testosterone must be completely discontinued before attempting fertility recovery.
Clinical Implications: For men who are symptomatic off testosterone or who require ongoing TRT for medical reasons, the ability to pursue fertility recovery while maintaining testosterone therapy represents a significant advance in clinical options.
Step 1 - Baseline Assessment: Obtain semen analysis, FSH, LH, total testosterone, and estradiol. Consider cryopreservation if any sperm are present.
Step 2 - Initiate hCG + Clomiphene (or enclomiphene): Start hCG 2,000-3,000 IU every other day plus clomiphene citrate 25-50mg every other day (or daily). The clomiphene helps maintain FSH/LH signaling that high-dose hCG can suppress.
Step 3 - Three-Month Reassessment: Repeat semen analysis and hormones. If estradiol is elevated, add anastrozole 0.5-1mg twice weekly.
Step 4 - Add FSH if Needed: If azoospermia or severe oligospermia persists at three months, add recombinant FSH 75 IU every other day or three times weekly.
Step 5 - Consider Surgical Sperm Retrieval: If azoospermia persists after 6+ months of maximal medical therapy, testicular sperm extraction (TESE) or micro-TESE should be considered for men pursuing IVF/ICSI.
Regarding fertility outcomes, a 2023 study demonstrated that 60% of subfertile men treated with clomiphene showed improved sperm concentration, with one-third of severely oligospermic patients improving to levels compatible with intrauterine insemination (>5 million total motile sperm). Importantly, sperm concentration improvements may take 9 months to become apparent, while testosterone levels typically plateau at 6 months—counseling patients on realistic timelines is essential.
• Testosterone, FSH, LH, and estradiol at 3 weeks to assess initial response and guide dose titration
• Repeat assessment at 3 and 6 months for testosterone optimization
• Semen analysis at 6 and 9 months if fertility is the primary goal
• Consider adding anastrozole if testosterone:estradiol ratio is suboptimal
Some men experience inadequate symptom relief on clomiphene despite normalized testosterone levels, possibly due to elevated estradiol (clomiphene raises both testosterone and estradiol) or the specific tissue distribution of clomiphene's estrogenic effects. For these patients, combination therapy with anastrozole or transition to TRT with hCG co-administration may be preferable.
A 2024 systematic review of gonadotropin therapy in hypogonadotropic hypogonadism found that combination therapy (hCG + FSH) achieved complete spermatogenesis in 86% of patients, compared to only 40% with hCG monotherapy. While some men can achieve spermatogenesis with hCG alone—particularly those with post-pubertal onset hypogonadism and larger baseline testicular size—the addition of FSH significantly improves success rates and may accelerate recovery.
Sperm First Appearing in Ejaculate: 3-6 months from start of therapy
Sperm Concentration Improvement on Clomiphene: First significant improvement typically at 9 months
Maximum Sperm Production on hCG + FSH: May take 12-24 months in some cases
Average Time to Recovery with "Reboot" Protocol: 4.6-7 months based on published series
• Total and free testosterone, estradiol monthly during titration, then every 3 months
• FSH and LH to assess HPG axis recovery (should rise on clomiphene; will remain suppressed on TRT)
• Consider inhibin B as a marker of Sertoli cell function and spermatogenic potential
• Recovery may take 12-24 months rather than 3-6 months
• Higher hCG doses (up to 5,000 IU three times weekly) may be needed initially
• FSH is more likely to be required
• Some men may have permanent impairment despite maximal therapy
Factors predicting better recovery include younger age, shorter duration of steroid use, larger baseline testicular size, and post-pubertal onset of use. Men with smaller testes (<12mL volume) at presentation may have more limited recovery potential.
The key principles are: (1) discuss fertility goals before starting TRT, (2) consider baseline semen analysis and cryopreservation for all men of reproductive age, (3) co-administer hCG if fertility preservation during TRT is desired, (4) use clomiphene as an alternative to TRT when fertility is the priority, and (5) employ aggressive hCG + FSH protocols to recover spermatogenesis when needed.
Every man considering TRT deserves informed consent that includes a clear discussion of fertility implications and the available strategies to mitigate them. With 2024 data now showing that fertility recovery is possible even while continuing TRT, the options for managing both hypogonadism and fertility have never been more flexible.
• How to Maintain Fertility and Testicular Size While on TRT – Comprehensive overview of fertility preservation strategies during testosterone therapy
• HCG Dosing: Are Two Weekly Doses as Effective as Three? – Practical discussion of hCG dosing frequency optimization
• HCG Use in Men with Low Testosterone – Foundational thread on hCG as monotherapy and adjunct therapy
• Clomiphene for Low Testosterone: An Alternative to TRT – Clinical evidence and patient experiences with clomiphene monotherapy
2. Lee JA, et al. Indications for the use of hCG for management of infertility in hypogonadal men. Transl Androl Urol. 2018;7(Suppl 3):S348-S355. [PMC Full Text]
3. Management of Male Fertility in Hypogonadal Patients on TRT. Medicina. 2024;60(2):275. [MDPI Full Text]
4. Huijben M, et al. Clomiphene citrate for men with hypogonadism: systematic review and meta-analysis. Andrology. 2022;10(3):451-469. [Wiley Full Text]
5. Herati AS, et al. New frontiers in fertility preservation in men with hypergonadotropic hypogonadism. Transl Androl Urol. 2020;9(Suppl 2):S227-S232. [PMC Full Text]
6. Wenker EP, et al. Recovery of spermatogenesis following TRT or AAS use. Asian J Androl. 2016;18(3):373-380. [PMC Full Text]
7. Clomiphene Citrate for Male Hypogonadism: Mechanisms and Clinical Implications. Pharmaceuticals. 2024;17(9):1233. [PMC Full Text]
8. Temporal Changes of Clomiphene on Testosterone and Semen Parameters. Urology. 2023. [PMC Full Text]
9. Esteves SC. hCG-based clinical treatments for infertile men with non-obstructive azoospermia. Andrology. 2025. [Wiley Full Text]
10. Pozzi E, et al. Sperm Recovery Time and Efficacy of Monotherapy vs Combination Therapies in CHH. World J Mens Health. 2025. [WJMH Full Text]
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Fertility preservation and recovery require individualized assessment by a qualified healthcare provider, ideally a reproductive urologist or endocrinologist with expertise in male fertility. hCG and FSH are prescription medications, and clomiphene citrate is used off-label for male hypogonadism.
About ExcelMale.com: ExcelMale is a men's health forum with over 24,000 members and 20+ years of archived discussions on testosterone replacement therapy, hormone optimization, and sexual health. Founded by Nelson Vergel, author of Testosterone: A Man's Guide and Beyond Testosterone, ExcelMale provides evidence-based information and peer support for men navigating hormone health decisions.
The clinical reality is stark: men on TRT can become azoospermic (zero sperm) within 10 weeks of starting therapy, and up to 10% may remain permanently infertile even after discontinuation. For younger men on TRT who desire future fertility—a population that has grown dramatically as testosterone prescriptions have increased 58% among men aged 35-44—this represents a critical gap in patient education and clinical care.
This comprehensive guide examines the evidence-based strategies for preserving fertility while on TRT, recovering spermatogenesis after testosterone-induced azoospermia, and selecting the optimal protocol based on individual circumstances and fertility goals.
Understanding TRT-Induced Infertility: The HPG Axis Shutdown
The hypothalamic-pituitary-gonadal axis operates as a finely tuned feedback loop. The hypothalamus releases gonadotropin-releasing hormone (GnRH) in pulsatile fashion, which stimulates the pituitary to secrete LH and FSH. LH acts on testicular Leydig cells to produce testosterone, while FSH acts on Sertoli cells to support spermatogenesis. Critically, spermatogenesis requires extremely high concentrations of testosterone within the testes—intratesticular testosterone (ITT) levels are normally 50-100 times higher than serum levels.When exogenous testosterone is administered, the brain senses adequate (or supraphysiologic) testosterone levels and responds by suppressing GnRH release. This cascades to reduced LH and FSH secretion, which in turn causes Leydig cell quiescence and declining ITT. A landmark study by Coviello et al. demonstrated that men receiving 200mg testosterone enanthate weekly experienced a 94% reduction in ITT within just three weeks when no protective measures were employed.
The severity and permanence of suppression depends on several factors: the dose and duration of testosterone use, the specific formulation (longer-acting preparations like testosterone undecanoate are more suppressive), individual variation in HPG axis sensitivity, and whether any fertility-preserving interventions are employed. Men who use anabolic-androgenic steroids (AAS) at supraphysiologic doses face even more profound and prolonged suppression.
Human Chorionic Gonadotropin (hCG): The Foundation of Fertility Preservation
Human chorionic gonadotropin is structurally similar to LH and binds to the same receptors on Leydig cells, stimulating testosterone production independent of pituitary function. This makes hCG uniquely valuable for men on TRT: it can maintain intratesticular testosterone and preserve spermatogenesis even when the HPG axis is suppressed by exogenous testosterone.Dosing for Fertility Preservation During TRT
The Coviello study established dose-response relationships that inform clinical practice. Men receiving 200mg testosterone enanthate weekly plus hCG at varying doses showed dramatically different ITT outcomes:hCG Dose-Response for Intratesticular Testosterone Preservation
hCG Dose | ITT Change from Baseline | Clinical Implication |
| Placebo | -94% | Severe suppression; azoospermia likely |
125 IU every other day | -25% | Partial protection; may be insufficient |
250 IU every other day | -7% | Near-complete preservation |
500 IU every other day | +26% | Complete preservation + enhancement |
Based on this data, most fertility specialists recommend 500 IU hCG every other day (approximately 1,500 IU weekly) as the standard co-administration protocol for men on TRT who wish to preserve fertility. This dose maintains ITT above baseline levels while on exogenous testosterone.
A retrospective study by Hsieh et al. confirmed the clinical relevance of this approach: 26 hypogonadal men on TRT who received concurrent hCG 500 IU every other day showed no difference in semen volume, sperm density, or motility after one year of treatment, and none became azoospermic. This represents a dramatic departure from the expected outcome of TRT-only regimens.
hCG for Testicular Size Maintenance
Beyond fertility preservation, many men on TRT are concerned about testicular atrophy—a common and often distressing side effect of HPG axis suppression. Approximately 80% of testicular volume consists of seminiferous tubules containing developing sperm; when spermatogenesis stops, the testes shrink. For men not actively pursuing fertility but wishing to maintain testicular size, lower hCG doses of 1,500 IU weekly (e.g., 500 IU three times weekly or 750 IU twice weekly) are typically sufficient to prevent atrophy while minimizing estradiol elevation.Recovering Spermatogenesis After TRT: The "Reboot" Protocol
For men who developed azoospermia or severe oligospermia while on TRT without fertility protection, the goal shifts from preservation to recovery. Spontaneous recovery after TRT cessation is possible but slow and uncertain—median time to reach 20 million sperm/mL is 3.4 months, but some men may take years, and up to 10% may never fully recover.Active intervention with gonadotropins dramatically accelerates recovery. A groundbreaking 2024 study from Baylor College of Medicine (Stocks et al., published in Fertility and Sterility) evaluated a "reboot" protocol using 3,000 IU hCG plus 75 IU FSH, both administered three times weekly, in 77 men with testosterone-induced azoospermia or severe oligospermia.
Key Findings from the 2024 Baylor "Reboot" Study
Recovery Rate: 74% of all treated patients demonstrated improvement in sperm concentrations, with mean sperm concentration increasing from 2.2 million/mL to 15.2 million/mL after an average of 7 months of treatment.Concurrent TRT Allowed: Remarkably, there was no significant difference in recovery rates between men who discontinued testosterone during the reboot (74% improved) and those who remained on concurrent TRT during hCG/FSH therapy (74% improved). This finding challenges the traditional dogma that exogenous testosterone must be completely discontinued before attempting fertility recovery.
Clinical Implications: For men who are symptomatic off testosterone or who require ongoing TRT for medical reasons, the ability to pursue fertility recovery while maintaining testosterone therapy represents a significant advance in clinical options.
The Standard Recovery Algorithm
For men with testosterone-induced infertility seeking to restore spermatogenesis, fertility specialists typically recommend the following stepwise approach:Step 1 - Baseline Assessment: Obtain semen analysis, FSH, LH, total testosterone, and estradiol. Consider cryopreservation if any sperm are present.
Step 2 - Initiate hCG + Clomiphene (or enclomiphene): Start hCG 2,000-3,000 IU every other day plus clomiphene citrate 25-50mg every other day (or daily). The clomiphene helps maintain FSH/LH signaling that high-dose hCG can suppress.
Step 3 - Three-Month Reassessment: Repeat semen analysis and hormones. If estradiol is elevated, add anastrozole 0.5-1mg twice weekly.
Step 4 - Add FSH if Needed: If azoospermia or severe oligospermia persists at three months, add recombinant FSH 75 IU every other day or three times weekly.
Step 5 - Consider Surgical Sperm Retrieval: If azoospermia persists after 6+ months of maximal medical therapy, testicular sperm extraction (TESE) or micro-TESE should be considered for men pursuing IVF/ICSI.
Clomiphene Citrate: The Fertility-Friendly TRT Alternative
For men with hypogonadism who prioritize fertility preservation, clomiphene citrate offers an alternative approach that treats hypogonadal symptoms while preserving or even enhancing spermatogenesis. Unlike exogenous testosterone, clomiphene works by blocking estrogen receptors in the hypothalamus, thereby disinhibiting GnRH release and stimulating endogenous testosterone production through increased LH secretion.Efficacy Data
A 2022 systematic review and meta-analysis of 19 studies comprising 1,642 patients found that clomiphene citrate treatment increased total testosterone by an average of 260 ng/dL, with concurrent improvements in LH, FSH, and symptom scores on validated questionnaires. Therapy duration in included studies ranged from 1.5 to 52 months.Regarding fertility outcomes, a 2023 study demonstrated that 60% of subfertile men treated with clomiphene showed improved sperm concentration, with one-third of severely oligospermic patients improving to levels compatible with intrauterine insemination (>5 million total motile sperm). Importantly, sperm concentration improvements may take 9 months to become apparent, while testosterone levels typically plateau at 6 months—counseling patients on realistic timelines is essential.
Clomiphene Dosing and Monitoring
Standard clomiphene dosing for male hypogonadism is 25-50mg daily or 50mg every other day. Lower doses (12.5-25mg daily) may be sufficient for some men and minimize estradiol elevation. Monitoring should include:• Testosterone, FSH, LH, and estradiol at 3 weeks to assess initial response and guide dose titration
• Repeat assessment at 3 and 6 months for testosterone optimization
• Semen analysis at 6 and 9 months if fertility is the primary goal
• Consider adding anastrozole if testosterone:estradiol ratio is suboptimal
Clomiphene Limitations
Clomiphene is not effective for all men with hypogonadism. It requires functional testes capable of responding to LH stimulation—men with primary hypogonadism (testicular failure) will not respond. It also requires intact hypothalamic-pituitary function; men with pituitary tumors, Kallmann syndrome, or other causes of hypogonadotropic hypogonadism need gonadotropin therapy (hCG ± FSH) rather than clomiphene.Some men experience inadequate symptom relief on clomiphene despite normalized testosterone levels, possibly due to elevated estradiol (clomiphene raises both testosterone and estradiol) or the specific tissue distribution of clomiphene's estrogenic effects. For these patients, combination therapy with anastrozole or transition to TRT with hCG co-administration may be preferable.
The Critical Role of FSH in Spermatogenesis Recovery
While hCG addresses the testosterone component of spermatogenesis by stimulating Leydig cells, optimal sperm production requires FSH action on Sertoli cells. FSH supports Sertoli cell function, promotes spermatogonial proliferation, and is necessary for quantitatively normal spermatogenesis. This is why combined hCG + FSH therapy achieves superior outcomes compared to hCG alone.A 2024 systematic review of gonadotropin therapy in hypogonadotropic hypogonadism found that combination therapy (hCG + FSH) achieved complete spermatogenesis in 86% of patients, compared to only 40% with hCG monotherapy. While some men can achieve spermatogenesis with hCG alone—particularly those with post-pubertal onset hypogonadism and larger baseline testicular size—the addition of FSH significantly improves success rates and may accelerate recovery.
FSH Options and Dosing
Recombinant FSH (follitropin alfa/Gonal-F or follitropin beta/Follistim) and human menopausal gonadotropin (hMG, which contains both FSH and LH activity) are available options. Typical dosing is 75-150 IU three times weekly, adjusted based on response. FSH is expensive and requires subcutaneous injection, so it is typically reserved for men who fail to recover spermatogenesis on hCG ± clomiphene alone.Practical Protocol Selection: Matching Treatment to Patient Goals
Scenario 1: Man Starting TRT Who Desires Future Fertility
Recommended Protocol: TRT + hCG 500 IU every other day from the outset. This prevents the fertility damage rather than trying to repair it later. Consider baseline semen analysis and cryopreservation as insurance.Scenario 2: Man on Long-Term TRT Now Wanting to Conceive
Recommended Protocol: Add hCG 3,000 IU three times weekly + clomiphene 25-50mg daily. Can remain on TRT per the 2024 Baylor data. Obtain semen analysis at baseline and every 3 months. If no improvement at 3-6 months, add FSH 75 IU three times weekly. Refer to reproductive urologist if azoospermia persists at 9-12 months.Scenario 3: Hypogonadal Man Who Prioritizes Fertility Over Symptom Control
Recommended Protocol: Clomiphene citrate 25-50mg daily as monotherapy. Avoid exogenous testosterone entirely. Monitor testosterone, estradiol, and semen parameters. Consider adding hCG if clomiphene alone is insufficient for symptom relief or fertility goals.Scenario 4: Man With Hypogonadotropic Hypogonadism (Pituitary/Hypothalamic Dysfunction)
Recommended Protocol: hCG 1,500-2,000 IU two to three times weekly, titrated to achieve normal testosterone. If spermatogenesis does not initiate within 4-6 months, add FSH 75-150 IU every other day. Note: Clomiphene will NOT work in this population as it requires intact hypothalamic-pituitary function. May take up to 2 years to achieve maximum sperm production.Monitoring and Realistic Timelines
Understanding the biology of spermatogenesis is crucial for setting appropriate expectations. The complete spermatogenic cycle—from spermatogonial stem cell to mature sperm in the ejaculate—takes approximately 74 days (about 2.5 months). This means that any intervention affecting spermatogenesis will take at least 3 months to manifest in improved semen parameters.Expected Timelines
Testosterone Response to hCG/Clomiphene: 2-4 weeks for initial rise; plateau at 4-6 weeksSperm First Appearing in Ejaculate: 3-6 months from start of therapy
Sperm Concentration Improvement on Clomiphene: First significant improvement typically at 9 months
Maximum Sperm Production on hCG + FSH: May take 12-24 months in some cases
Average Time to Recovery with "Reboot" Protocol: 4.6-7 months based on published series
Monitoring Parameters
• Semen analysis every 3 months until goal achieved• Total and free testosterone, estradiol monthly during titration, then every 3 months
• FSH and LH to assess HPG axis recovery (should rise on clomiphene; will remain suppressed on TRT)
• Consider inhibin B as a marker of Sertoli cell function and spermatogenic potential
Special Considerations: AAS Users and Prolonged Suppression
Men who have used anabolic-androgenic steroids (AAS) at supraphysiologic doses often face more profound and prolonged HPG axis suppression than those on therapeutic TRT. Higher doses, longer duration of use, and the use of particularly suppressive compounds (e.g., nandrolone, XXXXXXXXXX) are associated with more difficult recovery. The same protocols apply, but expectations should be tempered:• Recovery may take 12-24 months rather than 3-6 months
• Higher hCG doses (up to 5,000 IU three times weekly) may be needed initially
• FSH is more likely to be required
• Some men may have permanent impairment despite maximal therapy
Factors predicting better recovery include younger age, shorter duration of steroid use, larger baseline testicular size, and post-pubertal onset of use. Men with smaller testes (<12mL volume) at presentation may have more limited recovery potential.
Conclusion: Fertility and TRT Can Coexist
The traditional view that TRT and fertility are mutually exclusive is outdated. With appropriate planning and intervention, men on testosterone therapy can preserve their fertility potential, and those who have already experienced TRT-induced infertility can often recover spermatogenesis with targeted medical therapy.The key principles are: (1) discuss fertility goals before starting TRT, (2) consider baseline semen analysis and cryopreservation for all men of reproductive age, (3) co-administer hCG if fertility preservation during TRT is desired, (4) use clomiphene as an alternative to TRT when fertility is the priority, and (5) employ aggressive hCG + FSH protocols to recover spermatogenesis when needed.
Every man considering TRT deserves informed consent that includes a clear discussion of fertility implications and the available strategies to mitigate them. With 2024 data now showing that fertility recovery is possible even while continuing TRT, the options for managing both hypogonadism and fertility have never been more flexible.
Related ExcelMale Forum Discussions
Explore these community discussions for real-world experiences and additional insights:• How to Maintain Fertility and Testicular Size While on TRT – Comprehensive overview of fertility preservation strategies during testosterone therapy
• HCG Dosing: Are Two Weekly Doses as Effective as Three? – Practical discussion of hCG dosing frequency optimization
• HCG Use in Men with Low Testosterone – Foundational thread on hCG as monotherapy and adjunct therapy
• Clomiphene for Low Testosterone: An Alternative to TRT – Clinical evidence and patient experiences with clomiphene monotherapy
Key References
1. Stocks BT, et al. Optimal restoration of spermatogenesis after testosterone therapy using hCG and FSH. Fertil Steril. 2025;123(4):607-615. [PubMed]2. Lee JA, et al. Indications for the use of hCG for management of infertility in hypogonadal men. Transl Androl Urol. 2018;7(Suppl 3):S348-S355. [PMC Full Text]
3. Management of Male Fertility in Hypogonadal Patients on TRT. Medicina. 2024;60(2):275. [MDPI Full Text]
4. Huijben M, et al. Clomiphene citrate for men with hypogonadism: systematic review and meta-analysis. Andrology. 2022;10(3):451-469. [Wiley Full Text]
5. Herati AS, et al. New frontiers in fertility preservation in men with hypergonadotropic hypogonadism. Transl Androl Urol. 2020;9(Suppl 2):S227-S232. [PMC Full Text]
6. Wenker EP, et al. Recovery of spermatogenesis following TRT or AAS use. Asian J Androl. 2016;18(3):373-380. [PMC Full Text]
7. Clomiphene Citrate for Male Hypogonadism: Mechanisms and Clinical Implications. Pharmaceuticals. 2024;17(9):1233. [PMC Full Text]
8. Temporal Changes of Clomiphene on Testosterone and Semen Parameters. Urology. 2023. [PMC Full Text]
9. Esteves SC. hCG-based clinical treatments for infertile men with non-obstructive azoospermia. Andrology. 2025. [Wiley Full Text]
10. Pozzi E, et al. Sperm Recovery Time and Efficacy of Monotherapy vs Combination Therapies in CHH. World J Mens Health. 2025. [WJMH Full Text]
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Fertility preservation and recovery require individualized assessment by a qualified healthcare provider, ideally a reproductive urologist or endocrinologist with expertise in male fertility. hCG and FSH are prescription medications, and clomiphene citrate is used off-label for male hypogonadism.
About ExcelMale.com: ExcelMale is a men's health forum with over 24,000 members and 20+ years of archived discussions on testosterone replacement therapy, hormone optimization, and sexual health. Founded by Nelson Vergel, author of Testosterone: A Man's Guide and Beyond Testosterone, ExcelMale provides evidence-based information and peer support for men navigating hormone health decisions.
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