I’ve been very interested in Dr. Saya’s fertility rankings posted below (HCG Monotherapy to Clomid Ratio For Fertility):
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.
My question is—couldn’t TRT+HCG in some cases be better for fertility than higher dose HCG Monotherapy?
I assume Dr Saya (@Dr Justin Saya MD maybe you can comment on this) placed HCG Monotherapy above T+HCG since the additional T is additionally suppressive. 100mg TC + 500iu EOD is worse for fertility than simply 500iu EOD, for example.
But couldn’t 100mg TC + 500iu EOD be better for fertility than say 1000iu or 1500 iu EOD (which are also standard monotherapy doses)? If 1000iu EOD is equally or more suppressive than 100mg TC + 500iu EOD (which seems like a reasonable assumption especially if one has a weak pituitary in which case both protocols may bring LH+FSH to 0), then wouldn’t it best to use the smallest dose possible to maintain normal ITT levels (which 500iu and less has shown to do)? Larger doses could bring a greater risk of desensitization or could cause excess intratesticular estradiol which is bad for fertility.
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.
My question is—couldn’t TRT+HCG in some cases be better for fertility than higher dose HCG Monotherapy?
I assume Dr Saya (@Dr Justin Saya MD maybe you can comment on this) placed HCG Monotherapy above T+HCG since the additional T is additionally suppressive. 100mg TC + 500iu EOD is worse for fertility than simply 500iu EOD, for example.
But couldn’t 100mg TC + 500iu EOD be better for fertility than say 1000iu or 1500 iu EOD (which are also standard monotherapy doses)? If 1000iu EOD is equally or more suppressive than 100mg TC + 500iu EOD (which seems like a reasonable assumption especially if one has a weak pituitary in which case both protocols may bring LH+FSH to 0), then wouldn’t it best to use the smallest dose possible to maintain normal ITT levels (which 500iu and less has shown to do)? Larger doses could bring a greater risk of desensitization or could cause excess intratesticular estradiol which is bad for fertility.
