Fertility - Restart?

[TheDude84]

Hey everyone, this is my first post here.

I'm 30 and have been on TRT for 5 years, ever since I had a Pituitary Adnoma removed. I'm currently infertile and at the point where I want to have a baby. I'm working with a Dr. on this and after trying Clomid and HCG alongside the T without any results have decided to try and come off the.

Anyone have an encouraging story for me? I'm kind of bummin' right now. I anticipate feeling like crap in a week or two but am hoping to respond well. I'm going to stay on the clomid and HCG so hopefully things get rolling with the Cyp out of the way. We'll see over the next few weeks, wish me luck.

 

[Vettester Chris]

Seems we're getting new "dude" members lately. Glad you joined!

OK, makes sense with what you're trying to accomplish, and thanks for giving us the heads up (no pun) on the pituitary adenoma. Here's the thing, Clomid would be great for promoting gonadotropin secretion GnRH -> LH & FSH. Both LH & FSH promote testicular activity, FSH being "key" with spermatogenesis via receptors in the Sertoli cells. So knowing you had the pituitary surgery, how effective is Clomid working for you to produce endogenous LH & FSH? Presuming you ran these pre/post therapy labs?

IF your pituitary function is unable to produce sufficient levels of these hormones, then you have some pretty good options. You touched a bit on the HCG. HCG is simply a mimic analog of LH. This will promote testicular activity in the leydig cells, which in turn produces endogenous testosterone. Again, HCG is the LH side of it, but it does not have the FSH analog. Look into HMG (Human Menopausal Gonadotropin), which will provide both LH & FSH. A combination of HCG and HMG "could" be the ticket! You can gauge it with sperm tests (count, motility, morphology ...) to see the progress.

Like with everything else, it's the labs that will tell you what is needed ...

 

[TheDude84]

After 2 months of Clomid @ 25mg ED and 1 month of HCG @ 150iu ED LH and FSH barely registered (<0.1 mlu/ml & 0.4 mlu/ml respectively). I guess the next step is to drop the Cyp completely and hope that I respond to the same dose of Clomid and HCG? We plan on running more labs in 4 weeks.

 

[Nelson Vergel]

I think you need higher doses of HCG to accomplish better sperm quality. Why not try Lipshultz' protocol of HCG 500 IU every other day plus testosterone replacement? He did not use Clomid.

 

[TheDude84]

I'm not opposed to trying it at all. I need to get my Doc on board before I deviate from his recommendation I think.

If I can get to the point of being fertile I can have sperm preserved and go back on TRT, correct?

 

[Randy]

My endo made me wait 6 months, since my last T injection, to see if my body would recover naturally. OMG, what a fkn horrible experience. We got enough sperm frozen for ISCI, did our first IVF cycle last year, which didn't work. Looking to try again in June. It's a bit crap for the female too as she has to take meds to suppress her hormones (she will likely get menopause symptoms). Wasn't as bad as a lot of the stuff you can read online at all.

 

[Nelson Vergel]

Lipshultz Fertility Protocol Using Testosterone and HCG

Here is Lipshultz protocol (attached)

Print it and discuss with your doctor.

I would suggest you use the protocol I show on this video splitting T dose to 33 mg plus 500 IU HCG three times per week. A sperm sample before starting and then 6-8 weeks later would be advisable.

https://www.excelmale.com/?s=149-Ho...o-Preserve-Fertility-Libido-and-Testicle-Size

 

[TheDude84]

I will send this to my doctor. He is on the "cutting edge" of TRT so I'm sure he is familiar with this already. I hope he is interested because I'm likely to feel pretty poorly here in another week or so.

 

[TheDude84]

Randy, you said you felt horrible? About how long after the last injection did it start? So far I'm good; its been a week. Was there anything that eased the symptoms other than T?

 

[Vettester Chris]

After 2 months of Clomid @ 25mg ED and 1 month of HCG @ 150iu ED LH and FSH barely registered (<0.1 mlu/ml & 0.4 mlu/ml respectively). I guess the next step is to drop the Cyp completely and hope that I respond to the same dose of Clomid and HCG? We plan on running more labs in 4 weeks.

If nothing is firing up after two months of Clomid, then it doesn't sound like your HPTA is able to produce these hormones with or without a SERM.

I like the HCG concept that Nelson mentions with Dr. Lipshultz, but why not look into HMG as well? I would think combining the two analogs (FSH and LH) would greatly improve the chances for spermatogenesis.

 

[Randy]

Sorry to be more specific, I felt horrible when going off T (Nebido) as that's called "testosterone undecanoate" - long slow release and very suppressive of natural hormone production. Basically I had NO testosterone for 5-6 months... the feeling of that isn't great. My system did recover enough by itself to get enough sperm frozen.

Studies have shown it can take about 12 months for a guy to create sperm post Reandron. However some guys still produce, just depends on the individual I guess.

Only T, eases the symptoms for me. There's nothing like it.

 

[Dr. John Crisler]

Here is Lipshultz protocol (attached)

Print it and discuss with your doctor.

I would suggest you use the protocol I show on this video splitting T dose to 33 mg plus 500 IU HCG three times per week. A sperm sample before starting and then 6-8 weeks later would be advisable.

https://www.excelmale.com/?s=149-Ho...o-Preserve-Fertility-Libido-and-Testicle-Size

That is a fascinating paper. Dr. Lipshultz has been a real blessing to our field of medicine.

I would note that maintaining fertility is quite different than restoring it.

 

[Randy]

Frankly what amazes me is how little most Doctors, Endocrinologists, and even Fertility Specialists know of how to treat fertility issues in guys with hypogonadism!

Thanks to the pioneers in our community this is changing!

 

[TheDude84]

So at this point I'm feeling pretty crappy. Major complaints are that i have been having headaches every day, haven't slept well in about a week, difficult to concentrate on mental tasks. I don't take any more blood tests for 2 weeks. Is there anything I can do in the meantime to help with these symptoms? I realize the answer is likely "suck it up buttercup" but I can't help but ask.

 

[Nelson Vergel]

TheDude84

Sorry you are feeling like crap. can you update us on any changes in your regimen since you started this thread?

 

[TheDude84]

I dropped testosterone injections completely as of January 3. I am taking Clomid @ 25mg ED and HCG @ 150 IU ED. I have been instructed to wait 4-6 weeks after the last injection and then test for Total T, FSH, LH and SHBG. Right now I'm just waiting for February to get here.

 

[Nelson Vergel]

Is your goal to get off everything eventually or to keep your fertility up? If it is the later, you will probably feel better with TRT+HCG.

 

[TheDude84]

The main goal right now is achieve fertility. I would love to be able to maintain fertility with a combination but we haven't been able to stimulate sperm production using Clomid and HCG while on TRT. Saving sperm for future use is an option if the only way to maintain fertility is to feel horrible. Does that all make sense?

 

[Nelson Vergel]

NO, it does not make sense. Most do not use Clomid plus HCG. Clomid is well known for not really improving quality of life.

Have you ever tried TRT+HCG as described in Lipshultz paper below?

You could also try FSH but that is a lot more expensive.

 

[TheDude84]

5 years ago when I started TRT I used HCG. After changing doctors I wasn't prescribed it for the last 4 years. I went back to the original doctor and am back on it. He seems to think that since LH or FSH don't hardly register on a blood test that in order to start production again I should drop T completely. I'm far from a doctor, I'm just doing what he suggests.