Fertility - Restart?

Nelson Vergel · Jan 21, 2015

No problem. I assume you had a sperm quality test done through each trial of regimens.

TheDude84 · Jan 21, 2015

I have had one done. It was after 1 month of clomid be before HCG. Since we haven't tested my sperm because LH and FSH barely register. I'm being told without those there is no use testing my sperm again.

Nelson Vergel · Jan 21, 2015

TheDude84

All men in the Lipshultz study did not have LH and FSH. That was the most amazing thing: TRT + HCG could increase intra testicular testosterone enough to enable sperm production. It seems that Leydig cells need a certain amount of testosterone inside the testicles to produce sperm even in the absence of FSH (HCG really acts as a LH mimicker, so you actually have an LH-like peptide in your blood when using HCG)

Why is it good to take HCG with testosterone replacement?

Nelson Vergel · Jan 21, 2015

By the way, read this recent post if you can:

Newbie looking to get my T up and get wife pregnant

Dr. John Crisler · Jan 21, 2015

A problem for the physician is every fertility expert in the country would immediately stop the TRT, and start Clomid.

Adding HCG to Clomid makes sense for the same reason as adding it to TRT. That is also why additional HCG may be prescribed to go with Menotropin (which is LH and FSH): to further increase intratesticular testosterone concentration.

Some men actually do well on Clomid and HCG as their "TRT"; they may start it for fertility, but then stay on it even after they begin the 2AM diaper changes.

Nelson Vergel · Jan 21, 2015

Thanks Dr Crisler. I think the issue with Clomid is that it may negatively affect quality of life in some men. Can you expand on your experience with this drug?

Dr. John Crisler · Jan 21, 2015

Nelson Vergel said:
Thanks Dr Crisler. I think the issue with Clomid is that it may negatively affect quality of life in some men. Can you expand on your experience with this drug?

Sure. For some men, Clomid is just awful. For others, it works very well.

The only way to find out to which group you belong is to try. And "try" means initiating therapy, waiting about 3 weeks, running labs, evaluating them, then making any necessary adjustments. That is because how you feel, AND how well it is working, may be worlds apart.

Too many men just quit after a few days. They did not give things time to work. Having said that, vision changes is an automatic No Go for clomiphene therapy. We just don't mess around with our eyes.

You have to watch LH and FSH--to see if it is working. That also decides your dose.

Watch Total Testosterone level. IF LH is up, and T is not, are you suffering primary failure? And remember, LH production is very cyclical.

You have to watch SHBG. IF it rises, you will need to produce more testosterone to overcome it.

IF it just blocks estrogen--subjectively--you are usually all good. But some men get estrogenic symptoms with it. The chance of that happening is lessened by starting at a lower dose, such as 12.5mgs per day.

"Start low/Go slow" never found a more poignant example. That way you know which direction to go when titrating dose.

The bottom line is you need someone who really knows what they are doing to direct your care. But living well on just a single tab per day certainly has its benefits.

TheDude84 · Jan 22, 2015

Great discussion. I appreciate you guys taking the time to chime in. Many very interesting points have been brought up.

I have labs scheduled for February 5th so I'll just have to see how those look and go from there. I have confidence in the advice I have been getting. I think I was mostly looking for some kind of reassurance that all of this will be worth it in the end. I've been fighting feeling discouraged about the whole thing.

Any other information or experiences with such a situation are always appreciated and interesting. Thanks again for your time everyone.

TheDude84 · Feb 6, 2015

Update. Just got back some of the recent blood work. Still waiting for T and Free T. LH and FSH are both up. 5.5mlu/ml (0.0-10.0mlu/ml) and 4.4mlu/ml (0.3-11.0 mlu/ml). This should be very encouraging, right? I've been off T Cyp for almost 5 weeks now and been taking Clomid and HCG daily. I hope this is looking like progress!

Only thing that looks strange is SHBG through the roof! 172nmol/l (10-57nmol/l). Yikes.

Dr. John Crisler · Feb 6, 2015

TheDude84 said:
Update. Just got back some of the recent blood work. Still waiting for T and Free T. LH and FSH are both up. 5.5mlu/ml (0.0-10.0mlu/ml) and 4.4mlu/ml (0.3-11.0 mlu/ml). This should be very encouraging, right? I've been off T Cyp for almost 5 weeks now and been taking Clomid and HCG daily. I hope this is looking like progress!

Only thing that looks strange is SHBG through the roof! 172nmol/l (10-57nmol/l). Yikes.

I believe it is!

You might consider adding 50mg of Danazol each day to lower your SHBG.

TheDude84 · Feb 11, 2015

So Testosterone tests came back. Free T was just below the midpoint of the range and Total was 40% higher than normal range. This came as a surprise to me because of the way I'm feeling. I don't really know how to interpret that. Seem strange? Good? Normal? Abnormal?

Dr. John Crisler · Feb 11, 2015

TheDude84 said:
So Testosterone tests came back. Free T was just below the midpoint of the range and Total was 40% higher than normal range. This came as a surprise to me because of the way I'm feeling. I don't really know how to interpret that. Seem strange? Good? Normal? Abnormal?

It means your had an excellent response to the Clomid, and that your SHBG rose as well.

TheDude84 · May 1, 2015

Been a while but just met with PCP. I'm not sure I agree with what he is telling me.

Short recap. Stopped testosterone, went on clomid and hcg. Couple months later LH and FSH are both up from where they were, Total T is high (1500 or so), Free T is normal, SHBG is really high (175-180). I don't feel great by any means but I can deal with it. I still haven't had a semen analysis that shows any sperm but it hasn't been more than 3 months since the cessation of cypionate.

Either way, doc is telling me to stop HCG because it is causing my T to go too high for sperm to be produced effeciently. Basically he is saying that high (total in this case) T will prevent Spermatogenesis. From what I understand HCG is stimulating Spermatogenesis and T production at the same time by mimicing LH. I went on Cyp in the first place because LH was too low after my Pituitary Adenoma was removed. The way I see it, stopping HCG would just put be back to low T and no sperm. Am I missing something obvious? Do any of you have any thoughts on this?

I did get a referral to a fertility doc but I don't think insurance will cover it. I feel like I need the second / third/ fourth opinion in this case. Maybe I'm wrong though, I'm not the doctor!

Dr. John Crisler · May 6, 2015

You might try taking oral Danazol at 50mg per day, to lower your SHBG.

TheDude84 · May 6, 2015

That would likely make me feel better? I don't feel horrible but not nearly as good as before.

The part that seems so odd to me is that he is telling me high total testosterone is suppressing sperm production. Does that make sense if the testosterone is not exogenous?

Dr. John Crisler · May 6, 2015

TheDude84 said:
That would likely make me feel better? I don't feel horrible but not nearly as good as before.

The part that seems so odd to me is that he is telling me high total testosterone is suppressing sperm production. Does that make sense if the testosterone is not exogenous?

If your LH and FSH are good, it basically doesn't matter.

That is why we use Clomid.