Going for semen analysis Tuesday. First one since starting TRT 1.5 years ago. Anyone want to take a bet?

[Stoak]

Started TRT/HRT 1.5 years ago. Have been on either 250iu/300iu HCG once or twice per week nearly the whole time outside of a few weeks in the beginning. Seem to feel best on 250iu HCG once per week on Wednesday mng and that's what I'm doing now. Monday mng 80mg test cyp/80mg Thur evening w/HCG 250iu Wed mng. I started this way with my initial clinic bc that was their reco. I switched to another clinic that said take up the dose and go twice per week so I tried that. Seemed to have settle on the once per week shot as best for me so that's what I do now.

I'm going for a semen analysis on Tuesday bc my wife wants another kid. We conceived a few months before I went on TRT (I was fertile but had total test in the 200-350 range and free t of 7). I am sure I could stop and do a medicated restart HCG/SERMS but I don't want to. Anyone else been in a similar situation or care to take a wager on what I'm looking at in terms of results? I'm only 40.

 

[Vince]

My guess, zero swimmers.

I'm hoping I'm wrong.

 

[Weasel]

I'll bet you're alright(not great) since you're using HCG.

 

[Vince]

I'll bet you're alright(not great) since you're using HCG.

I think the amount of HCG is too small, to be of any help.

 

[Jay Ara]

You need some FSH to stimulate the sperm production, I went to the same process and I stopped TRT for 6 months, froze my swimmers and back on TRT.
I had 1500 HCH every other day and 300iu GonalF every other day too.
After 5 months my levels went from 0 to 70 million p/ml.
We have 2 good blastocyst frozen waiting to be transfer.

 

[Stoak]

You need some FSH to stimulate the sperm production, I went to the same process and I stopped TRT for 6 months, froze my swimmers and back on TRT.
I had 1500 HCH every other day and 300iu GonalF every other day too.
After 5 months my levels went from 0 to 70 million p/ml.
We have 2 good blastocyst frozen waiting to be transfer.

how long were you on TRT and what was your protocol?

 

[Jay Ara]

@Stoak
I was around 2 years on, previously I was 1 year off (and my wife got pregnant naturally but unfortunately had a miscarriage) and my doctors did not prescribe me anything and I felt miserable, this time I felt better than nothing but not as good as on TRT.
I'm on 1 Nebido (4ml x 250mg/ml) every 10 weeks, no AI, nothing special.

I feel good, I had before every 9 and 8 weeks but my hematocrits started to go up.

Since Feb this year I'm keeping the 10 weeks interval and I feel good, but I'm looking forward to my next shot in 3 weeks.

I'm on TRT for about 8 years now and went off because of insurance and fertility 2 or 3 times over the whole period.

I hope I answered your question.

 

[Stoak]

@Stoak
I was around 2 years on, previously I was 1 year off (and my wife got pregnant naturally but unfortunately had a miscarriage) and my doctors did not prescribe me anything and I felt miserable, this time I felt better than nothing but not as good as on TRT.
I'm on 1 Nebido (4ml x 250mg/ml) every 10 weeks, no AI, nothing special.

I feel good, I had before every 9 and 8 weeks but my hematocrits started to go up.

Since Feb this year I'm keeping the 10 weeks interval and I feel good, but I'm looking forward to my next shot in 3 weeks.

I'm on TRT for about 8 years now and went off because of insurance and fertility 2 or 3 times over the whole period.

I hope I answered your question.

When your sperm count was zero were you using HCg in addition to your TRT protocol? Bc that may be a rather big difference between our situations.

 

[Jay Ara]

No, I was not using HCG when my sperm count was zero.
Good luck with your test, let us know the result whenever you have it.
All the best!
Jay

 

[Stoak]

No, I was not using HCG when my sperm count was zero.
Good luck with your test, let us know the result whenever you have it.
All the best!
Jay

Thanks. Yes I will share the results here.

 

[Neil]

Best wishes

 

[Stoak]

It would appear that I'm completely infertile with zero viable sperm. What's amazing is that the clinic I started with told me that I could maintain fertility using HCG. Maybe it was a sneaky way of saying it would be helpful if I ever come off or just a sales tactic. Now it's time to decide whether to use HCG+FSH and stay on TRT or come off and get things going naturally again. Everything I use is pharmaceutical, from my local American pharmacy. Actavis testosterone cypionate + Merck/Organon Pregnyl. I haven't talked to my urologist yet. Anyone know what the high debris levels would mean?

Collection Complete	Yes		1000
	Abstinence Days	5	2 - 5	1000
	Smoker	NO		1000
	Volume	1.8	>1.0 (mL)	1000
	Appearance	abnormal / translucent		1000
	Liquifaction	complete		1000
	Viscosity	Non-Viscous		1000
	pH	7.0 L	7.2 - 8.0	1000
	Debris Levels	High		1000
	White blood cells and round cells	16	0 - 50	1000
	Agglutination	None		1000
	Progression	Non-Motile		1000
	Motility	0 L	50 - 100	1000
	Total Motile	0	(mil/mL)	1000
	Concentration mL	0	(mil/mL)	1000
	Total Sperm Count	0	(mil/mL)	1000
	Normal Morphology	0 L	>15	1000
	Abnormal Morphology	0	0 - 85	1000
	Head Defects	0		1000
	Midpiece Defects	0		1000
	Tail Defects	0		1000
	Cytoplasmic Droplets	0		1000
	- NOTES:
	- 20 hpf observed, there were no motile and no motile sperm cells seen.

 

[Jay Ara]

Hi @Stoak ,

I have been there, I can imagine how you feel.

You have two options now, stop, do a PCT and combine with HCG and FSH or try to keep with your your TRT regime + FSH. I would reduce the dosage if you increase HCG to avoid high estrogen.
I’m not a doctor, just sharing the experience I had.
Please check some articles from @Nelson Vergel where you can find typical recovery and maintenance protocols.
I think your doctor will recommend stop with TRT and increase HCG and add FSH (I used GonalF, some people use Menopur).

Share with us your urologist idea if you do not mind.

Good luck to you!
Jay

 

[Vince]

A nice article written by healthman.

Semen analysis results after adding FSH to TRT and hCG

So after 6 months of adding FSH to my TRT protocol I got a sperm analysis done. A quick background. My fertility was normal before TRT and went to zero when I started TRT without HCG. Adding HCG 500 IU 2x a week my sperm analysis results were: sperm count 2.1mm (normal >=20mm) total sperm 7.2mm...

www.excelmale.com

 

[Nelson Vergel]

What's amazing is that the clinic I started with told me that I could maintain fertility using HCG.

What was your hCG protocol?

 

[Stoak]

What was your hCG protocol?

My protocol varied between 250iu once per week to 300iu twice per week. The majority of my time spent on TRT was at 250iu e3.5D. I thought I preferred 250iu once per week but now I really don't know for sure. One thing I neglected to add was that I finished an 8 week Deca 140mg weekly run (my last shot of 40mg (I was injecting EOD/this was US pharmacy compounded) was 6 weeks before the semen analysis). I'm wondering if had I not used the deca so soon before the semen analysis would my parameters have turned out better?

I'm being treated currently by my local urologist who is not a TRT specialist so I had a consult with a well known TRT doctor out of Europe this weekend. I wanted to to be able to go to the urologist prepared. I explained my situation and he recommended 1000iu HCG E3D and 75iu HMG E3D along with zinc and vitamin E supplementation. He seemed to think I'd know in a month if things were going in the right direction based on a semen analysis and said if I stopped T injects, the HCG/HMG would keep my total test approximately in the 500s as long as I was on this protocol.

One thing to note, I injected 1000iu of HCG yesterday IM (I had previously been doing subQ most of the time) and I literally had a nocturnal erection in the middle of the night that I thought was going to turn to priaprism. My morning woods and nocturnal erections have been spotty as of late as well and my libido isn't great in fact it is terrible but my functioning is fine, so this tells me that my HCG dose may have been too low all this time (or it is just part of the bizarre honeymoon dose change protocol) and I was just kind of getting by bc I hadn't been on TRT for too too long... but now at 1.5 years in while using deca 2X, maybe my upstream hormones weren't getting manufactured enough. I have my uro appt tmrw, will get as much bloodwork as he will order, and let you guys know what happens.

The main decision I have is whether to come off T and go with the HCG/HMG protocol or stay on T and do it.

 

[Nelson Vergel]

I seem like a broken record. This is the data we have on HCG plus TRT. Your dose was super low.

Best HCG Dose for Men on TRT: Two Studies That Used HCG with Testosterone

Note:HCG mimics LH but it is not LH and it's not picked up by the LH blood test. In fact, it suppresses LH like endogeneous testosterone does. But the amazing thing that the study below found is that HCG can increase sperm production and quality even in the absence of LH AND FSH. Most...

www.excelmale.com

 

[Stoak]

I seem like a broken record. This is the data we have on HCG plus TRT. Your dose was super low.

Best HCG Dose for Men on TRT: Two Studies That Used HCG with Testosterone

Note:HCG mimics LH but it is not LH and it's not picked up by the LH blood test. In fact, it suppresses LH like endogeneous testosterone does. But the amazing thing that the study below found is that HCG can increase sperm production and quality even in the absence of LH AND FSH. Most...

www.excelmale.com

According to that study 250iu 2X per week should be enough to maintain at least some level of spermatogenesis... 7% below baseline should be enough to maintain SOMETHING. I may be one of the unlucky ones, but you have to remember that at least from what I have seen 250iu 2X per week is the standard prescribed TRT dose and now I'm starting to bet that many many many men who think they are fertile on TRT bc they use this dose of HCG are wrong. I'd actually be willing to bet that most men on any dose of HCG during TRT are infertile. My initial clinic told me that 250iu ONCE per week would be enough! Why on earth would they ever low ball it when they can charge extra for HCG and arimidex?

I know that you spent many years on just T and then added HCG much later. Did you ever get a semen analysis after adding HCG in your more recent years?

 

[Cataceous]

... I'd actually be willing to bet that most men on any dose of HCG during TRT are infertile. ...

You'd probably lose. We see quite a few reports of successful pregnancies with guys on only the TRT/hCG combo; reports of failure are less common. The anecdotal data has limited statistical value, but in general it seems like problems are more likely to be reported than successes.

HCG + HRT. Dr. Lipshultz has several studies under his belt showing that most men on HRT can maintain their fertility if they add in low dose HCG. One study put men either on injections or daily transdermal (topical) testosterone gels and then added in 500 IU every other day of HCG. The abstract states the remarkable results that “no impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.” [6]​

Look Into Fertility Concerns - Peak Testosterone

I see young men on the Peak Testosterone Forum with low testosterone all the time. In fact, probably around half of the regular...

www.peaktestosterone.com

 

[Stoak]

You'd probably lose. We see quite a few reports of successful pregnancies with guys on only the TRT/hCG combo; reports of failure are less common. The anecdotal data has limited statistical value, but in general it seems like problems are more likely to be reported than successes.

HCG + HRT. Dr. Lipshultz has several studies under his belt showing that most men on HRT can maintain their fertility if they add in low dose HCG. One study put men either on injections or daily transdermal (topical) testosterone gels and then added in 500 IU every other day of HCG. The abstract states the remarkable results that “no impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.” [6]​

Look Into Fertility Concerns - Peak Testosterone

I see young men on the Peak Testosterone Forum with low testosterone all the time. In fact, probably around half of the regular...

www.peaktestosterone.com

Then there are only 3 rational explanations for my situation

1) HCG dosage is ALL or NOTHING for me... in that study even the guys at 125iu maintained ITT at 25% below baseline. We don't know if that's enough to maintain spermatogenesis BUT I have ZERO... not 1/2/3/5 mln sperm... ZERO. And I have been using HCG 250iu-600iu per week for a year and a half.

2) I developed some sort of ejaculatory blockage during the last year and a half that wasn't there 2 years ago when I fathered a daughter and I'm actually making some sperm but not ejaculating it.

3) Using nandrolone made me azoospermatic whereas had I stuck just to testosterone, I may have seen some HCG benefit.