How Men Can Use HCG with Testosterone to Improve Fertility, Libido and Testicular Size- Part 3

[Excel Male]

HUMAN CHORIONIC GONADOTROPIN (HCG) INJECTION


Human Chorionic Gonadotropin is commonly prescribed for:


Increasing a woman's chance of pregnancy
Helping the production of testosterone and sperm in males
Treatment of cryptorchidism (specific birth problem of the testes) in male children




Multiple strengths of Human Chorionic Gonadotropin are available:

3,000 IU - 50,000 IU per Lyophilized Vial


The dosage form available for Human Chorionic Gonadotropin is Injection Solution. Empower Pharmacy’s injection solutions are compounded under the stringent USP 797 guidelines for sterile compounding, and sterility, endotoxin, potency and pH testing is performed on every batch. Our quality-assurance process ensures the consistency and uniformity of every solution for injection we dispense.


U.S. Brand Names: Pregnyl, Novarel

Pharmacologic Category: Hormone

What is this medicine used for?

Human chorionic gonadotropin (HCG) is used for different reasons in men and women. HCG is used in combination with other fertility drugs to increase a woman's chance of pregnancy. In men or adolescent boys, HCG helps the production of testosterone and sperm. HCG is also used in male children with cryptorchidism, a specific birth problem of the testes. It may also be used for weight loss in conjunction with a special diet.

Key warnings before taking this medicine: Your health care provider needs to know if you have any of these conditions: asthma; cyst on the ovary; heart disease; migraine; kidney disease; ovarian cancer or other female-related cancer; prostate cancer or other male-related cancer; seizures; an unusual or allergic reaction to HCG or other products; pregnant; breast-feeding. Your healthcare provider will monitor treatment, including urine samples, blood tests, or ultrasound exams. If you think you have become pregnant, contact your healthcare provider at once.

What are the precautions when taking this medicine? Possible interactions include: herbal or dietary supplements, like blue cohosh, black cohosh, or chasteberry. This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use.

How is it best taken? This medicine is either injected into a muscle (intramuscular) or under the skin (subcutaneous). Ask your doctor which way is right for you. Use exactly as directed. Take your medicine at regular intervals. It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or healthcare provider to get one. Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for male children as young as several months of age for selected conditions, precautions apply.

What do I do if I miss a dose? It is important not to miss your dose. Call your doctor or health care professional if you are unable to keep an appointment. If you are giving your own injections and miss a dose, take it as soon as you remember. If you forget until the next day, skip the missed dose and continue with your schedule. Do not use double or extra doses. Call your healthcare provider if you are unable to keep an appointment. For women receiving fertility treatment, it is important not to miss a dose as the success of your fertility treatment depends on proper use of this medication.

What are some possible side effects of this medicine? Changes in emotions or mood, headache; pain, irritation or inflammation at the injection site; fatigue. This list may not describe all possible side effects. Call your health care provider immediately if you are experiencing any signs of an allergic reaction: skin rash, itching or hives, swelling of the face, lips, or tongue. For boys: acne; breast enlargement; enlargement of penis and testes; development of facial or pubic hair; a sudden increase in height. For women on fertility treatments: indigestion; nausea, vomiting; passing small amounts of urine; shortness of breath; stomach area or pelvic pain or bloating; swelling; rapid weight gain.

How should I store this medicine? Keep this medicine in a refrigerator below 41°F (5°C). Keep all medicine out of the reach of children. Throw away any unused medicine after the expiration date. Do not flush unused medications or pour down a sink or drain.

General statements: Do not share or take any one else's medicine. Talk with your healthcare provider before starting any new medicine, including over-the-counter, natural products, or vitamins. This medication was compounded specifically for you. This patient information summarizes the most important information about your medication; if you would like more information, talk with your doctor.

 

[Nelson Vergel]

LVJR:

This is a great question.

Yes, testosterone replacement shuts down LH and FSH, which shuts down the production of testosterone and sperm by the testicles. So the testicles' Leydig cells start losing volume due to inactivity. They do not die off, they just hibernate and lose size. The testosterone inside of the testicles also decreases which further decreases their size.

HCG mimics LH. It has been shown to make Leydig cells produce testosterone. It has also been shown to increase the amount of testosterone inside the testicles (Intratesticular testosterone or IT). The use of HCG alone to increase testosterone is not as popular as testosterone replacement due to several factors: 1- cost since large doses of HCG would be required, 2- quality of life of HCG alone vs TRT may be worse (this has not been validated by comparison studies), 3- concerns about long term high dose HCG use and its potential effect on desensitization of Leydig cells to it.

When used in small doses 2-3 times per week along with testosterone replacement, HCG can reverse the decrease of intratesticular testosterone. HCG's effect as a LH mimicker plus its ability to increase IT seem to be the reasons why men were able to preserve fertility (normal sperm) when using testosterone replacement plus 500 IU HCG every other day in Dr Lipshultz' study. The main surprising result of that study is that normal sperm quality can be preserved by this combo even in the absence of FSH, a gonadotropin thought to be essential in sperm production.

I would love to see a study that compares men using 2000-3000 IU of HCG per week to men using 500 IU 2-3 times per week +TRT monitoring their testicular size, sex drive and sperm quality over 6 months. That study would prove what we already know but will provide needed data for insurance reimbursement.

Print the attached study from Lipshultz et al that shows that HCG+TRT was able to preserve fertility in men. I am trying to get them to publish an extension of that data so that we also see the effect of quality of life and sex drive in these men.

This is an emerging field and unfortunately very few medical groups publish their results. I have been advocating for DR Lipshultz to also publish quality of life and sex drive data in men using TRT+ HCG since anecdotally know that HCG may boost sex drive in men on TRT alone. Testicular size is also increased back to baseline. However, these two anecdotal findings need to be validated by published data before insurance companies take this combination seriously.

 

[Nelson Vergel]

This is the package insert (product label) of Profasi, Serono's HCG brand (expensive brand found in regular pharmacies, NOT compounded HCG)



DESCRIPTION:

Human chorionic gonadotropin (HCG), a polypeptide hormone produced by the human placenta, is composed of an alpha and a beta sub-unit. The alpha sub-unit is essentially identical to the alpha sub-units of the human pituitary gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well as to the alpha sub-unit of human thyroid-stimulating hormone (TSH). The beta sub-units of these hormones differ in amino acid sequence.

Chorionic Gonadotropin is a water soluble glycoprotein derived from human pregnancy urine. The sterile lyophilized powder is stable. When reconstituted, the solution should be refrigerated and used within 30 days.

Each vial, when reconstituted with provided diluent, will contain: Chorionic Gonadotropin 2,000, 5,000, or 10,000 USP Units, Mannitol 100mg, Dibasic Sodium Phosphate 16 mg, Monobasic Sodium Phosphate 4 mg, with Benzyl Alcohol 0.9% as preservative, in Water for Injection.

CLINICAL PHARMACOLOGY:

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens and the corpus luteum of the ovary to produce progesterone. Androgen stimulation in the male leads to the development of secondary sex characteristics and may stimulate testicular descent when no anatomical impediment to descent is present. This descent is usually reversible when HCG is discontinued. During the normal menstrual cycle, LH participates with FSH in the development and maturation of the normal ovarian follicle, and the mid-cycle LH surge triggers ovulation. HCG can substitute for LH in this function.

During a normal pregnancy, HCG secreted by the placenta maintains the corpus luteum after LH secretion decreases, supporting continued secretion of estrogen and progesterone, and preventing menstruation. HCG HAS NO KNOWN EFFECT ON FAT MOBILIZATION, APPETITE OR SENSE OF HUNGER, OR BODY FAT DISTRIBUTION.

INDICATIONS AND USAGE:

HCG HAS NOT BEEN DEMONSTRATED TO BE EFFECTIVE ADJUNCTIVE THERAPY IN THE TREATMENT OF OBESITY. THERE IS NO SUBSTAN- TIAL EVIDENCE THAT IT INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR “NORMAL” DISTRIBUTION OF FAT, OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTED DIETS.

1. Prepubertal cryptorchidism not due to anatomic obstruction. In general, HCG is thought to induce testicular descent in situations when descent would have occurred at puberty. HCG thus may help to predict whether or not orchiopexy will be needed in the future. Although, in some cases, descent following HCG administration is permanent, in most cases the response is temporary. Therapy is usually instituted between the ages of 4 and 9.

2. Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a pituitary deficiency) in males.

3. Induction of ovulation and pregnancy in the anovulatory, infertile woman in whom the cause of anovulation is secondary and not due to primary ovarian failure, and who has been appropriately pretreated with human menotropins.

CONTRAINDICATIONS:

Precocious puberty, prostatic carcinoma or other androgen-dependent neo- plasm, prior allergic reaction to HCG. HCG may cause fetal harm when administered to a pregnant woman. Combined HCG/PMS (pregnant mare’s serum) therapy has been noted to induce high incidences of external con- genital anomalies in the offspring of mice, in a dose-dependent manner.

The potential extrapolation to humans has not been determined.

WARNINGS:

HCG should be used in conjunction with human menopausal gonadotropins only by physicians experienced with infertility problems who are familiar with the criteria for patient selection, contraindications, warnings, precautions, and adverse reactions described in the package insert for menotropins. The principal serious adverse reactions during this use are: (1) Ovarian hyperstimulation, a syndrome of sudden ovarian enlargement, ascites with or without pain, and/or pleural effusion; (2) Enlargement of preexisting ovarian cysts or rupture of ovarian cysts with resultant hemoperitoneum; (3) Multiple births, and (4) Arterial thromboembolism.

The diluent used for reconstitution contains benzyl alcohol. Benzyl alcohol has been reported to be associated with a fatal “Gasping Syndrome” in premature infants.

PRECAUTIONS:

General:


1. Induction of androgen secretion by HCG may induce precocious puberty in patients treated for cryptorchidism. Therapy should be discontinued if signs of precocious puberty occur.

2. Since androgens may cause fluid retention, HCG should be used with caution in patients with cardiac or renal disease, epilepsy, migraine, or asthma.

Drug/Laboratory test: HCG can cross react in the radioimmunoassay of gonadotropins, especially luteinizing hormone. Each individual laboratory should establish the degree of cross reactivity with their gonadotropin assay. Physicians should make the laboratory aware of patients on HCG if gonadotropin levels are requested.

Carcinogenesis, Mutagenesis, Impairment of Fertility: There have been sporadic reports of testicular tumors in otherwise healthy young men receiving HCG for secondary infertility. A causative relationship between HCG and tumor development in these men has not been established. Defects of fore- limbs and of the central nervous system, as well as alterations in sex ratio, have been reported in mice on combined gonadotropin and HCG regimens. The dose of gonadotropin used was intended to induce superovulation. No mutagenic effect has been clearly established in humans. Fertility—see “Indications and Usage.”

Pregnancy: Teratogenic effects—Category X: See “Contraindications” section. Combined HCG/PMS (pregnant mare’s serum) therapy has been noted to induce high incidences of external congenital anomalies in the offspring of mice, in a dose-dependent manner. The potential extrapolation to humans has not been determined.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when HCG is administered to a nursing woman.

Pediatric Use: Safety and effectiveness in children below the age of 4 have not been established.

ADVERSE REACTIONS: (See WARNINGS)

Headache, irritability, restlessness, depression, fatigue, edema, precocious puberty, gynecomastia, pain at the site of injection. Hypersensitivity reactions both localized and systemic in nature, including erythema, urticaria, rash, angioedema, dyspnea and shortness of breath, have been reported. The relationship of these allergic-like events to the polypeptide hormone or the diluent containing benzyl alcohol is not clear.

DOSAGE AND ADMINISTRATION: (Intramuscular Use Only):

The dosage regimen employed in any particular case will depend upon the indication for use, the age and weight of the patient, and the physician’s preference. The following regimens have been advocated by various authorities.

Prepubertal cryptorchidism not due to anatomical obstruction:

(1) 4,000 USP Units three times weekly for three weeks.

(2) 5,000 USP Units every second day for four injections.

(3) 15 injections of 500 to 1,000 USP Units over a period of six weeks.

(4) 500 USP Units three times weekly for four to six weeks. If this course of treatment is not successful, another is begun one month later, giving 1,000 USP Units per injection.

Selected cases of hypogonadotropic hypogonadism in males:

(1) 500 to 1,000 USP Units three times a week for three weeks, followed by the same dose twice a week for three weeks.

(2) 4,000 USP Units three times weekly for six to nine months, following which the dosage may be reduced to 2,000 USP Units three times weekly for an additional three months.

Induction of ovulation and pregnancy in the anovulatory, infertile woman in whom the cause of anovulation is secondary and not due to primary ovarian failure and who has been appropriately pre-treated with human menotropins (See prescribing information for menotropins for dosage and administration for that drug product).

5,000 to 10,000 USP Units one day following the last dose of menotropins. (A dosage of 10,000 USP Units is recommended in the labeling for menotropins).

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED

Chorionic gonadotropin for injection, USP, is available in 10 mL lyophilized multiple dose vial sets containing either:
5,000 USP Units per Vial—NDC 44087-8005-3
10,000 USP Units per Vial—NDC 44087-8010-3

with 10 mL vial bacteriostatic water for injection, USP (containing benzyl alcohol 0.9% v/v).

Storage: Store dry product at controlled room temperature 15°-30° C (59°-86° F). AFTER RECONSTITUTION, REFRIGERATE THE PRODUCT AT 2°-8° C (36°-46° F) AND USE WITHIN 30 DAYS.

 

[Excel Male]

How to find a doctor that prescribes HCG: https://www.excelmale.com/forum/sho...t-Prescribes-Testosterone-HCG-and-Anastrozole

 

[Nelson Vergel]

Video on how to use this site: How to Use ExcelMale.com For Your Maximum Benefit

 

[Nelson Vergel]

Best HCG Posts on ExcelMale.com

These are the top HCG related posts on ExcelMale.com as of June 2014

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[Nelson Vergel]

Another interesting study that showed that HCG use along with testosterone improves testicular function and testosterone despite increases in estradiol. They did not see regression of testicular size or functions after using a high dose of HCG for 5 months.


Human Chorionic Gonadotropin and Testicular Function: Stimulation of Testosterone, Testosterone Precursors, and Sperm Production Despite High Estradiol Levels


Matsumoto et al. The Journal of Clinical Endocrinology & Metabolism. Volume 56, Issue 4

Abstract

Excessive gonadotropin stimulation of the testis induced by the administration of high doses of hCG or LH markedly decreases testicular function in experimental animals. The adverse effects of supraphysiological gonadotropin stimulation are thought to be mediated, in part, by the very high levels of estradiol produced. We administered a supraphysiological dosage of hCG together with exogenous testosterone (T) to normal men for several months. The combination of these agents produced very high serum estradiol (E[SUB]2[/SUB]) levels and (we assume) high intratesticular E[SUB]2[/SUB] levels. In this setting of supraphysiological gonadotropin stimulation and high E[SUB]2[/SUB] levels, we examined serum levels of T, the δ[SUP]4[/SUP] and δ[SUP]5[/SUP] steroid precursors of T, and sperm production. After a 3-month control period, five normal men received T enthanate (T; 200 mg, im, weekly) for 3–5 months. Then, while T was continued in the same dosage, all subjects were given hCG (5000 IU, im, three times weekly) for an additional 4–6 months. Serum E[SUB]2[/SUB] levels during hCG plus T treatment increased to a mean (±SEM) of 158 ± 16 pg/ml.

Despite the very high E[SUB]2[/SUB] levels generated by this prolonged administration of hCG and T, hCG stimulated a mean increase of 5.1 ng/ml in the total T level and 0.18 ng/ml in the free T level over those found during T administration alone. These increments in T levels approximate normal blood T levels in man. Significant changes in serum levels of δ[SUP]4[/SUP] steroid precursors of T biosynthesis occurred during the study. Serum progesterone and 17-hydroxyprogesterone levels fell significantly with gonadotropic suppression induced by T administration alone and then increased significantly with hCG stimulation. In contrast to the changes seen in serum levels of δ[SUP]4[/SUP] precursors, there were no significant changes in levels of δ[SUP]5[/SUP] steroid precursors of T biosynthesis. An increased ratio of 17-hydroxyprogesterone to T during hCG administration was the only suggestion of an E[SUB]2[/SUB]-induced block in steroid synthesis. hCG also significantly stimulated sperm production, as assessed by sperm concentration, motilities, and morphologies, in spite of the very high serum E[SUB]2[/SUB] levels; the mean sperm concentration increased from 1.0 ± 1.0 million/cc during T administration alone to 46 ± 16 million/cc during hCG plus T treatment.

We conclude that chronic administration of supraphysiological dosages of hCG can stimulate testicular function in man, despite very high E[SUB]2[/SUB] levels, and that hCG in these dosages does not lead to severe testicular regression in man. Perhaps a higher dosage of hCG administered to men would replicate the severe testicular suppression reported in experimental animals. (J Clin Endocrinol Metab 56: 720, 1983)

Affiliations
Division of Endocrinology, Department of Medicine, University of Washington School of Medicine, Veterans Administration Medical Center (A.M.M., W.J.B.), Seattle, Washington 98108; Public Health Hospital (C.A.P.), Seattle, Washington 98105; and the Department of Reproductive Medicine, University of California at San Diego (B.R.H., R. W.R.), La Jolla, California 92093

 

[Nelson Vergel]

Here are reconstitution instructions for HCG provided by Empower Rx Pharmacy

 

[Excel Male]

Does your doctor prescribe testosterone plus HCG?
Please help your doctor get more business and other men who are looking for good doctors. Let us know if your doctor prescribes testosterone plus HCG by filling out this survey. Thanks!!

TRT plus HCG Doctors Survey

 

[Nelson Vergel]

New video that shows how to combine HCG in the same injection with testosterone twice per week:

 

[Nelson Vergel]

Using Testosterone But Having Problems Getting a Prescription for HCG? CLick here

 

[Nelson Vergel]

Effects of Three Different Medications on Metabolic Parameters and Testicular Volume

 

[Nelson Vergel]

Preserving fertility in the hypogonadal patient: an update

Ranjith Ramasamy, Joseph M Armstrong, Larry I Lipshultz

Recovery of spermatogenesis in anabolic steroid suppressed patients

For healthy patients who use exogenous testosterone and are unable to establish a pregnancy because of the deficient spermatogenesis, there are now solutions to reverse the negative impact of testosterone supplementation. In our experience treatment involves discontinuation of exogenous testosterone and administration of 3000 units of hCG (either with the aromatase inhibitor anastrozole or the selective estrogen receptor modulator tamoxifen or clomiphene citrate) intramuscularly every other day for 3 or more months. As higher doses of hCG are known to suppress FSH levels, simultaneous administration of clomiphene citrate not only preserves, but enhances the secretion of FSH and LH from the anterior pituitary. With such treatments, testosterone-induced azoospermia was successfully reversed with hCG therapy in nearly all men receiving treatment. While further studies need to be carried out, every-other-day intramuscular hCG therapy is a viable option in the treatment of men who suffer suppressed spermatogenesis due to testosterone replacement. However, recovery is not immediate; patient spermatogenesis returned in 4-6 months.

Algorithm for simultaneous treatment of hypogonadism and preservation of fertility

An algorithm based on historical evidence may be followed in determining the appropriate course of therapy for men who desire to maintain fertility yet wish to correct their significant symptoms of hypogonadism with TST ([Figure 1]). In men seeking for hypogonadal symptoms and low testosterone, the first question addressed must be whether fertility is desired. If it is not, the patient may maintain testicular size by adding 1500 IU hCG weekly. If the patient desires to maintain some degree of testicular size, he may cycle off of TST every 6 months, with a 4 week treatment cycle of 3000 IU hCG every other day. If a man does wish to maintain fertility, a baseline semen analysis should be performed and the timeframe for which the patient desires to establish a pregnancy discussed. For those patients desiring to establish a pregnancy within 6 months, testosterone therapy should be discontinued, and treatment begun with 3000 IU hCG ± clomiphene citrate (25 mg daily) and a semen analysis performed every 2 months. If the semen analysis remains suboptimal and FSH continues to be suppressed, adding Gonal f (FSH) 75 IU to an hCG regimen can be considered. In those patients desiring to establish a pregnancy within 6-12 months, testosterone therapy can be continued with 500 IU hCG every other day ± clomiphene citrate. Those patients desiring to establish a pregnancy after more than 12 months should cycle off testosterone every 6 months with a 4 week cycle of 3000 IU hCG every other day.

 

[Nelson Vergel]

Gonadotropin Therapy in Men With Isolated Hypogonadotropic Hypogonadism: The Response to Human Chorionic Gonadotropin Is Predicted by Initial Testicular Size

ALLEN S. BURRIS et al.

The Journal of Clinical Endocrinology & Metabolism. Volume 66, Issue 6>


Abstract

This study was designed to determine whether exogenous hCG alone can complete spermiogenesis in men with isolated hypogonadotropic hypogonadism (IHH). hCG was administered to 22 men with IHH until maximal testicular growth was achieved. Their mean testicular volume increased from 5.5 ± 1.1 (±se) mL (pretreatment) to 10.8 ± 1.6 mL (maximum) during treatment (P < 10[SUP]−6[/SUP]). The maximum mean testicular volume was highly positively correlated with initial volume (r = 0.84; P < 10[SUP]−6[/SUP]). All men attained normal serum testosterone levels, and 7 of 22 men achieved supraphysiological serum estradiol levels.
During hCG treatment, 14 of the 22 men had sperm appear in their semen. Six of 11 men with complete gonadotropin deficiency, defined as an initial mean testicular volume less than 4 mL, became sperm positive during hCG treatment. In contrast, 9 of 11 men with partial gonadotropin deficiency (initial mean testicular volume of 4 mL or more) produced sperm during treatment (P< 0.001). Sperm concentration was highly positively correlated with both pretreatment (r = 0.65;P < 0.01) and final testicular volume (r = 0.73; P < 0.0001). Of 13 men attempting to impregnate their partners, 7 were successful in initiating conception; a total of 8 pregnancies ensued. The sperm concentration at the time of conception was less than 10 million/mL in all but 1 man.
Our study demonstrates that hCG, in the absence of exogenous FSH, can complete spermiogenesis in men with partial gonadotropin deficiency. The response to hCG in men with IHH is predicted by the initial testicular volume.

 

[Nelson Vergel]

Testosterone Side Effect Management Table

 

[Nelson Vergel]

How to care for and store your HCG (or any peptide)

 

[Nelson Vergel]

How Men Can Use HCG with Testosterone to Improve Fertility, Libido and Testicular Size- Part 1

 

[Nelson Vergel]

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility

 

[Nelson Vergel]

Abstracts printed from AUA2016.org

Duration of Testosterone Therapy and Male Age Predict Time to Return of Normal Total Motile Sperm Count after Human Chorionic Gonadotropin Therapy

Authors: Taylor P. Kohn*, Matthew R. Louis, Stephen M. Pickett, Mark C. Lindgren, Alexander W. Pastuszak, Larry I. Lipshultz, Houston, TX

Abstract: PD07-11

Introduction and Objectives

Testosterone therapy (TTh) reduces sperm counts in men. For men with testosterone-associated azoospermia and severe oligospermia, treatment includes TTh cessation and human chorionic gonadotropin (hCG) therapy. However, optimal duration of hCG therapy needed for sperm recovery or the expected extent of sperm recovery remains unknown. We identify factors affecting the length of time needed for sperm recovery and for sperm counts to reach >5 million/mL after TTh and subsequent hCG therapy.

Methods
Retrospective chart review of men seen at a single academic andrology clinic between 2004-2015 was performed. All included patients presented with infertility, were on TTh at the time of the visit, and had an initial semen analysis with azoospermia or severe oligospermia. Men ceased TTh and were started on hCG, and had a second semen analysis within 6 months of starting hCG. The number of men with total motile sperm count (TMC) >5 million was determined. Logistic regression analysis evaluated the relationship between the number of men with TCM >5 million and time on TTh, age, T formulation, treatment with or without clomiphene citrate, initial T level, and initial sperm count.

Results
A total of 55 men were identified with a mean age of 40.0 (range 27-69) years and a mean duration of TTh of 42.0 (range 0.5-240) months. Of the 55 men, 36 (65.5%) achieved a TMC of >5 million within 6 months of stopping TTh and starting hCG. Two variables had a strong associations with the likelihood of achieving TMC >5 million: age (p = 0.04) and time on TTh (p = 0.01). T formulation, initial T level, initial sperm count, and clomiphene citrate use were not significantly associated. Multivariate logistic regression demonstrated that both time on TTh (OR=0.781, p=0.016) and patient age (OR=0.941, p=0.050) decrease the probability of achieving a TMC >5 million within 6 months (Figure 1).

Conclusions
Men with infertility associated with TTh can resume sperm production adequate for initiating pregnancy by IUI using hCG combined therapy. The likelihood of achieving sufficient sperm counts within 6 months of TTh cessation and initiation of hCG is related to patient age and duration of TTh. Clinicians should counsel older men or men on long-term TTh that recovery of spermatogenesis may be slower than in other men.