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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
How to Improve Sperm Quality, LH, FSH and Testosterone in Infertile Men
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<blockquote data-quote="DS3" data-source="post: 167234" data-attributes="member: 18514"><p>Dr. Lipshultz keeps his patients on HCG year-round in order to retain fertility. Personally I never use more than 150 units EOD (just personally can't handle it). His suggestion before coming off of T is to do a semen analysis to determine the health of your sperm and whether or not coming off T is necessary. If coming off T is necessary after a semen analysis has demonstrated less than optimal sperm quality even while taking low-dose HCG with T, then he suggests coming off T and doing the following protocol (basically what you just read in the study i sent you). </p><p></p><p>"As a rule, all men who are actively trying for a pregnancy should immediately stop taking testosterone or AAS. This may include men taking non-prescribed AAS or men receiving TTh for an established history of hypogonadism. These men should instead start a regimen consisting of 3,000 IU HCG intramuscular or subcutaneous every other day [<a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B18" target="_blank">18</a>]. CC 25 to 50 mg PO (per os, by mouth) daily should also be incorporated to help promote FSH production and pituitary function [<a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B69" target="_blank">69</a>]. During this time, repeat SA's should be obtained every 2 to 3 months along with serum labs [<a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B70" target="_blank">70</a>]. A detailed treatment algorithm is provided in <a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#F1" target="_blank">Fig. 1</a>. Men with oligospermia should be offered cryopreservation when appropriate while men with persistent azoospermia despite treatment and no prior history of fertility or sperm on SA should have genetic studies performed to rule-out an easily diagnosable pre-existing etiology. If pregnancy is not achieved with neither FSH levels or SA parameters showing improvement, clomiphene should be discontinued and recombinant FSH 75 to 150 IU every other day should be added [<a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B18" target="_blank">18</a>]. If this fails, testicular sperm retrieval with possible microdissection should be offered in conjunction with in-vitro fertilization as a final chance for biologic paternity. Once pregnancy has been achieved, a discussion regarding the reinitiation of TTh can be had with special consideration to future fertility goals."</p><p></p><p><a href="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002" target="_blank">Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery</a></p><p></p><p>So that would look like:</p><p>(1) Conduct Semen Analysis, the start:</p><p>3000 IU HCG EOD</p><p>25-50 mg Clomid ED</p><p>(2) After 2-3 months, conduct second semen analysis:</p><p>IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD</p><p></p><p>***Dr. Lipshultz also advises that if E2 becomes an issue, which it likely will at this dosage, arimidex with be necessary to add in. </p><p></p><p>I was not suggesting that you do not need to get off Testosterone. I was saying that frontline treatment by Dr. Lipshultz is to stay on HCG @ 500 IU EOD to maintain fertility. However, if you are unable to achieve/maintain fertility and want to conceive a child, then the previously mentioned protocol is the way to go.</p></blockquote><p></p>
[QUOTE="DS3, post: 167234, member: 18514"] Dr. Lipshultz keeps his patients on HCG year-round in order to retain fertility. Personally I never use more than 150 units EOD (just personally can't handle it). His suggestion before coming off of T is to do a semen analysis to determine the health of your sperm and whether or not coming off T is necessary. If coming off T is necessary after a semen analysis has demonstrated less than optimal sperm quality even while taking low-dose HCG with T, then he suggests coming off T and doing the following protocol (basically what you just read in the study i sent you). "As a rule, all men who are actively trying for a pregnancy should immediately stop taking testosterone or AAS. This may include men taking non-prescribed AAS or men receiving TTh for an established history of hypogonadism. These men should instead start a regimen consisting of 3,000 IU HCG intramuscular or subcutaneous every other day [[URL='https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B18']18[/URL]]. CC 25 to 50 mg PO (per os, by mouth) daily should also be incorporated to help promote FSH production and pituitary function [[URL='https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B69']69[/URL]]. During this time, repeat SA's should be obtained every 2 to 3 months along with serum labs [[URL='https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B70']70[/URL]]. A detailed treatment algorithm is provided in [URL='https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#F1']Fig. 1[/URL]. Men with oligospermia should be offered cryopreservation when appropriate while men with persistent azoospermia despite treatment and no prior history of fertility or sperm on SA should have genetic studies performed to rule-out an easily diagnosable pre-existing etiology. If pregnancy is not achieved with neither FSH levels or SA parameters showing improvement, clomiphene should be discontinued and recombinant FSH 75 to 150 IU every other day should be added [[URL='https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002#B18']18[/URL]]. If this fails, testicular sperm retrieval with possible microdissection should be offered in conjunction with in-vitro fertilization as a final chance for biologic paternity. Once pregnancy has been achieved, a discussion regarding the reinitiation of TTh can be had with special consideration to future fertility goals." [URL="https://wjmh.org/DOIx.php?id=10.5534/wjmh.190002"]Management of Anabolic Steroid-Induced Infertility: Novel Strategies for Fertility Maintenance and Recovery[/URL] So that would look like: (1) Conduct Semen Analysis, the start: 3000 IU HCG EOD 25-50 mg Clomid ED (2) After 2-3 months, conduct second semen analysis: IF fertility isn't achieved, replace Clomid with FSH @ 75-150 IU EOD ***Dr. Lipshultz also advises that if E2 becomes an issue, which it likely will at this dosage, arimidex with be necessary to add in. I was not suggesting that you do not need to get off Testosterone. I was saying that frontline treatment by Dr. Lipshultz is to stay on HCG @ 500 IU EOD to maintain fertility. However, if you are unable to achieve/maintain fertility and want to conceive a child, then the previously mentioned protocol is the way to go. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
How to Improve Sperm Quality, LH, FSH and Testosterone in Infertile Men
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