Human spermatogenesis requires both FSH and micromolar (µM) locally-secreted intratesticular paracrine T

madman · Dec 7, 2025

Male HPG axis

Human spermatogenesis requires both FSH and µmolar locally-secreted intratesticular paracrine T

- 100X serum concentration is normal

- 10-20X serum will do and is achievable with hCG 500 iU 2-3X/week

Can't be sustained by µmolar nmolar circulating endocrine T

madman · Dec 7, 2025

Sexual Dimorphism in Gametogenesis

Triphasic Maturation of Testes

madman · Dec 7, 2025

Cells of the testis

Exogenous androgens in the system (exogenous T)

- shutdown of LH/FSH secretion

- even though we increase levels of testosterone in circulation we actually cause levels in the testes to collapse and also spermatogenesis likewise collapses

madman · Dec 7, 2025

Spermatogenesis-induction in HH 101

madman · Dec 7, 2025

Gonadotropin therapy for Spermatogenesis

hCG (LH half life is. far too short), acting on Leydig cell LHCGR

madman · Dec 7, 2025

Thread 'Fertility maintenance or restoration in men before, during, and after TRT or AAS'

Sep 25, 2022

Fertility Preservation in Hypogonadal Men (2018)
Robert J. Carrasquillo and Ranjith Ramasamy

Introduction

Testicular failure is defined as the impairment or loss of both the endocrine functions of the testis (production of testosterone, or T) and exocrine function (production of spermatozoa). Testicular failure can result from the pathology of the testis itself or disorder at any point in the hypothalamic-pituitary-gonadal axis. Primary testicular failure is characterized by normal/low T in the presence of the elevated follicle-stimulating hormone...

madman · Dec 7, 2025

Thread 'TESTICULAR SHRINKAGE AND TESTOSTERONE THERAPY'

Dec 30, 2023

If you're considering testosterone replacement therapy, understanding its effects on testicular size is crucial. Learn why shrinkage occurs, the treatments available to mitigate this side effect, and why testicle size usually has minimal impact on your overall health. Urologist John Smith, MD, delves into these aspects to provide a comprehensive view.

2:50-4:40

What Men Should Know About Testicular Shrinkage and Testosterone Therapy

Considering testosterone replacement therapy? Understand its impact on testicular size, treatment options for mitigating shrinkage, and why it's usually a minimal health concern.

healthcare.utah.edu

nodoctor · Dec 7, 2025

madman said:
Thread 'TESTICULAR SHRINKAGE AND TESTOSTERONE THERAPY'

Dec 30, 2023

If you're considering testosterone replacement therapy, understanding its effects on testicular size is crucial. Learn why shrinkage occurs, the treatments available to mitigate this side effect, and why testicle size usually has minimal impact on your overall health. Urologist John Smith, MD, delves into these aspects to provide a comprehensive view.

2:50-4:40

What Men Should Know About Testicular Shrinkage and Testosterone Therapy

Considering testosterone replacement therapy? Understand its impact on testicular size, treatment options for mitigating shrinkage, and why it's usually a minimal health concern.

healthcare.utah.edu

madman

trt; testosterone; testicular atrophy; hcg

Replies: 6

Forum: Testosterone Side Effect Management

Just as a data point, I did over 12 years with literally no break on therapeutic dosages of testosterone with periodic peptides, Hcg, etc., with 0 FSH and 0 LH for a significant period of time… At least a decade, and after a painful coming off period of 2-3 months My LH and FSH are now well up into the normal range, so now I am seeing whether my testosterone and swimmers will follow suit. Just got my latest lab.

madman · Dec 7, 2025

nodoctor said:
Just as a data point, I did over 12 years with literally no break on therapeutic dosages of testosterone with periodic peptides, Hcg, etc., with 0 FSH and 0 LH for a significant period of time… At least a decade, and after a painful coming off period of 2-3 months My LH and FSH are now well up into the normal range, so now I am seeing whether my testosterone and swimmers will follow suit. Just got my latest lab.

Did you have an SA done pre-TTh?

Chances are at your age especially being on exogenous T for over a decade your baseline T will not be stellar.

Hard to say where your sperm parameters sit but keep in mind endogenous T will recover back to baseline much sooner than sperm parameters.

With gonadotropin therapy it can be anywhere from 3-6 months or in many cases longer if stopping cold turkey.

nodoctor · Dec 7, 2025

Oh man. Happy to share, but what is SA? And what is TTH? I’m thinking about sprinkling in some clomiphene citrate and hcg since basically at this point, I have secondary hypogonadism, but agreed that I really have no idea how long it will take if ever. Frankly, I don’t feel as awful as I thought I would even though 250 total and even farther below normal range on free should be pretty miserable.

madman · Dec 7, 2025

nodoctor said:
Oh man. Happy to share, but what is SA? And what is TTH? I’m thinking about sprinkling in some clomiphene citrate and hcg since basically at this point, I have secondary hypogonadism, but agreed that I really have no idea how long it will take if ever. Frankly, I don’t feel as awful as I thought I would even though 250 total and even farther below normal range on free should be pretty miserable.

Semen analysis.

Testosterone therapy.

Your TT 250 ng/dL is dismal and the critical fraction FT would be in the gutter if you had normal SHBG or fall in the grey zone if you had very low SHBG.

Standardized/harmonized reference range for TT 264-916 ng/dL and your hitting 250!

nodoctor · Dec 7, 2025

I was off the chart semen analysis for years, and then went to zero probably for the last six years, so we will see if it comes back or not. Luckily, I banked a bunch just in case because I knew the risk of long-term therapeutic testosterone replacement therapy.

Ironically, 250 was roughly what I was before starting therapy 15+ years ago, but I do not remember what my free was. I have the old lab tests because I have always saved those things. I will try to look it up for my next update here.

madman · Dec 20, 2025

Thread 'Preserving spermatogenesis in TD: innovations in replacement and stimulatory therapies'

Dec 20, 2025

* Fertility preservation remains an important consideration in the management of hypogonadal men. While exogenous testosterone therapy effectively alleviates symptoms, it suppresses the HPG axis and impairs spermatogenesis. Alternative therapeutic strategies—including short- acting formulations (intranasal and oral testosterone undecanoate), SERMs such as enclomiphene citrate, and concomitant administration of low-dose hCG—are under active investigation as potential options for maintaining or restoring fertility potential. Continued investigation and long-term outcome data...