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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Male infertility and gonadotropin treatment
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<blockquote data-quote="madman" data-source="post: 244565" data-attributes="member: 13851"><p><strong>Fig. 4. <u>Illustration depicting the gonadotropin therapy algorithm used at the ANDROFERT Center for infertile males with nonobstructive azoospermia</u>. The hormonal treatment relies on the off-label use of hCG alone or in association with FSH. After signed informed consent, patients are commenced on recombinant human chorionic gonadotropin (rec-hCG; choriogonadotropin alfa, Ovidrel 250 mg/0.5 ml prefilled pen ready for injection, Merck, Brasil), with the dose of 80 mg (~2080 IU) applied subcutaneously, twice weekly. The rec-hCG dose is lowered to a minimum of 40 mg or increased to 250 mcg (6500 IU) per injection to maintain the total testosterone level between 500 and 900 ng/dl. If the serum FSH level drop below 1.5 IU/l during rec-hCG stimulation, supplementation with rec-FSH (rec-FSH; follitropin alfa, Gonal-f 300 IU/0.5 ml, prefilled multidose pen ready for injection, Merck, Brasil) is commenced. A fixed dose of 150 IU 2e3X times a week is given concomitantly with rec-hCG therapy for at least three months. An aromatase inhibitor (AI; anastrozole; 1 mg, Eurofarma, Brasil, or Arimidex; 1 mg, AstraZeneca, Brasil) is added off-label, in a dose of 1 mg daily, anytime during the treatment course if the estradiol levels exceeded 50 pg/mL or total testosterone (ng/dl) to estradiol (pg/mL) ratio (T/E ratio) turned <10. The aromatase inhibitor is administered orally in a fixed dose to keep estradiol levels below 50 pg/mL and a T/E ratio >10. The follow-up includes hormone measurements (serum FSH, LH, estradiol, total testosterone, free testosterone, SHBG, and 17-hydroxy-progesterone levels) and liver enzymes (patients taking AIs) every three to four weeks. Semen analysis is carried out three months after the treatment commencement and then every four weeks in patients who continued therapy for over three months. If viable sperm are found in any semen analysis during treatment, sperm cryopreservation is carried out. Otherwise, patients are subjected to microdissection testicular sperm extraction (micro-TESE) for at least a 3-month treatment. Reprinted with permission, ANDROFERT© 2022. All rights reserved.</strong></p><p><strong>[ATTACH=full]28788[/ATTACH]</strong></p><p><strong>[ATTACH=full]28789[/ATTACH]</strong></p></blockquote><p></p>
[QUOTE="madman, post: 244565, member: 13851"] [B]Fig. 4. [U]Illustration depicting the gonadotropin therapy algorithm used at the ANDROFERT Center for infertile males with nonobstructive azoospermia[/U]. The hormonal treatment relies on the off-label use of hCG alone or in association with FSH. After signed informed consent, patients are commenced on recombinant human chorionic gonadotropin (rec-hCG; choriogonadotropin alfa, Ovidrel 250 mg/0.5 ml prefilled pen ready for injection, Merck, Brasil), with the dose of 80 mg (~2080 IU) applied subcutaneously, twice weekly. The rec-hCG dose is lowered to a minimum of 40 mg or increased to 250 mcg (6500 IU) per injection to maintain the total testosterone level between 500 and 900 ng/dl. If the serum FSH level drop below 1.5 IU/l during rec-hCG stimulation, supplementation with rec-FSH (rec-FSH; follitropin alfa, Gonal-f 300 IU/0.5 ml, prefilled multidose pen ready for injection, Merck, Brasil) is commenced. A fixed dose of 150 IU 2e3X times a week is given concomitantly with rec-hCG therapy for at least three months. An aromatase inhibitor (AI; anastrozole; 1 mg, Eurofarma, Brasil, or Arimidex; 1 mg, AstraZeneca, Brasil) is added off-label, in a dose of 1 mg daily, anytime during the treatment course if the estradiol levels exceeded 50 pg/mL or total testosterone (ng/dl) to estradiol (pg/mL) ratio (T/E ratio) turned <10. The aromatase inhibitor is administered orally in a fixed dose to keep estradiol levels below 50 pg/mL and a T/E ratio >10. The follow-up includes hormone measurements (serum FSH, LH, estradiol, total testosterone, free testosterone, SHBG, and 17-hydroxy-progesterone levels) and liver enzymes (patients taking AIs) every three to four weeks. Semen analysis is carried out three months after the treatment commencement and then every four weeks in patients who continued therapy for over three months. If viable sperm are found in any semen analysis during treatment, sperm cryopreservation is carried out. Otherwise, patients are subjected to microdissection testicular sperm extraction (micro-TESE) for at least a 3-month treatment. Reprinted with permission, ANDROFERT© 2022. All rights reserved. [ATTACH type="full"]28788[/ATTACH] [ATTACH type="full"]28789[/ATTACH][/B] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Male infertility and gonadotropin treatment
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