Need opinion on fertility uro visit yesterday.

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lt84

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Background: Husband was DXed with low-T in January. Total T was sitting at 160; free T 12. He'd been suffering from a complete lack of libido and ED for about 18-20 months. His LH and FSH were both WNL sitting in the mid-range (6.3 and 6). We had a baby naturally 2.5 years ago.

We are trying to conceive, so the test clinic put him on 100mg test cyp/week (divided into 2 doses), 800iu HCH (also divided into 2 doses), .3mg anastrazole twice a week, and 50 mg of Clomid daily. He had no baseline SA at that point. After 4.5 months on the regimen, his total T was 929 and free T was 28. Hubby said he felt "absolutely no different" even with those elevated T levels. Libido still in the tank. However, he had a zero count SA last month so the clinic stopped his test cyp, anastrazole, and HCG and said to take the 50mg of Clomid every other day.

We ended up going to the Cleveland Clinic to see a fertility urologist to make sure we were on the right track. She basically told us two things: 1. his sexual issues weren't caused by the low T and were in his head since raising his T to 929 didn't have any effect on his libido. and 2. that oral Clomid was our best bet.

Something isn't sitting right with me. I don't know what the heck is going on, but my husband went from being virile and a sex maniac to us having sex literally almost never and when we do, it's a chore. He says he has lost penile sensation as well. He can do it, it's just not enjoyable to him anymore.

In terms of treatment, she said HCG wouldn't help him get his sperm count going. She said all we need is Clomid. We will have a repeat SA in 30-60 days. She referred us to a sex therapist.

I'm lost. He's lost. We are tired of doctors and shelling out tons of money to yield no results. If anyone has any insight here, it would help. He's confused how he could father a child just a couple years ago easily and now not have any sperm whatsoever. We never had a baseline SA, so I have no idea what his numbers were prior to treatment. We need to figure something out fast. He is starting to withdraw because he feels like less of a man and despite reading hundreds of studies, I cannot find anything like this. How could his T get so high and him feel no different? He also went off the T cold turkey and again, says he feels no different.

ETA: I should also add that his blood lipids went absolutely crazy on the TRT regimen. It was a little high to begin with, but his total cholesterol went up to nearly 300 and his ratios were awful. Not sure if that's worth mentioning or not.
 
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Background: Husband was DXed with low-T in January. Total T was sitting at 160; free T 12. He'd been suffering from a complete lack of libido and ED for about 18-20 months. His LH and FSH were both WNL sitting in the mid-range (12 and 6). We had a baby naturally 2.5 years ago.

We are trying to conceive, so the test clinic put him on 100mg test cyp/week (divided into 2 doses), 800iu HCH (also divided into 2 doses), .3mg anastrazole twice a week, and 50 mg of Clomid daily. He had no baseline SA at that point. After 4.5 months on the regimen, his total T was 929 and free T was 28. Hubby said he felt "absolutely no different" even with those elevated T levels. Libido still in the tank. However, he had a zero count SA last month so the clinic stopped his test cyp, anastrazole, and HCG and said to take the 50mg of Clomid every other day.

We ended up going to the Cleveland Clinic to see a fertility urologist to make sure we were on the right track. She basically told us two things: 1. his sexual issues weren't caused by the low T and were in his head since raising his T to 929 didn't have any effect on his libido. and 2. that oral Clomid was our best bet.

Something isn't sitting right with me. I don't know what the heck is going on, but my husband went from being virile and a sex maniac to us having sex literally almost never and when we do, it's a chore. He says he has lost penile sensation as well. He can do it, it's just not enjoyable to him anymore.

In terms of treatment, she said HCG wouldn't help him get his sperm count going. She said all we need is Clomid. We will have a repeat SA in 30-60 days. She referred us to a sex therapist.

I'm lost. He's lost. We are tired of doctors and shelling out tons of money to yield no results. If anyone has any insight here, it would help. He's confused how he could father a child just a couple years ago easily and now not have any sperm whatsoever. We never had a baseline SA, so I have no idea what his numbers were prior to treatment. We need to figure something out fast. He is starting to withdraw because he feels like less of a man and despite reading hundreds of studies, I cannot find anything like this. How could his T get so high and him feel no different? He also went off the T cold turkey and again, says he feels no different.
Here's an excellent thread by HealthMan. It will definitely help.

Semen analysis results after adding FSH to TRT and hCG
 
UPDATE: He had his test numbers drawn yesterday and they came back at 123. The uro said discontinue Clomid and started him on 1500iu of HCG 3x a week.
 
Here's an excellent thread by HealthMan. It will definitely help.

Semen analysis results after adding FSH to TRT and hCG

Thank you. I would LOVE to get him on FSH, but the fertility uro said they don't even use it-- and said she doesn't even usually prescribe HCG because it's "so hard to get." However, she called today and due to his natural T numbers falling so low (they tested yesterday), she switched him to 1500iu HCG 3x a week.

He's pretty dead set on sticking with her for awhile. Is there a way to get FSH without concurrently enrolling at Defy right now? I might be able to talk him into trying Defy in a month or two if his numbers don't improve on the HCG monotherapy, but he's not open to switching again right now because we just switched providers this month.
 
Thank you. I would LOVE to get him on FSH, but the fertility uro said they don't even use it-- and said she doesn't even usually prescribe HCG because it's "so hard to get." However, she called today and due to his natural T numbers falling so low (they tested yesterday), she switched him to 1500iu HCG 3x a week.

He's pretty dead set on sticking with her for awhile. Is there a way to get FSH without concurrently enrolling at Defy right now? I might be able to talk him into trying Defy in a month or two if his numbers don't improve on the HCG monotherapy, but he's not open to switching again right now because we just switched providers this month.
Defy medical uses empower pharmacy. Have your doctor contact empower pharmacies and send the scripts to them. They have excellent prices on FSH and HCG, plus there is no supply issues.
 
Defy medical uses empower pharmacy. Have your doctor contact empower pharmacies and send the scripts to them. They have excellent prices on FSH and HCG, plus there is no supply issues.

I have collected no fewer than 12 studies showing that FSH added to HCG has great results in cases like hubby. I will give her 60 days for HCG only. If his next SA is still zero count, I will insist on FSH. She said they don't prescribe it there, but she also said they don't routinely use HCG... so I will make this happen. I'll definitely use Empower because I'm sure we will be paying cash for it. TY!
 


TY Fifty. I was surprised she even offered 1500 3x a week. It seems the standard in urology is 1500 2x a week. Unfortunately, we are dealing with The Cleveland Clinic here- so the docs there aren't as pliable as I wish they were. I think we're going to have to stick out this regimen for 30-60 days before she will be willing to make changes (either at next blood panel or SA). I will be relentless with this. I will bring up higher dosage at our next appointment. 6 months would be awesome at this point. Most of the studies I'm seeing have a median time to pregnancy of 18-28 months. Taking all this into consideration. TY.
 
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I do wonder if he should continue the Clomid, though. She said he should discontinue. Most the studies I'm reading for gonadotropin therapy either use HCG monotherapy or HCG + HMG or rFSH. I haven't seen much with a SERM combined with a gonadatropin.
 
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