Regaining fertility after 3 years of TRT, no hCG

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Peac0ck

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Hello,

I am long time lurker on this forum but finally decided to make an account because despite excessive searching on the web, I am not sure what to do next.

I am a male, 31 years old and have been on trt for the last 3 years now (125mg/week test-E everyday injections, no arimidex and no hCG) because of prior low testosterone and the familiar symptoms. The reason for my hypogonadism is probably the one 4 months AAS-cycle of 500mg test-E/week I did when I was 26.

Now my wife and I want to have a child and and I am considering which option would be the most beneficial for me to regain fertility. I have been reading other topics on the board and it seems that my best bet will be to come off testosterone entirely but since I feel really good on my current protocol I'd like to keep the off time to the minimum. My trt-doctor suggested to just cut the test-dose in half and take hcG 'till my wife is pregnant. He does not want to prescribe clomid.

tl;dr:
- on 125mg test-E week and want to regain fertility
- doctor wants me to cut test-dose in half (62.5mg/week) and add hcG 'till preganancy
- Clomid, FSH and HMG are NOT available to me.

My questions are the following:
  • What do you think of my doctor's suggestion to cut testosterone dose in half (to 62.5 mg/week) with hCG 'till pregnancy?
  • Wouldn't it be better for faster recovery to just drop the testosterone entirely and only take the hCG 'till pregnancy?
  • I have read hCG is also suppressive and should only be used the first weeks after trt followed by clomid. Will continuous hCG (monotherapy or with half dose trt) without clomid even be beneficial?
  • Are there any studies or indications that hCG or former exogenous testosterone use can lead to deformed sperm or increased probability for a miscarriage?
Thank you!
 
Last edited:
Defy Medical TRT clinic doctor
Peac0ck said:
Hello,

I am long time lurker on this forum but finally decided to make an account because despite excessive searching on the web, I am not sure what to do next.

I am a male, 31 years old and have been on trt for the last 3 years now (125mg/week test-E everyday injections, no arimidex and no hCG) because of prior low testosterone and the familiar symptoms. The reason for my hypogonadism is probably the one 4 months AAS-cycle of 500mg test-E/week I did when I was 26.

Now my wife and I want to have a child and and I am considering which option would be the most beneficial for me to regain fertility. I have been reading other topics on the board and it seems that my best bet will be to come off testosterone entirely but since I feel really good on my current protocol I'd like to keep the off time to the minimum. My trt-doctor suggested to just cut the test-dose in half and take hcG 'till my wife is pregnant. He does not want to prescribe clomid.

tl;dr:
- on 125mg test-E week and want to regain fertility
- doctor wants me to cut test-dose in half (62.5mg/week) and add hcG 'till preganancy
- Clomid, FSH and HMG are NOT available to me.

My questions are the following:
  • What do you think of my doctor's suggestion to cut testosterone dose in half (to 62.5 mg/week) with hCG 'till pregnancy?
  • Wouldn't it be better for faster recovery to just drop the testosterone entirely and only take the hCG 'till pregnancy?
  • I have read hCG is also suppressive and should only be used the first weeks after trt followed by clomid. Will continuous hCG (monotherapy or with half dose trt) without clomid even be beneficial?
  • Are there any studies or indications that hCG or former exogenous testosterone use can lead to deformed sperm or increased probability for a miscarriage?
Thank you!
Click to expand...
I’m in a similar boat buddy only add 8 years of age on my end. Let’s keep in touch and see what works and what doesn’t work. I’m looking to get my wife pregnant as well but not come off. My advice would be to use HCG and rFSH from the outset, along with enclomiphene. That’s my plan come Jan 1
 
Peac0ck said:
Hello,

I am long time lurker on this forum but finally decided to make an account because despite excessive searching on the web, I am not sure what to do next.

I am a male, 31 years old and have been on trt for the last 3 years now (125mg/week test-E everyday injections, no arimidex and no hCG) because of prior low testosterone and the familiar symptoms. The reason for my hypogonadism is probably the one 4 months AAS-cycle of 500mg test-E/week I did when I was 26.

Now my wife and I want to have a child and and I am considering which option would be the most beneficial for me to regain fertility. I have been reading other topics on the board and it seems that my best bet will be to come off testosterone entirely but since I feel really good on my current protocol I'd like to keep the off time to the minimum. My trt-doctor suggested to just cut the test-dose in half and take hcG 'till my wife is pregnant. He does not want to prescribe clomid.

tl;dr:
- on 125mg test-E week and want to regain fertility
- doctor wants me to cut test-dose in half (62.5mg/week) and add hcG 'till preganancy
- Clomid, FSH and HMG are NOT available to me.

My questions are the following:
  • What do you think of my doctor's suggestion to cut testosterone dose in half (to 62.5 mg/week) with hCG 'till pregnancy?
  • Wouldn't it be better for faster recovery to just drop the testosterone entirely and only take the hCG 'till pregnancy?
  • I have read hCG is also suppressive and should only be used the first weeks after trt followed by clomid. Will continuous hCG (monotherapy or with half dose trt) without clomid even be beneficial?
  • Are there any studies or indications that hCG or former exogenous testosterone use can lead to deformed sperm or increased probability for a miscarriage?
Thank you!
Click to expand...
Any success?
 
Johnny Test said:
I’m in a similar boat buddy only add 8 years of age on my end. Let’s keep in touch and see what works and what doesn’t work. I’m looking to get my wife pregnant as well but not come off. My advice would be to use HCG and rFSH from the outset, along with enclomiphene. That’s my plan come Jan 1
Click to expand...

Wouldn’t HMG be better since it’s both LH and fsh? Opposed to using HCG and FSH. Or is there benefits to using HCG and fsh together that HMG can’t accomplish on its own?
 
I think the issue is the quantity of LH in hMG and its half-life: low on both counts. The short half-life means you'd want multiple injections daily to come close to mimicking the natural action of LH. This and cost make it impractical as monotherapy compared to less frequent dosing of hMG/FSH combined with hCG acting as the LH analog.
 
www.excelmale.com

HMG to HCG IU equivalency?

Does anyone know roughly how much IU of HMG would equal 500IU of HCG? The HMG comes in 75IU or 150IU amps, and apparently 75IU is enough for our needs. Just would like to know the equivalency between HMG and HCG, if even possible to calculate.
www.excelmale.com www.excelmale.com
 
So let’s say u can only use 2 compounds out of HCG, HMG and FSH. Do u guys think HCG with fsh would be the most optimal fertility protocol? Or HMG with HCG would be preferred? I would assume HCG, HMG and FSH together would be the most ideal, but most of us have to consider cost. So if cost is being considered, what would be the ideal fertility stack?
 
Peac0ck said:
Hello,

I am long time lurker on this forum but finally decided to make an account because despite excessive searching on the web, I am not sure what to do next.

I am a male, 31 years old and have been on trt for the last 3 years now (125mg/week test-E everyday injections, no arimidex and no hCG) because of prior low testosterone and the familiar symptoms. The reason for my hypogonadism is probably the one 4 months AAS-cycle of 500mg test-E/week I did when I was 26.

Now my wife and I want to have a child and and I am considering which option would be the most beneficial for me to regain fertility. I have been reading other topics on the board and it seems that my best bet will be to come off testosterone entirely but since I feel really good on my current protocol I'd like to keep the off time to the minimum. My trt-doctor suggested to just cut the test-dose in half and take hcG 'till my wife is pregnant. He does not want to prescribe clomid.

tl;dr:
- on 125mg test-E week and want to regain fertility
- doctor wants me to cut test-dose in half (62.5mg/week) and add hcG 'till preganancy
- Clomid, FSH and HMG are NOT available to me.

My questions are the following:
  • What do you think of my doctor's suggestion to cut testosterone dose in half (to 62.5 mg/week) with hCG 'till pregnancy?
  • Wouldn't it be better for faster recovery to just drop the testosterone entirely and only take the hCG 'till pregnancy?
  • I have read hCG is also suppressive and should only be used the first weeks after trt followed by clomid. Will continuous hCG (monotherapy or with half dose trt) without clomid even be beneficial?
  • Are there any studies or indications that hCG or former exogenous testosterone use can lead to deformed sperm or increased probability for a miscarriage?
Thank you!
Click to expand...
Late reply to your OP but I did a very similar protocol where I cut my T down from 200 mg weekly to 50 mg and increased my HCG from 250 IU per week to 500 IU ED for three weeks followed by 500 IU EOD for 2 months. My wife was pregnant within the first month. Our boy is 5 months old now and is perfectly healthy.

Fertility can be maintained on exogenous T with the use of adequate doses of HCG. 500 IU EOD is the established dose for maintaining the required levels of intratesticular testosterone (ITT) for normal testicular functioning.

Dropping exogenous T would be a fruitless effort as no HPTA function will be regained if using high dose HCG. Recovering your HPTA isn’t your goal anyways; fertility is, which is what the HCG is used for.

Guys that have a hard time becoming fertile on adequate doses of HCG probably have not given the HCG enough time to work (Dr. Lipshultz at BCM suggests a 6 month runway), or were infertile (knowingly or unknowingly) going into TRT.
 
Last edited:
Gman86 said:
So let’s say u can only use 2 compounds out of HCG, HMG and FSH. Do u guys think HCG with fsh would be the most optimal fertility protocol? Or HMG with HCG would be preferred? I would assume HCG, HMG and FSH together would be the most ideal, but most of us have to consider cost. So if cost is being considered, what would be the ideal fertility stack?
Click to expand...
HCG takes the place of LH, so you just need to get FSH from either hMG or rFSH, not both. Wiki puts it this way: "FSH is available mixed with LH activity in various menotropins including more purified forms of urinary gonadotropins such as Menopur, as well as without LH activity as recombinant FSH (Gonapure, Gonal F, Follistim, Follitropin alpha)."
 
Thank you, Gman, for tuning me into this thread. Similar boat here, guys.

I've done two protocols so far - first, cutting back T and increasing HCG - 500iu every other day. Did that for almost 120 days. Did another semen analysis and still no sperm.

Then did a protocol with HCG every other day, and FSH every other day - did that protocol for 90 days. Have my next semen analysis in 10 days - hoping it went from zero to at least a low sperm count.

Since FSH is not being compounded in the U.S. at the moment, I sourced some HMG, and plan to start that near the end of January.

Just curious - were you all told, or do you believe, that your T needs to be cut back by 50% in order for this protocol to work? I though I read another thread here with a gent who didn't alter his T; but, just added in HMG and HCG twice a week and was successful within 6 mos.

Just thought I'd slide into this thread and maybe we can all keep each other posted on progress. I'm still hopeful for conception without coming off the T altogether - fingers crossed.
 
MrWrldWide said:
Thank you, Gman, for tuning me into this thread. Similar boat here, guys.

I've done two protocols so far - first, cutting back T and increasing HCG - 500iu every other day. Did that for almost 120 days. Did another semen analysis and still no sperm.

Then did a protocol with HCG every other day, and FSH every other day - did that protocol for 90 days. Have my next semen analysis in 10 days - hoping it went from zero to at least a low sperm count.

Since FSH is not being compounded in the U.S. at the moment, I sourced some HMG, and plan to start that near the end of January.

Just curious - were you all told, or do you believe, that your T needs to be cut back by 50% in order for this protocol to work? I though I read another thread here with a gent who didn't alter his T; but, just added in HMG and HCG twice a week and was successful within 6 mos.

Just thought I'd slide into this thread and maybe we can all keep each other posted on progress. I'm still hopeful for conception without coming off the T altogether - fingers crossed.
Click to expand...

I know HCG obv didn’t work for u, but my only child so far was conceived on accident while on test and HCG. Obv didn’t scale back my test dose since I wasn’t even trying to conceive. HCG was at 1000iu’s/ week. Had been on TRT for about 6 years at that point. Had been using HCG on and off throughout those 6 years. It’s funny, was actually off of HCG for 2 months when my son was conceived, but maybe the HCG’s effects on sperm were still present. So technically I was only on test at the time, but again, the HCG I had been taking prior most likely resulted in increased sperm production still. Or maybe I was still fertile on test alone, not really sure tbh. But scaling back on ur test dose, while already only using TRT dosages, doesn’t seem necessary, imo
 
MrWrldWide said:
Thank you, Gman, for tuning me into this thread. Similar boat here, guys.

I've done two protocols so far - first, cutting back T and increasing HCG - 500iu every other day. Did that for almost 120 days. Did another semen analysis and still no sperm.

Then did a protocol with HCG every other day, and FSH every other day - did that protocol for 90 days. Have my next semen analysis in 10 days - hoping it went from zero to at least a low sperm count.

Since FSH is not being compounded in the U.S. at the moment, I sourced some HMG, and plan to start that near the end of January.

Just curious - were you all told, or do you believe, that your T needs to be cut back by 50% in order for this protocol to work? I though I read another thread here with a gent who didn't alter his T; but, just added in HMG and HCG twice a week and was successful within 6 mos.

Just thought I'd slide into this thread and maybe we can all keep each other posted on progress. I'm still hopeful for conception without coming off the T altogether - fingers crossed.
Click to expand...
It is not always necessary to drop back or stop exogenous T consumption in order to maintain or regain fertility on TRT. I personally dropped T back from 200 mg to 50 simply because the combination of high dose HCG (500 EOD) and high dose T makes me very aggressive.

HCG used EOD at a dose of 500 IU has been demonstrated to maintain fertility at a high TRT dosage of 200 mg/weekly. However, two of the most cited doctors in men’s fertility, Dr. Ramasamy and Dr. Lipshultz, have also theorized that some men on long-term TRT many need to come off to regain fertility while administering high doses of HCG and Clomid. The runway for recovering fertility on such as protocol is 6 months according to them. Dr. Lipshultz told me about 3 years ago that he has yet to find a man he could not make fertile again.

Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men - PMC

Hypogonadism among men desiring fertility preservation presents a unique challenge to physicians. Over the past decade the number of younger men with hypogonadism has increased dramatically. These men are often treated with testosterone replacement ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Dr. Ramasamy’s work is above; he discusses Dr. Lipshultz’s work in the article as well.
 
Last edited:
DS3 said:
It is not always necessary to drop back or stop exogenous T consumption in order to maintain or regain fertility on TRT. I personally dropped T back from 200 mg to 50 simply because the combination of high dose HCG (500 EOD) and high dose T makes me very aggressive.

HCG used EOD at a dose of 500 IU has been demonstrated to maintain fertility at a high TRT dosage of 200 mg/weekly. However, two of the most cited doctors in men’s fertility, Dr. Ramasamy and Dr. Lipshultz, have also theorized that some men on long-term TRT many need to come off to regain fertility while administering high doses of HCG and Clomid. The runway for recovering fertility on such as protocol is 6 months according to them. Dr. Lipshultz told me about 3 years ago that he has yet to find a man he could not make fertile again.

Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men - PMC

Hypogonadism among men desiring fertility preservation presents a unique challenge to physicians. Over the past decade the number of younger men with hypogonadism has increased dramatically. These men are often treated with testosterone replacement ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov

Dr. Ramasamy’s work is above; he discusses Dr. Lipshultz’s work in the article as well.
Click to expand...
Thanks, DS3. Right - I understand the HCG + Clomid protocol. In my consultations with Defy, this is essentially the HPTA restart protocol, no? I mean, the HCG slowly gets phased out, the Clomid remains and you eventually go back to natural T, LH and FSH production, was my understanding. I also understood this to be an absolutely grueling 6-month process, which I am trying to avoid like the plague. My T was VERY low prior to TRT, and HCG tends to send my E through the roof - I'm just anxious that it would be a very depressing, grueling process for me. If it ends up being the only option, then it is what it is - I'll grin and bear it. But, I want to try to regain fertility without coming off exogenous testosterone first, before getting to the last resort.

And, I thought that there seems to be some success in doing this with reasonable amounts of HMG. It makes logical sense in my head: exogenous T shuts down the HPTA axis. As a result, the brain stops secreting LH and FSH. But, if you supplement the LH analog - HCG - and actual FSH (from HMG) - then the natural function of the HPTA feedback loop is circumvented, right? Ultimately, the receptors in your testicles should be receiving everything they need to initiate and develop sperm, right? HCG increases the ITT according to numerous studies posted in these forums, and the HMG contains the FSH which should trigger the sertoli cells to create new sperm. I mean, in theory, that sounds right to me, but I am NOT a doctor LOL.

I also know I had fertility prior to starting TRT, as I conceived two children prior to starting it. So, I don't believe natural infertility is my problem.

In any event, I'm so thankful for a forum like this where we can all discuss our experimentation/results. I'll be sure to post my SA results here, after the HCG/FSH protocol I did for the last 90 days. I'm hoping for ANY improvement above ZERO sperm count. I then plan to continue a similar regiment, but with HMG (due to the current lack of production of FSH by compounding pharmacies). I'm planning to try to continue the HCG and HMG protocol without coming off my TRT dose. If that doesn't do it for me, then my final step will likely be the HCG/Clomid HPTA restart regiment you outlined. I hope that's not the case; but, we shall see.
 
MrWrldWide said:
Thanks, DS3. Right - I understand the HCG + Clomid protocol. In my consultations with Defy, this is essentially the HPTA restart protocol, no? I mean, the HCG slowly gets phased out, the Clomid remains and you eventually go back to natural T, LH and FSH production, was my understanding. I also understood this to be an absolutely grueling 6-month process, which I am trying to avoid like the plague. My T was VERY low prior to TRT, and HCG tends to send my E through the roof - I'm just anxious that it would be a very depressing, grueling process for me. If it ends up being the only option, then it is what it is - I'll grin and bear it. But, I want to try to regain fertility without coming off exogenous testosterone first, before getting to the last resort.

And, I thought that there seems to be some success in doing this with reasonable amounts of HMG. It makes logical sense in my head: exogenous T shuts down the HPTA axis. As a result, the brain stops secreting LH and FSH. But, if you supplement the LH analog - HCG - and actual FSH (from HMG) - then the natural function of the HPTA feedback loop is circumvented, right? Ultimately, the receptors in your testicles should be receiving everything they need to initiate and develop sperm, right? HCG increases the ITT according to numerous studies posted in these forums, and the HMG contains the FSH which should trigger the sertoli cells to create new sperm. I mean, in theory, that sounds right to me, but I am NOT a doctor LOL.

I also know I had fertility prior to starting TRT, as I conceived two children prior to starting it. So, I don't believe natural infertility is my problem.

In any event, I'm so thankful for a forum like this where we can all discuss our experimentation/results. I'll be sure to post my SA results here, after the HCG/FSH protocol I did for the last 90 days. I'm hoping for ANY improvement above ZERO sperm count. I then plan to continue a similar regiment, but with HMG (due to the current lack of production of FSH by compounding pharmacies). I'm planning to try to continue the HCG and HMG protocol without coming off my TRT dose. If that doesn't do it for me, then my final step will likely be the HCG/Clomid HPTA restart regiment you outlined. I hope that's not the case; but, we shall see.
Click to expand...
Your plan sounds solid. One correction in the thought-process, though. The HCG and optional Clomid protocol (which I would opt for HCG monotherapy should that be the direction you have to go) is not intended to restart your HPTA. The HCG would be run at a high dose of 3000 IU EOD until fertility is reached. HCG itself is suppressive, so even without the exogenous T it would be highly unlikely you would regain any HPTA function.

I agree with you thoughts on staying on TRT. Dropping back to 50 mg per week for the period of time that I did it combined with the HCG was miserable enough for me.
 
DS3 said:
Your plan sounds solid. One correction in the thought-process, though. The HCG and optional Clomid protocol (which I would opt for HCG monotherapy should that be the direction you have to go) is not intended to restart your HPTA. The HCG would be run at a high dose of 3000 IU EOD until fertility is reached. HCG itself is suppressive, so even without the exogenous T it would be highly unlikely you would regain any HPTA function.

I agree with you thoughts on staying on TRT. Dropping back to 50 mg per week for the period of time that I did it combined with the HCG was miserable enough for me.
Click to expand...

Thanks for the clarification, DS3. I think I misspoke a bit. According to my consultations with Defy, the HPTA restart protocol would be discontinuation of the T, increase of HCG, and addition of Clomid - to start - so that it's not a cold turkey stop. Then titrating the HCG down until it's gone over weeks until it's nothing left but the Clomid, which then also eventually gets pulled around the 6-mos mark. Sounded like it's periods of weeks/months to slowly titrate everything down - the only thing that goes cold-turkey is the T, which scares the hell out of me.
 
MrWrldWide said:
Thanks for the clarification, DS3. I think I misspoke a bit. According to my consultations with Defy, the HPTA restart protocol would be discontinuation of the T, increase of HCG, and addition of Clomid - to start - so that it's not a cold turkey stop. Then titrating the HCG down until it's gone over weeks until it's nothing left but the Clomid, which then also eventually gets pulled around the 6-mos mark. Sounded like it's periods of weeks/months to slowly titrate everything down - the only thing that goes cold-turkey is the T, which scares the hell out of me.
Click to expand...
Agreed. Stopping T would reduce quality of life for most, even with HCG still present. HCG and FSH/HMG should work in sufficient doses over time. HMG is 75 IU 3 times per week, typically.
 
Beyond Testosterone Book by Nelson Vergel
MrWrldWide said:
Thanks for the clarification, DS3. I think I misspoke a bit. According to my consultations with Defy, the HPTA restart protocol would be discontinuation of the T, increase of HCG, and addition of Clomid - to start - so that it's not a cold turkey stop. Then titrating the HCG down until it's gone over weeks until it's nothing left but the Clomid, which then also eventually gets pulled around the 6-mos mark. Sounded like it's periods of weeks/months to slowly titrate everything down - the only thing that goes cold-turkey is the T, which scares the hell out of me.
Click to expand...
Keep us updated. I’m running a restart of my own.
 
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