Regaining Fertility; TRT+HCG+FSH

[Focus]

I’m very grateful for this forum and the information I have gotten from it is excellent. I am a 48 year old man that has been on TRT since 2008. My wife and I want to have a baby now. Semen analysis pre 2008 was good on volume, motility etc. After TRT it went to 0. I decided to get off of TRT and just do Clomid (50mg/Day) and HCG (500-700iu 3x/ week). I followed this for the last 4 months. It goes without saying that I feel like crap. Very little libido and not the same energy etc. Home semen analysis was negative, but understandable since it had only been 3 months off TRT. My Lab results after 3 months of Clomid + HCG are posted below.

After reading Healthman’s post and others I became inspired!
( Semen analysis results after adding FSH to TRT and hCG) I wasn’t aware that TRT+HCG+FSH was an option. I woke up today and went to my PCP armed with information and she wrote a script for the three (TRT+HCG+FSH). I normally get my HCG locally at Medica Compounding Pharmacy Hallandale Beach, Florida. They have been great and the prices are good. This time around, I decided to go with Empower Pharmacy for my HCG and FSH after all the good things I have read.

My protocol will be:
50mg Test. Cypionate/ 2x/ week
500iu HCG EOD
75iu FSH 2x/ week

Hopefully this will do the trick. After 3 months I plan on doing blood work and a S.A. If this doesn’t work then I will see a urologist. I will post my results and welcome feedback and advice. Thank you!

 

[HealthMan]

I’m very grateful for this forum and the information I have gotten from it is excellent. I am a 48 year old man that has been on TRT since 2008. My wife and I want to have a baby now. Semen analysis pre 2008 was good on volume, motility etc. After TRT it went to 0. I decided to get off of TRT and just do Clomid (50mg/Day) and HCG (500-700iu 3x/ week). I followed this for the last 4 months. It goes without saying that I feel like crap. Very little libido and not the same energy etc. Home semen analysis was negative, but understandable since it had only been 3 months off TRT. My Lab results after 3 months of Clomid + HCG are posted below.

After reading Healthman’s post and others I became inspired!
( Semen analysis results after adding FSH to TRT and hCG) I wasn’t aware that TRT+HCG+FSH was an option. I woke up today and went to my PCP armed with information and she wrote a script for the three (TRT+HCG+FSH). I normally get my HCG locally at Medica Compounding Pharmacy Hallandale Beach, Florida. They have been great and the prices are good. This time around, I decided to go with Empower Pharmacy for my HCG and FSH after all the good things I have read.

My protocol will be:
50mg Test. Cypionate/ 2x/ week
500iu HCG EOD
75iu FSH 2x/ week

Hopefully this will do the trick. After 3 months I plan on doing blood work and a S.A. If this doesn’t work then I will see a urologist. I will post my results and welcome feedback and advice. Thank you!

View attachment 7135View attachment 7136

Best of luck! If you are in a hurry i would up the FSH to 50-75IU EOD

 

[Focus]

Best of luck! If you are in a hurry i would up the FSH to 50-75IU EOD

Thank you! I will definitely do that. Did you also use Anastrozole to block estrogen? What dose and frequency?

 

[HealthMan]

Thank you! I will definitely do that. Did you also use Anastrozole to block estrogen? What dose and frequency?

I wouldn’t add anastrozole without checking your E2 after at least 6 weeks into your protocol. You might run into some E2 issues due to the high dose of HCG but wait until you cross that bridge.
In my personal experience HCG 500IU twice a week vs 3x a week made not much of a difference to my sperm count. Less than 500IU twice a week it did negatively affected my count.

 

[Sides]

You are definitely on the right track with test + HCG + FSH, and it worked for me. I have been on testosterone for over 27 years now, and had a zero sperm count in November of 2017 when my wife and I embarked on our fertility journey. Over the course of 11 months, my sperm count went from zero to 35 million by the time my wife and I had IVF done in October, and my wife is now pregnant with our child.

As your sensitive estradiol is already comparatively low (18.8 according to your labs), I would not add anastrozole as it might drive your E2 too low and crush your libido, although admittedly the low E2 might result in a higher sperm count. My fertility doctor had me try letrozole when we were going through the fertility process, but even a small dose (.5mg) crushed my E2 to less than 5 and also crushed my libido and energy. I would only suggest adding a small dose of anastrozole if further labs show that your E2 increases due to possible increased aromatization from the HCG, but then be cautious and only add a very small dose to see how you respond to it.

Also, as HealthMan mentioned, although twice-weekly injections of FSH will work, I would advise increasing injection frequency to EOD or if possible small daily injections for optimal results. Personally I did small twice-daily injections just to have as stable levels as possible. The half life of FSH is fairly short (20 hours if injected subcutaneously), so small frequent injections will probably give you better results than larger less-frequent injections.

From the Empower Pharmacy website regarding FSH:

Pharmacokinetics: Urofollitropin is administered subcutaneously or intramuscularly. Based on the steady state ratio of the peak plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC), subcutaneous (SC) and intramuscular (IM) administration of urofollitropin are not bioequivalent. Metabolism of urofollitropin has not been studied in humans.

Route-Specific Pharmacokinetics: Intramuscular Route: Multiple doses of urofollitropin IM resulted in Cmax and AUC of 77.7% and 81.8% compared to multiple doses of urofollitropin SC. Peak blood concentrations after 150 IU daily injections for 7 days was 11.5 IU/L for IM administration. The maximum plasma concentration was obtained at approximately 10 hours following intramuscular administration. The elimination half-life is roughly 15 hrs after 7 days of IM administration.

Subcutaneous Route: Peak blood concentrations after 150 IU daily injections for 7 days was 14.8 IU/L for SC administration. The maximum plasma concentration was obtained at approximately 10 hours following SC administration. The elimination half-life is roughly 20 hrs after 7 days of SC administration.

FSH INJECTION | Compounding Pharmacy - Empower Pharmacy

Best of luck to you on your fertility journey! If it worked for me after 27 years of testosterone use, I am sure it will work for you as well. If you have any questions, I am happy to try to help as much as I can.

 

[Focus]

You are definitely on the right track with test + HCG + FSH, and it worked for me. I have been on testosterone for over 27 years now, and had a zero sperm count in November of 2017 when my wife and I embarked on our fertility journey. Over the course of 11 months, my sperm count went from zero to 35 million by the time my wife and I had IVF done in October, and my wife is now pregnant with our child.

As your sensitive estradiol is already comparatively low (18.8 according to your labs), I would not add anastrozole as it might drive your E2 too low and crush your libido, although admittedly the low E2 might result in a higher sperm count. My fertility doctor had me try letrozole when we were going through the fertility process, but even a small dose (.5mg) crushed my E2 to less than 5 and also crushed my libido and energy. I would only suggest adding a small dose of anastrozole if further labs show that your E2 increases due to possible increased aromatization from the HCG, but then be cautious and only add a very small dose to see how you respond to it.

Also, as HealthMan mentioned, although twice-weekly injections of FSH will work, I would advise increasing injection frequency to EOD or if possible small daily injections for optimal results. Personally I did small twice-daily injections just to have as stable levels as possible. The half life of FSH is fairly short (20 hours if injected subcutaneously), so small frequent injections will probably give you better results than larger less-frequent injections.

From the Empower Pharmacy website regarding FSH:

Pharmacokinetics: Urofollitropin is administered subcutaneously or intramuscularly. Based on the steady state ratio of the peak plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC), subcutaneous (SC) and intramuscular (IM) administration of urofollitropin are not bioequivalent. Metabolism of urofollitropin has not been studied in humans.

Route-Specific Pharmacokinetics: Intramuscular Route: Multiple doses of urofollitropin IM resulted in Cmax and AUC of 77.7% and 81.8% compared to multiple doses of urofollitropin SC. Peak blood concentrations after 150 IU daily injections for 7 days was 11.5 IU/L for IM administration. The maximum plasma concentration was obtained at approximately 10 hours following intramuscular administration. The elimination half-life is roughly 15 hrs after 7 days of IM administration.

Subcutaneous Route: Peak blood concentrations after 150 IU daily injections for 7 days was 14.8 IU/L for SC administration. The maximum plasma concentration was obtained at approximately 10 hours following SC administration. The elimination half-life is roughly 20 hrs after 7 days of SC administration.

FSH INJECTION | Compounding Pharmacy - Empower Pharmacy

Best of luck to you on your fertility journey! If it worked for me after 27 years of testosterone use, I am sure it will work for you as well. If you have any questions, I am happy to try to help as much as I can.

First off congratulations on your pregnancy, I can imagine how great that news was. Your story adds to the inspiration I have already gotten. Thank you!

I posted my planned protocol as a baseline, but am definitely making adjustments as I here other people's experiences. I am definitely going to up the FSH frequency. Thanks for pointing that out. It seems like SC more frequently results in better concentrations of FSH than IM more frequently. It makes sense to spread out the quantity in shots that are closer together in frequency. I have to do some figuring out like perhaps 25iu ED as opposed to 50iu EOD.

As far as the estrogen blocker, i'm going to postpone adding it until I do blood work a few weeks into the protocol. I'll let that guide my Anastrozole dosage.

Thanks again for the advice and for taking the time to read and respond to my post!

 

[Focus]

Here's an update of info that may be helpful to someone. I received my RX from empower pharmacy today. They were great and answered all my questions. They do not give prices over the phone until they receive a prescription. My costs were:
HCG 12,000iu- $75
FSH 1,500iu- $479
Overnight shipping via UPS- $40

My Adjusted dosage will be:
FSH 25iu ED
HCG 500iu 2x week
50mg of T Cypionate 2x week

If you are new to iu, I found this site that helps a lot with mixing amounts to get the result you want. It's made for HCG but calculating FSH is the same. I hope. Lol.

HCG Dosage Calculator

 

[Sides]

I see the prices have increased slightly since I bought FSH from Empower this autumn, when I got a 1,200iu vial for $325. Probably reflects the increased demand as more people become aware that they are offering FSH. Nevertheless, those are still fantastic prices, and Empower really does take care of you.

By comparison, when I had to buy Gonal-F (FSH) for my wife's IVF procedure in October, a 900iu pen cost me $714, and that was with a huge discount from the fertility pharmacy. If you look up the prices for Gonal-F 900iu pens using GoodRx or a similar site, you will see that the 900iu pens often cost $2000 or more. So for Empower to offer FSH at such a low price is really an amazing bargain.

I think your adjusted program looks great, and the longer you can run it, the better results you will have as your body gets used to producing sperm again. For me, it was an eleven month process, but then I had been shut down for 27 years. Hopefully you will get back on line, up and running quicker than I did.

 

[HealthMan]

Yeah. Through Defy they upped the price from 350 to 625. Very disappointing. From sort of affordable to not really that affordable. It is a shame.

 

[Focus]

Here's one way to break it down. Regardless, It has gotten more expensive.

$325÷1200iu=27¢/iu
$479÷1500iu=32¢/iu
$625÷1500=42¢/iu
$714÷900iu=79¢/iu

 

[Sides]

Here's one way to break it down. Regardless, It has gotten more expensive.

$325÷1200iu=27¢/iu
$479÷1500iu=32¢/iu
$625÷1500=42¢/iu
$714÷900iu=79¢/iu

That's an excellent way of breaking down the price increase compared to other forms of FSH available through pharmacies. Empower (and Defy) have raised the prices, but it's still a bargain compared to Gonal-F and other FSH on the market.

And from my own experience, it's definitely worth the price. Those of us who have been on testosterone for a long time will often need FSH along with HCG to get back some reasonable degree of fertility. There is no doubt in my mind that my wife's pregnancy would not have happened without my use of HCG, HMG, and FSH.

 

[HealthMan]

That's an excellent way of breaking down the price increase compared to other forms of FSH available through pharmacies. Empower (and Defy) have raised the prices, but it's still a bargain compared to Gonal-F and other FSH on the market.

And from my own experience, it's definitely worth the price. Those of us who have been on testosterone for a long time will often need FSH along with HCG to get back some reasonable degree of fertility. There is no doubt in my mind that my wife's pregnancy would not have happened without my use of HCG, HMG, and FSH.

It is still cheaper than brand names. But does it make it right? A lot of brand names of other drugs bump up prices quite a bit just because someone desperately needs that drug (life saving drugs and fertility drugs are a good example). But the cost of making the drug never really changed. They are just increasing their profit.
I was fairly disappointed when i found out Defy increased the price that much (looks like empower didn’t increase the price that much and Nelson once mentioned they were actually losing money with FSH). If someone from Defy reads this I would like to ask them to reconsider the price increase. This is an already fairly expensive drug and men using it are desperate trying to regain their fertility.

 

[HealthMan]

An idea would be to make testosterone + HCG + FSH an standard protocol for young men on TRT. That way they could possibly keep prices low by increasing volume of sales.

 

[HealthMan]

https://fastivf.com/wp-content/uploads/2018/01/WS-upload-RX-.pdf

A few online pharmacies with good review offering more affordable HMG and FSH.

 

[HealthMan]

Clinical efficacy and cost-effectiveness of HP-human FSH (Fostimon®) versus rFSH (Gonal-F®) in IVF-ICSI cycles: a meta-analysis. - PubMed - NCBI

 

[luckyg]

I woke up today and went to my PCP armed with information and she wrote a script for the three (TRT+HCG+FSH).

Hey @Focus - Great post following up from @HealthMan success and inspiring post!

I am in the same situation. TRT 100mg per week for 5 years and for the last 14 months HCG 500iu EOD to try get my fertility back but the latest results below aren't great

I am seeing an andrologist for the first time tomorrow based in the fertility clinic.

I am sure she will just want me to come off TRT to get results and will not be aware of any other possible protocols.

You mentioned you went to your PCP armed with information.

Do you know of any papers or studies I could show her regarding using FSH along with TRT and HCG? I am spedning the day looking myself also but if you can pass me any info you used, it would be greatly appreciated.

 

[Focus]

Hey LuckyG, thanks. I'm clinging on to hope too and the stories and info shared here help a lot. Especially knowing that there are Dr.'s here like @Dr Justin Saya MD as well as @Nelson Vergel who have first hand experience with this. Here are good links with clinical data using HCG & FSH.
Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use
Systematic review of hormone replacement therapy in the infertile man

I would also take testimonials from people on this forum to your doctor like HealthMan and Sides . I will keep updating this thread as I progress and please do the same. Sharing personal experiences are powerful for people on the same boat.

 

[luckyg]

Thanks Focus.

I was quite impressed with myself this morning up until the appointment with the andrologist.

I spent 6 hours yesterday compiling studies, highlighting certain areas and also printing out 4 difference anecdotal case studies from this forum.

The andologist had none of it and wouldn't even read the journal study or anything I handed to her. She said she has enough experience to know the only way is to go cold turkey off TRT.

She was a very ignorant dinosaur.

Our meeting went on for over an hour which was basically a back and forth argument. She just simply couldn't have her vast experience challenged and once she dug her heels in she wasn't budging!

Unfortunately, she is inside the fertility clinic we wish to use so now I have to go outside or do it on my own before I can return with good sperm to use.

I'm searching around for doctors to help but that will take a while as i am outside the US.

In meantime have been searching to buy FSH online and can only find HMG.

Can anyone help me understand the diference between using HMG vs rFSH to help restore fertility for men on top of TRT and HCG?

 

[Sides]

luckyg,

That's very unfortunate you had that experience with the andrologist. Believe me, I understand your frustration. It is very difficult to find an open-minded fertility specialist, or a doctor in general, who is willing to embrace ideas and approaches outside of the norm and off the beaten path.

All you can do is use their assistance and experience for what it is worth, and go outside of that on your own to get you to where you want to be.

In my own case, my fertility doctor would prescribe me HCG, but not HMG or, initially, FSH. I had to source black-market HMG (Menopur and Merional) on my own for most of my protocol, and then he finally agreed to prescribe me FSH at the very end. You will probably have to go the same route and procure your own HMG.

HMG is mixed FSH and LH, it contains both usually in equal concentrations (150iu FSH and 150iu LH per vial, for instance.)

In your case, you will be using it for it's FSH. The extra LH you will have to take into account when deciding how much HCG to use, as you will need to use HCG as your analogue for LH. HMG on it's own doesn't have enough LH to provide high enough levels of intra-testicular testosterone, so you will need both HMG and HCG for optimal fertility.

In the article that Focus already gave you:

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use

You can read this section on the importance of having both HCG and either FSH or HMG to provide optimal fertility:

"FSH given alone or in combination with testosterone has proven unsuccessful at inducing spermatogenesis or maintaining spermatogenesis in those previously induced with hCG/FSH (hCG 1500 IU and HMG 150 IU both subcutaneous and 3 times per week), confirming the need for maintenance of elevated ITT.46 However, long-term use of hCG alone can induce spermatogenesis in up to 70% of patients, with a greater effect seen in men with initial testis length >4 cm, but further improvement is appreciated with the addition of FSH (HMG) suggesting a timelier recovery with both gonadotropins."

You can look at Table 1 to see approximate levels of FSH or HMG along with HCG that have restored fertility for men in our situation.

Best of luck to you. HCG and HMG worked well for me for most of my fertility protocol, before my doctor agreed to prescribe me FSH. As long as you are getting your FSH and LH (or HCG), you are getting everything you need to successfully produce sperm.

Cheers,

Sides

 

[luckyg]

That was a really informative answer. A huge help. Thank yo so much @Sides.