Support for HMG during TRT to restore count

[joeaverage]

First post. I recently learned Im shooting blanks after 4 years on TRT. This board has been very helpful in giving me some real hope and understanding of the problem.

I want to restore my count but I do not want to come off TRT. Its really changed my life in so many ways.

My current doc told me to come off, which i will if i have too but want to try to stay on first.

I have discussed with another TRT doc that HCG + HMG combo seems to be most effective. He said he wasn't aware of HMG use for this purpose. He did say he was open to trying it if there was some evidence of its efficacy, which i respect and understand even if it's a bit surprising that he wouldn't be aware.

So I've been through pubmed and found a couple one off studies and a good review such as below that seem to support the combo quite well.

I am wondering if anyone else is aware of other science or literature that i could pass along that would help the cause.

I am also wondering if this HCg/HMG combo is well-known enough that maybe i should just keep looking for a doc that knows and won't make me jump through hoops.

Appreciate any help.

Maintenance of spermatogenesis in hypogonadotropic hypogonadal men with human chorionic gonadotropin alone. - PubMed - NCBI
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854084

 

[Vince]

Here's a good thread.

Semen analysis results after adding FSH to TRT and hCG

 

[Sides]

HMG with HCG and T works very well, and there is plenty of medical literature to support the use of HMG. Or you could just use FSH instead of HMG. HMG is mixed FSH and LH, so since HCG is already acting as an LH analog, all you really need from HMG is the FSH anyway.

My fertility doctor wouldn't prescribe me HMG, but would prescribe me FSH from Empower Pharmacy after I showed him studies and literature on it's use. Try to get your doctor to prescribe you FSH, and you will be fine.

 

[StillPushin]

Hcg and Hmg work wonders while on TRT. I’m 40 years old and have been on TRT for around 4 years now. I ran Hcg 500 iu eod alone for about a month, then started a 2/12 month run of Hcg 500iu eod and Hmg 30iu ed. My goal was to regain fertility and get my wife pregnant. She has been extremely sick for a week and we went to the ER last night because she couldn’t hold down and food or liquids. Turns out she’s pregnant! We are super excited that it happened so fast!

This website and a certain member here helped me understand the process, and I am forever grateful for that. Many friends argued that I had to completely quit TRT in order to regain fertility. That was not the case for me and many others. I hope this post helps someone else have a better understanding of the process.

 

[Sides]

T + HCG + HMG (or FSH) is amazing and will help many men on TRT to have children. That protocol made it possible for me to get my wife pregnant after I had been on testosterone for over 27 years. Now she is 9 months pregnant with our child, and our daughter is due to be born next Friday. I never came off testosterone, just added in HCG and HMG (and later FSH.) If we decide to have a second child, I will do the exact same thing.

Congrats to StillPushin for getting his wife pregnant! Our examples should help give hope to other men in the same situation.

 

[HealthMan]

T + HCG + HMG (or FSH) is amazing and will help many men on TRT to have children. That protocol made it possible for me to get my wife pregnant after I had been on testosterone for over 27 years. Now she is 9 months pregnant with our child, and our daughter is due to be born next Friday. I never came off testosterone, just added in HCG and HMG (and later FSH.) If we decide to have a second child, I will do the exact same thing.

Congrats to StillPushin for getting his wife pregnant! Our examples should help give hope to other men in the same situation.

HMG is LH + FSH. Depending on dosage and frequency HCG is not necessarily at all

 

[Sides]

HMG is LH + FSH. Depending on dosage and frequency HCG is not necessarily at all

Well, while I always learn a lot from your posts, I have to disagree with you there. Yes, HMG is LH + FSH. However, there is not sufficient LH in HMG to achieve optimal levels of intra-testicular testosterone and optimal fertility, at least not without spending a small fortune, as HMG is usually an expensive product.

Most preparations of HMG are 75/75iu or 150/150iu of LH and FSH. This amount of LH is useful, but comparatively little compared to the 500iu of HCG or more suggested every-other-day or twice a week in most fertility protocols.

And HCG is actually preferred to LH in fertility protocols, due to the much longer half-life of HCG compared to injected LH (30-36 hours compared to only 30 minutes or so), and the increased LH receptor activity of HCG.

The bottom line is that the most effective (and cost-effective) fertility protocols are going to include some combination of HCG to optimally stimulate the Leydig cells to produce high enough levels of intra-testicular testosterone, and HMG or FSH to optimally stimulate the Sertoli cells for spermatogenesis.

"Human chorionic gonadotropin (hCG) is a naturally occurring protein produced by the human placenta with a serum half-life of approximately 36 h. Structurally, hCG shares an identical α-subunit with LH and FSH. However, hCG has a unique β-subunit that is virtually identical to the LH β-subunit except that it has an additional 24 amino acid tail at the amino terminus of the protein, which is highly glycosylated and leads to both a longer circulating half-life of hCG (~36 h) versus LH (~30 min) and increased receptor activity. The increased LH receptor activity, along with its longer half-life, makes it a clinically useful LH analog."

"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.47 The success of inducing spermatogenesis with a combination of hCG and FSH is supported by several studies (Table 1).41,42,45,48,49,50,51,52,53 In these data, most begin by stimulating endogenous testosterone production with trial of hCG alone with doses ranging from 1500 to 5000 IU 2–3 times per week titrated according to serum testosterone levels. Most experts treat with hCG alone for 3–6 months after which a certain number of cases will result in spermatogenesis induction. In those without adequate spermatogenesis induction, treatment proceeds with the addition of FSH with doses ranging from 75 to 400 IU 2–3 times per week titrated according to semen analysis results."

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

 

[HealthMan]

Well, while I always learn a lot from your posts, I have to disagree with you there. Yes, HMG is LH + FSH. However, there is not sufficient LH in HMG to achieve optimal levels of intra-testicular testosterone and optimal fertility, at least not without spending a small fortune, as HMG is usually an expensive product.

Most preparations of HMG are 75/75iu or 150/150iu of LH and FSH. This amount of LH is useful, but comparatively little compared to the 500iu of HCG or more suggested every-other-day or twice a week in most fertility protocols.

And HCG is actually preferred to LH in fertility protocols, due to the much longer half-life of HCG compared to injected LH (30-36 hours compared to only 30 minutes or so), and the increased LH receptor activity of HCG.

The bottom line is that the most effective (and cost-effective) fertility protocols are going to include some combination of HCG to optimally stimulate the Leydig cells to produce high enough levels of intra-testicular testosterone, and HMG or FSH to optimally stimulate the Sertoli cells for spermatogenesis.

"Human chorionic gonadotropin (hCG) is a naturally occurring protein produced by the human placenta with a serum half-life of approximately 36 h. Structurally, hCG shares an identical α-subunit with LH and FSH. However, hCG has a unique β-subunit that is virtually identical to the LH β-subunit except that it has an additional 24 amino acid tail at the amino terminus of the protein, which is highly glycosylated and leads to both a longer circulating half-life of hCG (~36 h) versus LH (~30 min) and increased receptor activity. The increased LH receptor activity, along with its longer half-life, makes it a clinically useful LH analog."

"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.47 The success of inducing spermatogenesis with a combination of hCG and FSH is supported by several studies (Table 1).41,42,45,48,49,50,51,52,53 In these data, most begin by stimulating endogenous testosterone production with trial of hCG alone with doses ranging from 1500 to 5000 IU 2–3 times per week titrated according to serum testosterone levels. Most experts treat with hCG alone for 3–6 months after which a certain number of cases will result in spermatogenesis induction. In those without adequate spermatogenesis induction, treatment proceeds with the addition of FSH with doses ranging from 75 to 400 IU 2–3 times per week titrated according to semen analysis results."

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

Agree about half life of LH and concentration in HMG. Hence my observations about dosage and frequency. Better go with HCG + FSH if money is an issue.