Testosterone & Fertility: Novel Techniques in Monitoring & Treating Hypogonadal Fertile Men: SERMs, hCG, rFSH, Aromatase Inhibitors

[madman]

Nelson's Excel kicking facts here!

Dr. Bernie dropping gems!

Something everyone needs to keep in mind here!

* There are very few large RCTs comparing theses strategies in the fertility-seeking hypogonadal male!

Limitations/Future Directions

Key Takeaways

 

[madman]

* Goal: RESTORE, not Replace

 

[madman]

HPG Axis Overview

 

[madman]

Dr. Lipshultz study!

 

[madman]

How Do We Restore Low T Levels in Men. who Desire Fertility

(Who may or may not have used TTh or AAS in past?)

 

[madman]

Tools in our Armamentarium

Testosterone Therapy Options for Fertility

 

[madman]

Benefits

* Preserve fertility

* Increase natural T




Clomiphene Citrate (CC)

Application

Dosing

Side effects/Disadvantages

Benefits

Post in thread 'Clomiphene citrate: A potential alternative for TRT in men with low testosterone'

Mar 31, 2023

Improvements in semen parameters in men treated with clomiphene citrate—A retrospective analysis - Excel Male Health Forum

Improvements in semen parameters in men treated with clomiphene citrate—A retrospective analysis Devang Sharma | Jacqueline Zillioux | Iyad Khourdaji | Katy Reines | Karen Wheeler | Raymond Costabile | Parviz Kavoussi | Ryan Smith Abstract Clomiphene citrate (CC) is commonly used off‐label...

www.excelmale.com

Enclomiphene citrate: A treatment that maintains fertility in men with secondary hypogonadism - Excel Male Health Forum

ABSTRACT Introduction: Hypogonadism is an important issue among the male population. Treatments such as exogenous testosterone have become very popular. One of the adverse effects of testosterone is its suppression of fertility. This has led to the use of alternative therapies such as selective...

www.excelmale.com

Treating Low Testosterone with Clomid, hCG and Aromatase Inhibitors: A Review of the Data - Excel Male Health Forum

Abstract Testosterone deficiency is defined as a total testosterone level <300 ng/dL confirmed on two early morning lab draws. Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. However, these...

www.excelmale.com

A paradoxical decline in semen parameters in men treated with clomiphene citrate (Clomid) - Excel Male Health Forum

A paradoxical decline in semen parameters in men treated with clomiphene citrate Tejas Gundewar | Manish Kuchakulla | Ranjith Ramasamy Abstract Clomiphene, a selective estrogen receptor modulator, has been utilized in managing male sub-fertility since 1967. Numerous controlled and...

www.excelmale.com

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• madman

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Thread 'Effectiveness of ClOmipheNe CitRate for the management of mEn wiTh infErtility (CONCRETE): A randomized double-blind placebo-controlled trial'

Oct 19, 2025

Long overdue!

* Clomiphene is a selective oestrogen receptor modulator that could stimulate testosterone secretion from the testes and boost spermatogenesis. Data from small randomised trials and observational studies suggest some benefit of using it to improve semen parameters in affected men. However, evidence of its efficacy and safety for use in this cohort remains heterogenous due to poor study quality


* The findings will be published in medical journals and international conferences. The results will be shared with the NHS repurposing programme to review Clomiphene...

• madman
• clomiphene; hypogonadism; fertility; rct
• Replies: 2
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

 

[madman]

Benefits

* Preserve fertility

* Increase natural T




Enclomiphene Citrate (EC)

Application

Dosing

Side effects/Disadvantages

Benefits

Enclomiphene Efficacy

Enclomiphene Data

Randomized Phase II trial

Enclomiphene vs. Clomiphene

 

[madman]

Benefits

* Can help increase T and preserve fertility




Aromatase Inhibitors (AIs)

Application

Dosing

Side effects/Disadvantages

Benefits

 

[madman]

Benefits

* Preserves fertility

* Maintains testicular size

* Concomitant use with TRT




Human Chorionic Gonadotropin (hCG)

Application

Dosing

Side effects/Disadvantages

Benefits

 

[madman]

* Typically reserve rFSH as an addition to cases of unsuccessful hCG monotherapy


* Not effective alone or with TRT to preserve fertility



Recombinant FSH (rFSH)

Application

Dosing

Side effects/Disadvantages

Benefits

 

[madman]

* Successful induction spermatogenesis w/combo hCG + FSH supported by several studies




Combination hCG/FSH

 

[madman]

* Historically controversial giving exogenous T will suppress GnRH, but low dose hCG can maintain testicular function




What about men who Can't/Won't stop TTh and desire Fertility

Concurrent TRT + hCG

 

[madman]

Monitoring & Safety

 

[madman]

Dr. Helen Bernie

This is What I Do:




Algorithm Summary

Algorithms

 

[madman]

Limitations/Future Directions

 

[madman]

Key Takeaways

 

[madman]

Thread 'Fertility maintenance or restoration in men before, during, and after TRT or AAS'

Sep 25, 2022

Fertility Preservation in Hypogonadal Men (2018)
Robert J. Carrasquillo and Ranjith Ramasamy


Introduction

Testicular failure is defined as the impairment or loss of both the endocrine functions of the testis (production of testosterone, or T) and exocrine function (production of spermatozoa). Testicular failure can result from the pathology of the testis itself or disorder at any point in the hypothalamic-pituitary-gonadal axis. Primary testicular failure is characterized by normal/low T in the presence of the elevated follicle-stimulating hormone...

• madman
• fertility/spermatogenesis; tth/aas; hypogonadism
• Replies: 34
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

• 

 

[madman]

Thread 'Scientists Discover Testicles Grow Larger With hCG + FSH Fertility Treatment—And Men Are Getting Better Results'

Nov 22, 2025

* To our knowledge, this is the first report demonstrating alterations in spermatogenesis as intratesticular morphological changes, specifically enlargement of seminiferous tubules, by US.

Ultrasonographic Seminiferous Tubule Changes Track Gonadotropin Response in Azoospermia​

The provided text is an excerpt from a retrospective observational study that explores the use of ultrasonography (US) to monitor changes in spermatogenesis in men with azoospermia due to hypogonadotropic hypogonadism (HH) who are undergoing gonadotropin replacement therapy. The...

• madman
• hh; azoospermia; spermatogenesis; ultrasonography
• Replies: 6
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

 

[madman]

Thread 'Human spermatogenesis requires both FSH and micromolar (µM) locally-secreted intratesticular paracrine T'

Dec 7, 2025

Male HPG axis

Human spermatogenesis requires both FSH and µmolar locally-secreted intratesticular paracrine T

- 100X serum concentration is normal

- 10-20X serum will do and is achievable with hCG 500 iU 2-3X/week


Can't be sustained by µmolar nmolar circulating endocrine T

• madman
• gonadotropins; lh/fsh/itt; t; sperm
• Replies: 12
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

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