TRT, Clomid, HCG, Anastrazole = zero sperm count?

[lt84]

I hope I'm posting this in the correct place, as I'm a new member and not a typical use as my husband is not into lifting. Still hoping i can find some help here because we've had a rough few months in regards to TRT and fertility. We are desperate for answers as my husband badly wants another child and he is 41 (I'm 35 myself).

Backstory:

Husband began exhibiting signs of low T about two years ago-- perhaps even three years ago. I was pregnant at the time and we wrote off his initial lack of interest in sex due to me being pregnant. It continued after our son was born in Dec. 2016. Son was conceived naturally and easily. It got to the point where we'd gone close to a year without sex, so hubby finally agreed something was wrong. He also was having ED at this point.

In Jan. of this year, we saw a uro who diagnosed him with low testosterone. Labs were drawn at 4:45 p.m. so his total number was probably a bit higher in the morning, but it was 160 as of Jan. Free T was within normal limits; FSH and LH both normal at 6; not elevated at all.

We sought a testosterone clinic for help as his urologist didn't want to prescribe HCG or Clomid and we were looking to conceive. The clinic ended up placing him on the following regimen, which he began at the end of January:

-100mg test cyp weekly (injected twice a week at 2x50mg)
-800IU HCG weekly (injected w/ test twice a week at 2x400IU)
-50mg Clomiphene (Clomid) daily
-.3mg Anastrazole daily

He also got Viagra to take as needed. Viagra helped with erections but he still complained of lack of sensation. After 3 months on this regimen, his blood was tested again. Total T level was 928 (also drawn at 5 p.m. so was probably higher in the morning), free T was 28, and LH/FSH were 0 and .2 respectively.

He remained on this regimen for 4.5 months until last week when he finally got a sperm analysis that I'd been insisting on since he started the regimen. The SA showed zero sperm in the sample but sperm fragments in a prep stain. No wonder why we hadn't conceived. :/

Called the clinic and they advised him to stop TRT and anastrazole immediately. Clomid reduce to 50mg every other day; stay at 400IU HCG twice a week. Will retest blood and semen in 6-8 weeks.

To say the least, these were not the results we were anticipating. I should also add that despite this crazy regimen, hubby says he felt and feels "absolutely no different." His sex drive has not improved whatsoever either.

We have a double issue here; as restoring our sex life and his health is a top priority. But he wants a sibling for our son, so pregnancy is our immediate goal. I am fine with adoption or even a donor, but he isn't budging: he wants his own child if at all possible. We had a child 2.5 years ago, so this is all extremely confusing to us both.

Does anything about this case sound off? Does it sound like his testicles just up and quit working based on numbers? He had absolutely no illness, trauma, radiation, etc. happen in this time frame. I'm concerned a this point that the regimen actually zeroed out his sperm even with the HCG and Clomid. His T was low before (free T was OK), but his FSH and LH weren't crazy high and he was obviously still producing some testosterone. They did not test prolactin, so I don't have those numbers.

Just looking for some input. TIA.

 

[Cataceous]

Wow, what a mess. The best thing you can do is call Defy Medical today if you're in the U.S. The suggested approach is likely to be Clomid alone, maybe small doses of anastrozole, until he's fertile and you get a child on the way. Then most likely he should switch to TRT + hCG to feel better in the long run.

 

[fifty]

See this table

HCG: How much is too much and is there a too much?

 

[fifty]

Also see this thread

Semen analysis results after adding FSH to TRT and hCG

 

[lt84]

Also see this thread

Semen analysis results after adding FSH to TRT and hCG

TY so much... both these threads have been extremely helpful.

 

[lt84]

Wow, what a mess. The best thing you can do is call Defy Medical today if you're in the U.S. The suggested approach is likely to be Clomid alone, maybe small doses of anastrozole, until he's fertile and you get a child on the way. Then most likely he should switch to TRT + hCG to feel better in the long run.

He is now on Clomid alone, so here's to hoping he starts producing sperm again. He's also started on 300mg CoQ10, 10,000 IU Vitamin D3, and 200mg zinc.

 

[Cataceous]

The question is why didn't they put him on Clomid alone to begin with? The smorgasbord treatment made it hard to separate out causes and effects. Here's Dr. Saya's fertility ranking:

A *very* generalized ranking of relative fertilities (with top being most fertile):

1. Clomid/SERM treatment
2(A). HCG + HMG (or lyophilized FSH)
2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.
3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)
3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)
4. TRT/AAS with no concurrent HCG.

What you have learned is that TRT + hCG is unlikely to make him fertile, though it does work for many guys—3(B) above. Also, TRT + hCG was enough to overcome the HPTA-stimulating action of Clomid.

 

[lt84]

The question is why didn't they put him on Clomid alone to begin with? The smorgasbord treatment made it hard to separate out causes and effects. Here's Dr. Saya's fertility ranking:

A *very* generalized ranking of relative fertilities (with top being most fertile):

1. Clomid/SERM treatment
2(A). HCG + HMG (or lyophilized FSH)
2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.
3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)
3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)
4. TRT/AAS with no concurrent HCG.

What you have learned is that TRT + hCG is unlikely to make him fertile, though it does work for many guys—3(B) above. Also, TRT + hCG was enough to overcome the HPTA-stimulating action of Clomid.

This is a huge problem that we've had. We don't know what caused the zero count SA. We know based on history that it's unlikely he has complete testicular failure simply because there was absolutely nothing that could have caused it and he had no issues whatsoever until a couple of years ago.

This clinic we went to (a testosterone clinic) clearly didn't know what they were doing. I researched before they started him on all this and knew from the moment he got his first shipment that something didn't add up, but I turned off my gut instinct and went with "they probably know what they're doing." I need to learn to not do that.

The clinic actually advised him to continue clomid and HCG. After speaking to a few people, we decided to ditch them and just continue the clomid until we can get to a fertility specialist. We are just hoping this zero count was induced by this regimen. This whole thing has left us confused and down around $2400-- and we're worse off than we were when we started. And on top of all that, my husband didn't even feel better.

Quick question: do you think a PCT cycle is necessary? We are a week out from the last test injection at this point and hubby feels OK. I've read that PCT isn't really as important in men who had impaired hormone levels prior to taking test, but I'm not sure.

 

[Cataceous]

...
We are just hoping this zero count was induced by this regimen. This whole thing has left us confused and down around $2400-- and we're worse off than we were when we started. And on top of all that, my husband didn't even feel better.

Quick question: do you think a PCT cycle is necessary? We are a week out from the last test injection at this point and hubby feels OK. I've read that PCT isn't really as important in men who had impaired hormone levels prior to taking test, but I'm not sure.

The worst-case scenario is that there is some progressive condition that led to infertility. But it seems more likely that the treatment itself was suppressive and created this condition. If the latter then Clomid should start turning things around in a couple months or so. Usually PCTs would involve hCG and then Clomid. You already had the hCG in there, so I don't think he needs to do anything except take Clomid, and maybe a little anastrozole if estrogenic side effects become a problem.

I still recommend Defy Medical for future needs, i.e. in making the eventual switch back to TRT. It seems to be a relatively small fraction of men who do well on Clomid long-term. Most likely he won't want to be on it longer than necessary to achieve your goals. After that a thorough evaluation and well-managed TRT protocol should help address his symptoms.

 

[lt84]

The worst-case scenario is that there is some progressive condition that led to infertility. But it seems more likely that the treatment itself was suppressive and created this condition. If the latter then Clomid should start turning things around in a couple months or so. Usually PCTs would involve hCG and then Clomid. You already had the hCG in there, so I don't think he needs to do anything except take Clomid, and maybe a little anastrozole if estrogenic side effects become a problem.

I still recommend Defy Medical for future needs, i.e. in making the eventual switch back to TRT. It seems to be a relatively small fraction of men who do well on Clomid long-term. Most likely he won't want to be on it longer than necessary to achieve your goals. After that a thorough evaluation and well-managed TRT protocol should help address his symptoms.

Thanks so much. I do think it's unlikely that it's a progressive condition, but we will see what the fertility clinic says in that regard. It happened right around the time I got pregnant, so part of me genuinely thinks it's psychological in some way.

We will absolutely look into Defy once we get pregnant. I know he will benefit from standard test therapy and I'm confident that it will be able to make him happier, healthier, and hopefully hornier one of these days! Thanks for taking the time to help me out!

 

[fifty]

He'll be fine. If he wasn't feeling great on his original protocol, I would suspect the .3mg anastrozole daily as a possible culprit. Does he have e2 sensitive labs along the way? I am guessing not.

Some younger guys go on a TRT protocol then are happy when they have 0 sperm count...it happens. The below individual was on 2x100mg test cyp and 2x250IU HCG per week. Read this for a different perspective:

"Just to be triple sure, I got a hold of some test kits vasectomy patients use to confirm their sperm count is zero and it’s safe to have unprotected sex without pregnancy risk. I ran through the test not once, but twice, and on different days, and sure enough, it reported ZERO SPERM COUNT every time.

It is now impossible for me to get a woman pregnant on accident. WAAAAHAHAHAHA! I AM A SEX GOD. If I decide I want kids later, I can go off the TRT for a few weeks, start producing sperm again, make a baby, and go right back on TRT. It really is male birth control."

Source: My Journey with Testosterone Replacement Therapy (TRT) – Part 3 - The Blackdragon Blog

 

[fifty]

Oh and if you're worried about PCT, a common PCT would be probably in line with your goals...hcg & clomid. See this link: Coming off TRT- Defy HPTA Reset Protocol

 

[lt84]

Oh and if you're worried about PCT, a common PCT would be probably in line with your goals...hcg & clomid. See this link: Coming off TRT- Defy HPTA Reset Protocol

Thank you for all the replies, Fifty. We appreciate it immensely.