TRT and fertility advice

I've posted previously about my low test journey.

The short of it is I have been diagnosed with very low T, but my wife and I are still trying to conceive. In order to help with this the doctor managed to get my tools operational again with a regimen of Clomid and I feel a lot better. The anxiety from the Clomid is a bit bothersome at times (especially when I wake up at 03h00 in the morning), but it is manageable.

The urologist doesn't want to keep me on Clomid indefinitely, and as I've been on it for six months he's only given me another two months at which point he suggests freezing the swimmers, switching to TRT and going the IVF route. My wife has her reasons not to want to go the IVF route. A semen analysis has confirmed my swimmers are bountiful and healthy. In terms of fertility there is no issue on my side at the moment.

I have come up with the following options so far.
1. From the studies I have read, it is possible to use Clomid indefinitely. Some studies have people using it for years at a time to no ill effect. For some reason people don't feel as good on Clomid as on TRT (ADAM score), but test levels are fine and reproductive functions are fine. So I can source my own Clomid and just carry on treating myself.

2. Use Clomid till the doctor stops prescribing it and ride it out for as long as my test levels stay high enough to try and conceive.

3. Halve the dose of my Clomid and stretch out the last two months to four (and possibly address the anxiety issue).

4. Go on TRT and hope I don't lose fertility for long enough to conceive. I have read some studies suggesting that on TRT with HCG it will stimulate testosterone via Leidig cells and the body might produce enough FSH to ensure fertility as the testes might only need a little bit of FSH to stimulate spermatogenesis, but I have conflicting reports on this. Some say once TRT is initiated fertility is over in no time.

Understandably I don't want to just go off Clomid and watch test drop to nothing again. Did low test once before and it wasn't pleasant. Any other suggestions or opinions on my options above?

vojago wrote: I've posted previously about my low test journey.

The short of it is I have been diagnosed with very low T, but my wife and I are still trying to conceive. In order to help with this the doctor managed to get my tools operational again with a regimen of Clomid and I feel a lot better. The anxiety from the Clomid is a bit bothersome at times (especially when I wake up at 03h00 in the morning), but it is manageable.

The urologist doesn't want to keep me on Clomid indefinitely, and as I've been on it for six months he's only given me another two months at which point he suggests freezing the swimmers, switching to TRT and going the IVF route. My wife has her reasons not to want to go the IVF route. A semen analysis has confirmed my swimmers are bountiful and healthy. In terms of fertility there is no issue on my side at the moment.

I have come up with the following options so far.
1. From the studies I have read, it is possible to use Clomid indefinitely. Some studies have people using it for years at a time to no ill effect. For some reason people don't feel as good on Clomid as on TRT (ADAM score), but test levels are fine and reproductive functions are fine. So I can source my own Clomid and just carry on treating myself.

2. Use Clomid till the doctor stops prescribing it and ride it out for as long as my test levels stay high enough to try and conceive.

3. Halve the dose of my Clomid and stretch out the last two months to four (and possibly address the anxiety issue).

4. Go on TRT and hope I don't lose fertility for long enough to conceive. I have read some studies suggesting that on TRT with HCG it will stimulate testosterone via Leidig cells and the body might produce enough FSH to ensure fertility as the testes might only need a little bit of FSH to stimulate spermatogenesis, but I have conflicting reports on this. Some say once TRT is initiated fertility is over in no time.

Understandably I don't want to just go off Clomid and watch test drop to nothing again. Did low test once before and it wasn't pleasant. Any other suggestions or opinions on my options above?

Stated from my endocrinologist, using Ovidrel while on TRT he is more than comfortable that I will be good to go when I'm ready for little ones. He does have me on a whack of it.. Recently he switched me to Pregnyl at my own request and has me on 2500iu twice a week. Most bodybuilders will say that's a crazy dose and I will land up desensitizing my testes to LH. Although I have not questioned him around this yet, it does not look like he is worried at this point and this is after 20+ years of using steroids.

The studies I have read on TRT with HCG shows intratesticular testosterone levels to be within 5% of baseline using 250 IU every other day. So that should preserve the testes. However, I have mixed reviews on fertility while on TRT and HCG.

Indications are that HCG on TRT will preserve the testes, even though the lack of FSH means there is no spermatogenesis while on TRT. This implies you need to come off TRT first before you become fertile. Preserving the testes and being fertile are two separate components. Not sure if they are both possible on TRT with HCG. This is where I am uncertain.

vojago wrote: The studies I have read on TRT with HCG shows intratesticular testosterone levels to be within 5% of baseline using 250 IU every other day. So that should preserve the testes. However, I have mixed reviews on fertility while on TRT and HCG.

Indications are that HCG on TRT will preserve the testes, even though the lack of FSH means there is no spermatogenesis while on TRT. This implies you need to come off TRT first before you become fertile. Preserving the testes and being fertile are two separate components. Not sure if they are both possible on TRT with HCG. This is where I am uncertain.

I will question this at my next visit.

00pump wrote: Stated from my endocrinologist, using Ovidrel while on TRT he is more than comfortable that I will be good to go when I'm ready for little ones. He does have me on a whack of it.. Recently he switched me to Pregnyl at my own request and has me on 2500iu twice a week. Most bodybuilders will say that's a crazy dose and I will land up desensitizing my testes to LH. Although I have not questioned him around this yet, it does not look like he is worried at this point and this is after 20+ years of using steroids.

2500 IU twice per week seems excessive and the old way of thinking. The studies I have read show 250 IU every other day gets you within 5% of baseline when on TRT and 500 IU puts you a little bit over, assuming you're secondary. Perhaps the nuke it approach is for primary hypogonadism.

Also, I've read somewhere (not a study, so take this with a grain of salt) that more than 500 IU every day is likely to result in Leidig cell desensitization, anything below is ok.

vojago wrote:

00pump wrote: Stated from my endocrinologist, using Ovidrel while on TRT he is more than comfortable that I will be good to go when I'm ready for little ones. He does have me on a whack of it.. Recently he switched me to Pregnyl at my own request and has me on 2500iu twice a week. Most bodybuilders will say that's a crazy dose and I will land up desensitizing my testes to LH. Although I have not questioned him around this yet, it does not look like he is worried at this point and this is after 20+ years of using steroids.

2500 IU twice per week seems excessive and the old way of thinking. The studies I have read show 250 IU every other day gets you within 5% of baseline when on TRT and 500 IU puts you a little bit over, assuming you're secondary. Perhaps the nuke it approach is for primary hypogonadism.

Also, I've read somewhere (not a study, so take this with a grain of salt) that more than 500 IU every day is likely to result in Leidig cell desensitization, anything below is ok.

I've read the same stuff and then I met the head of endocrinology who is a celebrity to other endos, and everyone wants a piece it his brain, what he has done for me is remarkable. Remember every single thing he does is with blood tests, around 5k a pop. He also worked with my cardiologist on a clinical trial I was put in, the two of them are the smartest minds in this country. So all my bloods are now spot on. I'll continue like this because when the bro science runs out and you have complications I'll feel more comfortable with the best in the country handling my health.

vojago wrote:

00pump wrote: Stated from my endocrinologist, using Ovidrel while on TRT he is more than comfortable that I will be good to go when I'm ready for little ones. He does have me on a whack of it.. Recently he switched me to Pregnyl at my own request and has me on 2500iu twice a week. Most bodybuilders will say that's a crazy dose and I will land up desensitizing my testes to LH. Although I have not questioned him around this yet, it does not look like he is worried at this point and this is after 20+ years of using steroids.

2500 IU twice per week seems excessive and the old way of thinking. The studies I have read show 250 IU every other day gets you within 5% of baseline when on TRT and 500 IU puts you a little bit over, assuming you're secondary. Perhaps the nuke it approach is for primary hypogonadism.

Also, I've read somewhere (not a study, so take this with a grain of salt) that more than 500 IU every day is likely to result in Leidig cell desensitization, anything below is ok.

I've read the same stuff and then I met the head of endocrinology who is a celebrity to other endos, and everyone wants a piece it his brain, what he has done for me is remarkable. Remember every single thing he does is with blood tests, around 5k a pop. He also worked with my cardiologist on a clinical trial I was put in, the two of them are the smartest minds in this country. So all my bloods are now spot on. I'll continue like this because when the bro science runs out and you have complications I'll feel more comfortable with the best in the country handling my health.

Very true. At the end of the day he is the doc with decades of experience, and we're just monkeys poking sticks at things we don't understand. It's great that it is working for you.

To get the thread back on track, I'm still looking for options, if anyone has some experience with fertility and TRT.

Hi Bud.

What dose Clomid does the doc have you on and do you take it everyday?

Doc prescribed 25 mg per day.

Inconveniently the Fertomid comes in 50 mg tablets, and my mind has convinced me I'm extra anxious on the day I take the 50 mg if I take it every other day. So I dutifully chop it into two 25 mg pieces for daily consumption.

Having trolled enough people I haven't found any conclusive research or even anecdotal reports on staying fertile while on TRT.

So I think it might be best to just go off Clomid once the prescription runs out and see what happens. As long as the tools keep working.

For the experienced guys, do you find you need to taper off Clomid or is it fine to just stop considering the long half life?

When I was on Clomid Montherapy the Endo Said Clomid and Novadex en Aromasin due to their long half lives are self tapering so you can just stop it.

I was on the Clomid only for 6months man my Estradion went high I looked and felt like shit on it. Bloated and had headaches and hot flushes constantly. I friend of mine was like you he felt like a million bucks on it

www.ncbi.nlm.nih.gov/pmc/articles/PMC6087849/

That answers most of the questions.

Watch this to also get rid of that story that has never gone away with to much hCG and the desensitized effects on the testes. I am on very high doses and it was always a worry for me having that in the back of my mind but after spending hours I cannot find actual evidence of this bar people just repeating the same thing. That medical article I posted above shows very high doses of hCG too.

00pump wrote: www.ncbi.nlm.nih.gov/pmc/articles/PMC6087849/

That answers most of the questions.

Thanks, this is what I was referring to.
"It was later shown that not only is intratesticular testosterone increased with co-administration hCG but spermatogenesis is preserved as well at one year follow up."

So this is an option.

I enjoy Dr. Rand but haven't seen this one yet. Thank you.

vojago wrote: I enjoy Dr. Rand but haven't seen this one yet. Thank you.

I also never viewed this till today.

Igf1 will make your sperm count super high that's for sure

Mr Z wrote: Igf1 will make your sperm count super high that's for sure

That's a very interesting read IGF and sperm. Amazing the results I've seen. I still struggle with some of them as they say hGH/IGF are they saying hGH increased ratio of IGF or what exactly are they saying.

Great Topic Gents. Thank you for sharing.

I too am sitting on low street corner with rather a low test and although TRT was an option Endo wants to send me for MRI head pituitary. Given my desire to have kids in the coming 18 months or so he will be looking at HCG only protocol. However, this Endo seemed clueless at best and to be frank spending R 2200 for a 30 min consultation with the promise of more to come has be questioning my engagements with this Endo.

I may have to look for someone in the JHB area who actually knows that which they speak of and has actually treated folk who find themselves in circumstances such as those which have visited us.

tylerx wrote: Great Topic Gents. Thank you for sharing.

I too am sitting on low street corner with rather a low test and although TRT was an option Endo wants to send me for MRI head pituitary. Given my desire to have kids in the coming 18 months or so he will be looking at HCG only protocol. However, this Endo seemed clueless at best and to be frank spending R 2200 for a 30 min consultation with the promise of more to come has be questioning my engagements with this Endo.

I may have to look for someone in the JHB area who actually knows that which they speak of and has actually treated folk who find themselves in circumstances such as those which have visited us.

My endo is the best in the game and he wants about going for a MRI, he said many people have benign tumors. And the last resort one would ever want to go with is trying to operate by the pituitary glad. All specialists made her believe she had cushings and needed to go for a MRI, he said to her to give him 6 months. He has turned her life around.. Again your body, your decisions, but unless you have extremely high levels of cortisol I personally would be hesitant to go hunting ghosts. Maybe get a second opinion before you go that route. I had so many elements out, and so many things needed to be taken care of to being balance to my body.

00pump wrote:

tylerx wrote: Great Topic Gents. Thank you for sharing.

I too am sitting on low street corner with rather a low test and although TRT was an option Endo wants to send me for MRI head pituitary. Given my desire to have kids in the coming 18 months or so he will be looking at HCG only protocol. However, this Endo seemed clueless at best and to be frank spending R 2200 for a 30 min consultation with the promise of more to come has be questioning my engagements with this Endo.

I may have to look for someone in the JHB area who actually knows that which they speak of and has actually treated folk who find themselves in circumstances such as those which have visited us.

My endo is the best in the game and he wants about going for a MRI, he said many people have benign tumors. And the last resort one would ever want to go with is trying to operate by the pituitary glad. All specialists made her believe she had cushings and needed to go for a MRI, he said to her to give him 6 months. He has turned her life around.. Again your body, your decisions, but unless you have extremely high levels of cortisol I personally would be hesitant to go hunting ghosts. Maybe get a second opinion before you go that route. I had so many elements out, and so many things needed to be taken care of to being balance to my body.

Pump. Thank you for the update it sounds like you have a super Endo at hand. I will have to broaden my search so that I can find this wonder-working specialist you have working to bring you to better states.

Very disappointed with my Endo and his lack of prep and insight into that which I shared. He was all to quick trying to get the next patient in rather than being committed to a focussed engagement. The hematologist who recommended him was far greater in the services she delivered.

Indeed I am on a hunt for a new Endo and will definitely get a second reading. What I don't understand is their desire for yet another set of bloods when the last I did were two weeks back? Three tests since May 2019 and the results are the same, yours truly is in need of some help:) Either way. Google be my friend and lead the way.

Pump how is your progress coming along and how many sessions have you had with your Endo?

tylerx wrote:

00pump wrote:

tylerx wrote: Great Topic Gents. Thank you for sharing.

I too am sitting on low street corner with rather a low test and although TRT was an option Endo wants to send me for MRI head pituitary. Given my desire to have kids in the coming 18 months or so he will be looking at HCG only protocol. However, this Endo seemed clueless at best and to be frank spending R 2200 for a 30 min consultation with the promise of more to come has be questioning my engagements with this Endo.

I may have to look for someone in the JHB area who actually knows that which they speak of and has actually treated folk who find themselves in circumstances such as those which have visited us.

My endo is the best in the game and he wants about going for a MRI, he said many people have benign tumors. And the last resort one would ever want to go with is trying to operate by the pituitary glad. All specialists made her believe she had cushings and needed to go for a MRI, he said to her to give him 6 months. He has turned her life around.. Again your body, your decisions, but unless you have extremely high levels of cortisol I personally would be hesitant to go hunting ghosts. Maybe get a second opinion before you go that route. I had so many elements out, and so many things needed to be taken care of to being balance to my body.

Pump. Thank you for the update it sounds like you have a super Endo at hand. I will have to broaden my search so that I can find this wonder-working specialist you have working to bring you to better states.

Very disappointed with my Endo and his lack of prep and insight into that which I shared. He was all to quick trying to get the next patient in rather than being committed to a focussed engagement. The hematologist who recommended him was far greater in the services she delivered.

Indeed I am on a hunt for a new Endo and will definitely get a second reading. What I don't understand is their desire for yet another set of bloods when the last I did were two weeks back? Three tests since May 2019 and the results are the same, yours truly is in need of some help:) Either way. Google be my friend and lead the way.

Pump how is your progress coming along and how many sessions have you had with your Endo?

Completely balanced. Liver has returned to normal, ferritin brought right now, cortisol down, testosterone levels balanced, growth hormone balanced, homocysteine slap bang in the middle, estrogen balanced, and uric acid balanced. I will be going for my 4th consultation in a year.. First way simply to engage and do blood tests, the second was to discuss results and start treatment, the 3rd HGH was introduced and also a requirement from my cardiologist to have him run some checks due to a clinical trial operation I went under in January and due to very little long term study he wanted to work with my Endo to see if the adrenals had been affected. However all that was found was ALT levels had significantly increased and my dose of NAC had been increased.

Hope OP was able to father a child since his original post. Haven't followed the entire thread so maybe this was addressed.

Discuss the option of adding Menopur with your Endocrinologist. Menopur is essentially human menopausal gonadotrophin (HMG), containing standardised doses of gonadtropins human follicle stimulating hormone (FSH) and human luteinising hormone (LH). Studies in men on TRT has shown successful fertility outcomes (reference: www.ncbi.nlm.nih.gov/pmc/articles/PMC4722247/ ).

The subject in the case was administered 150 IU rFSH three times a week adjunctly with hCG. Menopur is rather expensive and treatment at the studied dose may be cost prohibitive for many. Commencing treatment at a more conservative dose may be a good idea and even result in successful outcomes.

No dice. My wife is seeing a doctor as well as she is worried there might be a problem on her side. Tests show I am fertile.

I've been off the Clomid for a few months and felt great, but it is starting to wear off. I was able to go every day, but now even every other day is becoming a problem. It seems the factory is shutting down again.

Clomid is not an option any more. The first few months were awesome but at some point anxiety and sleep became a real problem. My next blood tests are scheduled in Feb, so we'll see where I'm at and then consider options.

I'll definitely look into Menopur. Thanks bud.