nice to have you on board doc.. the rest of the staff and i are really excited about this!!
ok... here i go with my question
been on trt for about 2 years..
ranging between 160-180m test a week (60-80mg twice a week)
adex .5mg twice a week
hcg 200iu twice a week (up until november of last year)
my wife dropped the baby bomb on me summer of last year.. up until then she didn't want to have kids and she decides to change her mind..
in november of last year i increased my hcg to 350iu eod... the limit of my script
mid january i did a semen analysis.. numbers came back at 5.5 million... knowing that i needed to get to 20 million to conceive i have bumped it up to 500iu eod in the last few weeks..
further knowing it takes 3 months for spermatogenesis to occur, i know i need to now go in for another semen analysis...
my question to you is simple..what hcg dosage would you put a trt patient on who is actually supplementing with tesotsterone cyp injections? im a bit concerned with going over 500iu eod because i have read a study that suggests anything over that will desensitize leydig cells... but is that just for the production of testosterone alone or will that also affect sperm count??
i have read a few different studies on the matter and talk to a fertility specialist or two.. one suggested 1500iu twice a week.. another suggested 5000iu once a week..
one study said 3000iu 3 times a week..
there are alot of numbers being tossed around here...
i am the boards head sports nutritionist and know how to eat to benefit sperm count, but im a little lost with this whole hcg thing.. for the time being i have stuck to 500iu eod.. though i now have a script for about 26000iu for the month..
thanks in advanced!
THIS IS A GREAT QUESTION!! I deal with this issue regularly and have been involved with men on AAS and TRT desiring fertility since 2005. Let's see if I can answer you question!
First thing is as you know, the basic physiology: the testes have 2 basic cells - Leydig cells for the production of testosterone in the presence of LH. Sertoli cells for the production of sperm and are activated by FSH
When men are on TRT, over time they become "infertile", not too mention can experience down regulation and even apoptosis of the basic germ cell lines of both cells aforementioned. This is beyond the scope of this reply, but I want everyone to know that these are not "simple" biologic process- nor are they understood!
I am aware of these "studies" you mention and they are limited in methodology, not to mention duration. There are NO good long-term studies looking at TRT and maintaining fertility, but boy are they needed!
The bottom line I can tell you is that most men on TRT have to come off testosterone and utilize either Clomid or HCG. Of course, I have seen a decent number of men "living" on TRT with regular small dose of HCG, eg, 250 to 500 iu SQ twice a week maintain fertility. I would say that this type of "dual" therapy is successful only in men younger than 35 years of age and certainly not with prior heavy steroid users.
As you know, a normal sperm count is over 15 million sperm per ML. You are obviously low at 5.5 million. I can not recommend what to do, but if this was one of my patients, I would discontinue testosterone and try HCG 2,500 iu IM QOD or Monday- Wednesday- Friday regimen. This, for most of my patients has worked great and in 3 to 6 months we have success.
I continue the patient on HCG, till the woman is in her second trimester ( spontaneous abortions are a reality) and then after a good report from the OB, we restore TRT.
As you said, there are a lot of "numbers" being tossed around and I would have to recommend that you see a fertility Urologist or a Doc like me that has years of clinical experience dealing with this medical issue.
On a cool note, when I "fail" at getting a man fertile with my "means" I have used various fertility experts all over the US, Canada and abroad. HCG works about 90 % of the time, next these Doc's go for HMG and when the BIG GUNS are needed, I see them use: Bravelle and Ovidrel- These are really cool new formulations for fertility and work like a charm! yet are very expensive!!
I hope this helps!!