It was concluded that doses of HCG that ware far lower than those typically used clinically (1,000–2,000 IU SC three times weekly) increased ITT concentrations in a dose-dependent manner in normal men with experimental gonadotropin deficiency.[1]. While clomid may be an effective option to treat testosterone deficiency and infertility in men, it is important to note that it does reduce GH ( growth hormone) secretion [17], lowers IGF-1 levels[18], and elevates SHBG levels (thereby lowering active free testosterone levels). Guay, A.T., et al., Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit? To maintain fertility in men with hypogonadism prescribed testosterone, Lipshultz said, clinicians should first insist on a semen analysis before beginning testosterone treatment. They should be trying to access this type of information and educating themselves more thoroughly in this area. This large analysis of 30 studies shows full reversibility within a predictable time course, and that various predictors affect the rate, but not the extent, of recovery. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. 16. If you have symptoms of low testosterone, TRT might be your best treatment option. [2] It is notable that in the survey 40% of respondent were at younger ages when ‘Late Onset Hypogonadism’ is generally not believed to be occurring. Clomid (clomiphene citrate) is a good treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and much lower cost compared with testosterone gel. Thus, in healthy men HCG increases the bioactive fraction of testosterone (free and non-SHBG-bound) to a greater extent than the TT level. [13-15] Suppression of gonadotropins (LH and FSH) deprives the testes of the signals required for both testosterone production and spermatogenesis, leading to markedly suppressed sperm counts in many men. By day 4 the mean serum testosterone level had risen to 178% +/- 13% (SEM) of a mean basal level (first five samples). Hsieh, T.C., et al., Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. 95(8): p. 3806-13. blood lipids, lipoproteins, glucose, fat mass, libido, psychological symptoms etc etc. Readers Note: There’s a lot of internal links in this article that will lead people to important pages for... Clinical practice guidelines rely heavily on results from randomized controlled trials (RCTs), which is the gold standard for medical... Flax Oil and Estrogenic Compounds: Should Men Avoid Flax Oil? No prescription will be provided unless a clinical need exists based on Bioidentical Hormone Replacement Therapy (BHRT), Bioidentical HRT - safe and effective treatment of menopausal symptoms, DHEA – why it is especially important for menopausal women, Menopausal HRT with non-bioidentical hormones - the WHI studies. 4. This inhibits GnRH (gonadotropin releasing hormone), which in turn inhibits the secretion of FSH (follicle-stimulating hormone) an LH (luteinizing hormone). In common with anabolic steroid use, TTh exogenously elevates testosterone levels and suppress LH and FSH, and thereby can cause infertility. Testosterone Replacement Therapy (TRT) and Fertility – how to get the best of both worlds - part 1. This rise was less than that in free testosterone (221% +/- 18%), which was in turn less than the rise in the non-SHBG-bound fraction (255% +/- 19%). Post-treatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. 2) lack of interest [6] 26 hypogonadal men with a mean age of 35.9 years were included. Nine of 26 men contributed to pregnancy with the partner during followup. 18. These assistive reproductive technologies are … 187(3): p. 973-8. I am just amazed that the Doctors that are accessible to us on the regular insurance plans and specialize in this area are so clueless. Due to the “negative feedback loop” described earlier, there is a risk of reduced fertility as a result of TRT. 21. [1], A large international web survey using the Aging Males' Symptoms (AMS) questionnaire showed the prevalence of symptomatic testosterone deficiency to be 80% in men aged 16–89 (mean 52 years). The studies outlined in this article give directions on dosages and treatment duration. While this effect is considered generally reversible, you might want to avoid testosterone therapy if you plan to have biological children. A better model for TTh related infertility might be to study HCG intervention outcomes after anabolic steroid use in men without background pituitary or testicular abnormalities. 2. Clomid is also easier to administer as it is an oral, and not an injectable like HCG. J Androl, 1991. No claim or opinion on this website is intended to be, nor should it be Main Outcome Measures 19. The monthly treatment cost, as per 2009, was: J Sex Med, 2008. 1. J Clin Endocrinol Metab, 2005. What are Bioidentical Hormones? Just through your blog, I came to know about Ovulation calculator. J Sex Med, 2008. Retrospective data collection was performed via chart review. On a Chinese study, 1 out of 100 men were able to conceive … 11. Clomid group – average age 42 years, receiving 50 mg clomid every other day. As shown in table 1, the typical probability of recovery to 20 million/mL was 67% within 6 months, 90% within 12 months, 96% within 16 months, and 100% within 24 months. 15. J Clin Endocrinol Metab, 2007. Coviello, A.D., et al., Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. The treatments significantly increased total testosterone levels to 573 ng/dL in the Clomid group (baseline, 277 ng/dL) and 553 ng/dL (baseline, 221 ng/dL) in the Testosterone Gel group. 6. Wang, C., et al., Oligozoospermia induced by exogenous testosterone is associated with normal functioning residual spermatozoa. [5] Baseline serum T (409 ng/dl, 14.1 nmol/liter) was 1.2% of ITT (34,046  ng/dl, 1174 nmol/liter). look forward to reading more of your articles. Int J Psychophysiol, 2012. Heatley, Effect of raising endogenous testosterone levels in impotent men with secondary hypogonadism: double blind placebo-controlled trial with clomiphene citrate. Just loved this, and will recommend this site to my friend who also trains, and is interested in the ‘real’ advanced knowledge on the subject. McLachlan, R.I., et al., Hormonal regulation of spermatogenesis in primates and man: insights for development of the male hormonal contraceptive. All men wishing to preserve fertility while on TRT should have a … 3. Mean follow-up was 6.2 months. Int J Endocrinol, 2013. and M.A. An alternative to TRT is to use HCG or clomid (clomiphene citrate) to increase endogenous testosterone production. Here I will outline options for men to increase endogenous testosterone production by non-TRT means, and ways to speed up spermatogenesis for those who chose to go the TRT route… It is a concern with traditional forms of trt (synthetic) but there are studies in China that shows that younger men who underwent trt regain fertility in a high number of cases. [1] Year 2006 is was estimated that more than 13.8 million men over 45 years of age visiting a primary care doctor in the United States have symptomatic androgen deficiency. Tang Fui, M.N., P. Dupuis, and M. Grossmann, Lowered testosterone in male obesity: Mechanisms, morbidity and management. Your email address will not be published. Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up. 13(5): p. 413-24. 80(12): p. 3546-52. [15], An interesting and practically relevant study was conducted to compare the effectiveness of clomid versus testosterone gel replacement therapy on biochemical and clinical efficacy, and treatment cost:[16]. It is common … Ko, E.Y., et al., Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association. Also, when using clomid it is especially important to monitor IGF-1 levels as well. [3] The husband was a bodybuilder who admitted to have used the anabolic steroids testosterone cypionate, methandrostenolone, oxandrolone, testosterone propionate, oxymetholone, nandrolone decanoate, and methenolone enanthate. However, it is important to remember that there are great inter-individual differences in endocrinology, especially when it relates to the hypothalamus, pituitary and testis. 17. All Rights Reserved. Higher rates of recovery are seen with shorter treatment duration, shorter-acting testosterone preparations, higher sperm concentrations at baseline, faster suppression of spermatogenesis, and lower blood LH levels at baseline. – Androgel® 1% (5 gm daily) = $265 Hey Will, great job done in choosing someone of this calibre to present information in their field. Clin Endocrinol (Oxf), 2013. Kim, E.D., et al., The treatment of hypogonadism in men of reproductive age. Realizing the importance of nutrition for maximal results in the gym, she went for a major in Nutrition at the University. 13. Results: 2013: p. 816740. 23(2): p. 149-62. Due my husband’s job, he is mostly out of station and it becomes difficult for us to coordinate during my fertility day. Very simply, the pituitary gland in the brain is … [17]. 79 Suppl 3: p. 1659-61. In many cases, the reduced sperm count caused by taking TRT will not be permanent. Low testosterone is very unlikely to cause fertility issues. TRT was combined with intramuscular injections of human chorionic gonadotropin (500 IU) every other day. Both HCG, HCG+T and clomid have good research backing up their efficacy. current medical history. Boosting Fertility When Testosterone Levels Are Low. 14. 189(2): p. 647-50. It was concluded that HCG appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. http://www.cagepotato.com/heres-what-happens-to-your-body-when-you-stop-using-trt/, The Science Of Bomb Proof Coffee/AlphaJoe Coffee. 10. Las Vegas that is focused on integrative wellness & longevity medicine, J Urol, 2012. 110(10): p. 1524-8. Madhukar, D. and S. Rajender, Hormonal treatment of male infertility: promises and pitfalls. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression due to T supplementation. In trials run by fertility clinics, patients who had experienced low … Ng Tang Fui, M., et al., Obesity and age as dominant correlates of low testosterone in men irrespective of diabetes status. After obtaining institutional review board approval, we retrospectively reviewed the medical records of hypogonadal men who desired fertility preservation during TRT and presented to a … It was concluded that HCG appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Thus, anabolic steroid-induced azoospermia which is persistent after cessation anabolic steroid use can be treated successfully with HCG and HMG. [19] However, it should be cautioned that return of spermatogenesis may be prolonged for some number of men, which may be of concern for those who still are interested in paternity. Millions of men in the United States use testosterone replacement therapy (TRT) to treat low testosterone (Low T). Int J Psychophysiol, 2011. Effects of Testosterone Administration for 3 Years on Subclinical Atherosclerosis Progression in Older Men. These recovery times are for endogenous (non-assisted) recovery. Thanks, Gary. I have read your blog, it was very informative. With the rise in testosterone supplement use, fertility doctors are warning men who would … 5(4): p. 998-1012. and D. Vasudevan, Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. As demonstrated in the contraceptive trials, while cessation of testosterone therapy often restores baseline testosterone levels, it might take up to 2 years (if non-assisted). 89(1): p. 133-6. 1 more conclusive fertility test actually tomorrow and if it still shows sub-fertile I'm being referred to the fertility … Are Fertility Problems Caused by TRT Permanent? Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility … Carruthers, M., The paradox dividing testosterone deficiency symptoms and androgen assays: a closer look at the cellular and molecular mechanisms of androgen action. Clin Pharmacol Ther, 2011. Stress, 2010. I must say, it is a rarity to be able to absorb an article and when finished, immediately feel that you’ve been educated. 153(5): p. 1628-30. 7. The good news is that there are effective options for men who are concerned about their fertility. If you have low testosterone, one way to improve sperm count is with gonadotropin injections. For those hypogonadal men who desire to protect their future fertility in the near future, testosterone supplementation should be done in a low dose, or temporarily discouraged. The concentrations of SHBG and albumin were constant. HCG and clomid can also be used after a TRT cycle to speed up recovery of natural (endogenous) testosterone production and spermatogenesis. Lancet, 2006. In the T enanthate/placebo group, LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94%. 4. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy. 18. Symptom scores improved significantly among clomid treated patients; the average pre-treatment ADAM score was 4.9 vs. 2.1 at follow up. An analysis of 30 studies from 1990-2005, in which sperm output was monitored every month until recovery, was conducted in order to investigate rate, extent, and predictors of spermatogenic recovery after male hormonal contraception. CC works by blocking estrogen (E) action in the pituitary. Fertil Steril, 1997. Hi, I have been on TRT for nearly a year. You may be wondering about testosterone replacement therapy (TRT) and fertility issues. Regards, Gary. When supplementing testosterone, despite normal-to-high blood levels of testosterone, intra-testicular testosterone levels necessary to maintain spermatogenesis may be too low. [5]. and W.J. It is involved in muscle and bone development, hair growth, and development of sex organs such as the penis and … In a study men with normal reproductive physiology were randomized to receive 200 mg T enanthate weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. Fertil Steril, 2013. Wondering the best way to keep fertility intact for when the time arises, not necessarily while taking T. If you missed part 1 on this topic, here it is http://www.brinkzone.com/mens-health/testosterone-replacement-therapy-trt-and-fertility-how-to-get-the-best-of-both-worlds-part-1, The same strategies apply to increasing endogenous testosterone production and speeding up its recovery after supplementation, as illustrated in the figure  below (click image to see it in full). Subjective follow up of patients receiving clomid was performed via telephone interview using the ADAM questionnaire. The ITT levels increased in a dose-dependent manner, with very low-dose HCG administration Moreover, blood levels of HCG were significantly correlated with both ITT and blood testosterone levels. She has completed one semester at the PhD-program “Exercise, Nutrition and Preventive Health” at Baylor University Texas, at the department of Health Human Performance and Recreation, and worked as an ISSA certified personal trainer. Eur J Endocrinol, 2002. 9. Another study confirmed that intra-testicular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose HCG, which may support continued spermatogenesis in patients on testosterone replacement therapy. – Testim® 1% (5 g daily) = $270 Da Ros, C.T. Bruce, Hi Monica, I really like your analytical approach but I feel it’s an uphill battle when seemingly qualified people like Dr. Neil Goodman (an endocrinologist) write articles like this on on his perspective of TRT http://www.cagepotato.com/heres-what-happens-to-your-body-when-you-stop-using-trt/ 11. Maestripieri, D., et al., Between- and within-sex variation in hormonal responses to psychological stress in a large sample of college students. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility … Off-label Prescribing in Medicine – GH Notable Exception! 9. Tan, R.S. Save my name, email, and website in this browser for the next time I comment. [4], HCG not only helps resume spermatogenesis after a TRT cycle, but also can be used in conjunction with TRT to preserve sperm quality. 8. 110(4): p. 573-8. TRT and Fertility – how to get the best of both worlds – part 2, Monica Mollica has a Bachelor’s and Master’s degree in Nutrition from the University of Stockholm, Sweden, and is an ISSA Certified Personal Trainer. When using HCG or clomid, it is important to do regular blood work and check all T fractions in order to monitor treatment efficacy. 14. Testosterone Replacement Therapy and Male Fertility If testosterone levels are lower than normal and you are experiencing infertility, your fertility doctor may suggest testosterone … 12. Doing so can lead to problems, according to Puneet Masson, MD, assistant professor of Urology and director of the Male Fertility Program at Penn Fertility Care. 2011. No differences in semen parameters were observed during greater than 1 year of followup. Previously I got my g/f pregnant quickly. Methods: 147(5): p. 617-24. [8-10] Stress induced cortisol elevation, by increasing SHBG, lowers the free active fraction of testosterone and thereby reduces its action.[11]. Wolf, Are salivary gonadal steroid concentrations influenced by acute psychosocial stress? The term bioidentical hormone does not have a standardized definition and thus often confuses patients and practitioners. This stimulates the production of sperm. Freeze your sperm and store it for when you want to have children Fertil Steril, 2003. [18] Therefore, during clomid treatment it is important to monitor the GH/IGF-1 axis and levels of SHBG and free testosterone, in addition to total testosterone levels and symptoms. As hormone... Hi Monica, I am 56 and live in the UK. Taylor, F. and L. Levine, Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost. 10. 22(10): p. 1269-75. It has given me appropriate knowledge about fertility and pregnancy. No impact on semen parameters was observed as a function of testosterone formulation. Schoofs, D. and O.T. Loss of fertility (often through a reduced sperm count) Testosterone Replacement Therapy alone can decrease the brain’s hormonal stimulation of the testes, reducing fertility and causing the testes to … In this article, we will reveal more about the effect of TRT on fertility, … It helps to maintain fertility, testicular and penis size, cognitive … My GP recently sent me for blood works and amongst the tests was a serum T level – the score that came back was 16.9 but while my GP said that was in a “normal” range, I have no idea what it means as I can’t see any similar types of scores in your articles. It was concluded that HCG appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. HCG (Human Chorionic Gonadotropin). To investigate how HCG affects the different fractions of serum T, eugonadal healthy men were injected with 6000 IU HCG i.m. J Obes, 2011. I assume as a result of TRT. Don't get fooled by marketing claims! Saad, F., Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? What Low Testosterone … [19-21] Therefore it is critical to go to a doctor who is well versed in the area, and who regularly have patients do blood work. Butzow, T.L., L.M. Andrology, 2013. Clomid mono-therapy is an effective way to increase T levels in the physiological range, and is cheaper that T gel. 15. J Androl, 2002. 90(5): p. 2595-602. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. 14(1): p. 10-5. Clin Endocrinol (Oxf), 1990. Hsieh, T.C., et al., Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. [19] Included in the study were 1,549 healthy eugonadal men aged 18-51 years, who underwent (>1200 man-years of) treatment with testosterone or testosterone -progestagen regimens and >700 man-years of post-treatment recovery. A married couple with primary sub-fertility secondary to anabolic steroid-induced azoospermia that was persistent despite 1 year of cessation from steroid use. J Androl, 2009. This large and rising prevalence of testosterone deficiency is gaining recognition among doctors and patients alike. Mulligan, T., et al., Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Saad, F. and L.J. and J.K. Amory, Pharmacologic development of male hormonal contraceptive agents. Not all men who start TRT are … A study using the Trier Social Stress Test (TSST). In my professional opinion, HCG should always form part of your Testosterone Replacement Therapy (TRT) protocol. Bremner, The effects of normal aging on the response of the pituitary-gonadal axis to chronic clomiphene administration in men. Tenover, J.S. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in infertility...however, in most cases, TRT induced infertility is reversible. Not run around. Average follow up was 23 months (Clomid group; range 8–40 months) vs. 46 months (Testosterone Gel group; range 6–149 months). fertility & trt Ever since the birth of my child, I have had numerous inquiries regarding how I was able to impregnate my Wife while being on H ormone R eplacement T herapy. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in infertility...however, in most cases, TRT … HCG is an LH analogue and thus stimulates testicular (Leydig cell) production of testosterone, and increases both intra-testicular testosterone (ITT) concentrations and serum T levels. How 2 Set Styles May Build Muscle In Half The Time. 1(6): p. 906-12. There were no adverse events reported. 99(3): p. 718-24. Barber, The role of obesity and type 2 diabetes mellitus in the development of male obesity-associated secondary hypogonadism. Yen, Clomiphene citrate reduces serum insulin-like growth factor I and increases sex hormone-binding globulin levels in women with polycystic ovary syndrome. The prevalence of testosterone deficiency (aka hypogonadism or Late Onset Hypogonadism), defined as total testosterone (TT) at or below 300 ng/dl is close to 40% in men aged 45 years and older presenting to primary care offices in the US. Copyright © 2021 Ageless Forever. She works a dietary consultant, health journalist and writer for. [8-14] At a dose of 100 mg/day for 2 months, clomid has also been shown to successfully reverse testosterone deficiency symptoms, restore testosterone levels, LH surges and the hypothlamic-pituitary-gonadal axis in a 30 year old male patient whose axis was previously shut off with multiple anabolic steroid abuse. Testicular atrophy is a sign that the testes are deprived of LH and FSH, and that endogenous testosterone production is impaired. Saboor Aftab, S.A., S. Kumar, and T.M. 3) lack of time to stay on top recent research findings, Greetings from Australia, to Will and Monica. The Alpha Male Challenge by James Villepigue, CSCS and Rick Collins, JD, CSCS Review By Will Brink and Elissa... “Bio Identical” hormones are being marketed strongly as a safer alternative to other forms. J Urol, 2013.