Expert Answered Reclaiming fertility after TRT with HCG and enclomiphene

[QuentinD]

Hi !
Ive been on TRT for 2 years without any hCG which was a mistake I already know that.

Now with my wife, we want a child. It's time for us and we are more than ready to get engaged on this new adventure.
But we can't wait, we want to have it as soon as possible.

Ive got tamoxifen, hCG and enclomiphene. It's been 3 weeks without any exogenous testosterone and taking 1500iU of hCG every two days to "wake up" my body.
Ive read that it's not optimal to mix tamoxifen and hCH at the same time, need to be alterned.

So... What next? Should I keep using hCH but with much lower dose, use tamoxifen and enclomiphene?

Thank for your help!
Best regards

 

[Donvitosharkone]

Hi !
Ive been on TRT for 2 years without any hCG which was a mistake I already know that.

Now with my wife, we want a child. It's time for us and we are more than ready to get engaged on this new adventure.
But we can't wait, we want to have it as soon as possible.

Ive got tamoxifen, hCG and enclomiphene. It's been 3 weeks without any exogenous testosterone and taking 1500iU of hCG every two days to "wake up" my body.
Ive read that it's not optimal to mix tamoxifen and hCH at the same time, need to be alterned.

So... What next? Should I keep using hCH but with much lower dose, use tamoxifen and enclomiphene?

Thank for your help!
Best regards

Hi mate!
Before doing anything,

Hormonal bloodwork, FSH, LH, Test, and a sperm analysis.

It does not make any sense to shoot in the dark

Shark

 

[Sam Bjorn]

Hi !
Ive been on TRT for 2 years without any hCG which was a mistake I already know that.

Now with my wife, we want a child. It's time for us and we are more than ready to get engaged on this new adventure.
But we can't wait, we want to have it as soon as possible.

Ive got tamoxifen, hCG and enclomiphene. It's been 3 weeks without any exogenous testosterone and taking 1500iU of hCG every two days to "wake up" my body.
Ive read that it's not optimal to mix tamoxifen and hCH at the same time, need to be alterned.

So... What next? Should I keep using hCH but with much lower dose, use tamoxifen and enclomiphene?

Thank for your help!
Best regards

Hi,

Your case is pretty typical, and I think it's time to write an article about this because everyone keeps making the same mistake.

My question is — did you stop taking the compounds and start this therapy on your own, or did you see an andrologist who told you to do it this way? I mean stopping testosterone and using HCG and SERMs.

And what testosterone doses were you using? Was it actual TRT or more of a cycle?

 

[QuentinD]

Hi,

Your case is pretty typical, and I think it's time to write an article about this because everyone keeps making the same mistake.

My question is — did you stop taking the compounds and start this therapy on your own, or did you see an andrologist who told you to do it this way? I mean stopping testosterone and using HCG and SERMs.

And what testosterone doses were you using? Was it actual TRT or more of a cycle?

That's true ! That's a pretty common mistake.
I was aware of the fact that i'll lost fertility. But not this fast and that the recover will be this long too. But anyway , that's too late. Now i have to move forward.

I was at 0.25mgr/week for two years. Its was for my personnal wellness.
I done it all by myself. I'm in France and it's really not common, so all the doctors judge you pretty badly. The answer is like "why did you do it? Now you have to wait, can't help"
So I read article, ask IA and follow the post therapy guide on driada to help me

 

[Sam Bjorn]

I understand. This is a fairly common situation. By 0.25 mg, I assume you mean 250 mg per week.
Here's what I'd recommend doing now:

1. Diagnostics​

Get a semen analysis, preferably including sperm DNA fragmentation testing. This will give us an understanding of your starting point. Don't expect a miracle — most likely, the results will be pretty bad or even very bad, but it's all fixable, and we'll need to track your progress throughout the treatment.

A semen analysis includes:

• Ejaculate volume
• pH
• Sperm concentration
• Total sperm count
• Progressive motility (PR)
• Non-progressive motility (NP)
• Immotile sperm (IM)
• Morphology according to strict criteria — percentage of sperm with normal structure
• Vitality — percentage of live sperm
• Agglutination — sperm sticking together
• Leukocytes — possible signs of inflammation
• Liquefaction time and viscosity

Vitality and some additional parameters may only be tested when indicated or may be included in a separate package. I don't know exactly which testing packages are available in your country or how much they'll cost, but at the very least, you should get a standard semen analysis. I think it might cost around €100–200. DNA fragmentation testing will be more expensive, so you can skip it for now if it's outside your budget.

2. Protocol​

Since the doctors told you to do nothing, I believe a protocol would definitely help speed up the recovery process. Here's what I recommend:

1. Continue using HCG at 1500 IU three times per week for another 4 weeks.
2. After finishing HCG, get blood tests. We want to see how well your testicles respond to HCG stimulation. Here's the list:

• Total testosterone
• Free testosterone
• SHBG
• Albumin
• Estradiol (preferably LC-MS/MS)
• Prolactin
• TSH

Depending on the results, we can plan the next steps. To explain briefly: if your testosterone is elevated, we'll know that your testicles are responding to HCG therapy, and then we can start using SERMs. I wouldn't rush into planning the entire protocol in advance, but in general, enclomiphene and tamoxifen will be useful if you already have them on hand.

3. General health​

I'd also recommend additional blood tests to check your overall health. Now is a good time to get everything in order, especially if you haven't been monitoring your blood markers before. I can put together that list for you as well.

4. Supplements​

This will also be an important part of both PCT and the subsequent fertility recovery process, because certain semen parameters can be improved with supplements. Andrologists often use them as an additional part of treatment. I can give you a list of these supplements if you want.

5. HMG​

This is probably going to be the most painful part... for your wallet. HMG is a synthetic analogue of FSH, the hormone that directly affects your fertility. It's also one of the main medications used to restore it.

You can start using it now and continue practically without interruption throughout the recovery process. The dosage is 75 IU three times per week (twice per week minimum). But the problem is that it's very expensive.

I know that in some countries, if you visit an andrologist and explain that you've been unable to conceive a child for more than 6 months, the government will cover HMG treatment. They pay for almost the entire cost of the medication. So find out how this works in your country. If there are no subsidies, you have two options: either pay for it yourself or don't use it. It's not a tragedy if you can't afford it, but most likely, your fertility recovery will take significantly longer.

What happens next​

I can explain how the treatment process will look. First, we need to understand how your testicles respond to stimulation. Based on that, we'll decide when to start using SERMs. Once we begin, we'll need to monitor the recovery of your sex hormone levels through regular blood tests and repeat the semen analysis every 3 months. That's a very brief overview. I don't want to write out a huge protocol right now because I don't yet know whether you're planning to follow it.

So I'll wait for your feedback.

Main steps (essential)​

1. Find out what's going on with your semen parameters through a semen analysis.
2. Continue HCG for another 4 weeks and get blood tests. If you can afford to start HMG, we can add it too (after seeing the semen analysis results — who knows, maybe you're a genetic exception who has managed to maintain good sperm parameters).
3. Based on the results, either continue HCG therapy or start using SERMs.
4. Once SERMs are introduced, monitor your hormone levels.
5. Track changes in your semen analysis.

Recommended​

1. Get a general health assessment through blood tests.
2. If there are any abnormal markers, especially those related to testosterone use, address them or keep them under control.
3. Monitor your blood pressure for one week.