Help with 7 Month TRT Levels, Fertility, Doctor

Hey guys,

I'm 26, 6'3" 185 lbs. 15ish% bf. I've been on TRT for 7 months after I finally got my levels checked because of fatigue, depression, no morning wood, bad erections, etc.

I'm having trouble because even after 7 months my levels aren't where they should be, I still have most of the symptoms, though some are much improved, and I'm beginning to be concerned with my current and future fertility.

I was born with an undescended testicle and had pubertal gyno that was corrected surgically.

I had a sperm count last week that resulted in the doctor calling me back an hour later saying that it was so low he wanted me retested at an outside lab to make sure it wasn't an error.

I've been on 60ml test. cyp. injected twice weekly, and on and off anastrozole. At some point I had a noticeable decrease in testicle size and ejaculation volume. My Dr. put me on HCG 250iu 3xweek. Both problems corrected but my levels were never checked. I was told I could only stay on a month before I would have to cycle off for a month before restarting. After discontinuing the nuts shrank again, etc.

I started TRT with low dhea-s levels(97 160-449ug/dl), was told to start supplementing, shot up to 800, was told to stop. Now down to 50...told to restart supplementation.

Labs time:

Pre-TRT LH/FSH

LH 2.3 1.7-8.6 mIU/mL
FSH 1.8 1.5-12.4mIU/mL

Test. and Estrogen labs were taken 1 month and 7 months after starting TRT.

Estradiol 19.3-->18.4 7.6-42.6 pg/ml
Total Test. 334-->647 280-1100 ng/dl
Free Test. 4.41-->8.23 1.9-27 ng/dl
SHBG 53-->55 10-80 nmol/l

Other Labs Taken at 7 months:

Pregnenolone 314 38-350 ng/dl
DHEA-S 49.5 160-449 ug/dl
t3 free 3.9 1.8-4.6 pg/dl
TSH 1.22 .27-4.2uiu/ml

I'm concerned that my symptoms haven't corrected and that my levels aren't coming up high enough. I'f I started at 4, then jumped to 8 free test. and want to be in the 20s, it seems like I have a long way to go.

How do I accomplish that without ending my chances at naturally conceived children?

I haven't seen much to back up my doctor's claims that anything over 1 month of hcg is counterproductive. How long is reasonable to use hcg while on trt?

Any other ideas to present to my doctor to get my test. levels up, fertility back to normal, etc.?

Thanks for any ideas

Michael

how soon do you want to have children?

wanting to have children within a year is actually one of the very few contraindications to starting testosterone therapy. for most men, however, fertility is regained (assuming they were capable before TRT) within a few months after stopping. although it is worth noting that some men still can get a woman pregnant on TRT. it is to be expected that your sperm count decreases when taking testosterone. that is completely normal and almost always reversible.

your numbers have definitely improved, but they obviously aren't where you want yet. you are not at the upper limit of testosterone dose though. so the logical step right now in that regard is to simply up the dosage about 25mg per week.

Children aren't immediate, but I got concerned with a 0 sperm count. My pre-trt lh/fsh seem lowish. Should I be pushing for continued hcg treatment?

There are a lot of variables to approach here ... I'll address 1 or 2 right now, then can always comment on others later.

Regarding your free testosterone. The reason you're facing such a futile battle is because of your SHBG being so high. Your testosterone binds to SHBG, and even loosely binds to albumin. The simple explanation is that your free and bio available testosterone will decrease when your SHBG is increased. Ideally, you want to be at a range of 2% to 3% on your free testosterone, mid range being great. Your free test is currently 1.27%, which is slightly lower than the last labs, where it was 1.34%. Notice how your SHBG respectfully also went from 53 to 55? You can see the correlation here.

For SHBG management, look into some stinging nettle root, as well as checking and maintaining your vitamin D level to the optimal range. Don't worry too much about the total test serum level, you're actually in a good range. Understand that the SHBG control is what's needed to get the balance here that you desire.

HCG (IMO) really isn't the greatest route to go if you're looking for a better sperm count. HCG mimics LH, but I would think that your doctor would want to see some FSH added into the mix, which is key for spermatogenesis. Talk to your medical team about HMG (Human Menopausal Gonadotropin), which will deliver both analogues of LH & FSH. Being that you had a condition with one of your testicles, I urge that you review anything and everything you read here with your doctor(s) before proceeding.

I'm sure plenty of other experienced members will have some comments too, so stay tuned ...

Quote:

---

Originally Posted by michael11

Children aren't immediate, but I got concerned with a 0 sperm count. My pre-trt lh/fsh seem lowish. Should I be pushing for continued hcg treatment?

---

If you had healthy sperm before TRT then you should EXPECT (there are never guarantees in medicine mind you) that if you come off TRT that sperm function will recover after 3-6 months, possibly a year.

Unfortunately, most docs know nothing about this. You should seek a urologist who specializes in male TRT and fertility if you want the best chance at monitoring this. An endo is probably a waste of time, as are most basic internist/family doc, but I'm not sure who you are seeing.