Recovery of spermatogenesis following TRT or AAS

[dece870717]

Don't really post anymore but I found this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854084/ published 2016 Feb 23 and it could be extremely helpful to some, it has a lot of very good information in it with many clinical/medical references. A lot of what's in there is really good for even newbies to know--staple information. Wasn't sure if it was more apporpriate to share this here or in the PCT section but I just picked this one.
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I really don't feel like doing a cliff notes version but I can copy and paste some of the more pertinent information:

"Follicle-stimulating hormone (FSH) from the pituitary stimulates Sertoli cells in the testis, which supports spermatogonial differentiation and maturation. Both FSH and maintenance of high intratesticular testosterone (ITT) levels (50–100 fold higher than serum) in response to LH are critical for normal spermatogenesis to occur.21,22,23,24 Historically, Sertoli cell-produced androgen-binding protein was thought to be responsible for such high ITT levels, but recent data suggest that other factors are also involved.25 Interestingly, animal studies have demonstrated that the absence of FSH signaling results in impaired spermatogenesis whereas loss of sufficiently high ITT levels results in the absence of spermatogenesis."

"FSH given alone or in combination with testosterone has proven unsuccessful at inducing spermatogenesis or maintaining spermatogenesis in those previously induced with hCG /FSH (hCG 1500 IU and HMG 150 IU both subcutaneous and 3 times per week), confirming the need for maintenance of elevated ITT.46 However, long-term use of hCG alone can induce spermatogenesis in up to 70% of patients,"

"Most experts treat with hCG alone for 3–6 months after which a certain number of cases will result in spermatogenesis induction. In those without adequate spermatogenesis induction, treatment proceeds with the addition of FSH with doses ranging from 75 to 400 IU 2–3 times per week titrated according to semen analysis results. Success defined as induction of spermatogenesis with >1–1.5 × 106 ml-1 sperm was reported to occur in 44%–100% of patients treated for 6–144 months.52 Pregnancy rates, when reported, were observed in 40%–75% of patients usually at sperm concentration levels below “normal.”42,51,54 Factors predicting success include larger baseline testis volume, previous natural gonadotropin exposure (normal puberty), and repeated treatment cycles whereas previous exogenous testosterone exposure and cryptorchidism portend a slower response although these findings are variable.42,55 It is important to consider these data are in men with HH due to classic causes and not patients with previous TRT/AAS use in whom better outcomes can theoretically be expected given the likelihood of normal pubertal development and HPG axis function at some point before TRT/AAS exposure."

"...finding from Depenbusch and colleagues that preservation of spermatogenesis is possible with hCG alone (500–2500 IU twice weekly based upon serum testosterone levels ) in men with HH and azoospermia in whom spermatogenesis was previously initiated with hCG/FSH.57 However, in this study, spermatogenesis was only maintained “qualitatively,” in that mean sperm concentrations with hCG alone were 43% of levels previously achieved with spermatogenesis induction using a combination of hCG and FSH, suggesting both are needed for “quantitatively” normal spermatogenesis. Alternatively, a series of hypogonadal men wishing to preserve fertility while initiating TRT with different agents (transdermal gels and injections) demonstrated that low-dose hCG (500 IU every other day) preserves all aspects of analyzed semen parameters despite improvement in serum testosterone levels, and with no differences observed between different types of TRT agent used."

"Case reports of CC use at higher doses (100 mg daily) in young men with ASIH resulted in normalization of the HPG axis within 2–3 months, but spermatogenesis was not evaluated.78,79 A small and retrospective case series looking at two men with idiopathic, acquired HH with oligospermia and azoospermia, and one man with ASIH and azoospermia who were each given CC 50 mg 3 times per week found 100% recovery of serum gonadotropins, testosterone, and spermatogenesis within 3 months and a 66% pregnancy rate.80 More recently, a larger retrospective series of 63 men given a combination of hCG 3000 IU 3 times per week and CC or tamoxifen demonstrated recovery of spermatogenesis to >1 × 106 ml-1 sperm in 98% of men in 4–5 months, with a mean initial sperm concentration of 22.6 × 106 ml-1.59 Similarly, a testicular salvage regimen of CC 25 mg daily or combination with hCG 3000 IU every other day for six men with a history of TRT presenting for VR resulted in normalization of the HPG axis and successful VR in 83% of patients."

" It is reasonable to start with hCG 3000 IU subcutaneous injection 3 times weekly for 3 months with additional titration pending interim serum testosterone levels although the optimal hCG dose has not been clearly established. If at 3 months seminal parameters have not improved, one could add FSH. A typical starting dose is rFSH 75 IU subcutaneous injection 3 times weekly.

"During gonadotropin therapy, adjunctive treatments with AIs or SERMs are typically implemented. Such an approach has demonstrated excellent results on average within 4–5 months.59 CC 25 mg daily or 50 mg every other day, titrated up to 50 mg daily, may demonstrate improvement in seminal parameters in as little as 3 months for men with HH. CC is cost effective and has been more effective as a combined therapy in this setting, with less extensive data to support it as a monotherapy.80 If the patient exhibits a low T/E ratio, an AI could be prescribed, with anastrozole 1 mg oral twice weekly is a reasonable starting dose that may be titrated up or down according to the response."

[kelkel]

Hey dece! Yes, we've posted that here a few times. It's a good read. A good thought though is to make every effort to preserve fertility throughout either TRT of a cycle. Read this study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

Scroll down to the HCG section for some interesting stats.