TRT and fertility

[Fraggle]

I have a question I'm hoping someone in this forum can help me with...

I completed recent pre-cycle blood work and discovered that my testosterone levels are very low... 197ng/dL total and 34.7 pg/dL free. I've never considered permanent testosterone therapy prior to this, so issues from long-term androgen use haven't really been in the forefront of my mind.

Basically, I'm 31 and plan on having children in the next 3-5 years. I have found very conflicting research with respect to fertility and testosterone supplementation. In some instances the low levels of testosterone and fertility actually benefits from the normalized test levels. On the other hand it seems like the suppression of LH and FSH result in a significant decrease in spermatogenesis. Clearly this could be corrected by tapering off the testosterone and using HCG and possibly FSH (expensive) but then I would run into erectile dysfunction and loss of libido... making conception that much more difficult.

I've got a follow-up appointment this afternoon, any words of wisdom or experience would be greatly appreciated on how to manage fertility and TRT so that I am prepared with information during the appointment...

[JanSz]

Originally Posted by Fraggle

I have a question I'm hoping someone in this forum can help me with...

I completed recent pre-cycle blood work and discovered that my testosterone levels are very low... 197ng/dL total and 34.7 pg/dL free. I've never considered permanent testosterone therapy prior to this, so issues from long-term androgen use haven't really been in the forefront of my mind.

Basically, I'm 31 and plan on having children in the next 3-5 years. I have found very conflicting research with respect to fertility and testosterone supplementation. In some instances the low levels of testosterone and fertility actually benefits from the normalized test levels. On the other hand it seems like the suppression of LH and FSH result in a significant decrease in spermatogenesis. Clearly this could be corrected by tapering off the testosterone and using HCG and possibly FSH (expensive) but then I would run into erectile dysfunction and loss of libido... making conception that much more difficult.

I've got a follow-up appointment this afternoon, any words of wisdom or experience would be greatly appreciated on how to manage fertility and TRT so that I am prepared with information during the appointment...

What is your present LH & FSH level?
If they are very high, that would mean your testis are going down, primary hypogonadism.
You should check your sperm now and save for future, right now, latter may be too late.

If your LH and FSH are low, good chance that your testis are ok but are not getting a signal to produce.
Check/MRI for pituitary tumor.
Use HCG to keep testis production.

Consider using my post #79 to guide you thru.
That is 2000-6000 iu /week
You should not need testosterone while on this protocol.
If that does not give you enough of BAT or you E2 raises and requires you to use more than about 2mg/week Arimidex, then consider adding a little of testosterone injections.
But external testosterone may interfere with your fertility.

Jan's BloodTest April13/2007 - Page 3

Test at Quest Diagnosics, at least these tests

Estradiol, Ultrasensitive, LC/MS/MS (30289X)
Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)
Dihydrotestosterone, Free, Serum (36168X)

[Fraggle]

Blood results:

FSH 3.0 mIU/mL reference 1.6 - 8.0
LH 6.4 mIU/mL reference 1.5 - 9.3
Total T 197ng/dL reference 250 - 1100
Free T % 1.76 reference 1.5 - 2.2
Free T 34.7 pg/mL reference 35.0 - 155.0
Estradiol 17 pg/mL reference 13 - 54


Don't think it's primary hypogonadism. My levels of LH and FSH are inappropriately normal.

I do have crohn's disease, however I've been in remission for nearly five (5) years and my sedimentation rate is 3.0. It always spikes when I have a flare, so it's not chronic disease related. I flat out refuse to take immunosuppressants and corticosteroids unless I'm facing iminite demise or obstruction, so adrenal related mediation is unlikely to be causal.

I know I'm fertile due to conception and miscarriages -- wife is hypothyrodic => difficulty carrying to term.

The endo I see is fairly aggressive, which, to be honest is fine by me. I've already developed osteopenia. The work I do requires intense concentration, focus and hours of overtime (mission critical software and systems analysis and design where human life and extremely large sums of money are involved) and I have noticed a steady decline over the last 3-4 years in my ability to function at the necessary level.

Obviously exogenous hormones are going to result in a decrease in FSH and LH and a concommitent reduction in spermatogenesis. I'm primarily interested to know if HCG during a cycle can ameliorate this issue to some extent. The alpha portion of HCG matches both LH and FSH. While the beta portion is more specific to LH I've heard that it has some moderate FSH like activity.

We would like to have children sometime in the next ~3-5 years.

[Valderama]

We would like to have children sometime in the next ~3-5 years.


Me too just need too find some bootie hehehehhe

[JanSz]

Originally Posted by Fraggle

Blood results:

FSH 3.0 mIU/mL reference 1.6 - 8.0
LH 6.4 mIU/mL reference 1.5 - 9.3
Total T 197ng/dL reference 250 - 1100
Free T % 1.76 reference 1.5 - 2.2
Free T 34.7 pg/mL reference 35.0 - 155.0
Estradiol 17 pg/mL reference 13 - 54


Don't think it's primary hypogonadism. My levels of LH and FSH are inappropriately normal.

I do have crohn's disease, however I've been in remission for nearly five (5) years and my sedimentation rate is 3.0. It always spikes when I have a flare, so it's not chronic disease related. I flat out refuse to take immunosuppressants and corticosteroids unless I'm facing iminite demise or obstruction, so adrenal related mediation is unlikely to be causal.

I know I'm fertile due to conception and miscarriages -- wife is hypothyrodic => difficulty carrying to term.

The endo I see is fairly aggressive, which, to be honest is fine by me. I've already developed osteopenia. The work I do requires intense concentration, focus and hours of overtime (mission critical software and systems analysis and design where human life and extremely large sums of money are involved) and I have noticed a steady decline over the last 3-4 years in my ability to function at the necessary level.

Obviously exogenous hormones are going to result in a decrease in FSH and LH and a concommitent reduction in spermatogenesis. I'm primarily interested to know if HCG during a cycle can ameliorate this issue to some extent. The alpha portion of HCG matches both LH and FSH. While the beta portion is more specific to LH I've heard that it has some moderate FSH like activity.

We would like to have children sometime in the next ~3-5 years.

Using
HCG and Arimidex=Liquidex=Anastrozole
tests in my previous post on this thread
E2D HCG and AI schedule
about once/month testing until stable levels are acheived
alot 6-9 months to figure out what your testis will deliver.

your goal should be
BAT (460-575) or within top 1/4 of range
E2 close to top (25-29)
DHT close to top range

You would benefit having NutrEval test done at Genova Diagnostics.
The report will give you a list of supplements and daily dose, specific to your condition.

Do also other crohn's related tests there.

Consider MRI of your pituitary glands.

Consider general testing list on my post #44
Jan's BloodTest April13/2007 - Page 2