TRT and Fertility Explained, An article by 3J

My wife and I have been married for a number of years. Throughout our relationship she held a very strong position regarding children, she didn’t want any. Her position on the matter was so strong that in early 2014 I decided to take the plunge into TRT. I got my protocol, got myself dialed in, and enjoyed the everlasting benefits. Sounds like a wonderful thing, right? Fast forward to summer of 2016 and my wife, having the woman’s prerogative, dropped the baby bomb on me. Here I am on trt for 2 years and now I have to conceive a child. Obviously, fertility was my first concern. Being the semi-smart man that I am, I made sure to stay on the lowest dosage of hCG to try and sustain some type of fertility if the day ever came that my wife and I decided we wanted children. I am now in the middle of dialing in protocols to increase my fertility (sperm count was at 5.5 million on 200iu hCG twice a week) and bring a bundle of joy into this world. As I started to probe the many possibilities and research the best route to tackle my infertility issues I wondered how many people were going through the same thing completely clueless on what to do. What a perfect time for an article on the matter since nothing drives me to write articles more than experiencing the issue first hand! In this article we will cover all the factors that lead to infertility secondary to TRT and the different approaches one can take to combat the issue.


The HPTA


The hypothalamic-pituitary-gonadal axis (HPTA) is a negative feedback loop system involving the hypothalamus, pituitary gland, and the gonads (testicles). Its main function in the body that concerns us in this article is the regulations of hormones which include testosterone and the development of sperm (spermatogenesis). In short, the hypothalamus releases a gonadotropin-releasing hormone (GnRH) which triggers the pituitary gland which directly affects the pituitary gland releasing the luteinizing hormone (LH) and follicle-stimulating hormone (FSH). The LH’s function is to signal the production of testosterone while the FSH signals the production of sperm. When testosterone is created in the body it is regulated by the aromatase enzyme. The male body likes to keep, roughly, a 10 to 1 ratio of testosterone to estrogen. When testosterone levels rise to a certain level the aromatase enzyme converts testosterone to estrogen. Estrogen regulates the negative feedback loop in the HPTA by inhibiting the production of GnRH.

Lets review this system in simple terms

HPTA
Hypothalamus -> GnRH -> Pituitary -> LH, FSH -> Gonads -> Testosterone, Spermatogenesis -> Hypothalamus +/- Estrogen = +/- GnRH


TRT and Fertility


To the naked eye its obvious that estrogen is the main regulator of the HPTA in natural healthy males (there are other hormones involved, but do not play a factor in what we are discussing). When a subject begins a TRT protocol the exogenous presence of testosterone overrides the negative feedback loop. The pituitary stops sending LH and FSH to the gonads and the natural production of testosterone along with everything else the LH and FSH regulate shuts down. Since FSH is the main conductor of spermatogenesis and that system has been shut down, you become infertile.


Spermatogenesis

Spermatogenesis is the process and development of sperm. It begins within the gonads and moves to the epididymis where sperm is stored until ejaculation. The important fact to take away from spermatogenesis is that the duration of the entire process can take anywhere between 2 to 3 months.


hCG and hMG Solutions to infertility


Wouldn’t it be wonderful if we could somehow just skip half this feedback loop and regulate the production of testosterone and spermatogenesis exogenously? Thankfully we have two very valuable compounds, hCG (Human Chorionic Gonadrotropin) and hMG (Human Menopausal Gonadotropin). hCG is a hormone typically produced by the embryo following implantation (all pregnancy tests test for the presence of hCG in the female subjects urine). Through science we have been able to synthetically produce hCG. In males, the importance of hCG comes with its ability to mimic LH. Injecting hCG is the equivalent of the pituitary releasing LH and giving the gonads the signal to produce testosterone. The gonads go back to work, keeping your system from shutting down completely. Though hCG has no effect on FSH, it does have an effect on spermatogenesis. Though your system is shut down there is FSH lingering around in the body. Studies have shown that there is usually more than enough FSH in the body to cause a rise in a males sperm count enough to conceive. If the desired response from hCG is not met, the use of hMG is a more practical approach. hMG kicks both LH and FSH into gear and causes a considerable rise in sperm production. Recall that the production of sperm takes up to 3 months to complete so the use of these medications have to be sustained for at least 3 months to start to see the real benefit from them.


hCG Protocol


Ive seen 3 different fertility specialists in the last month and each one had a different dosage and frequency of hCG injection that they preferred. Once said 600iu every other day, the second said 1500iu twice a week, and the last one surprisingly said 5000iu once a week. One study on males taking exogenous testosterone had 49 subjects who had a sperm count less than 1 million (average is 20 million and up) on 3000iu of hCG sub-q every other day. An increase in spermatogenesis was found in 47 of the 49 men. The average duration to the return of spermatogenesis was 4.6 months and the mean sperm count was 22.6 million/ml. So higher dosages of hCG seem to be conclusively beneficial to those on TRT (1). Since hCG itself at that dosages seems to produce enough sperm to conceive, the use of hMG would be justified on a case to case basis.

So here I am, 2 months into my small 400iu of hCG every other day protocol. After doing the research that I have done, I have made an appointment with a fertility specialist to present this study and get on a dosage that will be sufficient for conception.

I hope that this article helps you in your fertility goals.

-3J


[h=4][/h]1. J Sex Med. 2015 Jun;12(6):1334-7. doi: 10.1111/jsm.12890. Epub 2015 Apr 22.
[h=1]The Use of HCG-Based Combination Therapy for Recovery of Spermatogenesis after Testosterone Use.[/h]Wenker EP[SUP]1[/SUP], Dupree JM[SUP]2[/SUP], Langille GM[SUP]3[/SUP], Kovac J[SUP]4[/SUP], Ramasamy R[SUP]5,6[/SUP], Lamb D[SUP]6[/SUP], Mills JN[SUP]7[/SUP], Lipshultz LI[SUP]5,6[/SUP].

bump!

Good information on a topic most of us overlook until that special women changes her mind, lol;

yea... i agree

this article isn't done.. i still want to cover hcg monotherapy.. gnrh therapy and hmg therapy.. i just wanted to get this info out there asap since its not regularly available on forums from what i have seen