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Advice for bringing sperm count back to normal after TRT


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#1 mondrian

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Posted 03 July 2014 - 01:21 AM

In short:

 

Would like to start a family, but diagnosed azoospermic after being on Testosterone Replacement Therapy (TRT) for about 10 years.

 

Have been to a clinic in Chiang Mai, Thailand where the doctor recommended HCG 2,000 iu every 3 days. Did not recommend any blood work, just a sperm count after 3 months.

 

I don't have many options at my current location but I'm in a position to manage my own treatment. I'm looking for some guidance on this. More than happy to do an online consultation with a doctor/professional to this end.

 

 

In detail:

 

I'm a 45 year old Caucasian male with a background in the biological sciences.  About 10 years ago I was diagnosed with Secondary or Hypogonadotropic Hypogonadism (HH). Since then I have been on testosterone enanthate injections (initially 250 mg every 2 weeks but after discussion with my doctor, decided to go to 80 mg every 4 days since the 2 week regime led to mood swings). Prior to being diagnosed with HH, I suffered from depression and lack of drive.

 

A few months ago my partner and I decided to try any start a family. I did a fertility check recently and the results were as follows:

 

Date:   14-May-2014

Seminal Volume:   2.0 ml

Semen pH:   8.0

Leucocytes:   Less than 1 million/ml

Sperm Concentration:   0.0 million/ml (no sperm detected)

 

 

Given I have been on TRT for the past 10 years, the azoospermia result comes as no surprise. However, I have never done a fertility check before so there is no way of knowing if the azoospermia is congenital or TRT induced.

 

I recently visited a fertility clinic in Chiang Mai, Thailand where I spend most of the year. The Australian trained Thai doctor suggested I:

 

1) Stop the TE injections

2) Start injections with HCG, 2000 iu every 3 days

 

He says he normally prescribes 1,000 iu every 3 days but I'm "a big guy" and my partner is 42 so I should probably get on the fast track. When I asked about getting blood work done (to monitor various hormone levels and see if the HCG dose I was getting was appropriate) he dismissed this saying "your goal is to increase your sperm count, not to worry about the levels of various hormones".

 

Based on my own research, it seems that; 1) The dosage of HCG he is prescribing may be too high; 2) It's important to monitor the levels of certain hormones so that the amount of HCG injected is tailored to individual. As I understand it, excessive amounts can be counterproductive (too much oestradiol, Leydig cell desensitization etc)

 

The doctor in Chiang Mai has already provided me with a months supply (at his recommended dose) so I am in a position to take charge of my own therapy. Given this and the fact that I don't have many options in Chiang Mai, I am seeking advice on the following:

 

1) How long to wait after my last TE injection to do baseline blood work for various hormone levels

2) I good starting dose for HCG

3) Which hormones to monitor and the target ranges for these hormones for the purpose of elevating my sperm count



#2 Merry33

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Posted 03 July 2014 - 11:28 AM

First of all - welcome to the board!

 

A few things:

 

When you were diagnosed with hypogonadotropic hypogonadism, did you ever have a semen analysis done then (sorry, think I just read the answer to that which is no, correct)? The reason I'm asking is that with this diagnosis I would assume that you might have never had a normal sperm count, even before you started TRT. My husband has the same diagnosis, and his sperm count is very far from normal (as in, our only option is IVF-ICSI).

 

As for the therapy - HCG injections is pretty much the way to go (some people go on clomid or aromatase inhibitors, but HCG seems to be most effective. I'm not sure if doing blood work right now would be all too useful because all your levels would be completely off due to the TRT. Hence I'd agree with your doctors that it's not necessary right now. If you wanted to do a true baseline you'd have to wait before starting the HCG. Not sure how long though, but guessing there is a way to figure out the half-life of testosterone.

 

The dose you're on seems pretty standard to me. I haven't seen dosages tailored much in men. It either works or it doesn't. The other thing is that there is really not many alternatives. And it's also very standard to just try for 3 months and then repeat the semen analysis/blood work. Levels in between are not usually monitored as they are not necessarily linked to your sperm count. Let's say you have congenital disease, eventhough your hormones will react to the HCG your sperm production won't. And the unfortunate reality is that this is the case for many men. I don't want to discourage you, as it might work in your case, but just be prepared that it might not (eventhough your testosterone will go up - but like I said, regulating your hormones won't necessarly have an impact on sperm production due to a variety of reason - genetics, tissue damage/lack of certain sperm-producing cells etc).

 

Good luck!


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#3 mondrian

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Posted 04 July 2014 - 04:53 AM

HI, Thanks for your feedback.

 

Did your husband receive HCG injections and if so, do you rember the dose and frequency?

 

The benefits of doing blood work are that you can see how much of a dose is enough for proper stimulation of sperm production. The hormone levels tell you how much HCG is enough. For example if the Leydig cells are over stimulated, they can become desensitised and won't produce the testosterone required. Testicular aromatase can also be overproduced which can lead to excessive estrogen levels and potentially bad side effects.

 

Good luck to you and your husband!



#4 Merry33

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Posted 04 July 2014 - 02:18 PM

Yes - he's been on 2500 units twice/week.

 

I get what you are saying, but like I said before - your hormone levels won't necessarily correlate with your sperm count though. If you have a genetic issue affecting your sperm production, your hormones will go up but you still won't be able to produce sperm (because there's something wrong in your pathway). Same thing for other issues, such as history of orchitis and so on (because there has been tissue damage etc). Thus to me the question is - do you want your testosterone to go up or your sperm count? If you want the latter to go up the only way to figure this out is a repeat semen analysis (because elevated testosterone doesn't mean higher sperm count, at least not in men with a diagnosis of secondary hypogonadism). Secondly, as you've been on TRT your testosterone is already up - so you'd have to wait until you're back to baseline (whatever that is for you) to see if you'll see another increase with the HCG.

 

I think it's typical to have all of this checked (hormone levels & sperm count), but usually only after 3 months. But of course there would be nothing wrong with checking after a few weeks or so. From what I know the usual management plan in case of negative results after 3 months would be to keep going for another 3 months, or add in FSH.


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#5 floriano

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Posted 17 March 2018 - 10:41 PM

Hello: hope it all went well and you've fathered/mothered a beautiful baby.

I am in a similar situation: azoospermic after TRT. Could you please share which clinic did you go to in Chiang Mai? We are based in Vietnam but doctors don't do the hcg treatment for makes here.

Thank you very much!