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.
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:
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