Background:
- 37M, 10 years on TRT (testosterone enanthate)
- Wife is 36, fertility confirmed normal
- Goal: natural conception
- No physician support for the protocol itself - doctors here (Alberta, Canada) have been useless beyond ordering bloodwork and referrals. Self-directing this based on literature.
Current Protocol (started March 31, 2026):
- HCG 5,000 IU/week (1,667 IU SubQ MWF)
- Clomiphene 25mg daily (175mg/week)
- Kisspeptin-10 100mcg SubQ 3x/week (MWF)
- Testosterone Enanthate 125mg/week (62.5mg 2x/week, Tue/Sat)
- Exemestane 12.5mg/week (6.25mg 2x/week on T days)
Rationale for keeping low-dose T: Baylor 2024 data showed concurrent TRT did not impair spermatogenic recovery. Using it as a QoL bridge rather than going cold turkey.
Baseline Bloods (March 30, ~2 PM, pre-protocol):
- FSH: <0.3 IU/L (undetectable)
- LH: <0.3 IU/L (undetectable)
- Total T: 42.8 nmol/L (supraphysiological — was on 150mg/week, reduced to 125mg)
- Free T: 1,317 pmol/L
- E2: 72 pmol/L
- SHBG: 21 nmol/L
Week 5 Bloods (May 6, ~2 PM):
- FSH: <0.3 IU/L (still undetectable)
- LH: <0.3 IU/L (still undetectable)
- Total T: 20.3 nmol/L (dose reduction worked — mid-range now)
- Free T: 527 pmol/L (normal)
- E2: 107 pmol/L (up from 72, still in range)
- SHBG: 27 nmol/L
All safety markers (CBC, liver, kidney, lipids) improved or stable. No issues there.
The problem: 5.5 weeks of HCG + clomid + kisspeptin and FSH/LH haven't budged. Pituitary is still completely asleep.
Current plan: Double the clomid to 50mg/day, continue HCG at 5,000 IU/week, retest at Week 8-9. If FSH still flat at that point, add HMG (75 IU 3x/week) to deliver FSH directly and bypass the pituitary.
What I'm looking for:
- Anyone with experience restoring fertility after long-term (5+ years) TRT - how long before your pituitary showed signs of life? Did clomid alone eventually work or did you need HMG/FSH?
- Opinions on the protocol - am I missing anything? Dosing look right?
- Is 5 weeks too early to be concerned about flat FSH given 10 years of suppression, or is this a red flag?
- For those who added HMG - what dose and frequency worked? How long before you saw sperm?
Appreciate any input. I've read through Ledesma 2023, Samplaski 2014, and the CUA guidelines but real-world experience from guys who've been through this is what I'm after.
Current Protocol (started March 31, 2026):
- HCG 5,000 IU/week (1,667 IU SubQ MWF)
- Clomiphene 25mg daily (175mg/week)
- Kisspeptin-10 100mcg SubQ 3x/week (MWF)
- Testosterone Enanthate 125mg/week (62.5mg 2x/week, Tue/Sat)
- Exemestane 12.5mg/week (6.25mg 2x/week on T days)
Rationale for keeping low-dose T: Baylor 2024 data showed concurrent TRT did not impair spermatogenic recovery. Using it as a QoL bridge rather than going cold turkey.
Would not even called 125 mg T/week a low dose as many men can easily hit a healthy let alone high trough FT on 100 mg T/week especially when split into more frequent injections.
Your wasting your time with the clomid and kisspeptin especially with the dose of exogenous T you are using as your HPG-axis will still be shut-down.
T + hCG + rFSH is where it's at if your goal is maintaining let alone improving fertility while on T-therapy.
Would not even waste my time with the AI unless the hCG is sky rocketing your estradiol.
Baseline Bloods (March 30, ~2 PM, pre-protocol):
- FSH: <0.3 IU/L (undetectable)
- LH: <0.3 IU/L (undetectable)
- Total T: 42.8 nmol/L (supraphysiological — was on 150mg/week, reduced to 125mg)
- Free T: 1,317 pmol/L
- E2: 72 pmol/L
- SHBG: 21 nmol/L
Keep in mind although TT is important to know FT is what truly matters here as it is the active unbound fraction of T responsible for the positive effects.
If these are your results at true trough (lowest point) before your next injection when you were injecting 150 mg T/week this is complete overkill as you are hitting a whopping most likely trough TT 1234.4 ng/dL (42.8 nmol/L) and more importantly sky-high trough FT 38 ng/dL (1317 pmol/L).
With a whopping trough TT 1234.4 ng/dL, somewhat lowish SHBG 21 nmol/L it is a given that your trough FT would be sky-high.
Your FT was. calculated using the go to linear law-of-mass action Vermeulen (cFTV) as this is the testing method used for free testosterone in Canada.
As I have stated numerous times on the forum over the years.
Always need to be mindful of your injection frequency/where trough FT sits.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Rare anybody would ever need to push their trough FT 30+ ng/dL in order to experience relief/improvement of low-T symptoms let alone reap all the positive benefits of having a healthy trough FT.
Need to keep in mind that there is a big difference between one running a high-end/high trough FT 20-25 ng/dL injecting daily vs twice-weekly vs once weekly.
Also going to be a big difference in peak--->trough on said protocol!
Many tend to overlook this and gun for a high-end/high trough FT only to end up struggling with sides especilly in the long run.
Just to put this in perspective most healthy young males would be hitting a cFTV 13-15 ng/dL or 10-12 ng/dL tested using the most accurate assay the gold standard Equilibrium Dialysis and this is a short-lived daily peak to boot!
Even if you take those natty outliers in the 97.5th percentile hitting a high FT 25.3 ng/dL again this is a short-lived daily peak to boot!
You have guys on T hitting a trough FT 25-30+ ng/dL injecting daily with FT elevated 24/7, EOD as in every 2 days (48 hrs post-injection),twice-weekly as in every 3.5 days (84 hrs post-injection), once weekly as in 7 days post-injection.
Clear as day many men are overmedicated on T especially from the get go!
Brainwashed by that more T is better mentality bulls**t!
Week 5 Bloods (May 6, ~2 PM):
- FSH: <0.3 IU/L (still undetectable)
- LH: <0.3 IU/L (still undetectable)
- Total T: 20.3 nmol/L (dose reduction worked — mid-range now)
- Free T: 527 pmol/L (normal)
- E2: 107 pmol/L (up from 72, still in range)
- SHBG: 27 nmol/L
All safety markers (CBC, liver, kidney, lipids) improved or stable. No issues there.
You reduced your T dose from 150--->125 mg/week (62.5 mg 2X/week) which has you hitting a descent trough TT 585.5 ng/dL (20.3 nmol/L) and more importantly a descent/healthy trough FT 15.2 ng/dL (527 pmol/L).
Your SHBG increased from 21--->27 nmol/L due to the decreased. androgen load.
Hard to compare your results TT, FT on 150 vs 125 mgT/week as you never stated your injection frequency on the 150 mg T/week protocol.
If you were splitting your weekly dose and injecting twice-weekly on both protocols and labs were done at true trough then I would say there is something wrong here with that UGL test you are using as your TT and more importantly FT took a major dive by reducing your dose 25 mg/week which would make no sense here!
The problem: 5.5 weeks of HCG + clomid + kisspeptin and FSH/LH haven't budged. Pituitary is still completely asleep.
I honestly don’t think chasing serum LH/FSH is the right endpoint here while you’re still running 125 mg T/week.
Your axis is still under significant negative feedback.
Even though you added clomid + kisspeptin your trough TT is still 585 ng/dL and more importantly trough FT 15 ng/dL, which means your average androgen exposure is clearly physiologic-to-high normal and peak TT and more importantly FT would be substantially higher.
Throwing in 5,000 IU/week hCG on top of that and the pituitary has very little reason to produce endogenous LH/FSH.
hCG is essentially replacing LH function at the testes and if you eventually add hMG/rFSH, you would also be bypassing endogenous FSH production directly. So spermatogenesis can recover even while serum LH/FSH stay near-zero.
I would put more weight behind a semen analysis which needs to be done 3-4 months after starting your fertility protocol.
Even then as I stated numerous times on the forum anyone starting T therapy that is planning on having children needs to get a baseline SA done.
Any doctor in the know would recommend this.
This is critical.
Hope you understand that It takes 2-3 months to make new sperm and even then it still may take longer to become fully fertile again.
You should have had a semen analysis done before adding in the hCG then retest in 3 -4 months.
Even then would have been ideal to have an SA done pre-TTh so you would have a baseline to compare to as some men have fertility issues before even jumping on exogenous T and did not know it!
If you are looking for the quickest recovery hCG + FSH would be where its at.
Current plan: Double the clomid to 50mg/day, continue HCG at 5,000 IU/week, retest at Week 8-9. If FSH still flat at that point, add HMG (75 IU 3x/week) to deliver FSH directly and bypass the pituitary.
Bad move here as again the you are wasting tour time with clomid let alone kisspeptin,
The addition of FSH with hCG is all that will be needed to regain fertility while using exogenous T.
Even then it is not a given seeing as you never had a baseline SA done
Hello folks,
Came across this forum in my new quest - get my wife pregnant.
I've been on self-prescribed TRT (UGL product with semi consistent bloodwork analysis) for around 7-8 years. A few blasts over the years in there earlier era, but just sitting in physiological numbers for the last 5 years, with occasional Anavar usage at a low dose.
I am 36. The wife and I have recently started to discuss having little ones, and aligning for our family planning, so I decided to go get a sperm analysis done. We all know what the result is; we knew what it would be going into it.
I've never...
27:57-31:47
*testosterone deficiency in men
On this episode of BackTable Urology, Dr. Mike Hsieh (UC San Diego) interviews Dr. Larry Lipshultz (Baylor College of Medicine) about his journey to becoming a renowned specialist in male infertility and reproductive medicine.
First, Dr. Lipshultz explains how he became interested in urology by working in a basic sciences surgery laboratory with a urologist. He became passionate about doing research in male infertility as an intern after hearing a Grand Rounds lecture...
Sit and dwell on that!
Think of all those overmedicated men on T-therapy gassed up on FT well beyond their natty genetic set-point and unfortunately many off them off the hop!
You can blame all those run of the mill T clinics, kiddie forums loaded with all those numbskulls, throw those blast n cruisers in there too and put the icing on the cake the cesspool of so called gurus polluting gootube!
Gotta love all those kiddie forums loaded with the brainwashed sheep still pushing that more T is better mentality dishing out piss poor advice!
So much misinformation littered on the net its...
