Spermatogenesis Recovery after Testosterone Use

[madman]

We do it big here!

 

[madman]

* 60% become azoospermia on IM injections

 

[madman]

* the largest % increases are seen in men of reproductive age

 

[madman]

Strategies to recover spermatogenesis

 

[madman]

* it took almost 2 years for all men to get back to their normal levels!



Cold Turkey

 

[madman]

Gonadotropin therapy

Remove exogenous testosterone

Add in HCG as it mimics LH which will directly stimulate the testicle

Potentiallly adding in FSH to directly stimulate spermatogenesis

Gonadotropin therapy

Costs of therapy

 

[madman]

SERM + Gonadotropin

Remove the testosterone therapy

Giving back the gonadotropins in the form of hCG or rFSH

Then adding in what's called a selective estrogen receptor modulator (SERM)

Age, Duration and Dose affects recovery

* a big takeaway here is that men who are older and men on higher doses took much longer to recover

Costs of therapy

 

[madman]

Testosterone + Gonadotropin

Prevention: Testosterone + HCG

* here in this study what they looked at was men on testosterone therapy who became azoospermic put them on sole hCG with testosterone and this is looking at their change in total motile sperm counts and you can see that some patients responded very well however not everybody does

Thread 'Restoring Fertility: The Role of hCG in Reversing Sperm Suppression from Non-Prescribed Androgens'

Mar 30, 2025

* The hCG treatment typically involved Ovitrelle, a single-dose injection pen containing 250 mcg of recombinant hCG, equivalent to 6,500 IU, which could be administered in multiple smaller doses (increments of 10 mcg = 260 IU). The standard treatment protocol consisted of three injections of 520 to 1,040 IU per week, though variations on this protocol were possible based on patient-specific factors such as cost considerations, past experience with hCG (e.g., side effects), urgency of achieving conception, and patient preferences.. Besides hCG treatment, athletes were...

• madman
• hypogonadism; hcg; gonadotropins; adverse events
• Replies: 7
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

Prevention: Testosterone + HCG ± FSH

* so Larry Lipshultz group they had an abstract they looked at what happens when we add in FSH and about 70% of their men were producing sperm in 6 months

Thread 'Optimal recovery of spermatogenesis with hCG/FSH reboot therapy in infertile men with a history of testosterone use'

Oct 29, 2024

Nelson's house!

Mix of therapeutic T doses and doses of T used/abused for the sole purpose of muscle enhancement!

Protocol was compounded purified preparations of hCG/FSH (3000 IU hCG + 75 IU of FSH) injected subcutaneously 3X/week (M/W/F)!




* We stratified the entire cohort into two groups: those not on concurrent testosterone therapy during hCG/FSH reboot (No testosterone therapy) vs. those who were (Concurrent testosterone therapy). Although testosterone dosing was not standardized within this latter cohort, all patients were undergoing 100 mg-400 mg of injectable...

• madman
• hypogonadism; infertility; hormone stimulation
• Replies: 20
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

 

[madman]

* My rule: If no sperm by 6 months, evaluate for NOA!

 

[madman]

Take home slide!


Algorithm we use in our institution

 

[madman]

Thread 'Fertility maintenance or restoration in men before, during, and after TRT or AAS'

Sep 25, 2022

Fertility Preservation in Hypogonadal Men (2018)
Robert J. Carrasquillo and Ranjith Ramasamy


Introduction

Testicular failure is defined as the impairment or loss of both the endocrine functions of the testis (production of testosterone, or T) and exocrine function (production of spermatozoa). Testicular failure can result from the pathology of the testis itself or disorder at any point in the hypothalamic-pituitary-gonadal axis. Primary testicular failure is characterized by normal/low T in the presence of the elevated follicle-stimulating hormone...

• madman
• fertility/spermatogenesis; tth/aas; hypogonadism
• Replies: 35
• Forum: hCG, Clomid & Others for Fertility, PCT or Low T

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