Hello I’m a 32 year old male with a history of anabolic steroid use at age 27. I’ve been having all the hallmark signs of hypogonadism Just had some recent blood work that show free test at 5.7 pg/dl. Total test at 37.3 ng/dl. LH at 0.7miu/ml. I’m very concerned with preserving fertility and wonder if you think a treatment modality like Enclomiphene might be beneficial or if given my lab work I should consider replacement with exogenous testosterone?

For you the answer would probably: Both are just fine. It more depends on your goals & what Sx you're feeling.

First, it's good to find a provider to is chill with previous UGL use & can advise on what effects that may have long term based on the substances.

For Enclomiphene it will raise your Testosterone levels but it boosts your natural production, so when you're already low it can only do so much. It tends to work better for men with already higher production like in the case of relative hypogonadism. That said, it will still provide benefit & is good for preservation like you said. The main downside is that it's typically pricier than normal Testosterone injections & it does impact IGF-1 in the body. So if the Sx you're concerned about are muscle gain and fitness, it may not be what you expect.

For normal TRT, this will lower spermatic production however there's a lot that can be done with HCG. If you're not looking to have a child now or in 6 months, it wouldn't be necessary to run HCG constantly but it would also be fine to run a low dose just to maintain things in a "ready" state. It's also very common to not run HCG at all until you're ready for children then crank the HCG dose up to 1500 units a week while trying. This is usually enough for 75% of men to stay on TRT and keep their benefits while having a child. Some may have to cycle off due to lower fertility in their partner or such. Running it low or waiting all together can also be a good call due to the price/extra Estrogen which can come with it.

TL:DR; Both are good, pros & cons, we'd do injections if your goals are super fitness focused.