question from a user
How important is it to start HCG with TRT if conceiving isn't in the plans for several years down the line? Once on TRT, how soon should hcg be started prior to attempting to conceive? Does sperm count go to normal or above normal on 500iu three times per week? Ty!
AlphaMD's Answer
All studies on concurrent use of hCG on TRT were done as a recovery study, not a preservation study. What that means is, all the data we have about hCG while on TRT were done in men who started TRT then added hCG later. There are currently zero published studies on men who started TRT along with hCG.
To summarize those studies, of the thousands of men included in the various studies close to 90% regained fertility completely, regardless of the duration of TRT before starting the hCG. The remaining 10% had no preceding semenalysis prior to starting TRT, so we have no proof that they were not infertile before starting the TRT to begin with.
Also, hCG does not work in primary hypogonadism, true testicular failure. So in those cases, adding hCG (or a SERM) will never really work for fertility anyways. Those studies did not differentiate between who was primary or secondary hypogonadism prior to including patients in the studies.
Ultimately, the data shows adding hCG at any point, from day one or 10 years after starting TRT, seems to all have the same end result…a 90% chance of maintaining/regaining fertility.
In the unlucky 10%, we have no proof that it was the TRT that caused the infertility, because we have no data to determine if they were even fertile prior to TRT
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