I have been in enclomiphene for a year, but my test has been going down, and I just haven't been feeling as great as I did overall after starting the enclo. A few weeks ago, my provider started me on 200mg Kyzatrex once per day at lunchtime aling with the enclomiphene, but I feel like this combination has been a detriment. I was told this combination will prevent testicular atrophy while raising my peak levels, but I've definitely been experiencing atrophy that is worsening. Originally, my testosterone was in the low 100s due to chemo and other medications. What are your thoughts on this program, and should I be doing something differently? I'm 32 and would like to preserve fertility if possible.

Based on how you've responded, and how adding that has gone - We'd suggest swapping to injectable TRT & HCG for fertility instead. The main issue with any use of Clomid or Enclomiphene is that it suppress IGF-1 production. So even if you add other things to the mix while continuing to take that, the issue remains. IGF-1 is responsible for much of the physical benefits you expect from TRT & lack of this may be the reason you feel lack of benefits. The main time that we may use Enclomiphene over traditional TRT is when someone is a relative hypogonadal patient with an already high Testosterone production level. If they have low production to begin with, there isn't much point in boosting it & lowering IGF-1 at the same time.

For fertility, HCG may be more expensive, but it does not cause the same issues. Additionally, many men tend to either use low amounts of HCG or none at all until 2-3 months before a conception window which they then boost up to moderate to high levels.

To confirm this, you could always test your IGF-1, but either way you will almost certainly "feel" better with traditional TRT.