question from a user
My wife and I I look to try for our third child next year, first post TRT, I wanted to get your thoughts on what i should be researching, asking my provider, and the approach with my doctor about potentially supplementing something to possibly assist with the process of getting natural testicular functioning back. I’ve done some researching, but it gets confusing and overwhelming with all the acronyms and different approaches there are (HCG, clomid, cold turkey, leave it in god’s hands etc.). I do want to be somewhat knowledgeable on what that should look like when having this conversation with my doctor and/or trt provider. What is your general approach when someone says they want to attempt to have a kid?
AlphaMD's Answer
So, to keep it simple, TRT is male birth control. While some men still can produce sperm while on TRT, you should never assume you are one of them. Adding hCG can restart the production of sperm by engaging the LH receptors on the Leydig cells. It takes 90 days for a sperm to come to maturity, meaning if you are on TRT and started hCG today, you would not have any functioning sperm for at least 3 months.
The algorithm for men on TRT and fertility is something like this:
Desired pregnancy // Treatment recommendation
< 6 months // Stop TRT. Start hCG 1500IU EOD ± clomid 25mg/day
6-12 months // Continue TRT, start hCG 500 IU EOD ± clomid 25mg/day
>12 months // Continue TRT, ± hCG 250-500IU weekly
So if you are in a time crunch, you stop TRT and hit it hard with hCG and maybe clomid if you want the added FSH boost (which is not always necessary).
If you have some time, then don't stop TRT and add in hCG, increasing the hCG when you actively start trying to conceive.
Clomid or enclomiphene is optional, though having FSH can help increase the quality of sperm produced.
Obviously, you should do semenalysis regularly (every 2 months) while on any of these protocols if fertility is a priority.
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