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TRT and Fertility

May 29, 2020 |

Testosterone deficiency is a common issue that 40% of men over 40 suffer from. Low testosterone (aka hypogonadism) is defined as total testosterone (TT) at or below 300 ng/dl. Up until even the past decade, symptoms of low testosterone were often viewed as a normal part of aging. These conditions include a lack of energy and motivation, low libido, poor sleep, brain fog, depression, and anxiety.

However, this large and rising awareness of testosterone deficiency is gaining popularity among both providers and patients. Testosterone Replacement Therapy (TRT) has become an effective treatment for men with suboptimal testosterone levels. While this has become an effective way to increase testosterone levels, it does come with its potential drawbacks.

Many patients who seek treatment for low testosterone are unaware that higher levels of testosterone given via treatment suppress the hypothalamic-pituitary-gonadal (HPG) axis which may ultimately lead to infertility. While this is an alarming fact, TRT-induced infertility is typically reversible. 

You see, testosterone supplementation and treatment interferes with spermatogenesis (sperm production). Testosterone treatments suppress the HPG axis via negative feedback. This inhibits GnRH (gonadotropin-releasing hormone), which by extension inhibits the secretion of FSH (follicle-stimulating hormone) and LH (luteinizing hormone). For normal levels of spermatogenesis, both intra-testicular testosterone and FSH are required.

When LH and FSH levels are low, it deprives the testes of the signals required for both testosterone production and spermatogenesis. Even with testosterone replacement therapy, the intra-testicular levels needed to produce sperm may be too low. Testicular atrophy is a noted side effect that the testes of deprived of LH and FSH and that your body’s natural testosterone production is inhibited.

The Fertility Booster

If you are trying to conceive and start a family, loss of sperm count is reversible, but best avoided if possible. When starting TRT, simply adding HCG (Human Chorionic Gonadotropin) can help reduce the negative side effects of increased testosterone levels. HCG is an LH analog which stimulates testicular (Leydig cell) production of testosterone and increases both intra-testicular testosterone (ITT) concentrations and serum T levels.

Recent studies have shown that when supplemented with HCG, blood levels of HCG were significantly correlated with both ITT and blood testosterone levels. And when HCG is used in conjunction with TRT, sperm quality can be preserved. 

Testosterone + HCG: The Baylor Study

A study from Baylor University showed that supplementing HCG in men undergoing testosterone replacement therapy preserved spermatogenesis. The study was a retrospective review of 4 years of hypogonadal men presenting to the Baylor andrology clinic.

It was reported on 26 men, concerned about their fertility, who were treated simultaneously with hCG treatment (500 IU every other day) and exogenous testosterone (19 men with intramuscular testosterone 200mg per week and 7 men with 5 Grams/day of transdermal gel) for an average of 6.2 months. 

Despite an average post-treatment level testosterone level of 1055 ng/dl, seminal parameters such as count, motility, and morphology did not significantly change during the periods of observation. The Baylor study demonstrated the ability of low dose hCG to maintain spermatogenesis despite the administration of exogenous testosterone.

Beginning Treatment

For those men that suffer from low testosterone, Testosterone/HCG is a great option to increase your body’s testosterone levels. Here at Limitless Male, we use a cutting-edge approach that includes testosterone and HCG to not only help increase your testosterone levels, but ensure that your overall health improves.