trt and hcg fertility

Treasure Island (FL): StatPearls Publishing; 2020 Jan-. In my professional opinion, HCG should always form part of your Testosterone Replacement Therapy (TRT) protocol. This is clearly impractical and unnecessary when HCG is a suitable alternative. 1. 2. PMID: 26172857; PMCID: PMC4741372. At CJA Balance, we believe in balancing TRT with hCG if you want to protect your fertility and improve your own testosterone function. This further suppresses the release of LH and Follicle Stimulating Hormone (FSH) from the pituitary gland. 14. Cooper TG, Noonan E, von Eckardstein S et al: World Health Organization reference values for human semen characteristics. [Updated 2020 Sep 30]. Also would there be any difference in taking the 1,000 IU […] Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy. HCG Dosage for Men to Increase Testosterone Author: Brian Hildebrandt, Last Updated: March 5, 2019 HCG injections are a common adjunct to testosterone replacement therapy among males. Clin Endocrinol, Epub ahead of print June 25, 2008. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. World J Mens Health. Additional benefits such as up-regulation of steroid hormones have also been purported, however there is not enough evidence at present to support this theory. Mean followup was 6.2 months. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy. Along with an increase in hematocrit, a major adverse effect of TRT is the diminished sperm production because of the If fertility is an issue with you then my recommendation is to use 250 iu weekly throughout the cycle or throughout testosterone replacement therapy. For men who do not desire to preserve fertility testicular size can be maintained while undergoing TRT with 1,000 to 1,500 IU of HCG given weekly which is enough to maintain pre-TRT levels of intratesticular testosterone in two-thirds of men. Leslie SW, Sajjad H, Siref LE. Complete the following form and one of our Patient Advocates will contact you. Furthermore, TRT induced infertility is a growing phenomenon in the setting of continued abuse of anabolic steroids.12 High dose HCG (3,000 IU every other day) has been used to successfully reverse exogenous T induced spermatogenic impairment, while low dose HCG has maintained intratesticular T levels during TRT, suggesting that it could also preserve semen parameters in men on TRT… Important Information for Current and Future Patients (COVID-19). 12. I was 250iu hcg weekly then 1000iu hcg weekly when my wife wanted a kid. South Dartmouth (MA): MDText.com, Inc.; 2000-. Furthermore, no statistically significant differences were noted in other semen parameters at any followup time (table 2). The effects of treatment on serum hormone values and serum parameters were assessed at followup. Hi all, I’m about to start TRT with Androgel 1.62% and was prescribed HCG 2x/week at 500 IU each dose to maintain fertility. Hello, I am on TRT. 9. Blair JA, Bhatta S, McGee H, Casadesus G. Luteinizing hormone: Evidence for direct action in the CNS. Andrea D. Coviello, Alvin M. Matsumoto, William J. Bremner, Karen L. Herbst, John K. Amory, Bradley D. Anawalt, Paul R. Sutton, William W. Wright, Terry R. Brown, Xiaohua Yan, Barry R. Zirkin, Jonathan P. Jarow, Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression. HCG Injections and Side Effects. Results: A total of 26 men with a mean age of 35.9 years were included in the study. Disappointingly we have had one NHS Endocrinologist recently state “Either the patient wants to retain fertility in which case you offer HCG, or they do not want to retain fertility in which case you treat with testosterone”. As life expectancy has increased in the last century, so has the prevalence of hypogonadism, which has important negative sequelae on the health of men. Series 10, No. I can go up to 2500iu of HCG weekly and 450iu HMG weekly. Low dose HCG appears to protect and support continued spermatogenesis when given in conjunction with injectable or topical TRT. The use of TRT without hCG may result in high serum levels of testosterone but low intra-testicular testosterone which may then result in decreased sperm count and infertility long-term. Epub 2009 Mar 17. This is how men can become sterile by taking testosterone. As GnRH is released in a pulsatile manner 4, in order to replicate the release of LH, you would need to use an LH-analogue which would have to be injected multiple times per day to mimic the physiological release of LH from the brain. My doctor has just prescribed me HCG and HMG for fertility. All men received intramuscular HCG (500 IU) every other day. Data from the National Health Survey. Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. Baseline T, FT and E were assessed before the start of TRT, as were baseline semen analyses. There is evidence to suggest that HCG can maximise penis size 21. HCG is protective and supportive of continued spermatogenesis when given in conjunction with injectable or topical TRT. 9-10 Longham Business Park LH is released in response to stimulation from Gonadotropin Releasing Hormone (GnRH) from the Hypothalamus. Homeostasis is a about maintaining physiological stability through feedback systems. I am on a 100mg of Test Cypionate twice a week along with 150iu of HCG daily. However, more recently we have had a referral from a Professor of Endocrinology who supports our work and already appreciates the benefit of HCG alongside testosterone due to to us sharing the care of a patient. Statistical significance was considered at p 0.05. Through telehealth, an experienced medical provider will consult with you to develop a customized plan of action for you. J Psychiatr Pract 2009; 15: 289. For more information on HCG, please refer to our HCG Fact Sheet. 4. J Sex Med 2011; 8: 272. Coviello AD, Matsumoto AM, Bremner WJ et al: Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. doi: 10.21037/tau.2018.04.11. Hyattsville: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics 2004. Read Now. American Urological Assocoiation – Evaluation and Management of Testosterone Deficiency (2018) – Published 2018.  https://www.auanet.org/guidelines/testosterone-deficiency-guideline. BJU Int 2011; 108: 1860. In fact, one of the doctors didn’t even want to prescribe HCG, and wanted to do clomid only and frighteningly thought HCGs role in fertility treatment was to maintain muscle mass and stimulate androgenic receptors and even dropped this gem “testosterone won’t make you strong, it’s when you combine it with HCG or steroids that you get really big” WTF! In: StatPearls [Internet]. The injections can increase the body’s production of testosterone and sperm production, thereby improving fertility. World J Urol 2003; 21: 341. It is not intended to diagnose, treat, cure, or prevent any health problem. If you are concerned about fertility, I would reevaluate your treatment protocol. In the cohort mean serum hormone levels before vs during treatment were T 207.2 99.2 vs 1,055.5 420.9 ng/dl (p 0.0001), FT 8.1 3.9 vs 20.4 13.5 ng/dl (p 0.02) and E 2.2 1.0 vs 3.7 2.6 ng/dl (p 0.11), supporting the efficacy of TRT in these men. Combining Evidence-Based Medicine & Clinical Expertise, To Give You A Much Needed Perspective. In order to appreciate the importance of HCG in TRT, you firstly need to understand the Hypo-Pituitary Gonadal (HPG) Axis and the role of LH within this axis and throughout the human body. I have read a few studies that show guys on TRT + HCG were able to get their wives pregnant. In: StatPearls [Internet]. The pituitary gland releases LH which stimulates the Leydig cells of the testes to produce testosterone. Epub 2018 Oct 10. No differences in semen parameters were observed during greater than 1 year of followup. MALE hypogonadism is characterized by low serum T and characteristic symptoms, including fatigue, decreased libido, erectile dysfunction, difficulty concentrating, sleep disturbances and loss of lean body mass or weight gain. Corona G, Monami M, Rastrelli G et al: Testosterone and metabolic syndrome: a meta-analysis study. (eds) Endocrinology of the Testis and Male Reproduction. Administering exogenous T in eugonadal men caused negative feedback in the hypothalamic-pituitary-gonadal axis and resulted in azoospermia or severe oligospermia (less than 5 million per ml) in 70% after 18 months of therapy.11 Notably, TRT cessation only partially restored fertility in up to 85% of these men. 6. No significant differences were observed in semen parameters between the injectable and transdermal TRT groups (table 3). Nedresky D, Singh G. Physiology, Luteinizing Hormone. Treatment for hypogonadal men who desire fertility preservation continues to be a challenge for physicians. Results vary from patient to patient. Unfortunately it is not a dose dependent relationship and as the length of the penis is restricted by the suspensory ligament, you cant defy genetics! Although HCG is a leutinizing hormone (LH) “mimic” and thus bypasses the pituitary and hypothalamuas, it at least keeps your testes in the game. Longer follow-up is needed to determine whether this benefit is sustained. HCG with TRT for Fertility and Testicular Atrophy, Effective Solutions for Erectile Dysfunction (ED), Medication and Injection Instructions for Penis Injections, Anabolic-Androgenic Therapies and Men’s Health, Bioidentical Hormone Replacement Therapy (BHRT), Testosterone Replacement Therapy for Women, Rx Skincare, Anti-Aging, and Topical Treatments. 11. There is also a tertiary cause for TD, which is a disproportionate amount of oestrogen that negatively influences the negative feedback loop. After obtaining institutional review board approval, we retrospectively reviewed the medical records of hypogonadal men who desired fertility preservation during TRT and presented to a single andrology clinic at Baylor College of Medicine between 2006 and 2010. Spermatogenesis is the process by which haploid spermatozoa are formed from germ cells. A larger sample size might have enabled us to better compare the observed effect among the different T formulations. HCG is an FDA-approved medication for treating specific conditions in both women and men. No action should be taken solely on the contents of this website or our testimonials. I previously discussed the various organic causes for this in The Men’s Health Clinic TRT Management Guidelines. Mean pretreatment semen parameters were volume 2.9 1.4 ml, density 35.2 29.6 million per ml, motility 49.0% 10.4%, FP 2.3 0.3 and TMS count 84.6 82.4 million. Int J Clin Practice 2006; 60: 762. Endocrinology. This is where the medication HCG (Human Chorionic Gonadotropin) comes in. When combined with testosterone and estrogen control (aromatase inhibitor) as described in the testosterone trifecta plan, it can help maintain long term fertility and hormonal balance. Intra-testicular testosterone is converted to oestradiol by the aromatase enzyme, oestrogen exerts its effects by aiding germ cell proliferation, differentiation and the final maturation of spermatids, as well as germ cell survival and apoptosis 11. Since the half-life of HCG is approximately 2 days 5, it allows us to effectively achieve stable blood levels with daily injections. To ascertain the effects of exogenous TRT and HCG on semen parameters the men were followed at 2 to 4-months intervals with semen parameters and hormonal assessment compared to pretreatment parameters. HCG mimics Lutenising Hormone (LH). It was probably unnecessary for me to do the jump as it was $100 a bottle of hcg… J Clin Endocrinol Metab. HCG is also effective in preventing infertility when used during testosterone replacement therapy. Oestrogens and spermatogenesis. Is this enough? Therefore, the use of HCG helps to preserve some testicular function and subsequent production of intra-testicular testosterone. 2019 Jan;37(1):45-54. doi: 10.5534/wjmh.180036. High estrogen negates most of the benefits of TRT, ... shrinking testicles and it’s often associated fertility problems. https://doi.org/10.1016/j.aju.2017.11.011. In traditional TRT, the use of exogenous testosterone suppresses the release of LH from the brain which subsequently results in infertility in the vast majority of men 6, 7. Unfortunately, there is a very small proportion of men who do not tolerate HCG. BH22 9BU, Copyright ©2021 Preventative Health Doctors Limited trading as ‘The Men’s Health Clinic’ - Company No. https://doi.org/10.1007/978-3-319-44441-3_9. Furthermore, TRT induced infertility is a growing phenomenon in the setting of continued abuse of anabolic steroids.12 High dose HCG (3,000 IU every other day) has been used to successfully reverse exogenous T induced spermatogenic impairment, while low dose HCG has maintained intratesticular T levels during TRT, suggesting that it could also preserve semen parameters in men on TRT.6,13. We know that LH receptors are found in numerous organs, most noticeably the brain 22, although the mechanisms by which LH / HCG exerts its effects is complex, most men will notice an improvement in cognition and libido. This may seem like a purely aesthetic consideration, however testicular atrophy can cause significant discomfort and distress 20. Call (813) 445-7342 to speakwith one of our Patient Advocates. Nine of 26 men contributed to pregnancy with the partner during followup. 3. PMID: 2776893. Primary Testicular Failure. We’re providing an industry update regarding the availability of Human Chorionic Gonadotropin (HCG). This small difference was not observed at any other followup point. My question is: Is there anyone with a personal experience of impregnating their woman while on TRT + HCG. Adults: National Health Interview Survey, 2002. Anderson RA and Wu FC: Comparison between testosterone enanthate-induced azoospermia and oligozoospermia in a male contraceptive study. To our knowledge this is the first report of fertility preservation in the setting of TRT with coadministration of low dose HCG. Some treatments require blood work or additional documentation to provide a comprehensive health overview. It’s important to get expert advice when considering HCG and to learn the HCG on cycle and process for it to work with your TRT treatment. In these cases, a combination of hCG and testosterone may be used. HCG is also used to increase testosterone in men with a … 7. 2. The use of HCG alongside testosterone is supported by the American Urological Association 12 and its role in maintaining fertility whilst on testosterone is well documented in the literature 13, 14, 15, 16. PMID: 29772111. Fertil Steril. Lethbridge-Çejku M, Schiller JS and Bernadel L: Summary Health Statistics for U.S. Always consult a physician or qualified health professional on any matters regarding your health or on any opinions expressed within this website. HCG not only helps resume spermatogenesis after a TRT cycle, but also can be used in conjunction with TRT to preserve sperm quality. 2018 Jul;7(Suppl 3):S348-S352. There are also other considerations outside of the obvious benefit in maintaining testicular function. Kim SO, Ryu KH, Hwang IS, Jung SI, Oh KJ, Park K. Penile growth in response to human chorionic gonadotropin (HCG) treatment in patients with idiopathic hypogonadotrophic hypogonadism. hCG May Preserve Fertility in Men — Sperm Count Can Return After Discontinuing TRT Testosterone Replacement Therapy (TRT) can often decrease sperm count, which is the main reason that men who still plan on having children will hold off on testosterone-based therapy and opt for hCG monotherapy … Amr El Meliegy, Ahmad Motawi & Mohamed Ahmed Abd El Salam (2018) Systematic review of hormone replacement therapy in the infertile man, Arab Journal of Urology, 16:1, 140-147, DOI: 10.1016/j.aju.2017.11.011. Epub 2018 Jun 14. HCG is often used as a replacement to injectable testosterone in men, undergoing testosterone replacement therapy (TRT) as a result of low-t. 09325917. Opinion is currently divided amongst Endocrinologists regarding the benefit of HCG in TRT due to the traditional treatment model always having been testosterone monotherapy. HCG is used to maximise natural intra-testicular production of testosterone through stimulation of the Leydig cells 9, it also allows the other physiological mechanisms within the testes to continue. 1. J Clin Endocrinol Metab 1996; 81: 896. Our emphasis is always on patient-centred care. Disappearance of exogenously administered human chorionic gonadotropin. 1989 Sep;52(3):398-400. doi: 10.1016/s0015-0282(16)60906-8. With HCG, these may keep producing, but to what extent, I'm not sure. The prevalence of male hypogonadism is reported to be 37% in the United States and a higher prevalence is observed with increasing age.1 The impact of T deficiency on the overall health of men was recently examined in meta-analyses.2–4 Hypogonadism was found to be linked to cardiovascular mortality, metabolic syndrome, osteoporosis, frailty, noninsulin dependent diabetes and depression. Our understanding and appreciation of that inter-relationship is ever evolving. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in … Human Chorionic Gonadotrophin – more commonly known as hCG – is used to increase sperm count in men. Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy. Whilst spermatogenesis is primarily under the influence of FSH stimulating the Sertoli cells of the testis, intra-testicular testosterone and oestrogen are also integral to this process. However, reassuringly a primary hypogonadism rarely signifies complete testicular failure 17. HCG is self administered as an injection into the subcutaneous fat, similar to insulin, with a tiny needle. In: Simoni M., Huhtaniemi I. Chronic Testicular Pain. 10. https://www.healio.com/news/endocrinology/20190323/lowdose-hcg-can-prevent-sterility-in-men-prescribed-testosterone?fbclid=IwAR2dobCk14hFFy5pLqCxtDbiO5LxlKQUgbnukZwnxJVz7-Ym73Q7ai8RZb0. Further followup of our cohort will provide additional data on the pregnancy outcome associated with concomitant low dose HCG therapy in the setting of TRT. II. The half-life of LH is only a few minutes 3. It would therefore seem logical to maintain function, rather than rely solely on exogenous testosterone to normalise your male androgen levels. I always recommend the use of HCG to all new patients, irrespective of the need to retain fertility, for the reasons discussed above. Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Our data demonstrate that concomitant administration of low dose HCG in men on TRT preserves spermatogenesis. As already explained, LH is the primary pituitary hormone that stimulates the Leydig cells of the testes to produce testosterone. Testosterone monotherapy is a rather short-sighted and dogmatic approach to treating Testosterone Deficiency (TD) when we know other hormones are suppressed through treatment. In traditional TRT, the use of exogenous testosterone suppresses the release of LH from the brain which subsequently results in … HCG / human chorionic gonadotropin is a medication that can increase the body's own production of testosterone and treat hypogonadism (low testosterone levels). The hypogonadism diagnosis was based on symptoms, including low libido, erectile dysfunction, low energy, poor concentration, inadvertent weight gain and sleep disturbances as well as serum T 300 ng/dl or less. Over 90% of my patients see the benefits of HCG alongside testosterone. All men were started on TRT using daily transdermal gels or weekly intramuscular injections as well as simultaneously on intramuscular HCG (500 IU) every other day. I believe it will eventually happen, though, for the reasons I … The use of HCG with TRT has been around for a long time but still has not made it into the mainstream yet. The prevalence of hypogonadism is within the 12% to 37% range in population based studies.1,7 According to data from the Centers for Disease Control, 74% of men visit a physician office annually.8 Extrapolating data from the United States Census and the reported prevalence of hypogonadism, approximately 14 million men 45 years old or older who visit a primary care physician office may have androgen deficiency.1 Many of these men are interested in maintaining fertility. Concurrent HCG use can preserve fertility in hypogonadal males desiring pregnancy while on TRT. HCG is less likely to be as effective as a fertility aid if the patient has low testosterone as a result of a primary hypogonadism (an issue with the testes). TD is typically as a result of either a primary hypogonadism, which is an issue with the testes, or a secondary problem which indicates an issue with the brain. PMID: 19293262. I remained more fertile than average male entire length of TRT while on HCG, but everyone’s response to TRT seems to be different. Furthermore, pregnancy information was incomplete in the cohort, in part because not all patients actively pursued pregnancy during the study period. I can’t emphasise enough how important it is to appreciate that all hormones are dependent, whether that relationship be direct or indirect. Fietz D., Bergmann M. (2017) Functional Anatomy and Histology of the Testis. Behre HM, Bergmann M, Simoni M, et al. As a result, balancing the medical and fertility concerns of hypogonadal patients is a growing challenge for physicians. Moskovic DJ, Katz DJ, Akhavan A et al: Clomiphene citrate is safe and effective for long-term management of hypogonadism. 2009 Jun;94(6):1910-5. doi: 10.1210/jc.2008-1846. TRT – Best Practice explains my rationalisation. HCG on TRT Doctors sometimes prescribe HCG when there are concerns around the size of a man’s testes or when maintaining fertility is important for starting a family. All information contained within this site is for informational purposes only. It’s often the difference between feeling good and feeling great. HCG is produced by the placenta to help maintain pregnancy by supporting the ovarian corpus luteum which, in turn, helps maintains the endometrial lining of the uterus 1, it would therefore be reasonable to question what role HCG might have in TRT? Irrespective of whether your family is complete, or you do not wish to preserve fertility using HCG alongside TRT, HCG will help preserve testicular size and function 18. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. [Updated 2020 Jul 17]. Corona G, Rastrelli G, Monami M et al: Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Samuel J. Ohlander, Mark C. Lindgren, Larry I. Lipshultz, Testosterone and Male Infertility, Urologic Clinics of North America, Volume 43, Issue 2, 2016, Pages 195-202, ISSN 0094-0143, ISBN 9780323444835, https://doi.org/10.1016/j.ucl.2016.01.006, https://www.thelancet.com/journals/lancet/article/PII0140-6736(90)92416-F/fulltext. Human Reprod Update 2010; 16: 231. It is worth keeping in mind that the positive effects of HCG in maintaining testicular functions is very dependent on the viability of the testes at the time of diagnosis. Your Patient Advocate will guide you and answer your questions. BJU Int 2012; 110: 1524. Treatment for hypogonadism typically includes TRT, which results in satisfactory amelioration of symptoms and normalization of serum T. However, treatment with exogenous T decreases serum gonadotropins, impairs normal spermatogenesis and suppresses intratesticular T. Azoospermia develops in up to 40% of patients on TRT and, as a result, treatment of hypogonadal men desiring to reproduce while on TRT remains a challenge.5 However, recent studies indicate that intratesticular T can be maintained during TRT with co-administration of low dose HCG, suggesting that exogenous HCG in the setting of TRT may also preserve spermatogenesis in these men.6 We hypothesized that HCG is protective and preserves spermatogenesis in patients undergoing TRT. We also discussed earlier how HCG mimics LH. Men were not queried regarding the timeline for achieving pregnancy and female fertility factors were not assessed for each couple. 168 Ringwood Road Whilst the study was conducted in men with a micro-penis, many of my patients report a fullness with HCG that they note decreases on cessation. The study was powered to identify a 45% difference in any semen parameter with an error probability of 20% and a total sample size of 24 patients required. 2015 Nov;76:57-62. doi: 10.1016/j.yhbeh.2015.06.020. LH plays a vital role in the synthesis and secretion of testosterone. This can be used to treat low sperm counts and decreased sperm quality and increase male fertility potential. 3. Men were followed after TRT initiation approximately every 2 to 4 months. The hCG benefits of slightly increased fertility are often used to compliment a TRT regimen—the 2 therapies used simultaneously can effectively address the symptoms of Low Testosterone while potentially lessening the side effect of disrupted sperm production. Ferndown If you remove a part of the jigsaw, you will never see the complete picture. J Clin Endocrinol Metab 2005; 90: 2595. I am wondering if any of you have conceived with that protocol or similar while on TRT. Our study is limited by several factors, including its retrospective nature, followup duration, small sample size and a lack of a control arm. Statistical comparisons between baseline and followup values were performed using the Student t test after evaluating our data set for parametricity using Q-Q plots and Kolmogorov- Smirnov goodness of fit testing. Dohle GR, Smit M and Weber RF: Androgens and male fertility. [Updated 2015 Aug 30]. Clomiphene citrate, a selective estrogen receptor modulator, is effective for increasing serum T and safe in hypogonadal patients on long-term therapy.9 Anastrazole, a potent aromatase inhibitor, increases serum T and bioavailable T, while decreasing E production.10 While these 2 treatment options preserve the hypothalamicpituitary- gonadal axis and spermatogenesis, minimal improvements in hypogonadal symptoms and lean body mass have been observed.9,10, Exogenous T induced decrements in semen parameters are well documented. Of the men 19 men were treated with injectable T formulations, while 7 used transdermal gels. testosterone replacement therapy (TRT) among men over the age of 40 years has increased more than 3-fold over the last decade [1].

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