Are you on TRT and concerned about your fertility?
Perhaps you've already begun testosterone replacement therapy and now you're worried that your fertility is going downhill and you want to know how you can preserve it. In this video, we explore this specific question: how to preserve spermatogenesis and fertility while you're on TRT.
Reference: https://pubmed.ncbi.nlm.nih.gov/8263139/
https://www.ncbi.nlm.nih.gov/pmc/arti...

In this video, we'll delve into the relationship between TRT and fertility, specifically exploring how to preserve spermatogenesis while undergoing TRT. We'll examine some of the research behind preserving spermatogenesis during TRT, or testosterone replacement therapy.
For those unfamiliar, testosterone replacement therapy (TRT) leads to decreased production of LH (luteinizing hormone) and FSH (folliclestimulating hormone). Both hormones originate from the pituitary gland in the brain and stimulate the testes to perform two primary functions. LH stimulates testosterone production by Leydig cells, while FSH triggers spermatozoa production by Sertoli cells.

The resulting testosterone, and subsequently converted estrogen, provides feedback to the brain, reducing the release of FSH and LH. Consequently, TRT lowers the production of these hormones, leading to reduced spermatogenesis. This is why TRT often causes the testes to shrink, as they lack the stimulatory effect of FSH and LH from the brain.

Not only does TRT reduce spermatogenesis, but it also directly diminishes testosterone production within the testes. While there's ample testosterone circulating in the body, the testes themselves produce minimal amounts. Depending on the dosage and initial level of spermatogenesis, most individuals will experience azoospermia (no sperm count) within approximately 10 weeks of starting TRT.

More alarmingly, around 10% of men will remain azoospermic even after discontinuing TRT. So, what options are available for those who desire both TRT and fertility preservation?

This is where HCG (human chorionic gonadotropin) therapy enters the picture. HCG therapy can help preserve spermatogenesis during TRT therapy, partly by maintaining intratesticular testosterone production.

In addition to its role in maintaining intratesticular testosterone production, HCG stimulates Sertoli cells to produce sperm. HCG functions as a mimetic or analog to FSH and LH, stimulating both aspects of spermatogenesis: testosterone production by Leydig cells and sperm production by Sertoli cells.

It's important to note that solely stimulating Sertoli cells with FSH will not initiate spermatogenesis in individuals with hypogonadism or low testosterone levels. This led to the discovery of the crucial role of intratesticular testosterone production in the spermatogenesis process. I'll include links to relevant research behind this video in the description.

A small study examined hypogonadotropic hypogonadal men, meaning they had low LH and FSH production along with low testosterone levels at the gonadal level. The study evaluated the ability of HCG plus testosterone to induce spermatogenesis after 24 months compared to FSH plus testosterone after 24 months. The study found that HCG plus testosterone successfully induced spermatogenesis, while FSH plus testosterone failed to do so.

This finding is quite intriguing, given that FSH directly stimulates the Sertoli cells responsible for sperm production. As mentioned earlier, HCG acts as an analog or mimetic for both FSH and LH. LH stimulates the testes to produce testosterone. The study's key takeaway is that having some form of LH mimetic is equally crucial as having an FSH mimetic.

This is because testosterone itself is an essential component of spermatogenesis. However, it needs to be produced locally within the testes. So, what does this mean for you in terms of TRT and maintaining your fertility, and how to prevent sperm count loss during TRT? Essentially, if you're undergoing testosterone replacement therapy and desire to conceive, HCG is a nonnegotiable addition to your treatment regimen.

After several months on HCG therapy, it's advisable to undergo a semen analysis to assess your sperm count and motility. If you haven't yet started TRT, consider getting a baseline semen analysis before starting treatment. However, if you're already on TRT, a semen analysis is crucial to determine your current sperm count and motility.

Whether your baseline sperm count is low or not, HCG therapy remains essential for preserving the spermatogenesis process. The semen analysis primarily serves to guide your HCG dosage. HCG dosage can vary significantly depending on whether you're aiming to maintain sperm production or actively trying to conceive. The dosage range typically falls between 500 IU per week and 4000 IU per week.