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Author Topic: Testosterone Treatment Fertility Rankings  (Read 3985 times)

Dr Justin Saya, MD

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Testosterone Treatment Fertility Rankings
« on: January 08, 2018, 02:22:50 pm »
I have this posted on another thread but PeakT asked me post this separately.  Here goes:

A *very* generalized ranking of relative fertilities (with top being most fertile):

1. Clomid/SERM treatment
2(A). HCG + HMG (or lyophilized FSH)
2(B). Baseline no treatment (no HPTA suppression via TRT, AAS, HCG mono, etc) - assuming no significant degree of primary/secondary/tertiary dysfunction.
3(A). HCG monotherapy (does in fact result in HPTA suppression, especially at higher doses, but *may* move up to #2 in select cases of SECONDARY/TERTIARY hypogonadism)
3(B). TRT + HCG (as we know many men are still able to maintain adequate fertility to conceive)
4. TRT/AAS with no concurrent HCG.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

Dr. John Crisler

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Re: Testosterone Treatment Fertility Rankings
« Reply #1 on: January 08, 2018, 08:29:51 pm »
AWESOME post!
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

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Re: Testosterone Treatment Fertility Rankings
« Reply #1 on: January 08, 2018, 08:29:51 pm »

Dr Justin Saya, MD

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Re: Testosterone Treatment Fertility Rankings
« Reply #2 on: January 09, 2018, 10:17:13 am »
Lead Physician & Medical Director
http://www.defymedical.com

NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

PeakT

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Re: Testosterone Treatment Fertility Rankings
« Reply #3 on: January 11, 2018, 05:11:21 am »
Thanks Dr. Saya for the great info.

I think on practical thing is that HMG is very expensive, right?  Clomid is dirt cheap, on the other hand, and HCG quite reasonable as well.  I think that governs a lot of what we see.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

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Re: Testosterone Treatment Fertility Rankings
« Reply #3 on: January 11, 2018, 05:11:21 am »


Dr. John Crisler

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Re: Testosterone Treatment Fertility Rankings
« Reply #4 on: January 14, 2018, 07:51:34 pm »
Thanks Dr. Saya for the great info.

I think on practical thing is that HMG is very expensive, right?  Clomid is dirt cheap, on the other hand, and HCG quite reasonable as well.  I think that governs a lot of what we see.
Yes--and you have to add in more HCG on top of HMG, too.

Empower carries HMG now.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

PeakT

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Re: Testosterone Treatment Fertility Rankings
« Reply #5 on: January 15, 2018, 04:24:18 pm »
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Dr Justin Saya, MD

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Re: Testosterone Treatment Fertility Rankings
« Reply #6 on: January 15, 2018, 05:02:15 pm »

Empower carries HMG now.

Good to know.

And lyophilized FSH.

A take home point for the average Joe, nothing will touch the SERMs when it comes to fertility (low cost, high efficacy - in most cases)...but may come at a trade-off.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

Joetown2001

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Re: Testosterone Treatment Fertility Rankings
« Reply #7 on: January 17, 2018, 06:33:51 am »

Empower carries HMG now.

Good to know.

And lyophilized FSH.

A take home point for the average Joe, nothing will touch the SERMs when it comes to fertility (low cost, high efficacy - in most cases)...but may come at a trade-off.
Do you have your patients who are interested in fathering children bank sperm before they start treatment, even if the protocol includes hcg?

Dr. John Crisler

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Re: Testosterone Treatment Fertility Rankings
« Reply #8 on: January 17, 2018, 06:48:17 am »

Empower carries HMG now.

Good to know.

And lyophilized FSH.

A take home point for the average Joe, nothing will touch the SERMs when it comes to fertility (low cost, high efficacy - in most cases)...but may come at a trade-off.
Thank you. I actually meant to instead refer to the lyophilized FSH.

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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

Boxcar

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Re: Testosterone Treatment Fertility Rankings
« Reply #9 on: January 17, 2018, 12:34:02 pm »

Empower carries HMG now.

Good to know.

And lyophilized FSH.

A take home point for the average Joe, nothing will touch the SERMs when it comes to fertility (low cost, high efficacy - in most cases)...but may come at a trade-off.
Do you have your patients who are interested in fathering children bank sperm before they start treatment, even if the protocol includes hcg?

That's what I was thinking - if fertility is really important, it might make sense to get some healthy sperm banked first (possibly while giving low dose Clomid a try).  My doc is a fertility and TRT specialist.  According to him, there is a 1-2 percent chance of longterm fertility issues, even after a guy stops TRT (I think this assumes no HCG).  So not a huge risk, but it is something that is going to be pretty importent to some people.  I would be curious to hear what the doctors think of this approach.

Thanks to Dr, Saya for the really helpful post!  This has come up lately with young guys who considered maintaining their fertility to have equal or greater importance, compared with treating their low testosterone.
Age: 36
178 lbs 5'8''

Current Treatment: 50 mg testosterone cypionate IM, twice a week
Low T Symptoms: Chronic pelvic pain, and other neuropathic pain.  Mild anxiety, low energy and low motivation
Meds: Amitriptyline (for pain, not depression), Clonidine (for sleep, not blood pressure)

Dr Justin Saya, MD

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Re: Testosterone Treatment Fertility Rankings
« Reply #10 on: January 17, 2018, 02:00:15 pm »
Banking sperm is analagous to a fertility insurance policy. It's not required, but never a bad idea.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

Dr. John Crisler

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Re: Testosterone Treatment Fertility Rankings
« Reply #11 on: January 18, 2018, 07:32:43 pm »
Banking sperm is analagous to a fertility insurance policy. It's not required, but never a bad idea.
You could also have a semen analysis done then, just to see what the landscape looks like beforehand.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

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Re: Testosterone Treatment Fertility Rankings
« Reply #11 on: January 18, 2018, 07:32:43 pm »