The HPTA includes the hypothalamus, then the pituitary, and the testes. The hypothalamus is the main control center. When test or estrogen levels are low, it signals the pituitary to secrete LH & FSH, which subsequently travels to the testes, where it stimulates testosterone and sperm production. When test or estrogen levels are high, it tells the pituitary to cut back on LH production. This is how the body regulates testosterone levels and sperm production.
Drugs such as SERM's and AI' tell the hypothalamus that estrogen levels are low, which in turn signals to the pituitary to secrete LH. This causes a "recovery" at the level of both the pituitary and the testes.
Drugs such as HCG and HMG cause both a partial recovery and a partial suppression. HCG is best described as artificial LH, as the testes respond to HCG in the same way they would respond to LH--by producing testosterone.
HMG is a combination of both LH and FSH--the actual hormones secreted by the pituitary. Therefore, when HMG is administered, it bypasses the pituitary and travels to the testes just like HCG would, but instead of stimulating only testosterone production, it stimulates both testosterone and sperm production, as LH is the stimulatory hormone responsible for testosterone production, while FSH is responsible for sperm production.
Both SERM's/AI's and HMG/HCG can stimulate testosterone and/or sperm production. However, which option is selected will depend on a number of factors. First of all, these drugs should not be combined, as they are contradictory to each other. By running HMG and/or HCG, you will suppress natural LH & FSH production at the pituitary, so by combining both SERM's/AI's with HMG/HCG, you will be telling the pituitary to both increase and decrease LH & FSH production at the same time.
It is similar to running PCT (SERM's/AI's) and AAS concomitantly. No one would use AAS during a traditional SERM/AI based PCT, as the AAS would overrule the stimulatory effect of the SERM's/AI's on LH and FSH release. Well, this is exactly what HMG and HCG do. When running HMG and/or HCG, testosterone and sperm production go way up, which makes the hypothalamus-pituitary think that too much LH & FSH are being secreted. The hypothalamus then stops signaling the pituitary to produce these hormones. Therefore, both HMG and HCG are suppressive at the level of the pituitary.
However, because HMG and HCG don't need the pituitary to initiate testosterone and sperm production, they can be used on-cycle in order to maintain test and sperm production. HCG is frequently used for this purpose, although HMG, due to both cost and being less well known, has not been used nearly as often in this capacity.
So, in order for your friend to decide which course of action is ideal he would first need to answer a few questions. Test and/or sperm production can be low for one of 3 reasons. He can be suppressed at the level of the pituitary and therefore the testes. Or, he could have sustained damage at the levels of the pituitary. Or, he could have sustained damage at the level of the testes. Or, it could have sustained damage at both. AAS can potentially cause all of these, which is why some ex-users are able to adequately restore testosterone and sperm production, while others are incapable and require lifelong TRT (note: TRT is suppressive of sperm production, which we will get to a minute).
Again, if his pituitary and testes are only suppressed and no serious damage has yet occurred, then a traditional SERM/AI combo will be able to restore test and sperm production sufficiently, as the pituitary will still be capable of secreting LH & FSH and the testes will still be capable or responding to these hormones. However, if damage has been done at either the testes or pituitary, he will need to pursue others options if he wants to impregnate his wife.
It is impossible to tell what situation someone might be in until they try each option and see what happens. Most doctors will recommend that an ex-steroid user first attempt to restore natural LH & FSH production via SERM/AI therapy. Now, HMG and/or HCG may be used initially, in order to restore functionality of the testes prior to engaging in SERM/AI therapy. We see this frequently with AAS users, who often self-administer HCG either on-cycle, or a few weeks after one's cycle has ended, after which the individual will typically begin using SERM's/AI's.
If an ex-steroid user can recover sufficiently with traditional therapy, he will be better off, as he will only need to rely on drugs for the initial recovery, after which his body will continue producing LH & FSH on its own. However, many long-term or heavy AAS users, particularly those who stay on for long periods of time without PCT, often do permanent damage to the pituitary and/or testes. In these cases, the individual may not be able to restore LH & FSH production to a sufficient degree...or if he can, the testes may not be able to respond to them well enough, which means he will require permanent outside assistance to maintain normal testosterone and/or sperm levels.
If damage is done primarily at the pituitary and not as much at the testes (this is most often the case in ex-AAS users), the he will be able to respond to HMG or HMG and HCG therapy, enabling him to restore testosterone and sperm production. However, he will need to continue using these drugs for as long as he wants to retain normal test and sperm levels. As soon as he goes off, they will go right back down to what they were before.
Now, if damage is done at the level of the testes, things become more serious, as the testes are the last stop in testosterone and sperm production. If you fuck up your pituitary, you can still artificially induce test and sperm production by injecting HMG or HMG & HCG, which will go directly to the testes and turn on test and sperm production. But, if you fuck up the testes, then nothing will work, as they will be incapable of responding to either your natural LH & FSH production, as well as HMG and HCG.
In these cases, the individual can always restore test levels through TRT, but sperm production will never be restored to normal, as we can't inject sperm directly into our bodies like we can with testosterone.
Also, keep in mind that TRT is suppressive of sperm production, as it will suppress LH & FSH production just like AAS will, thereby making the person sterile or very close to it. Why does exogenous testosterone suppress FSH production? The hypothalamus uses testosterone levels as a guide for both LH and FSH production. When test levels fall, the hypothalamus signals the pituitary to produce both LH and FSH. When test levels rise, the hypothalamus signals the pituitary to stop the release of LH & FSH. So, by injecting exogenous testosterone into your body, the hypothalamus senses an abundance of testosterone and subsequently tells the pituitary to stop production of both LH and FSH, effectively shutting down sperm production.
In your friend's situation, I would recommend the following.
If he is going to continue using AAS, then HMG and HCG is the only option. Keep in mind that the medical field has not yet determined the ideal method of co-administering these drugs for the purpose of restoring testosterone and sperm production in males. However, the following option has been studied in men with good results:
HCG @ 2,000 IU Mon/Wed/Fri
HMG (75 iu LH/75 iu HCG) @ Tues/Thurs/Sat
If he is going to discontinue using AAS, then he might want to try the following:
Days 1-28: HCG @ 2,000 EOD
Days 1-28: HMG (75 iu LH/ 75 iu FSH) EOD
Beyond day 28: Clomid @ 100 mg/day
Beyond day 28: Aromasin @ 10 mg/day (5 mg in AM/ 5 mg in PM)
It could take up to 6 months of therapy in those who are severely suppressed to begin seeing good results, so don't lose hope if after 60 days things haven't gone as planned. In some cases it can take up to a year for maximum test and sperm level to be achieved. If by that point levels are still insufficient, it is safe to say that extensive damage has been done to the HPTA and that HMG & HCG will be required.
How quickly and to what degree someone recovers with traditional PCT will depend greatly on their genetics. Those who (pre-steroid) had very high natural test and sperm levels are more likely to make an acceptable recovery. For example, if someone's natural T levels were 1,500 ng/dl and their sperm count was 500 million with 80% active sells and quality of movement rated at #4, then this person is still going to possess average to above average fertility even if he only makes a 50% recovery.
On the other hand, if someone had a test level of only 300 ng/dl and a sperm count of 20 million, with 50% active cells and quality of movement rated at #2, a 50% recovery would leave him horribly inadequate in terms of test levels and fertility. Some people's bodies just want to have a high test and sperm level and will recover much more easily than others. Hell, some people can be currently blasting heavy cycles and STILL impregnate their wives/girlfriends, even after years of being on. In their case, the genetic drive to produce LH & FSH is so strong that they continue producing these hormones to a meaningful degree even when exposed to the suppressive influence of AAS. Of course, most people are NOT like this, which is why even 200 mg of testosterone is considered effective birth control in 97% of TRT users.
I knew a doctor who used to be a urologist (he died a few years ago), who used steroids for 15 years back in the mid-70's and throughout the 80's. He never did PCT...and 5 years after stopping all AAS, his body had restored his T levels back to a whopping 1,200 ng/dl. He told me that prior to using AAS, he had tested over 2,000 ng/dl, which is extremely high--high enough to fail a drug test. Some people are genetic freaks in this way. This man was. Plenty of other guys fall on the complete opposite end of the spectrum, with T levels in the 300-400 range (which is actually deficient, but I don't feel like getting into that right now) and sperm counts barely which are no better.
How well we recover in terms of both testosterone production and fertility comes down to many factors.
* Total length of exposure to AAS
* Total dosage and AAS type
* Were AAS cycled with PCT, or where they used for years with little to no off-time?
* Individual genetics.
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