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HELP! Still shooting blanks after 3 years on hCG and 9 months on hCG + Clomid

nastyn8

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I'm pretty sure my nuts are fried after 6+ years of TRT.... Here's my story.

About 8 years ago I had my test levels checked after a friend of mine suggested I have it done and my total test was around 200. I was 30 y.o., 6ft, around 280lbs and was constantly feeling like crap. The doctor recommended putting me on TRT (Cypionate) .5ml 2x a week. I started on that and felt great, started working out more, and eventually ended up losing around 60lbs and felt like I was on top of the world. Fast forward 5 years, i'm married now and want to have a kid with my wife. I tell the doctor this and he very nonchalantly recommends I go on hCG and in about 3 months I should be "good to go". So 3 months go by, I have blood work done and my test levels are in the high 600s. He tells me everything looks great and I should be conceiving in no time. Well, 6 months go by and nothing yet, so he recommends I do a seamen analysis. We get the results and it's literally zero. Right around now is when I start noticing that i'm feeling like crap again and the weight is really starting to come back on. He says it's unrelated to anything and increases the dose of hCG from 2000iu 2X a week to 2500iu 2X a week. Another 6 months go by and still zero seamen count, still good blood work results, and still packing on the pounds. He increases the doses of hCG to 3000iu 2X a week and starts talking about the possibility of taking a seamen sample via in injection into my testicles if in 3 months we still have no results.

It's now been 3 years of trying to conceive and my doctor claims that the lack of results have anything to do with my 6 years of being on TRT. I remind him that I have a 9 year old child and that one point in my life (before being on TRT) I was able to conceive just fine. I have asked about my 60lbs weight gain since I was put on hCG and my very high estridol levels and he says that it has nothing to do with being on hCG. I've started doing some research on my own and find that there is just too much out there for me to form a viable solution for the next steps. a year ago I stopped taking the hCG and figured If I came everything that hopefully my seamen count would return to normal (since the hCG was clearly doing nothing for me). I definitely felt like crap for the first month but I noticed that my testicles returned back to normal size and so did my seamen volume. I was starting to become hopeful that things were returning back to normal and that my seamen count would also. I had another analysis done earlier this week and we got the results back..... zero. Literally zero. I told my doctor I was off of hCG and that I started feeling normal again and he said I need to go back on it. I just feel stuck. Damned if I do, damned if i dont.

My hope is that I can avoid having needles stuck in my testicles and that I can somehow figure out how to get my count back up naturally. I really need someone out there to give me there opinion on what exactly is wrong here. Part of my problem is that this doctor is very well known in my area and when i've tried to get a second opinion, other doctors say they typically just refer patience to my current doctor. Some of the things i've suggested to him have been trying a different medication other than hCG, like perhaps clomid. I've suggested taking a look at my estridol levels and why i'm gaining so much weight and have zero motivation. He says none of those things will change anything and says we can either increase the hCG dose or go the surgical route.

I finally got connected with an actual fertility doctor in my area 9 months ago and he looked at my history and recommended hCG + clomid. I get on that protocol and go in for a semen analysis around month 6. Zero... So here we are today. around 3 years of hCG and the last 9 months were hCG+Clomid. Lab results show my LH and FSH are within normal range. So when I mention to him that "hMG sounds like it will help me" he always replies that my levels look good and that hMG or Gonal F would only be doing the same thing that i'm already doing. Does anyone have any advice??

I'm scheduled for the surgery for next month, but honestly i'm not very confident that it's going to prove successful. My testicles are not as full and large as they were before I started TRT and I'm afraid that they are just completely fried.

Anyone.... please....
 

John99Test

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You are completely off of TRT correct? Have you tried HMG? That’s often used in conjunction with HCG to regain fertility. Google Dave Palumbo’s fertility protocol. It’s worked for hundreds of people. You have to go completely off of exogenous test.
 

nastyn8

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You are completely off of TRT correct? Have you tried HMG? That’s often used in conjunction with HCG to regain fertility. Google Dave Palumbo’s fertility protocol. It’s worked for hundreds of people. You have to go completely off of exogenous test.
Correct, back around 2016 my doctor took me off of cypionate completely and started a very intense hCG only protocol. At one point up to 3500iu 3X a week!

Thank you for the suggestion about hMG. I've asked my doctor about it and he doesn't know much about it, but he knows about gonal F, would that be similar?
 

bad rad

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Any chance you're primary? That would explain the lack of results. I'd drop the hCG down to 200iu daily since too much causes high E2 production and that damages the Leydig cells making them less responsive.

What's your Clomid dose? Too much will also shut down your response to it. I'd take 25mg daily max but that was too much for me. I started having estrogen issues and my testicles shrank again.
 

nastyn8

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Any chance you're primary? That would explain the lack of results. I'd drop the hCG down to 200iu daily since too much causes high E2 production and that damages the Leydig cells making them less responsive.

What's your Clomid dose? Too much will also shut down your response to it. I'd take 25mg daily max but that was too much for me. I started having estrogen issues and my testicles shrank again.
Thanks for the response! I'm not sure what primary is, but i'm going to look into it now. So for hCG my current dose is 1000iu 3X weekly and 25mg Clomid 3X weekly. At the beginning of every week i take .25mg of anastrozole to help with E2 as I was having major side effects from it.

As for the primary question, is that something that can be developed by being on TRT for a long time? I have a 10 year old son and a couple of "oops" incidents back in the day when I was young and dumb, so I know before TRT I was producing sperm. When I got on TRT I wasn't interested in having kids so I was prescribed cypionate for 6 years straight which I'm assuming completely shut me down.
 

nastyn8

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Part of my issue could also be that the hCG I take comes in 10000iu vile which lasts me around 3 weeks... I'm noticing that when I first mix it, I can feel a "rush". My testicles get "full" over the next 24 hours and I feel great. By the time I get to week 2, I don't get the same feeling. My testicles begin to shrink again and stay that way for a couple weeks until I mix a new vile. That ebb and flow I believe may be causing some issues with production since there is no consistency. I'm storing it in a refrigerator so not sure why it's losing potency after a week.
 

bad rad

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Too much hCG will shut down the Leydig cells. After 1000iu dose there is about 96 hours of refractory when the testes won't respond to another dose. 500iu has a 3 day active life. I'd cut that dose way back and do it daily. hCG should last about 30 days mixed before degrading. You can freeze any unused hCG without issues.

You can try 10-20mg Test and 200iu hCG daily as it may help. That's my preferred TRT schedule for myself. Most docs prescribe way too much hCG and the localized E2 production will inhibit your response to hCG. The only fix is a lower dose since SERMs/AI won't affect the E2 in the testes.

Primary means your testicles stopped responding to LH/FSH initially. Pretty uncommon compared to secondary that is a LH/FSH issue.
 

nastyn8

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Thanks for the response! I'll cut down to 200iu daily, i'll stay at 25mg Clomid 3x week, and .25mg anastrozole. I've sent a message to my doctor about hMG or gonal-f. From what i've read, adding in hMG or gonal-f should kick start things again. I'm really hoping so. This has been years in the making and my doctor is pushing for surgery to try and extract directly from my testicles, and it's actually scheduled for mid October. I'm just not confident it will yield anything given the testicular atrophy I still experience every other week.
 

bad rad

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I just saw the part about your LH/FSH being normal range. What your serum testosterone level? If it's too low your body won't produce sperm since the Sertoli cells need a localized, high concentration of testosterone. That's why hCG tends to promote fertility.

Have you tried dropping the hCG for a few weeks since your HPTA is working again? Those high doses of hCG are counterproductive.
 

Reload

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What surgery are you having done?

I have a similar history of AAS use. Tried unsuccessfully to get my wife pregnant for years. We tried everything. Got so frustrating it stated to put a major strain on our relationship. Finally made an appointment with an established IVF clinic. My wife checked out fine. I was the problem. My semen analysis showed azoospermia. Plus the very few that were around showed terrible motility/morphology. Specialists there said only way was through ICSI due to my horrible #'s.

IVF techniques have greatly improved the chances of individuals such as yourself having a child. I have 2 very healthy daughters today both conceived through IVF with ICSI. In fact our second daughter was a stored embryo from the first ICSI fertilization thawed out and inserted 5 years later.
 

John99Test

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Thanks for the response! I'll cut down to 200iu daily, i'll stay at 25mg Clomid 3x week, and .25mg anastrozole. I've sent a message to my doctor about hMG or gonal-f. From what i've read, adding in hMG or gonal-f should kick start things again. I'm really hoping so. This has been years in the making and my doctor is pushing for surgery to try and extract directly from my testicles, and it's actually scheduled for mid October. I'm just not confident it will yield anything given the testicular atrophy I still experience every other week.
If the doc won’t prescribe you HMG,
pick some up from Clearsky Pharmacy. It’s about 1K for a full course of 4 months, but worth it. Plus with compounding pharmacies not allowed to make it any more it’s becoming more and more scarce. That’s what I did.
 

John99Test

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What surgery are you having done?

I have a similar history of AAS use. Tried unsuccessfully to get my wife pregnant for years. We tried everything. Got so frustrating it stated to put a major strain on our relationship. Finally made an appointment with an established IVF clinic. My wife checked out fine. I was the problem. My semen analysis showed azoospermia. Plus the very few that were around showed terrible motility/morphology. Specialists there said only way was through ICSI due to my horrible #'s.

IVF techniques have greatly improved the chances of individuals such as yourself having a child. I have 2 very healthy daughters today both conceived through IVF with ICSI. In fact our second daughter was a stored embryo from the first ICSI fertilization thawed out and inserted 5 years later.
Great to hear. Did insurance cover all of that?
 

John99Test

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I just saw the part about your LH/FSH being normal range. What your serum testosterone level? If it's too low your body won't produce sperm since the Sertoli cells need a localized, high concentration of testosterone. That's why hCG tends to promote fertility.

Have you tried dropping the hCG for a few weeks since your HPTA is working again? Those high doses of hCG are counterproductive.
Weird that his LH and FSH are normal. Desensitizing with too much HCG could be it.
 

he-man100

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What exactly are your numbers on the 1000ie HCG +25mg clomid 3x week? Testerosterone +lh fsh?
If testosterone is decent and lh fsh are only low normal you could try to drop the HCG and stay on clomid only to hopefully raise lh fsh to high levels while maintaining decent testosterone.
 

nastyn8

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What surgery are you having done?

I have a similar history of AAS use. Tried unsuccessfully to get my wife pregnant for years. We tried everything. Got so frustrating it stated to put a major strain on our relationship. Finally made an appointment with an established IVF clinic. My wife checked out fine. I was the problem. My semen analysis showed azoospermia. Plus the very few that were around showed terrible motility/morphology. Specialists there said only way was through ICSI due to my horrible #'s.

IVF techniques have greatly improved the chances of individuals such as yourself having a child. I have 2 very healthy daughters today both conceived through IVF with ICSI. In fact our second daughter was a stored embryo from the first ICSI fertilization thawed out and inserted 5 years later.
The surgery is MESA or TESA. Basically going to extract fluid directly from the testicles to see if they can find anything. We are all for IVF, but IVF is useless if I'm not producing semen. My semen analysis results over the last couple of years have been 0 ppm. So it's not that I have a low sperm count, I literally have ZERO.

I'm really liking the idea of dropping down the hCG dose or even getting rid of it completely. I have always suspected that hCG was not doing for me what it's supposed to do. Today I injected 100iu vs the normal 1000iu i'm prescribed. I did that along with the 25mg clomid. I'm tempted to cancel my surgery appointment in a couple weeks and see how low/no hCG protocol works for me.
 

nastyn8

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Weird that his LH and FSH are normal. Desensitizing with too much HCG could be it.
I think you're right. Too much hCG. My first hCG prescription was for 2500iu 3X a week and it only went up from there after that. The past 9 months i've been at 1000iu 3X a week, but still suffer from testicular atrophy and zero sperm count. I've always suspected the hCG was the issue but i've had 2 doctors now tell me how "it's supposed to be working by now".

Coming off hCG and going strictly clomid should keep my test levels up correct? My last lab results had my test in the 650 range (300-900 "normal" range) but that's while taking 1000iu hCG 3X week.
 

nastyn8

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I just saw the part about your LH/FSH being normal range. What your serum testosterone level? If it's too low your body won't produce sperm since the Sertoli cells need a localized, high concentration of testosterone. That's why hCG tends to promote fertility.

Have you tried dropping the hCG for a few weeks since your HPTA is working again? Those high doses of hCG are counterproductive.
Going to drop hCG for a couple weeks and go strictly clomid. I'll keep the anastrozole around incase I start to get high E2 symptoms. Thanks for this suggestion!
 

he-man100

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I think you're right. Too much hCG. My first hCG prescription was for 2500iu 3X a week and it only went up from there after that. The past 9 months i've been at 1000iu 3X a week, but still suffer from testicular atrophy and zero sperm count. I've always suspected the hCG was the issue but i've had 2 doctors now tell me how "it's supposed to be working by now".

Coming off hCG and going strictly clomid should keep my test levels up correct? My last lab results had my test in the 650 range (300-900 "normal" range) but that's while taking 1000iu hCG 3X week.

If your test is 650 on hcg your not desensitized. Also hcg can only desensitise your leydig cells not the sertoli cells if it`s even possible at all. You should try to get your fsh up as high as possible while maintaining decent testosterone. Are your lh fsh on hcg +clomid?
 

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