@alextatem: Everything you’ve been told ab...
@alextatem
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Apr 10, 2026
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Everything you’ve been told about TRT and your balls is wrong. 💉🏀
I’ve published on this. I treat it daily. I train other MDs on it.
Here’s the truth about preserving and restoring testicular function on TRT 🧵👇 (1/12)
I’ve published on this. I treat it daily. I train other MDs on it.
Here’s the truth about preserving and restoring testicular function on TRT 🧵👇 (1/12)
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🚫 MYTH: “TRT is a one-way street”
The AUA guidelines literally use the word “trial” for testosterone therapy.
This isn’t always a lifetime commitment. We need to stop scaring men out of treatment.
Especially if we can offer proper support.
🔗 doi.org/10.1016/j.juro…
The AUA guidelines literally use the word “trial” for testosterone therapy.
This isn’t always a lifetime commitment. We need to stop scaring men out of treatment.
Especially if we can offer proper support.
🔗 doi.org/10.1016/j.juro…
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✅ REALITY: You can maintain testicular function ON TRT.
HCG is the key.
Our early papers recommended 1500 IU once weekly. We’ve since learned that’s not enough for many men.
I now use 1500 IU twice weekly. 💉
HCG is the key.
Our early papers recommended 1500 IU once weekly. We’ve since learned that’s not enough for many men.
I now use 1500 IU twice weekly. 💉
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🚫 MYTH: “Recovery after stopping TRT takes forever”
Without help? Sure — could take up to a year or longer. Some men never fully return to baseline.
🔗: pubmed.ncbi.nlm.nih.gov/35000898/
Especially if they skipped HCG and were on TRT for years.
But “without help” is the key phrase. 👇
Without help? Sure — could take up to a year or longer. Some men never fully return to baseline.
🔗: pubmed.ncbi.nlm.nih.gov/35000898/
Especially if they skipped HCG and were on TRT for years.
But “without help” is the key phrase. 👇
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✅ REALITY: We can accelerate recovery of T and sperm with meds.
• Enclomiphene → most men solid by 3-4 months re: T, but not yet for sperm. Best when focused on T
• HCG → faster for fertility w/ weeks, not months.
• HCG + FSH → FASTEST path to fertility 🏁 (HMG works too)
• Enclomiphene → most men solid by 3-4 months re: T, but not yet for sperm. Best when focused on T
• HCG → faster for fertility w/ weeks, not months.
• HCG + FSH → FASTEST path to fertility 🏁 (HMG works too)
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🚨AND we’ve shown men STILL ON testosterone can have excellent fertility on HCG + FSH.
74% of men improved sperm counts — same rate whether on or off T.
🔗 doi.org/10.1016/j.fert…
74% of men improved sperm counts — same rate whether on or off T.
🔗 doi.org/10.1016/j.fert…
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Age and duration of T use matter when it comes to both T and sperm recovery. Older men and longer users recover slower.
But 70% still hit a total motile count >5M within 12 months on HCG-based therapy.
🔗 doi.org/10.1016/j.fert…
But 70% still hit a total motile count >5M within 12 months on HCG-based therapy.
🔗 doi.org/10.1016/j.fert…
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The OG paper: HCG-based combo therapy restored spermatogenesis in 95.9% of men with T-related azoospermia or severe oligospermia.
Avg time to recovery: 4.6 months. Mean first density: 22.6M/mL. 🔬
🔗 doi.org/10.1111/jsm.12…
Avg time to recovery: 4.6 months. Mean first density: 22.6M/mL. 🔬
🔗 doi.org/10.1111/jsm.12…
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🚫 MYTH: “HCG + enclomiphene is the best recovery combo”
My mentor Larry Lipshultz was the first to publish on this. The logic was sound — add Clomid to boost natural FSH production.
But the data told a different story. 👇
My mentor Larry Lipshultz was the first to publish on this. The logic was sound — add Clomid to boost natural FSH production.
But the data told a different story. 👇
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✅ REALITY: Enclomiphene does nothing here.
When we checked gonadotropins, FSH was undetectable on HCG + enclomiphene.
Patients recovered sperm on HCG alone elsewhere.
Enclomiphene is simply overpowered by HCG at the pituitary. It adds nothing. 🪫
When we checked gonadotropins, FSH was undetectable on HCG + enclomiphene.
Patients recovered sperm on HCG alone elsewhere.
Enclomiphene is simply overpowered by HCG at the pituitary. It adds nothing. 🪫
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So what does this mean for you?
• Enclomiphene best option to recover T after TRT for most men
• Better still if men were on HCG during TRT
• If highly motivated for fertility → high dose HCG +/- FSH
• Enclomiphene adds E2 burden with zero proven benefit in that context
• Enclomiphene best option to recover T after TRT for most men
• Better still if men were on HCG during TRT
• If highly motivated for fertility → high dose HCG +/- FSH
• Enclomiphene adds E2 burden with zero proven benefit in that context