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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)
🚫 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. 🔗 <a target="_blank" href="https://doi.org/10.1016/j.juro.2018.03.115" color="blue">doi.org/10.1016/j.juro…</a>
✅ 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. 💉
🚫 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. 🔗: <a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/35000898/" color="blue">pubmed.ncbi.nlm.nih.gov/35000898/</a> Especially if they skipped HCG and were on TRT for years. But “without help” is the key phrase. 👇
✅ 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)
🚨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. 🔗 <a target="_blank" href="https://doi.org/10.1016/j.fertnstert.2024.10.019" color="blue">doi.org/10.1016/j.fert…</a>
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. 🔗 <a target="_blank" href="https://doi.org/10.1016/j.fertnstert.2016.10.004" color="blue">doi.org/10.1016/j.fert…</a>
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. 🔬 🔗 <a target="_blank" href="https://doi.org/10.1111/jsm.12890" color="blue">doi.org/10.1111/jsm.12…</a>
🚫 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. 👇
✅ 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. 🪫
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