TRT and Fertility – how to get the best of both worlds - part 1

The prevalence of testosterone deficiency (aka hypogonadism or Late Onset Hypogonadism), defined as total testosterone (TT) at or below 300 ng/dl is close to 40% in men aged 45 years and older presenting to primary care offices in the US.[1] Year 2006 is was estimated that more than 13.8 million men over 45 years of age visiting a primary care doctor in the United States have symptomatic androgen deficiency.[1] 
 
A large international web survey using the Aging Males' Symptoms (AMS) questionnaire showed the prevalence of symptomatic testosterone deficiency to be 80% in men aged 16–89 (mean 52 years).[2] It is notable that in the survey 40% of respondent were at younger ages when ‘Late Onset Hypogonadism’ is generally not believed to be occurring.[2] The surprisingly high prevalence of raised scores indicating testosterone deficiency in the younger age groups may be due to the increasing prevalence of conditions in these age groups known to reduce testosterone levels, such as obesity [3-7] and chronic work stress. [8-10] Stress induced cortisol elevation, by increasing SHBG, lowers the free active fraction of testosterone and thereby reduces its action.[11] 
 
This large and rising prevalence of testosterone deficiency is gaining recognition among doctors and patients alike. However, while testosterone replacement therapy (TRT) confers great benefits to men with sup-optimal testosterone levels, it also comes with some side-effects which are especially relevant for men who wish to have a family...Many testosterone users and even clinicians [12] are unaware that exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis and may result in infertility...however, in most cases, TRT induced infertility is reversible. If paternity is of interest to you, read on...
 
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TRT and Fertility – how to get the best of both worlds - Clomid and HCG - part 2

In part 1 - "TRT and Fertility – how to get the best of both worlds" - I covered issues related to the effect of TRT (Testosterone Replacement Therapy) on male fertility. Here I will outline options for men to increase endogenous testosterone production by non-TRT means, and ways to speed up spermatogenesis for those who chose to go the TRT route...
 
The same strategies apply to increasing endogenous testosterone production and speeding up its recovery after supplementation, as illustrated in the figure:
 
 
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Dr. Pierce's Medical Organization Affiliations

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