What is the dosing schedule for HMG while on TRT?
Im only 27 and will be going on TRT in the next month. Im planning on having children in the future and want to remain fertile. From my research it seems like using HCG would not help with fertility issues since its like LH, which only stimulates the leydig cells to produce Test.
HMG is like FSH which stimulates the Sertoli cells which induce sperm production.
Could I run HMG alone or would it need to be ran w/ HCG?
It appears that 75 - 150 iu of HMG 2-3 times weekly is the standard dose. You would need hCG also - this will ensure high llevels of intra-testicular testosterone - which are required for sperm maturation.
You can be fertile on hCG alone - but the studies I have read suggest that fertily (in terms of sperm count) is around 20% of YOUR normal levels (ie if all was working well for you)
Studies below on hCG and HMB
Zhonghua Nei Ke Za Zhi. 2005 Nov;44(11):836-9.
[The application of gonadotropin in treatment of male central hypogonadism]
[Article in Chinese]
Di FS, Cui YG, Jia Y.
Department of Endocrinology and Key Laboratory, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
OBJECTIVE: To observe the efficacy of human chorionic gonadotrophin (hCG) and hCG plus human menopausal gonadotropin (HMG) for central hypogonadism in male patients. METHODS: 64 men with central hypogonadism were recruited in this study, including 19 patients with Kallmann syndrome, 41 patients with idiopathic hypogonadotrophic hypogonadism (IHH) and 4 patients with hypogonadism after brain surgery. 33 patients were treated with hCG 1500 IU intramuscularly twice a week, whereas 31 patients were treated with intramuscular hCG 1500 IU plus HMG 75 IU twice a week, for at least 6 months. RESULTS: After treatment, all patients felt stronger physically and 42/64 patients developed beard, pubes or armpit hair. The testis volume enlarged significantly [(3.08 +/- 2.44) ml vs (8.92 +/- 5.37) ml, P < 0.001], and serum follicle-stimulating hormone, luteinizing hormone and testosterone concentrations were higher significantly than those before treatment (P < 0.05). 6/64 patients underwent spermatorrhea and 2 patient were found to have spermatogenesis. If judged by the testis volume, 52 patients (81.2%) were effective and 12 patients were ineffective. CONCLUSIONS: For male patients with the central hypogonadism, hCG and hCG plus HMG can promote the pubertal development and maturation of second sex characteristics, as well as enhance the physical strength; in some patients both androgen production and spermatogenesis can be achieved.
PMID: 16316564 [PubMed - indexed for MEDLINE]
Arch Androl. 2004 Jul-Aug;50(4):267-71.
Induction of spermatogenesis in idiopathic hypogonadotropic hypogonadism with gonadotropins in older men.
Samli MM, Demirbas M, Guler C.
Department of Urology, Afyon Kocatepe University, School of Medicine, Turkey. msamli@tr.net
We investigated the treatment results in 6 azoospermic idiopathic hypogonadotropic hypogonadism (IHH) cases that remained untreated 41-47 years of age. Medical history, physical examination, hormone profile measurements, peripheral blood karyotype, skull X-ray and/or magnetic resonance imaging were performed. Patients received 1,000 to 5,000 IU hCG, 2-3 times per week, and 75 to 150 IU hMG, 2-3 times per week for 24 months. Serum testosterone levels were assessed every month for maximum 6 months to evaluate optimal dose of treatment and then every 3 months thereafter. Sperm counts were assessed every 3 months. Testosterone level increased from 2.7 +/- 0.9 mIU/L to 22 +/- 7.04 mIU/L with treatment; testicular volume increased by 4.6 ml during the treatment. Sperm were detected in the ejaculate in 3 out of 6 patients on the 22nd, 18th, and 15th month of treatment. 3 patients underwent testicular biopsy; histopathology revealed tubular hyalinization. Spermatogenesis in older men with IHH was restored by exogenous gonadotropins.
Successful treatment of anabolic steroid-induced azoospermia with human chorionic gonadotropin and human menopausal gonadotropin.
Menon DK.
Department of Obstetrics and Gynecology, University Malaya Medical Centre, Kuala Lumpur, Malaysia. drmenon2000@yahoo.co.uk
Comment in:
Fertil Steril. 2004 Jan;81(1):226.
OBJECTIVE: To document for the first time the successful treatment using human chorionic gonadotropin (hCG) and human menopausal gonadotropins (hMG) of anabolic steroid-induced azoospermia that was persistent despite 1 year of cessation from steroid use. DESIGN: Clinical case report. SETTINGS: Tertiary referral center for infertility. PATIENT(S): A married couple with primary subfertility secondary to azoospermia and male hypogonadotropic hypogonadism. The husband was a bodybuilder who admitted to have used the anabolic steroids testosterone cypionate, methandrostenolone, oxandrolone, testosterone propionate, oxymetholone, nandrolone decanoate, and methenolone enanthate. INTERVENTION(S): Twice-weekly injections of 10,000 IU of hCG (Profasi; Serono) and daily injections of 75 IU of hMG (Humegon; Organon) for 3 months. MAIN OUTCOME MEASURE(S): Semen analyses, pregnancy. RESULT(S): Semen analyses returned to normal after 3 months of treatment. The couple conceived spontaneously 7 months later. CONCLUSION(S): Steroid-induced azoospermia that is persistent after cessation of steroid use can be treated successfully with hCG and hMG.
Thanks for the great read. I see running HMG can get expensive, but well worth it if fertility is a concern.
hCG dose cross activate FSH receptors. Not by a great amount, but sufficient for testicular maintenance. hCG will prevent damage. Later on if a sperm count indicates issues you can switch to HMG.
That medical report with 20,000 iu hCG per week is irresponsible. Yes the testes will respond, but LH receptors will down regulate and make getting normal all the more difficult. This info is dangerous and misleading.