First time posting and looking for help.
I seem to be unresponsive to HCG + FSH therapy.
I had been on TRT for about 15 years, which kept my testosterone at the high side of normal range, with excursions above the normal range at times. Prior to starting TRT, I already had 2 children from a previous relationship, but I’d like to have a child with my current partner. My sperm count is zero with a diagnosis of non-obstructive azoospermia. My testicles were moderately atrophied and my semen volume was below average.
At the beginning of 2023, I started adding HCG to my TRT, with HCG dosing adding up to less than 1000 IU per week. One improvement was that my testicles noticeably increased in size.
In an attempt to regain fertility following nearly 15 years of TRT (test cypionate only), around September/October 2023 I started tapering off Testosterone before starting HCG 2000 IU 3 times weekly. Due to a lack of any increase in testosterone, my urologist had me titrating up to my current dosing of HCG (Pregnyl) 5000 IU EOD with FSH (Menopur) 75 IU every day.
The problem is that my testosterone levels have steadily decreased and show no sign of going up. Worse still, while I do experience orgasms, I have no semen ejaculate at all! As in, totally dry, as if I did not have an orgasm.
Here is my most current blood work from blood drawn 8 days ago:
TESTOSTERONE, TOTAL, MS 7 L Reference Range: 250-1100 ng/dL
TESTOSTERONE, FREE 0.9 L Reference Range: 35.0-155.0 pg/mL
THYROGLOBULIN ANTIBODIES <1 Reference Range: < or = 1 IU/mL
THYROGLOBULIN 28.8 ng/mL Reference Range: 2.8-40.9
HCG 114 H Reference Range: 0-3
FSH 9.1 Reference Range: 1.4-12.8 mIU/mL
LH 2.8 Reference Range: 1.5-9.3 mIU/mL
WHITE BLOOD CELL COUNT 5.8 Reference Range: 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 4.46 Reference Range: 4.20-5.80 Million/uL
HEMOGLOBIN 14.3 Reference Range: 13.2-17.1 g/dL
HEMATOCRIT 41.2 Reference Range: 38.5-50.0 %
MCV 92.4 Reference Range: 80.0-100.0 fL
MCH 32.1 Reference Range: 27.0-33.0 pg
MCHC 34.7 Reference Range: 32.0-36.0 g/dL
RDW 12.0 Reference Range: 11.0-15.0 %
PLATELET COUNT 236 Reference Range: 140-400 Thousand/uL
MPV 10.4 Reference Range: 7.5-12.5 fL
ABSOLUTE NEUTROPHILS 3625 Reference Range: 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1531 Reference Range: 850-3900 cells/uL
ABSOLUTE MONOCYTES 447 Reference Range: 200-950 cells/uL
ABSOLUTE EOSINOPHILS 128 Reference Range: 15-500 cells/uL
ABSOLUTE BASOPHILS 70 Reference Range: 0-200 cells/uL
NEUTROPHILS 62.5 Reference Range: 38-80 %
LYMPHOCYTES 26.4 Reference Range: 15-49 %
MONOCYTES 7.7 Reference Range: 0-13 %
EOSINOPHILS 2.2 Reference Range: 0-8 %
BASOPHILS 1.2 Reference Range: 0-2 %
THYROID PEROXIDASE ANTIBODIES 3 Reference Range: <9 IU/mL
PROLACTIN 3.2 Reference Range: 2.0-18.0 ng/mL; One week later 13.0 Reference Range 3.5-19 ng/mL
T4, FREE 1.0 Reference Range: 0.8-1.8 ng/dL
TSH 1.32 Reference Range: 0.40-4.50 mIU/L
ESTRADIOL <15 Reference Range: < OR = 39 pg/mL
PSA, TOTAL 0.12 Reference Range: < OR = 4.00 ng/mL
SEX HORMONE BINDING GLOBULIN 48 Reference Range: 10-50 nmol/L
Lipid Panel from Nov. 2023;
Total Cholesterol 196 Normal Value: < 200 mg/dL
Triglycerides 192 Normal Value: < 150 mg/dL
HDL Cholesterol 32 Normal Value: > 39 mg/dL
LDL Cholesterol 126 Normal Value: < 100 mg/dL
Cholesterol/HDL Ratio 6.1 Normal Range: 0.0-4.9
MRI, with and without contrast, all normal, including pituitary
Awaiting scrotal ultrasound results, but tech says vascularization seems normal
Has anyone else experienced this? Does anyone have any insight and help? My urologist, who specializes in males, says it’s a “head scratcher”. I am 55 years old in pretty damn good shape for my age. While on TRT, I was 200 lbs ripped (defined abs). Now, I am 190 lbs not ripped (no abs). I still lift weights 4 times per week (although my max weights are declining) and go to wrestling twice a week.
If there is any other information someone might need to give a potential solution, I’ll be happy to provide.
Thanks in advance for any advice!!