TRT and Fertility: Comparing the Adjuncts That Actually Work

0:09 Hey everybody, this is Hunter Williams. I hope you're doing amazing wherever you are in the world. Today's video is basically going to be a comparison of all of the different fertility adjuncts or agents that you would use alongside testosterone therapy replacement. This is something, obviously, if you have watched any of recent podcasts or livestreams I've done, that is very important to Taylor and I right now because we are working on family planning and having a family, hopefully sooner than later. And so I've been going deep on obviously the adjuncts to TRT, what to use.

0:40 The good thing is this is a relatively simple thing to do, but in the spirit of my fertility journey, which I'll talk about more in future, obviously as it progresses, I want today to go over some of these agents and talk about which ones are good, which one's might not be as good and which once you'd use to either enhance fertility to the point of actually having conception with your partner, or maybe it's just to maintain fertility at a little bit of a baseline level so that when the time comes, you are a bit ahead of the game, so to speak, as opposed to just being on testosterone,

1:12 not having that and then having to really kickstart everything from the bottom. but that's what we're going to be talking about today. I think it'd be really fine. And whether you're a man or a woman, maybe fertility is not that important to you, but I it's important. To understand this, because even if it not important, to some of these things might still be things that you want to add onto your testosterone therapy. They might not be, they might be beneficial. In a lot of cases, some men do better when they add these to their testosterone, therapy, do perfectly well without them and they don't need them.

1:43 But I think some men do do better. And we'll talk a little bit about that today. So strap up. That's what we're going to go over. As always, make sure you're on the email list. that's the best place to keep in touch with me. All I do is really just send a couple emails a week, notifying you of new videos or any of the other things that I'm working on in the form of a written article. And also too, if you want to check out my private group, do live coaching calls with me and the members of the group and also interact with the forum or have the ability to message me directly to make sure your question gets answered. That is the place to be. Check out the Axion Collective. All right.

2:13 We're going to hop in today and go over all of these agents and what they mean for you. So strap in and we're gonna learn about fertility. All right, today we're gonna go over some of the TRT adjuncts for fertility and whether that's for just preserving fertility, for enhancing fertility or even just maintaining a little bit of testicular function. I think a lot of men can benefit from this conversation and potentially women too, if your partner is on testosterone therapy or you're considering going on to testosterone on therapy. Now, why do we need these adjuct in the first place?

2:43 Let's go just in case. You need your memory refreshed or you've never come across this before, or maybe you're even considering testosterone. This is something you want to look at. So men on TRT often seek to maintain fertility and avoid testicular atrophy despite suppressed natural hormone production. Basically testosterone therapy will shut down the brain's luteinizing hormone and follicle stimulating hormone release, otherwise known as LH and FSH for short, which causes the testes to stop producing testosterone and sperm. over time if you use exogenous testosterone long enough, yes, you will shut down this natural mechanism in your body and eventually you WILL lose the same

3:23 sperm that you probably had before, or at least the SAME sperm parameters. The ones we're going to talk about today are the most popular ones. I'm sure there's some other ones out there, but for the intents and purposes of brevity and just condensing this down, we are going talk in Clomophene, HCG, HMG Kiss Peptin and Gonadarelin and what those actually do, what they look like and how we would use them. Now, in clomophene first, this seems to be more of the popular one, probably because it's orally bioavailable and you can use it in a pill or a tablet. How does it work though? The first thing it does is it blocks, it is known as a CIRM, which is a Selective Estrogen Receptor Modulator.

3:57 And what that means is that it block estrogen's feedback at the hypothalamus metuitary gland, Which then, when we do that, increases LH and FSH to release and stimulate natural testosterone and sperm production. On average, most people, and most men, will see testosterone go up around 160 nanograms per deciliter, around a 160 points, while lowering estradiol by around six points which isn't that much. And it preserves fertility and testicular function during TRT. So you could use this just to maintain a little bit testicular function and to help preserve your sperm while on TRD.

4:31 Only 9% of men report decreased libido versus 33% on actual clomophene. And clopophane is basically a modification of regular clonophine to have a little bit less side effects. So only around 9 percent reports decreased the libidio, whereas like one in three men on clomorphine itself, which is clomyphene citrate, will have decreased. There's also fewer emotional side-effects, more balanced hormonal feeling. That goes into one of the isomers known as zoochromophen, which has been removed from regular clomophene for in-chlamophane.

5:02 The cool thing about it is that it's orally available. Typically the dose is going to be 12 and a half to 25 milligrams. You can maintain LH and FSH output naturally alongside of your testosterone. There are minimal estrogen related side effects, especially relative to regular Clomaphene. It also preserves sperm production at testicular size. And then we do see higher pregnancy rates than Clamopheme. Now, at this time of me doing this video, it's actually not FDA approved for men, so it will be used off label in a lot of cases. It requires a functional pituitary response.

5:33 What that means is if your pitutary isn't really working that well, you might not see that much of a benefit. I'm using clomophene and due to probably some, well what I know to be pituitar dysfunction, from my concussions in the past. It didn't really do anything for me in that sense. My total testosterone did go up from where it was, but my LH and FSH didn' really move the needle that much. And probably that's from the fact that I had a lot of concussion,s but that doesn't mean it won't work for you. Some people get headaches and visual disturbances. I think from a long-term use case, this is not something I would want to be on for years consecutively, just because there is some data out there that

6:11 says that it could impair vision. And clomophene is probably better than clomorphene itself, obviously, but it wouldn't be something that if I'm going on testosterone that I'd say, okay, for the next 30 years, I'm going to be using enclomaphene. You're probably not going want to do that. However, the short-term can be good. In a lot of cases for younger guys, they'll use this to try to help kickstart their pituitary. If for any reason it's been shut down through lifestyle, diet and environmental factors. And so they can use it short term and to maybe bridge the gap before they go on testosterone therapy.

6:41 But to me, I think it is obviously useful, but it isn't something that I would use long term. I would rely on some of the other ones we're going to talk about, but I think it can be relatively effective at maintaining sperm motility and fertility while you're starting testosterone therapy. For me, this would be one of those ones, I thing for a guy that's a little bit younger that is just starting testosterone therapy and says, hey, in the next two to three years, and start testosterone therapy at the same time. To me, that's the best use case of enclomaphene to where you're going to kind of maintain the natural production you are having anyway over time and really

7:16 not see any change in the practice of your actual testosterone or how the testosterone feels. Now the next one is going to be HCG. That stands for human chorionic gonadotropin. HCD, I think in my opinion, is much more powerful. There's a direct action. So it mimics luteinizing hormone or LH, which bypasses the brain directly to stimulate the latex cells and the testes for testosterone production. Again, in doing so, it makes L H rather than acting as a serum, for the purpose of fertility is gonna be stronger.

7:46 The standard protocol is anywhere from 150 to 500 IU two to three times weekly to prevent testicular atrophy and maintain intratesticular testosterone during testosterone therapy. I think most guys do well at like 250 IUs two or three time per week. Really, that's the baseline amount you need to be good. Now, if fertility is of concern, meaning that you're actively trying to conceive like I am myself right now, I'm doing it 1,000 IUs three times per week, which is 3,00 Ius per weeks, obviously a bigger dose, but I've really trying move the needle on my sperm.

8:21 Whereas like in a normal case, once we have kids and have all the kids we want, probably just go back to either nothing or just that 250 I use two to three time per a week to maintain this testicular fullness. I personally have never had what I would call a lack of testicular fullness without HCG, but I do notice that it is a little bit more full with HCJ. But for me, it's not that much more. And even with 3000 I use per week and having been doing that for several weeks now, It's, not much different for, me. Whereas a lot of guys, they just lose like all of their testicular fullness when they don't have HC.

8:56 This is the most well-established for fertility preservation, and you can usually return sperm in six to nine months for most men who become azo-spermic on TRT, which just means without sperm. And in some cases it can be even three months, but HCG itself relative to enclomaphene is going to prevent 90% reduction In sperm count seen on TRT alone, it maintains intratesticular testosterone, which is crucial for spermatogenesis. And also in a lot of guys, not in all guys but in lot guys that can improve energy, libido, strength and mood and it restores the complete hormonal milieu

9:28 including testicular precursors. However, it can increase estradiol levels. And so that's why if you're going to just use it for preservation instead of active conception, you want to start probably a little bit lower somewhere in that 250 IU two to three times per week range, maybe even up to a thousand IUs total to usually avoid issues. Now, even at 3000 Ius for me alongside of HMG, which I'm going talk about next, I don't feel like I have high estrogen issues. I do perfectly fine on that. A lot of that probably can relate to a guy's body fat percentage.

9:58 The higher the bodyfat, the more he's going to aromatize that testosterone into estradiol, which can then raise estrdiol levels. But HDG is the first adjunct for many men on TRT concerned about fertility or testicular function with decades of proven safety and efficacy. Now, it seems like in a lot of cases, pharmaceutically at least, its harder to source, but in the research world, you have a lotta people that are selling it. So it's pretty easy if you're in, the ecosystem that I'm in.

10:31 The next one is going to be HMG, and this is gonna be human menopausal gonadotropin. Now, whereas HCG just mimics LH, H-M-G contains a one-to-one ratio of FSH and L-H activity, which directly stimulates both the sertoli cells and the lytic cells. So this going be a little bit more direct acting on actually activating sperm. And for the purpose of needing fertility, this not something if you just want to preserve fertility. that you would need to use all the time. But like in my case right now, I'm using this to help increase my sperm parameters.

11:03 HCG is introduced when, or excuse me, HMG, is introduce when HCGA alone doesn't increase sperm counts after three to six months. The typical dose is 75 to 150. I use two to three times per week. I'm doing 75 IUs three times weekly right now, so what would that be? 225 Ius of HMG per week, and it significantly improves sperm motility and morphology. Most men recover spermatogenesis on HCG and HFG combination therapy pretty quickly. We'll see how fast it happens for me, but it I think is moving along nicely right and I'll probably test again soon just to see where things are at.

11:38 But HMG matters because it provides the FSH component, whereas HCG is only the LH component that neither TRT or HCGs supply. And it's essential for men actively trying to conceive as FSh directly stimulates sperm production. Studies show the combination of HC and HG achieve sperm reduction faster than just HC alone with majority recovering fertility within six to 12 months. In a lot of cases, sometimes even three months, depending on how shut down you were. The pro of this is this gold standard for fertility, induction, improved sperm count, motility, and morphology.

12:10 The cons is, this one is much more expensive. So it's injectable. Obviously it is not needed unless actively pursuing pregnancy, but a lot of cases you'll see in the research world, a vial of HMG is 75 IUs, which means you need to go through three vials per week. And usually a Vial is somewhere in neighborhood of like 50 to 70 bucks. So that ends up being, you know, on the low end, probably 150 bucks per week, which is 600 bucks a month. And so it's not cheap, whereas HCG you can get a lot cheaper than that.

12:41 It's still a decent price, but HMG is much more expensive, obviously, because it's gonna be something that moves the needle much more. So a little bit more expensive than it is. And then obviously too, if you're getting it pharmaceutically, it even that much or you can source pins of HMG or in some cases is actually bioidentical FSH, which is even better. That's one thing I'm gonna to be doing. Again, for the intents and purposes of like talking about drug pharmacokinetics is pretty similar, but the bio identical F SH seems to stronger.

13:11 The next one is going to be Kispeptin, and I wouldn't say so much that this is really going be a fertility drug, although I think in some women it can definitely help with fertility. I've seen it anecdotally in men help too, but it's basically an upstream master switch. What KISPEPTIN does is it triggers GnRH release in the hypothalamus, which is gonadotropin-releasing hormone. And then this stimulates both LH and FSH from the pituitary. With kisspeptin, we do see a libido enhancement. So it enhances brain sexual arousal centers and increases penile blood flow.

13:43 And so it's kind of one of those ones that is used much more in like the oxytocin PT-141 side of things, much that would be for fertility, although it can be used for a fertility. It's an experimental compound some clinics use as an HCG alternative, typically 100 microgram daily injections is going to be what most people use. It does have a short half life, so it only is in circulation for minutes. Requires frequent dosing or infusion pumps for sustained effect. I would say really, probably if you're covering your bases should be doing it three times a day, but at least twice a. But what it does is potentially preserve fertility and testosterone in one treatment by stimulating both hormones.

14:18 And I have seen more of this helping in the libido enhancement side of things. I think for women, it can be effective at helping with fertility, but for men too, HCG, HMG and enclomaphene are all going to be better for fertility parameters. However, there can some benefit to using it. For fertility, but I think much more on the libido side of things, there seems to be a lot of data around helping men with arousal when they're using kids' peptin. So I don't think it's a replacement for testosterone, obviously. Could raise endogenous testosterone a little bit, yeah, sure. But I thinks it is much something that you would add on in addition to just add an extra layer of health there.

14:55 But kids' peptum just promises a future tool to keep the HPTA, which is the hypothalamus pituitary testicular axis, alive during TRT and potentially boost libido, but it's still on the experimental side, with some practicality hurdles to overcome. And again, I just don't think, relatively speaking, it is going to stand up to HCG long-term. The next one is gonadareline, and I debated whether or not I should put this in here. But I did because there are some clinics and pharmacies that will prescribe this, and this one is going to be a lot more affordable, but it's because it doesn't work as well.

15:26 Basically, gonadarolin is a synthetic gonaderolin-releasing hormone that directly stimulates the LH and FSH released from the pituitary. It must be given in a pulsatile fashion to mimic the natural rhythm. It's gained popularity as a low cost alternative to HCG because the cost of HCGs has gone up a lot in recent years because it became scarce and is primarily used for testicular size maintenance rather than fertility. So we don't see as much fertility in this. Around 50% of men just don' t seem to respond to it at all.

15:57 The effectiveness varies widely. Some men like it. but others see very little effect, especially if they're already on testosterone and older men on TRT done having children who want to prevent extreme testicular shrinkage without high costs could be a good fit for this. I would say that's really like the only situation. It's approximately 75% cheaper than brand name HCG making it accessible for budget conscious patients. And it's not ideal for men prioritizing fertility preservation. It does not reliably maintain intratesticular testosterone or sperm production on TRT. Really the only use case I think is for man that are past their fertility days that want something that's cheaper than HCG to use that might work a little

16:35 half as good. So it preserves testicular size better than testricular function. And for fertility goals, HCG remains superior. So not really much to say there with that, but I did want to throw it in there because it's something I think people get hurt. You know, they get recommended by their doctors or whatever, and it really just not as good. I would much rather source HCJ from the research world than I. Would get good at irrelevant for my doctor if I had my choice. Just to sum up, obviously you have enclomaphene, which is good. I would say it's not the best.

17:05 HCG is kind of the gold standard. And I think if you can get it, it is relatively affordable, I wouldn't use HC and lean on that the most. HMG really only there when pregnancy is priority. You can layer in whether you're on HC or on clomophene. you could probably layer a little bit of KSP here and there to help with libido enhancement and arousal. not so much with the fertility side of things, but hey, it's not going to hurt. And then gonaderelin, cheap, alternative to some of these. I really wouldn't recommend it again, unless it is just fertility is not an issue and you just want something cheap that you're going be able to get from

17:38 your doctor. To sum up, TRT doesn't require sacrificing fertility. That is a big myth. And I think in this video, I didn't really drive home enough is that most guys think, Oh man, there's no way I can get on testosterone. Cause I want to have kids and I just don't want do that. Now, if you want the guarantee that you're not going to. Have any issues yet. Don't start testosterone, but in a lot of cases, especially with the the world today. Now, some guys are just not fertile even without testosterone therapy. And so it's like, you're going to have to use some of these anyway, in a lot of cases, depending on how old you are, or depending upon how well your sperm

18:11 parameters are. So you might even start having to start using encomphene or HCG without Testosterone. I think in that case it was like why not go ahead and add in testosterone because you feel a lot better than you would if you were just doing those solo. But again, if we want to boost natural testosterone, that's going to be where we lean on in clomophene. HCG and HMG are going be the best for fertility. Libido enhancement, we can use kisspeptin and then for budget friendly option, gonadarilin would be there. And again, the Enclomophene, Kispeptin, and Gonaturilin work through the HPTA axis to encourage natural production.

18:44 Whereas HCG and HMG are a direct replacement to replace the signals and directly stimulate the testes. So they're much more of the brute force option. And some men use HCD plus enclomorphene together for balance, multi-pronged hormone optimization. I think that that may be overkill in some cases, but if a guy's not on testosterone and he wants to do that, I don't see any issue with it. But with the right strategy, you can enjoy the benefits of testosterone no matter what your age is and still be okay. I think that's the biggest myth in all of this is that testosterone will kill your fertility.

19:17 And there are lots of guys that have lived to tell the tale about being on testosterone and using it at the same time. So, well, I have to come off testosterone to conceive. My plan is to not do that for a while unless it becomes like really dire. So we'll see where that goes. I can't guarantee that I won't, but I think in the case of using most of these things, you can stay on testosterone and still be okay. Obviously it's a case by case basis. obviously everyone's going to be different, But if we're kind of adhering to some of those practices, I you should be good to go. And that is it for the slides.

19:49 And that is my overview of the main fertility adjuncts for testosterone therapy. If you get one takeaway from this, just know that you can still conceive using testosterone. Obviously I can't guarantee that for everyone, but fertility is not guaranteed whether or not you're on testosterone on therapy, it's one of those things that's going to be highly individual relative to the man's health. And then obviously the female conversation is really kind of separate from today. Although, I think females can use some of these agents. They would be used a lot differently in most cases.

20:19 But this is what I am doing for fertility, really relying on HCG and HMG in the short term. Maybe if needed, I'll throw in some kisspeptin. I thing for the purpose of just preserving function and clomophene can be a good option, especially if a guy's younger. It just wouldn't be something that I would say like, okay, for next 20 years, i'm going to plan to be on clomorphine alongside my testosterone. Whereas with HCg,I see no issue with that for long term based on the data we have. But let me know if this one was helpful to you guys. I know it's a little bit more of a niche topic. You know, fertility is not as big of an issue as fat loss or cognitive function or immune health or any of those things,

20:53 but I think it is relevant nonetheless. And you know the more we talk about optimizing, the hormone optimization is going to be a piece of that. Optimizing testicular function is gonna be a piece for a lot of guys to be able to have alongside of their testosterone to optimal function, whether or not fertility is an issue, but just having optimal sexual function and optimal testicular function for the long term. I'd love to hear your feedback on this one. Drop a comment. Let me know your feed back thoughts. And maybe if you're using these, you don't need them. I don' think it's something that everybody has to do, but a lot of guys can stand to benefit from it for the long term.

21:28 But thank you guys so much. In closing, I am so grateful to get to what I do. You guys make this the best job in the world. So thank whatever shape or form it is that you support me, whether it' liking, commenting, subscribing, sharing this with your friends or family, being on the email list, using my code of places. That is what helps me exist to be able to bring these messages to you guys. So I reciprocate back the support I get from you with my content, and I am so blessed to get to do this. Just know that even if you never reach out to me or whatever, that you are appreciated, you're loved, it's a dream come true for me to able bring this to.

22:03 Thank you, guys, so much.