Can TRT really ruin your fertility? In this video, Dr. Rena Malik explains the connection between testosterone replacement therapy ...

what-your-doctor-isn39t-telling-you-about-testosterone-and-fertility

What Your Doctor Isn&#39;t Telling You About Testosterone and Fertility?

did you know that testosterone might make you infertile I'm Dr Reena Malik urologist and pelvic surgeon and today we're going to talk about how you can treat low testosterone and still preserve fertility now we know that testosterone use is on the rise particularly for young men in fact between 2001 and 2011 testosterone prescriptions quadrupled for men in their 40s and tripled for men in their 50s and approximately 12% of men who are starting testosterone therapy are between the ages of 18 and 39 which are prime reproductive years even more an estimated 3 million of American men are abusing anabolic steroids which also will cause infertility now this trend raises a critical question how do we treat low testosterone without compromising fertility first let's talk about why testosterone caus cuses infertility so traditionally when you take testosterone replacement therapy this suppresses your body's natural ability to create testosterone and this is crucial for making sperm after you start testosterone replacement therapy the intratesticular testosterone levels drop so low that sometimes men develop what's known as Asos spermia and this can happen as quickly as 10 weeks after starting and even after you stop trt it can take anywhere from 6 months to 18 months for sperm production to come back to normal and in about 4 to 10% of men they may never recover their complete sperm count so some of you might be thinking well that's great it's like a contraceptive but not exactly not everyone gets to zero sperm one study found that administering testosterone to men who didn't have low testosterone resulted in azospermia or severe oligos spermia meaning less than 5 million sperm per milliliter in 70% of men after 18 months of therapy so that's not zero sperm and that's still 30% who still have enough sperm to have children now even those with less than 5 million sperm per milliliter can f children however it is very difficult now the good news is there are ways to treat low testosterone while preserving your fertility to start off there's two off Lael medications that are often used to increase testosterone without causing a suppression of your body's ability to make natural sperm production and natural testosterone one of these is called HCG or human chonic gonadotropin this acts very similar to a hormone in our body called lutenizing hormone this is produced by the pituitary gland in the brain and it has a long halflife of about 36 hours compared to about 30 minutes for LH so LH in the body stimulates Ling cells in the testicles to produce testosterone and by mimicking LH HCG also promotes the production of testosterone in the testicles which is really important for being able to maintain sperm production or spermaticus it has even been shown to help maintain sperm production in men while they're on trt in one study they looked at men who were on trt who were getting 500 international units of HCG every other day and after about a year these men still maintained their sperm counts the other medication is chopine citrate also known as Clomid now this is a selective estrogen receptor modulator or a therm now this has typically been used for the treatment of female infertility however it does have applications in treating both low testosterone as well as male infertility it works by blocking estrogen receptors in the brain specifically in an area called the hypothalamus now this blockage then interferes with the negative feedback of estrogen on the release of those hormones LH and FSH and this is because when your body makes testosterone it gets converted to estrogen and so when your body senses a lot of estrogen around it then slows down the production of testosterone conversely when there's low estrogen it's going to tell you to make more LH and FSH and subsequently more testosterone so in terms of maintaining sperm production you can take either one of those medications on its own and they've both been shown to increase testosterone levels quite well however they don't always show the ability to improve all symptoms of what we call hypogonadism related to low testosterone so these symptoms can include very commonly low libido fatigue brain fog difficulty gaining muscle mass depression or mood changes as well as erectile dysfunction so sometimes people will take these medications and feel like maybe they're beo hasn't improved as much as they wanted even though their testosterone levels are normal so if you're on trt and want to have kids you still can preserve fertility while you're on trt but it depends on where you are in the Journey of trying to start conceiving now based on Expert literature there's sort of three recommendations if you want to start fing children within the next 6 months the recommendation is to stop testosterone therapy immediately start HCG therapy 3,000 international units injected either intramuscularly or subcutaneously every other day you may consider in any of these cases adding Clomid 25 milligram daily or every other day and while you're doing this you want to get a seen analysis every two months to monitor your progress and see where your semen parameters are if you're not seeing improvements you can also add Rec combinant FSH 75 international units at any point during this time if you find you see sperm production you can always consider cryopreserving or freezing that sperm so you can use it for ixie or other forms of fertility management if you're planning for a pregnancy within 6 to 12 months at that point you can continue on your testosterone replacement therapy but add 500 international units of HCG every other day with or without chopine citrate now if you are thinking about sort of long-term term more than 12 months away the recommendation is to continue testosterone replacement therapy but every 6 months you want to cycle off and during that off cycle you want to lose 3,000 international units of HCG every other day for 4 weeks and then go back on trt it's important to realize the reason we do this is if you just stop trt the recovery of your fertility isn't immediate on average it takes about 4 months for sperm to return to the ejaculate but it can take up to 2 years for some and the factors that play a role in this include how old you are so older men generally take longer to recover and how long you've been on trt the longer you've been on trt the longer it's going to take to recover and lastly your initial sperm count so if you have good sperm count initially you will tend to have recovery sooner compared to those who have lower sperm counts on average if you look at a 30-year-old who's been on trt for one year there's a 90% chance that he's going to get a total motal concentration of sperm of greater than 5 million at 12 months now if you have been taking trt for longer this decreases from 90% by 3% every year of trt you've been on if for every age or every year older you are this decreases by 1.7% so you can sort of calculate your likelihood of recovering your sperm production now this is a really important thing please see a male fertility expert if you are on trt and want a father children so they can guide you in the process and make sure that you are achieving your fertility goals the sooner you start doing these fertility preserving treatments the better your chances are and you definitely need to make sure that you are monitored appropriately while you are taking these medications I hope you guys found this helpful if you are interested in learning about testosterone make sure you check out my playlist about testosterone I've talked a lot about different facets of boosting testosterone I've even talked about testosterone boosters do they work do they not work so make sure you check it out and as always I'm going to take care of yourself because you are worth it

Dr.

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