Dr. Shaikh Sadaf
Endocrinology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have low testosterone of 100. My urologist put me on medication and gave me options, to which I do not know what is better. Either true Testosterone, hCG or Clomid. I am only 30 years old, so he advised against testosterone because of the possible fertility issues. My testosterone was checked four years back, and my levels were 350. Since then, my levels have dropped dramatically. However, I will try to have a child in the next few years. I need treatment, but I do not want to hurt my fertility. I was taking true Testosterone and came off of it with hCG and Clomid in the past. All blood work for three weeks in a row shows low testosterone. Prolactin was checked to be safe, and it shows normal levels. I would like to get an expert opinion.
Hello,
Welcome to iciniq.com.
I just read your query, and from what you have attached (attachments removed to protect the patient's identity), it appears that you have very low testosterone levels. If you are deficient in testosterone, it is better to take testosterone replacement therapy in any form suitable for you. Prior testosterone therapy will not affect fertility prospects. Although when you desire fertility, it must be stopped before initiating gonadotropin therapy.
Regards.
Patient's Query
Hi doctor,
Thank you for the reply.
My urologist's concern was that taking testosterone could result in my sperm count dropping to zero and that I could have fertility issues. His advice is to do hCG or Clomid instead to boost natural test levels. Are you saying that you do not think that is the best? Should I do a combination of these medications if he allows it? What is your reasoning?
Hi,
Welcome back to icliniq.com.
The sperm count decline is not permanent. It will recover once testosterone is stopped. According to your wish to conceive now or later, the treatment can be planned with your plans being of primary importance. For example, if you need fertility now, then go for hCG (human chorionic gonadotropins) or clinic therapy. However, if you need to improve your testosterone levels for the general well-being of your body, then you can opt for testosterone replacement therapy. What you need now will decide your therapy choice, to be honest. All are better options. It cannot be a combination of all treatment options, and it does not work like that.
Testosterone treatment aims at:
1) Improving libido and sexual function.
2) Improving mood and well-being.
3) Improving muscle mass and strength.
4) Preventing osteoporosis.
Whereas the therapy itself can cause a decrease in sperm count temporarily. So when fertility is desired, HCG or Clomid (Clomiphene) are prescribed.
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Endocrinology
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