17 - OH Progesterone : HCG + TRT Efficacy Predictor
To find out if sperm count is normalized in men using hCG plus TRT, several studies have found that 17OH-P blood level is correlated to intratesticular testosterone (ITT) required for the testicles to make sperm, so testing for this hormone could not only save time while optimizing HCG dose/frequency but also eliminate the need to perform testicular aspirations, a very difficult procedure to do. Sperm count does not stabilize until 6-8 weeks after starting hCG plus TRT, so knowing your 17OH-progesterone blood level can give you a quick way to determine if your hCG dose and frequency is adequate before your first follow-up semen analysis after 8 weeks.
The 17-OH Progesterone Test and Fertility
Testosterone Replacement Therapy (TRT) shuts down upstream hormones like LH and FSH required for sperm production, so men on TRT generally have difficulty fathering a child. Some studies show that adding human chorionic gonadotropin (hCG) to a TRT protocol may improve sperm production since hCG is an analog of LH that could stimulate sperm production. But optimizing hCG dose and frequency based on sperm count can be time-consuming since it takes at least eight weeks to see changes in sperm tests. Fortunately, there is an easier way to predict the efficacy of the hCG+TRT protocol without having to wait for eight weeks between hCG dose/frequency changes.
To find out if sperm count is normalized in men using hCG plus TRT, several studies have found that the 17-OH-Progesterone blood level is correlated to intratesticular testosterone (ITT) required for the testicles to make sperm, so testing for this hormone could not only save time while optimizing HCG dose/frequency but also eliminate the need to perform testicular aspirations, a challenging procedure to do. Sperm count does not stabilize until eight weeks after starting hCG plus TRT, so knowing your 17-OH-progesterone blood level can quickly determine if your hCG dose and frequency are adequate.
This test uses liquid chromatography/mass spectrometry (LC/MS), the most accurate method for hormone testing.
Why is 17-OH-Progesterone Testing Important in Men on TRT plus hCG?
The use of testosterone replacement therapy (TRT) increases blood levels of testosterone but, surprisingly, decreases the testosterone level inside the testicles (Intratesticular Testosterone or ITT). ITT is key for proper sperm production. This ITT decrease is due to the LH and FSH shutdown that occurs with TRT. This shutdown decreases ITT and sperm production in men on TRT. These two gonadotropins are required to maintain healthy levels of ITT and, thus, sperm production. Some men on TRT become infertile because of this issue. ITT levels are usually ten times higher than regular blood levels. Having high testosterone blood levels on TRT have no positive effect on ITT. Only increasing LH or FSH can increase ITT. That is where hCG comes in.
Several studies have found that using human chorionic gonadotropin (hCG) while on TRT can normalize ITT and sperm production in some men (older age and longer pre-exposure to testosterone predicted poorer response). However, the optimum dose and frequency of hCG vary in every man.
Fortunately, there are several ways to determine if the dose/frequency of hCG while on TRT is effective in improving sperm production:
- Performing a sperm count/quality test (which requires at least eight weeks wait period) and/or
- Measuring an upstream hormone to testosterone called 17-hydroxyprogesterone (17OH-P) (measured within two weeks of starting hCG). TRT decreases 17OH-P and other upstream hormones due to LH's shutdown. Since hCG mimics LH, using hCG plus TRT may normalize upstream hormones like 17OH-P which are essential for sperm production.
A study found that a 17OH-P level greater than 6.5 nmol/L (or 215 ng/dL) was found to normalize ITT while using HCG doses of 500 IU every other day plus testosterone enanthate injections given at 200 mg/week. However, only testing sperm count/quality after eight weeks of hCG initiation makes it possible to determine whether if HCG is effective in improving fertility in men on TRT. As men get older, they are exposed to more extended periods on TRT, and their response to HCG may decrease. These men may need other fertility-enhancing combination approaches using clomiphene, HMG, or FSH (follicle-stimulating hormone).
References:
Amory et al. Serum 17-hydroxyprogesterone strongly correlates with intratesticular testosterone in gonadotropin suppressed normal men receiving various dosages of human chorionic gonadotropin. Fertility and Sterility. Vol. 89, No. 2, February 2008
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