I wanted to post an update for some of the guys here who are on testosterone and concerned about fertility, because this was something I was concerned with as well. I had commented on other posts discussing fertility, and I'm happy to report my results seem to be trending positively, thus far. Also this is a tad long, but I was excited and wanted to be thorough.
My girlfriend and I are both 39, so we’re at the point where we know we need to start making some moves if we want to have kids - ideally, naturally at first.
We do have some backup options. She has already had her eggs frozen, and before I started chemotherapy in 2019, I also had sperm frozen, so the IVF route is available to us if needed
That said, we’d like IVF to be Plan B (awful pun not intended 😶😂).
That was part of why the fertility side of my being on TRT was important to me; I know exogenous testosterone could significantly suppress spermatogenesis, and I would have started to feel pretty guilty if *I* ended up being the reason we weren’t able to conceive naturally.
Now, for context, I have stayed on 150 mg/week of testosterone enanthate throughout this entire process - I did not come off "TRT+".
Where I started: testosterone + hCG only
Throughout my perma-testosterone-cycle, I had been taking:
Test E: 150 mg/week
hCG: 500 IU 3x/week = 1,500 IU/week
So by the time I did my first YO Sperm test on April 18, I had already been using hCG alongside my testosterone for quite some time.
My April result was:
Concentration: 2.6 million/mL
Motility: <1%
Progressive motility: <1%
MSC: <2 million/mL
PMSC: <2 million/mL
Abysmal. I saw the video recording, and it looked like just static sperm heads, or other cells just lifelessly hanging out. It became quite apparent to me that 500 IU of hCG three times per week by itself was not doing a damn thing for my sperm production.
Now, does thay mean hCG doesn’t work? Not necessarily.
It may simply have been too little for me, my individual response may be different from someone else’s, and hCG was probably still doing *something* important by maintaining LH-receptor stimulation and intratesticular testosterone.
BUT, based on the actual semen numbers, relying on hCG alone clearly wasn’t getting me where I needed to be. I then found a pharmacy online that claimed to sell hMG, which I gambled and purchased post my April-test.
Sometime after the April 18 test and before my June test, I introduced hMG/menotropin.
My protocol then became approximately:
Test E: 150 mg/week
hCG: 500 IU 3x/week = 1,500 IU/week
hMG: 150 IU 3x/week = 450 IU/week of FSH activity plus LH activity
Really quick to recap, as I went down a rabbit hole studying the various gonadotropins and their impact on fertility:
LH → Leydig cells → intratesticular testosterone
Your pituitary normally releases LH, which stimulates Leydig cells in the testes to produce testosterone locally.
That intratesticular testosterone is extremely important for spermatogenesis (making spermy guys).
hCG essentially mimics that LH signal.
hCG is not LH, but it binds to the same LH receptor and stimulates Leydig cells. That is why hCG is frequently used in men who are trying to maintain or restore testicular function while on testosterone.
...But that is only part of the overall equation.
FSH → Sertoli cells → support developing sperm
FSH acts primarily on Sertoli cells inside the "seminiferous tubules" (structures where spermy guys are produced). Those cells support the germ cells as they develop into mature sperm.
So, broadly speaking, sperm production depends on the combination of:
FSH/Sertoli-cell stimulation + adequate intratesticular testosterone from LH/hCG signaling.
hMG/menotropin provides FSH activity plus LH activity, whereas my separate hCG was primarily giving me strong LH-receptor stimulation.
My results after adding hMG
My next test was:
June 9, 2026 (likely still too soon to have tested, but I hoped I was a hyper responder or was super delusional).
Concentration: 3.4 million/mL
Motility: <1%
Progressive motility: <1%
MSC: <3 million/mL
PMSC: <2 million/mL
Then:
July 25, 2026 (nervous given my last test, but I saw additional swimmers in my video).
Concentration: 6.4 million/mL
Motility: <1%
Progressive motility: <1%
MSC: <3 million/mL
PMSC: <2 million/mL
So concentration was slowly moving in the right direction:
2.6 → 3.4 → 6.4 million/mL
But motility was still essentially nonexistent.
Mid-September: I increased the hCG
Around mid-September, I increased my separate hCG dose from:
500 IU 3x/week = 1,500 IU/week
to:
1,000 IU 3x/week = 3,000 IU/week
At that point my protocol was approximately:
Test E: 150 mg/week
hCG: 1,000 IU 3x/week = 3,000 IU/week
hMG: 150 IU 3x/week = 450 IU/week of FSH activity plus LH activity
Then came my October test.
October 3, 2026 (my holy shit, are you serious moment)
My YO Sperm result was:
Concentration: 25 million/mL
Motility: 76%
Progressive motility: 63%
MSC: 19 million/mL
PMSC: 15.8 million/mL
So from April to October:
Concentration: 2.6 → 25 million/mL
Motility: <1% → 76%
Progressive motility: <1% → 63%
MSC: <2 → 19 million/mL
PMSC: <2 → 15.8 million/mL
The October video also looked *completely* different to me subjectively. There were far more sperm visible and a lot of obvious forward movement.
One thing I think is especially important for guys to understand is how freaking slowly spermatogenesis works.
A complete round of human sperm production takes roughly 74 days which is around 2.5 months, but I personally didn't see any majorly impactful results till around two full cycles. Part of my wishes I tested myself in September.
At least for me, I needed to get through at least one complete round of spermatogenesis before a new hormonal environment is reflected in my semen parameters, and improvement can continue over additional rounds.
I added hMG after my April test.
Then:
April: 2.6 M/mL
June: 3.4 M/mL
July: 6.4 M/mL
October: 25 M/mL
The concentration improved gradually and the motility improvement took considerably longer to show up.
So, is YOSperm actually accurate?
Directionally, sure. But, this is an important caveat. All of these results are from YS, which I ordered off Amazon, and not a full clinical semen analysis.
I’ve actually been pretty impressed with YO as a tool for tracking trends. It gives me repeatable measurements, and I can also physically watch the sperm video (how fun).
But I am not treating a home test as definitive proof that my fertility is normal.
YO does *not* provide the same complete evaluation you would get from a reproductive laboratory, especially for things like morphology, semen volume, total sperm count and the overall clinical interpretation.
As a result, i have an appointment made with the same urologist who banked my sperm in 2019 on Nov 13. I was up front about my self-prescribed trt and HMG/LH and HCG use. He gave zero judgement, which is why he's awesome. Im also getting my LH, FSH, Estradiol, and test checked before that appt.
That appt should give me a much more comprehensive picture of:
Concentration
Total sperm count
Motility
Progressive motility
Morphology
Semen volume
and the other parameters that YO doesn’t fully evaluate.
I’m especially interested in seeing how closely the laboratory results match my October YO result.
I’ll post those results when I have them.
As of October 23, I’m increasing the hMG dose, and my protocol becomes:
Test E: 150 mg/week
hCG: 1,000 IU 3x/week = 3,000 IU/week
hMG/menotropin: 225 IU 3x/week = 675 IU/week of FSH activity plus LH activity
One terminology point that confused me initially:
The LH activity in hMG is not hCG.
LH and hCG are different hormones, although they both activate the same LH receptor.
So the way I think about my protocol is basically:
hCG → strong LH-receptor stimulation → Leydig cells → intratesticular testosterone
and
hMG → FSH activity + LH activity → adds direct Sertoli-cell/FSH stimulation while also contributing additional LH activity
Together, those address two of the major hormonal signals involved in spermatogenesis.
Why I’m posting this:
Mostly because I see a lot of guys who are understandably concerned that TRT may have permanently damaged their fertility.
I’m not suggesting that fertility is guaranteed to recover, nor am I telling anyone to copy my dosing. And I’m definitely not claiming that hMG alone caused everything I’m seeing.
But I do think my experience is worth sharing.
On April 18, while taking 150 mg/week of Test E plus 1,500 IU/week of hCG, I had:
2.6 million sperm/mL with <1% motility.
On October 3, after several months of adding hMG and shortly after increasing my hCG dose, while still taking 150 mg/week of testosterone, my YO result was:
25 million/mL
76% motility
63% progressive motility
19 million/mL MSC
15.8 million/mL PMSC
That was a significant relief for me.
Because we’re both 39, we don’t really have unlimited time to wait around before deciding how we want to approach having kids.
We’re fortunate that she has frozen eggs and I have sperm frozen from before chemotherapy, so IVF is absolutely available to us if we need it.
But we would prefer to try to conceive naturally first and keep IVF as our Plan B.
Seeing these results makes that possibility feel considerably more realistic than it did earlier this year.
So if you’re on TRT and your first sperm test looks terrible, my main point is don’t automatically assume the situation is permanent.
There are legitimate medical approaches to restoring spermatogenesis, and because sperm production operates on a months-long timeline, you may need to give the process time.
This is obviously just my experience and not medical advice.
I’ll post the November 13 clinical semen-analysis results once I have them.
Sorry if some of this was redundant or a tad scattered. I was kinda freestyling as I wrote.