PROTOCOL FOR TERMINATION TRT IN ORDER TO CREATE A PREGNANCY

It is not unusual for couples to want to have a family or to add to their family. For men and women this usually requires two important factors: 1) the female partner can become pregnant, and 2) the male partner is capable of donating viable sperm to cause her to become pregnant. For men on Testosterone Replacement Therapy (TRT) and/or women on Hormone Replacement Therapy (HRT) there can be issues regarding both of these situations. Will the woman be able to become pregnant on HRT and will the male partner be able to get her pregnant while on TRT.

This then brings up a number of additional questions. For women, will HRT block ovulation and implantation or will it help this process. For men, will TRT reduce sperm count and make making causing pregnancy more difficult or impossible. For women already on HRT this might require that she either stops or reduces her daily dosage of HRT. For men, it means much the same thing, he may either have to stop or reduce his daily dosage of TRT.

One very important issue for both is when should HRT or TRT be reduce or stopped? Another is, who makes that decision? The answer to the first question is the same for both men and women, when you make the decision you want to get pregnant. The answer to the second question is more difficult for men then women. For women, the decision to stop or reduce HRT should be decided and made after consultation between her and her gynecologist. For men, there are two steps to this decision. If the man knows that his partner will want to become pregnant sometime in the future (near or far) then we recommend a urologic evaluation or at minimum a sperm count and seminal fluid evaluation for future fertility. This is best done before starting TRT. Since there is no agreed upon protocol of what to do beyond taking the initial sperm count and seminal fluid evaluation for fertility, we recommend periodic reevaluations either yearly or at least every two years while on TRT. If the individuals sperm count is dropping or becoming abnormal, a consultation with urologist or infertility specialist should be done to decide whether or not to stay on TRT.

If you are a non-post-menopausal women choosing to stop or reduce HRT in order to get pregnant:
If you are planning to start trying to get pregnant in the near future, 6 months to a year, but you are not ready yet, you can choose to stop HRT at any time or to stay on it until you have talked with your gynecologist and let him/her withdraw you from HRT.

If you have no medical problem associated with HRT, and you are choosing to stop on your own immediately, then it is generally best recommended that you continue using HRT at least until after your next regular menstrual period begins and then stop HRT once your period has started.

If your periods are irregular, or you have not had one in 1 to 3 months and you know you are not pregnant then you can stop HRT whenever you like. Please note that you may or may not have withdrawal bleeding. This bleeding may only be spotting, or it may be lighter, the same, or heavier then your usual menstrual periods. If bleeding continues more than 30 days check with your gynecologist as an exam and testing may be necessary.

You can stop by simply stopping the use of any and all oral and/or injectable hormones, unless your physician has given you other instructions, then follow your physician’s instructions.

For Men To Maintain Sperm Viability

Low levels of testosterone may be responsible for infertility in some men. Maintaining a physiologic testosterone level can help maintain or even increase male fertility. Infertility can have multiple causes and may depend on genetics, general health, fitness, diseases and dietary contaminants. Living a healthy lifestyle and diet are also important. Certain supplements can help boost sperm count and increase fertility.

Supplements That Can Help Increase Fertility:

D-Aspartic Acid
D-aspartic acid (D-AA) is a form of aspartic acid, an amino acid sold as a dietary supplement. D- AA should not be confused with L-aspartic acid, which has no value for fertility and also sold as a supplement. In various study infertile men given between 2 and 3 grams of D-AA for two weeks to three months increased their testosterone levels by 30–60% and sperm count and motility by 60–100%. D-AA when taken by men with normal to high testosterone levels found that D-AA didn’t increase testosterone levels any further and in some cases even reduced testosterone levels when D-AA was given in high dosages.

Vitamin C
Adequate intake of antioxidants, such as vitamin C, can help counteract some of the harmful effects of age, an unhealthy lifestyle or environmental pollutants. There is evidence that vitamin C can improve semen quality. Taking 1,000-mg vitamin C supplements twice a day for up to two months increased sperm motility by 92% and sperm count by more than 100%. It also reduces the proportion of deformed sperm cells by 55%.

Vitamin D
Observational studies show that vitamin D-deficient men were more likely to have low testosterone levels. Taking as little as 3,000 IU of vitamin D3 every day for one year can increase testosterone levels by around 25%. High vitamin D levels may be linked to greater sperm motility, but the evidence is still unclear.

Vitamin E
Another antioxidant found in the form of tocopherol and tocopherol, is fat soluble and protects lipids. Sources include wheat germ, seabuckthorn, nuts, seeds, whole grains, green leafy vegetables, kiwifruit, vegetable oil, and fish-liver oil.

Tribulus Terrestris
Tribulus terrestris (puncturevine), is a medicinal herb often used to help enhance male fertility. While Tribulus terrestris does not raise testosterone levels, research indicates that it can, in some men, enhance the libido-promoting effects of testosterone It may also increase erectile function in some men.

Fenugreek
Fenugreek (Trigonella foenum-graecum) is a popular culinary and medicinal herb. In one study men who strength-trained four times a week took 500 mg of fenugreek extract daily and experienced a significant increase in testosterone levels, strength and fat loss when compared to a placebo.

In several other studies men taking 600 mg of Testofen, a supplement made from fenugreek seed extract and minerals, daily for six weeks to three months self reported improved libido, sexual

performance, strength, erectile function and the frequency of sexual activity as well as significantly increased testosterone levels.

Zinc
Zinc is an essential mineral found in high amounts in meat, fish, eggs and shellfish. Observational studies suggest that low zinc levels or deficiency is associated with low testosterone, poor sperm quality and an increased risk of male infertility. Taking zinc supplements increased testosterone levels and sperm count in individuals with low in zinc levels. Zinc supplementation 15 to 100 mg daily, may reduce the decrease in testosterone levels often associated with excessive amounts of high-intensity exercise. Zinc can be found in a variety of foods like red meat, fish, and eggs.

Ashwagandha
Ashwagandha (withania somnifera) is a medicinal herb that has been used in India since ancient times. Studies suggest that ashwagandha may improve male fertility by boosting testosterone levels. In at least one study men with low sperm cell counts showed that taking 675 mg of ashwagandha root extract per day for three months significantly improved fertility. Specifically, it increased sperm counts by 167%, semen volume by 53% and sperm motility by 57%, compared to the start of the study. In comparison, minimal improvements were detected among those who got a placebo treatment.

Maca Root
Maca root is a plant food from central Peru. Traditionally, it has been used for its ability to enhance libido and fertility. Several studies showed that men taking between 1.5 and 3 grams of dried maca root for three months improved self-reported sexual desire (libido) and sexual performance.

In other studies, men with mild erectile dysfunction, 2.4 grams of dried maca root slightly improved self-reported erectile function and sexual well-being. Taking 1.75 grams of maca root powder every day for three months increased sperm counts and motility in healthy men. Taking 1.5–3 grams of maca root per day for three months had no effects on testosterone or other reproductive hormones in healthy, fertile men.

Coenzyme Q10
There is some evidence that coenzyme Q10 can improve quality of semen.

L-Carnitine
L-Carnitine is an amino acid that plays an important role in fertility and reproduction. It is essential for the production, formation, and maturation of sperm. Usual dosagefor fertility is 400 to 600 mg l-carnitine taken daily.

Antioxidant Supplements Which May Not Play a Direct Role in Fertility but Can Help:
Vitamin A, beta-carotene, cryptoxanthin, polyphenols, manganese and superoxide dismutase (SOD), lutein, lycopenes, zeaxanthin, astaxanthin, flavones, flavonoids, flavonones, stilbenoids, polyphenols, nonflavonoid phenolics, capsaicinoids, oxalic acid, phytic acid, R-á-Lipoic acid, as well as the hormone melatonin and iodides.

Other Tips

Here are 14 additional tips to boost fertility and sperm count/quality:

• Lead a Healthy Lifestyle: Unhealthy lifestyle practices impair your overall health, including fertility. Stop smoking and get off of all drugs that can impair your fertility.

• Eat a Healthy Diet: Eat a diet rich in nutrients vitamins, minerals micro- and macro-nutrients. A diet high in antioxidant foods, fruits, vegetables, and whole grains can combat free radicals and improve the quality and quantity of your sperm. Eat lots of protein and be sure to include: poultry, fish, dairy products, and avocados. Avoid foods high in cholesterol so that you maintain heart health.
• Eat A Diet High In Healthy Fats: Eat foods high in polyunsaturated fats, especially omega-3 and omega-6 found in fish and walnuts as they are associated with higher sperm counts compared to the typical monounsaturated fats found in burgers, fries, and other fast foods typical of the Western diet. Monounsaturated fats were shown to reduce overall sperm count and activity.
• Stay Well Hydrated: Drink 8 to 10, 8 ounce glasses of water or water based drinks daily
• Exercise Regularly: a regular exercise program not only improves your confidence and physical performance, it may also raise your testosterone levels. This can improve semen quality as well as your fertility.
• Lose Excess Weight: Obesity is associated with infertility. If you are infertile and obese, weight loss should be one of your top goals.
• Limit Alcohol Intake: Avoid heavy alcohol consumption, as it may reduce testosterone levels and impair semen quality.
• Get Enough Folate: A few studies indicate that a low intake of folate may impair semen quality.
• Get Adequate Sleep: Getting adequate sleep is vital to maintaining your health. Restricted or excessive sleep has also been linked to poor semen quality. Get at least 7-7.5 hours of sleep nightly.
• Snack on Walnuts: Eating a lot of antioxidant-rich foods, such as walnuts, seems to benefit fertility.
• Avoid Eating Too Much Soy: Soy is rich in isoflavones, which are associated with lower semen quality
• Avoid Stress: Chronic stress and episodic anxiety reduce sexual satisfaction and can cause release of hormones which can impair fertility. When we are chronically stressed large amounts of cortisol is released and chronic cortisol release leads to burn out and reduced blood testosterone levels.
• Skip the Hot Tub: Hot water can lower sperm count and make getting your partner difficult to get pregnant.
• Get Infections and Exposure to Toxic Chemicals Dealt with Immediately: Both infections and exposure to toxic chemicals can significantly lower sperm counts. If exposed seek help immediately.

Sperm counts are important, both as a marker for fertility and as an indicator of overall health and physical well-being. Many things in life can affect sperm levels and it is important to recognize and deal with them immediately and accordingly. Take time to evaluate yourself and see where you can make changes in the areas above to improve the quality and number of your sperm.

HCG (Human Chorionic Gonadotropin) may be started prior to stopping TRT or may be, if desired used, consistently while on TRT. This will have been discussed in detail with you and you will have an opportunity to discuss its use with an OB/Gyn, Urologist or Infertility Specialist from starting on TRT.

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©2021 Allen Lawrence, M.D.