Preserving Fertility During TRT: Evidence-Based Options for Men

By Levitas Academy – Leaders in Testosterone Restoration Research & Education 

Why Fertility Matters in Testosterone Therapy 

At Levitas Academy, our TRT Research & Development Programme is founded on one principle that testosterone restoration should enhance vitality without compromising fertility. 

While Testosterone Replacement Therapy (TRT) restores energy, libido, and focus, it can suppress the body’s natural luteinising hormone (LH) and follicle-stimulating hormone (FSH) the very hormones responsible for sperm production. 

That’s why clinicians within the Levitas Hormones for Life network often incorporate human chorionic gonadotropin (hCG) to sustain intratesticular testosterone. This helps preserve testicular function, but fertility preservation requires more. 

The Science: Why hCG Alone Isn’t Enough 

Spermatogenesis is driven by two key pituitary hormones: 

• LH: Stimulates Leydig cells to produce testosterone within the testes. 

• FSH: Activates Sertoli cells to support sperm maturation. 

A University of Münster study demonstrated that maintaining only LH activity through hCG was insufficient. Men who initially regained spermatogenesis with hCG + hMG (FSH + LH) saw rapid sperm decline once hMG was withdrawn: 

• 6 months: Sperm counts fell to ~30% of prior levels. 

• 12 months: Only 40% of original counts remained. 

• 24 months: Persistent suppression; one participant became azoospermic. 

Conclusion: hCG sustains testosterone, but FSH is essential for long-term sperm production. 

Clinical Insights from the Levitas TRT Programme 

At Levitas Clinics, men fall into two fertility profiles: 

1. High baseline sperm count (75–100 million/mL) – May tolerate moderate hormonal fluctuation. 

2. Borderline or low sperm count – Require dual-hormone therapy (hCG + FSH/hMG) to prevent subfertility. 

A baseline semen analysis and repeat monitoring every 12–16 weeks are essential components of the Levitas TRT clinical pathway. 

Advanced Fertility-Preserving Options 

1. TRT + hCG (Baseline Preservation) 

• Goal: Maintain testicular function and partial spermatogenesis. 

• Protocol: 

• Testosterone (100–150 mg/week or equivalent transdermal/oral). 

• hCG (500–1,000 IU subcutaneously 2–3× per week). 

• Outcome: Preserves testicular volume; partial protection of sperm production. 

2. TRT + hCG + FSH/hMG (Full Fertility Maintenance) 

• Goal: Sustain or restore full spermatogenesis. 

• Protocol: 

• hCG (1,000 IU subcutaneously 2–3× per week). 

• hMG (75 IU FSH + 75 IU LH) or recombinant FSH (75 IU) 2–3× per week. 

• Outcome: Normalisation of sperm counts within 3–6 months. 

3. Enclomiphene-Based Protocol (Pituitary Preservation) 

• Goal: Preserve natural LH and FSH secretion. 

• Protocol: 

• Enclomiphene citrate (12.5–25 mg daily, 5 days/week). 

• Optional low-dose topical testosterone for symptom control. 

• Mechanism: Stimulates pituitary release of both LH and FSH, maintaining sperm production naturally. 

Monitoring Framework 

Parameter	Baseline	8–12 Weeks	24 Weeks	Target
Testosterone	✓	✓	✓	20–30 nmol/L
LH & FSH	✓	✓	✓	Mid-range
Estradiol	✓	✓	✓	<150 pmol/L
Semen Analysis	✓	✓	✓	Sustained sperm output
Testicular Volume	✓	–	✓	Stable or increased

Adjunctive Support 

• Micronutrients: Zinc, Selenium, Vitamin D, CoQ10. 

• Lifestyle factors: Quality sleep, stress reduction, avoidance of heat exposure, anabolic steroids, and alcohol. 

• Aromatase control: Use micro-dosed AI if estradiol levels rise excessively. 

The Levitas Perspective 

The Levitas Hormone Restoration Service integrates science and holistic health. Our clinics across London, Guildford, Esher, and Surrey deliver personalised TRT and fertility management, ensuring hormonal balance and reproductive health coexist. 

At Levitas Academy, our R&D division pioneers fertility-conscious TRT protocols, blending Enclomiphene-based pituitary restoration, gonadotropin support, and nutrient optimisation redefining hormone restoration for the modern man. 

Levitas TRT Programmes are designed to restore strength, performance, and fertility all at once. 

Key Takeaways 

• hCG alone preserves testosterone, not full fertility. 

• FSH and hMG are required to sustain spermatogenesis. 

• Enclomiphene-based therapies offer natural, fertility-preserving testosterone enhancement. 

• Levitas Clinics lead in precision TRT with fertility-conscious design.