Q: Do you need to come off from TRT while you’re trying to improve your fertility and focus on fertilization, allowing your girlfriend to conceive?
A: Actually it’s not necessary.
As a matter of fact, quitting TRT will make things worse in terms of sex drive.
See, 5PDEi aka Cialis (Tadalafil) & Viagra (sildenafil) aren’t enough; they just improve blood flow and erection.
Libido is a matter of brain, because testosterone is a cerebral hormone (Abraham Morgentaller).
Hence the desire to have intercourse is purely dependent upon androgen levels (T/DHT).
On the other hand, testosterone administration will shut off HPTA and testicles will inevitably shrink.
This downsize will cost eventually in fertility in the long term.
Testicles consist of Leydig and Sertoli cells.
The former produce testosterone; the latter spermatozoa.
This reflects on LH/FSH in blood work.
Known as gonadotropins, produced in adeno hypophysis (front lobe).
During TRT they both go down to zero, since TRT is exogenous supply.
In order to maintain fertility, we need to use HCG (human chorionic gonadotropin) that kicks Leydig cells.
This will produce intra testicular testosterone.
That in turn will mature the sperm.
We can also use HMG (human menopausal gonadotropin) that practically is synthetic FSH and kicks Sertoli cells.
This combination is powerful and can become miraculous in cases of oligospermia (<20M/ml).
We may also improve motility of spermatozoa, by the use of tocopherol and zinc.
Vitamin E helps with speed of flagellum of spermatocytes, while zinc is an ingredient of the prostatic fluid that composes 80% of semen.
Clomiphene citrate allegedly can assist in fertility, throughout elevation of testosterone.
However it has a negative impact on free testosterone, due to elevation of SHBG.
Finally mesterolone is supposed to increase FSH and presumably spermatozoa count.
Nevertheless as an androgen it suppresses HPTA and LH too.
Therefore it’s not good to be used without a SERM or HCG/HMG.