Fertility Support: Preserving Fertility on Testosterone Therapy
HCG, clomiphene, and peptides to maintain fertility on TRT.
Drug Monographs
Clomiphene Citrate (Clomid)
Clomid, Serophene
A SERM that has been used off-label for decades to treat male hypogonadism. Clomid stimulates the pituitary to release more LH and FSH, which signals the testes to produce more testosterone. Contains both enclomiphene and zuclomiphene isomers. Preserves fertility but some men experience mood-related side effects from the zuclomiphene component.
Enclomiphene
Androxal (not FDA approved)
A selective estrogen receptor modulator (SERM) that stimulates the body's natural testosterone production by blocking estrogen feedback to the pituitary gland. Unlike exogenous testosterone, enclomiphene preserves fertility and testicular function. Popular among younger men and those planning to have children. Taken as a daily oral tablet.
Gonadorelin
Factrel
A synthetic version of GnRH (gonadotropin-releasing hormone) that stimulates the pituitary to release LH and FSH. Used as an alternative to HCG for maintaining testicular function and fertility during TRT. Became more popular after HCG compounding restrictions. Requires more frequent dosing than HCG.
HCG (Human Chorionic Gonadotropin)
Pregnyl, Novarel, Ovidrel
A hormone that mimics LH (luteinizing hormone) to stimulate the testes to produce testosterone and maintain testicular size and function during TRT. Commonly used alongside testosterone to prevent testicular atrophy and preserve fertility. Requires subcutaneous injection but uses small insulin-type needles.
Kisspeptin
Compounded only
A neuropeptide that stimulates GnRH release from the hypothalamus, triggering the natural HPG axis to produce testosterone. Emerging fertility-preserving alternative to HCG and gonadorelin. Works upstream in the hormonal cascade, potentially offering more physiologic stimulation. Limited availability and research compared to established options.
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