Paul Turek
speaker
358 appearances
1 recordings
1 series
first heard Jun 2025
last heard Jun 2025
Paul Turek’s voice in public audio — every appearance, attributed to the second.
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Appearances
And I said, because we believe it's always reversible in the field of infertility in men. And so that got me a little worried. And so now I kind of worry about five to 10 years of use. After five or 10 years of use, you may not get it back.
Depends on dosing and everything, right? If they're doing 250 a week. No, I mean, in our practice, it would be 50 twice a week. Published a study when I was a fellow in Houston of a guy who took it for 25 years. And we drove at him with gonadotropins as HCG and FSH. And we didn't get anything, but we got a low number of sperm back.
And I just had a guy from Louisiana come in, 25 years of chronic use. I did a mapping procedure to find sperm in his testicle and he's going to be having a kid, but he made a couple of sperm. But you pump him full of HCG and synthetic FSH. And get nothing. And then you have to look in the testicle because production can be low enough to be there, but not coming out.
But this is the rescue protocol. It's LHFSH. Basically, there's three ways to do it. One is never stop the testosterone suddenly. Interesting. Because men will hit the doldrums and go, and they'll flop over like they have the flu. They'll feel like shit and they'll get right back on it. They'll feel terrible because they have nothing going on.
If you take the testosterone away, their system's turned off. They're not making their own. It takes time to get the system to reactivate. So that's the hardest. So I always taper testosterone. Over what period of time? Six weeks, typically. You have the dose for two, have the dose for two, and then off for two. And then you measure.
And that's getting out of the white water into the green wall a little bit. So that's a little smoother. So taper. And then I offer them two options. One option is taper alone. Taper with Clomid or in Clomiphene, which is a little quicker, getting the pituitary to turn back on. So that will soften the blow of the feeling of feeling completely fatigued. Or more aggressively, HCG and Clomid.
So for most people, that's not a price worth paying. With that taper over a month or two, I usually check their T levels at around two weeks off of the last testosterone, and that's the lowest they'll be. And if they're in a good range there, you can use that as a predictor of their response. What would be good?
Okay. All right. But then to get them to where they want to be depends on their symptoms and what they're happy with. You won't know until you wait longer to see how high you can get them. That's the lowest they'll be, but they'll be off of testosterone. And if they go along that taper and they're not tolerating, I try to tell them, don't go back. Just stay there because time will help you.
You're not going to feel maybe that great, but try to do this. Because if you don't, if you go back, then we have to start over. But if you just maintain it for a while, you'll feel better. And some of them dip a little bit, but remarkably, most men do really well with that taper.
Yesterday, I operated on a man, testicular sperm retrieval on a man who's azoospermic for genetic issues, and he was on testosterone for 10 years because he needed it. His testicles were failing. And I said, you're not going to make sperm on this. So... We put him on HCG, which didn't do anything for him, felt terrible, and did that for a year. And he said, I can't do this anymore.
I said, okay, or maybe it was six months. And I said, I need a little more time for you to be off testosterone. But since you've been on HCG for six months. And what dose did you have him on? 3,000, three times a week. That's a whole vial a week. Wow.
Interesting. You can maintain whatever's going on in the testicle with HCG and take any testosterone you want. That's an important lesson. Yeah. Here's the catch though. The caveat is it was done in, I think, Finnish bodybuilders. They were doing a cycle of steroids, huge amounts. They took Lotus HCG 500 twice a week.
And John Amory has worked out and Washington has worked out all the exact doses, but 250 to 500 twice a week is a good dose for that. It keeps your intertesticular testosterone high, keeps your sperm production going. And they went on both concurrently for 12 weeks and their sperm counts were normal the whole time. At any dose of tea.
Now, what happened after that is people start saying, you can preserve your fertility on testosterone replacement, which is possible. They missed half the story. But it was only 12 weeks. And if you're doing it for three years and you miss your dose of HCG, boom, you're done. You're cooked. You're going to go to zero. So unopposed testosterone without it. So you have to be... 95% compliant.
The Clomid doesn't work. HCG is the one. Yeah. Clomid doesn't improve intertesticular testosterone levels like HCG does. It's ineffective. Got it. It will potentially make you more recoverable. If you do it 80%, you'll be zero, even though you thought you might have a superb count, but your recovery will be faster because it's done something.
But the only way to maintain your current fertility is you have to be 100% compliant with dual therapy. You can't go on monotherapy with testosterone.
Well, I think muscle mass. So with aging, it's a great one. I mean, it used to be like growth hormone with age wasting syndrome, things like that. I mean, muscle mass is a key for men.
No, I think the only reason would be if you want testicles to be big. Okay. So just volume. I just created a new procedure to make testicles larger naturally by putting a fat injection in the hydrosil space in men on testosterone because they don't like their small testicles.
So it's all natural and there's no prosthetics and you can't tell. It makes them nice and big and testes fat grafting and it's fabulous.
So the test that says outside the body, it's three degrees cooler than the rest of the body. So 95 versus 98 degrees Fahrenheit. And then there's a reason for that unknown. We had that conversation. We don't really know why, but it may be that it's an immunologic sanctuary and that's the only way to do it and that God or Darwin could figure out.
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