Paul Turek

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

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.