If you’re on testosterone replacement therapy (TRT) and want to protect your fertility, preserve testicle size, or just feel more balanced, you’re not alone. Many men are combining TRT with medications like clomiphene, enclomiphene, and hCG to help their bodies stay active while on treatment.

Let’s break down how these three tools work—and why they might matter to you.

What Are Clomiphene and Enclomiphene?

Clomiphene citrate (and its more refined version, enclomiphene) are oral medications that help your brain send natural signals—called LH and FSH—to your testicles. These signals tell your body to keep making its own testosterone and sperm.

Originally, men used clomiphene after steroid cycles to “restart” their natural hormone production. But today, it’s also used alongside TRT to support fertility and maintain testicular function even while taking testosterone.

Instead of waiting until TRT stops to “reboot” your system, these medications help keep your testicles working while you’re still on TRT. This can lead to more stable moods, better libido, and greater confidence that your fertility won’t take a back seat.

What Does hCG Do?

Human chorionic gonadotropin (hCG) is an injectable hormone that mimics LH, but instead of asking your brain to send a signal, it sends the message directly to your testicles. This helps:

• Prevent testicular shrinkage
• Support sperm production
• Keep intratesticular testosterone levels up

You can think of clomiphene/enclomiphene and hCG as working on different ends of the system:

• Clomiphene/enclomiphene tell your brain to send a signal
• hCG skips the brain and sends the signal straight to your testicles

Why Add These to Your TRT Plan?

When you’re on TRT, your brain senses high testosterone levels and stops producing LH and FSH—which means your testicles can shrink, and sperm production may slow or stop. This process is called HPT axis suppression.

Adding hCG helps bypass that suppression by directly stimulating the testicles—even while your brain stays “off.” With low, controlled doses (usually 2–3 times per week), you keep things running without overwhelming your body.

This can make a big difference for:

• Men who want to have kids now or in the future
• Men concerned about testicle size or natural testosterone production
• Men looking for a smoother, more natural feeling on TRT

The Big Picture: How They Work Together

Here’s a simple analogy:

• TRT is like adding gasoline to the tank (your body gets testosterone externally).
• Clomiphene/enclomiphene are like nudging the fuel gauge to keep the engine sensors working (your brain keeps trying to send natural signals).
• hCG is like directly turning on the engine (your testicles get told to keep working, regardless of what the brain says).

If you want to preserve fertility, maintain natural function, and feel more balanced, using clomiphene, enclomiphene, or hCG with TRT could be a smart move—especially under the guidance of a knowledgeable doctor.

Final Thought

These aren’t “must-haves” for every man on TRT—but if you care about long-term hormone health, fertility, and testicular function, talk to your provider about whether clomiphene, enclomiphene, or hCG should be part of your personalized TRT plan.

 

 

References

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3. Lin B, Twigg SM. Dose-dependent response to long-term clomiphene citrate in male functional hypogonadotropic hypogonadism. Endocrinology, Diabetes & Metabolism Case Reports. 2023;2023(1):EDM22-0242.
4. Hsieh MH, et al. HCG with TRT for Fertility and Testicular Atrophy. Defy Medical. 2022.
5. Rainer A, Pai R, Masterson T. Safety of human chorionic gonadotropin monotherapy for men with hypogonadal symptoms and testosterone >300 ng/dL. Journal of Sexual Medicine. 2022;19(Suppl 1):S5.
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