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Malaguarnera et al., 2010[29]

Goal: Maximize sperm production while on testosterone therapy Approach: HCG 500 IU subcutaneously every other day Consider adding FSH or HMG if response insufficient after 3 months Semen analysis at baseline, 3 months, and 6 months Timeline: Initial testosterone response: 2-4 weeks Sperm appearance: 3-4 months Significant count improvement: 4-6 months If conception remains the urgent priority, discontinuing TRT while increasing HCG to 3000 IU every other day accelerates recovery