A guide to Clomid, hCG and fertility-safe testosterone treatment.

Low testosterone is a common but often overlooked contributor to male infertility. For men seeking to restore hormonal balance without impairing reproductive potential, fertility-preserving treatments offer a clinically effective alternative to traditional testosterone replacement therapy (TRT) which shuts off the body’s natural sperm production.

In this guide, we’ll explain how fertility-friendly treatments like clomid (clomiphene citrate) and hCG work, who they’re right for, and how to combine them with lifestyle strategies for optimal results, all without sacrificing fertility.

Introduction

Testosterone plays a vital role in male fertility by supporting the production of sperm. It is produced mainly in the testicles and helps stimulate the development of sperm cells within the testes. Testosterone also supports the overall health and function of the reproductive system, including maintaining sex drive and ensuring the proper environment for sperm to mature.

When testosterone levels are too low, a man’s ability to make healthy sperm can be affected, which may lead to difficulty in achieving pregnancy. In fact, low testosterone is found in about 15% of men who experience infertility. Identifying and treating low testosterone can sometimes improve sperm production and overall reproductive health.

However, it's important to understand that simply giving testosterone as a medication doesn't always help and can sometimes actually reduce fertility. Here's why and how testosterone levels relate to male fertility:

How testosterone supports fertility:

• Sperm production (spermatogenesis): Inside the testicles, testosterone works alongside other hormones (like FSH and LH) to stimulate the cells responsible for producing sperm.
• Maintaining testicular function: Adequate testosterone helps keep the environment in the testes suitable for sperm growth and maturation.
• Sexual health: Testosterone helps maintain libido (sex drive) and erectile function, which are essential for natural conception.

When stimulating the body’s own production of testosterone can help:

• For secondary hypogonadism. If low testosterone is due to a condition like secondary hypogonadism (where the brain doesn't signal the testes properly), then stimulating the body to make its own testosterone–rather than giving external testosterone–is often effective.
• For preserving fertility. Fertility-friendly treatments such as clomid, hCG injections, or aromatase inhibitors can help boost the body's natural testosterone production while preserving sperm production.

Important caution for men who want to preserve their fertility:
Taking testosterone supplements or injections directly can shut down the body’s natural sperm production.This is because external testosterone tells the brain there’s enough hormone, leading it to stop signaling the testes to produce both testosterone and sperm. If you want to preserve your fertility while addressing low T symptoms, please consult with one of our doctors.

1 – What are the most common symptoms of low testosterone?

The symptoms of low testosterone vary depending on when you actually develop it. In adult males, the common symptoms that one may experience include:

• Erectile dysfunction
• Decreased sex drive (reduced libido)
• Difficulty concentrating
• Decrease in muscle mass
• Low mood
• Development of breast tissue (gynaecomastia)
• Excessive tiredness (fatigue)
• Loss of bone density (osteoporosis)
• Decrease in beard and body hair growth
• Infertility
• Hot flushes

2 – What’s the best treatment for low T while preserving fertility?

The best treatment depends on the underlying cause (typically secondary hypogonadism), but for men who want to maintain or improve fertility, the following options are preferred:

Clomid (Clomiphene Citrate). Best for most men with secondary hypogonadism, especially younger men who wish to conceive. Clomid works by blocking estrogen receptors in the hypothalamus, which stimulates the pituitary gland to increase production of luteinising hormone (LH) and follicle-stimulating hormone (FSH). These in turn stimulate the testes to produce more testosterone and support sperm production. Taken as a pill orally.

hCG (human Chorionic Gonadotropin). Best for men with low LH or men recovering from TRT, or when Clomid alone isn’t effective. hCG works by mimicking the action of LH and directly stimulating the Leydig cells in the testes to produce testosterone. It also supports sperm production by maintaining intratesticular testosterone levels. Taken as an injectable.

Combination: Clomid + hCG. Best for men who do not respond fully to either therapy alone, or who are transitioning off TRT and want to preserve or restore fertility.

Combination: Clomid + aromatase inhibitors. Best for men with hypogonadism who cannot or do not wish to use injections, and who show high estradiol levels on Clomid alone. An aromatase inhibitor can help rebalance testosterone-to-estradiol, but this protocol is usually avoided by doctors due to strong side effects associated with long-term use. Typically reserved for short-term or specific cases and not as a standard fertility-preserving protocol.

Not recommended for men who want to preserve fertility: TRT alone. Exogenous testosterone replacement therapy (TRT) suppresses the body’s natural production of LH and FSH, leading to significant reductions in sperm production and testicular size. For men actively trying to conceive, TRT alone is contraindicated in men seeking to preserve fertility. Even then, Clomid or hCG-only approaches are generally preferred.

3 – Will I get the same benefits from fertility-friendly treatment as TRT?

Clomid and/or hCG can provide most or all of the same benefits as TRT, only on a slightly slower timeline.

Similar benefits:

• Increased total and free testosterone levels
• Improved libido and sexual performance
• Better mood, confidence, and motivation
• More stable energy throughout the day
• Enhanced cognitive function and mental clarity
• Reduction in body fat (especially with lifestyle changes)
• Increased muscle mass and strength (though often slower than TRT)

Unique advantages of Clomid/hCG:

• Preserve or improve sperm production and fertility
• Maintain or increase testicular volume (no shrinkage)
• Stimulate your body’s own natural testosterone production
• Can often be discontinued or tapered without long-term suppression
• Are reversible, with minimal withdrawal effects when properly managed

4 – Why is maintaining healthy testosterone levels important for health and longevity?

Healthy testosterone levels aren't just about muscles or libido–although they’re important too! Healthy testosterone levels are a foundational hormone for male vitality, resilience, and long-term health. Maintaining them helps prevent serious diseases, supports independence in older age, and may extend lifespan.

5 – How long does it take to see results after starting Clomid and/or hCG?

Most men begin to notice initial improvements from Clomid and/or hCG within 3 to 6 weeks, particularly in energy levels, libido, sexual desire, mood and motivation.

More visual outcomes such as improved muscle tone, reduced body fat, and enhanced sperm parameters typically take 8 to 12 weeks or longer to appear, depending on:

• Baseline testosterone levels
• Dose and adherence
• Lifestyle factors (sleep, stress, training, diet)
• Individual responsiveness to treatment

For fertility-specific improvements, increased sperm count and motility can take effect within 3-6 months, which aligns with the sperm production cycle.

6 – Will Clomid and/or hCG cause testicular shrinkage?

No. Unlike TRT, which often reduces testicular size, Clomid and hCG typically maintain or increase testicular volume, since they stimulate natural testicular activity.

7 – How safe are these fertility-friendly low T treatments?

Clomid and hCG are generally considered safe and well-tolerated when prescribed appropriately and monitored by a specialist doctor like our team at Heracles. Both medicines have been licensed by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and have been used for decades in male fertility care.

At Heracles, we sometimes prescribe them ‘off-label.’ This simply means that while the medicines are licensed, we use them in ways not specifically listed on their licence. Off-label prescribing is common in medicine and is based on solid clinical evidence, research, and many years of therapeutic use. In practice, this allows our doctors to tailor treatment so you can safely boost testosterone while protecting fertility.

8 – Are there any side-effects to taking Clomid and/or hCG?

Like any medication, fertility-friendly low T treatments may induce side effects. They are usually mild, temporary, and manageable.

Clomid – possible side effects:

• Mood changes – irritability, anxiety, emotional sensitivity
• Headaches
• Visual disturbances – blurry vision or seeing floaters (rare and usually reversible)
• Breast tenderness
• Bloating or fluid retention
• Acne or oily skin
• Mild gastrointestinal discomfort in some cases
• Hot flushes / hot flashes
• Low-grade gynecomastia – very rare
• Deep vein thrombosis (DVT) – very rare
• Hepatitis (drug-induced) – very rare

hCG – possible side effects:

• Water retention / bloating
• Breast tenderness or sensitivity
• Emotional fluctuations
• Acne or increased oiliness of skin
• Injection site irritation or swelling
• Headaches or mild fatigue
• Testicular discomfort – rare, often transient
• Gynecomastia – very rare
• Deep vein thrombosis (DVT) – very rare
• Intracranial hypertension – extremely rare

With both Clomid and hCG, it’s important to be monitored by a doctor long-term and have blood tests every 3-6 months to begin with.

9 – Who can NOT take Clomid and/or hCG?

Anyone who has active or suspected prostate cancer must not take Clomid and/or hCG because testosterone may accelerate growth of existing prostate cancer (though it doesn't cause it).

Anyone who has active or suspected breast cancer (although rare in men) must not take Clomid and/or hCG because testosterone can stimulate hormone-sensitive tumours.

Anyone who has the following conditions must not take Clomid/and or hCG:

• High prolactin
• Pituitary tumors
• Severe psychiatric conditions
• Severe liver disease
• Primary hypogonadism – the testes cannot respond to LH/FSH stimulation. Please consult with a doctor for an accurate diagnosis of your hypogonadism type.

10 – Why can’t I take Clomid and/or hCG if I have prostate cancer?

You cannot take Clomid and/or hCG if you have active or suspected prostate cancer because it may slightly increase PSA levels or exacerbate existing prostate issues, even if it doesn’t directly cause it.

11 – Can I consume alcohol while taking Clomid and/or hCG?

Yes, you can drink alcohol while taking fertility-friendly low T treatments, but in moderation. Excessive alcohol can interact with these medications and increase the risk of side effects or make your symptoms worse. Light to moderate drinking (1-2 drinks) is considered generally safe.

12 – How long do I need to take Clomid and/or hCG for?

The length of time you’ll need to take Clomid or hCG depends on your individual goals, symptoms, and how your body responds to treatment. Some men use these therapies for a short period (3-6 months) to restore natural testosterone production or improve fertility ahead of conception. Others may require longer-term use (6-12 months or more) to maintain stable testosterone levels and support sperm quality, especially in cases of ongoing secondary hypogonadism.

13 – How can I change my lifestyle to support fertility-friendly low T treatment?

For the first time in medical history, chronic disease is catching up with age as a risk factor for low T. Lifestyle changes have become a core part of treating low testostrone–not just as a complement to medication, but often as a first-line treatment, especially for mild-to-moderate cases. Here’s what you can change to get the most out of your treatment:

• Lose excess weight in order to reduce your chances of cardiovascular disease and diabetes as common risk factors, as well as to naturally improve testosterone levels.
• Exercise regularly. Aim for 45-60 minutes a day, 4-5 times a week with a minimum of 150 minutes. Focus on a combination of resistance training and aerobic activity in order to improve both muscular and cardiovascular health, promote insulin sensitivity and support weight loss.
• Eat a testosterone-friendly diet. A diet that is moderate to high in healthy fats (olive oil, nuts, seeds, oily fish, avocados etc.), rich in protein (1.6-2.2g protein per kilogram of bodyweight) and moderate in mostly unrefined carbohydrates, is best for overall health and healthy testosterone levels.
• Quit smoking. There’s no excuse. Smoking has a negative effect on all aspects of health including testosterone production, hormone balance, and fertility.
• Limit alcohol. The healthiest amount of alcohol is no alcohol. A few social drinks at weekends may be ok for some but if you're looking for optimal hormonal health, consider quitting altogether.
• Improve sleep. Poor sleep is one of the strongest lifestyle-related contributors to low testosterone in men. Around 90% of daily testosterone is produced during deep (slow-wave) sleep, especially during the first half of the night. Poor sleep = lower testosterone.
• Reduce stress and anxiety. An obvious one, but essential in addressing the root cause of low testosterone. Chronic stress and anxiety lead to an excess of a hormone called cortisol. Studies have shown that chronically elevated cortisol is inversely correlated with total and free testosterone levels in men.

14 – What’s the best diet alongside Clomid and/or hCG?

The best diet to support healthy testosterone levels is one that:

• Reduces body fat (especially visceral fat)
• Reduces inflammation and insulin resistance
• Avoids testosterone-lowering factors (processed food, alcohol, sugar)

As part of your treatment plan at Heracles, you will get access to nutrition education and lifestyle advice to support fertility-friendly low T treatments. We cover more than just the basics of a healthy diet, enabling you to fuel your body for high performance and longevity.

15 – How can I support my mindset to get the most out of Clomid and/or hCG?

These treatments work physically–but the brain plays a huge role in how well they function. Here’s how to mentally set yourself up for success:

• Build daily routines that reinforce progress. Structure and consistency are key to maximising the benefits of Clomid and/or hCG. For example, wake and sleep at consistent times, lift weights or train 3-4x a week, prepare nourishing meals, journal your progress (libido, mood, energy etc).
• Set realistic expectations. Clomid and/or hCG can improve libido, energy, mood, body composition, etc., but it’s not instant. Benefits take weeks to months and depend on sleep, training, nutrition, stress, and dosing. Avoid the quick fix mentality–think of these treatments as a foundation, not a shortcut.
• Manage stress levels to keep cortisol in check. High stress and cortisol can blunt the benefits of Clomid and/or hCG. Try incorporating breathing techniques (box breathing is very effective), daily walks in nature, cold exposure, guided meditation.

As part of your treatment plan at Heracles, you will get access to mindset techniques and mental health ‘hacks’ to support your journey. Clomid and/or hCG may be a physical manifestation but psychology plays a huge role–we will teach you how to calm your nervous system so that your mindset can be more effective at making change.

16 – Are Clomid and/or hCG addictive?

Clomid and/or hCG are not addictive. Unlike substances that cause chemical dependence or withdrawal symptoms, these treatments work by stimulating your body’s own hormone production rather than replacing it. You won’t develop cravings or a need to continue them for non-medical reasons. In fact, compared to TRT, Clomid and hCG have a much lower risk of long-term dependence–both biologically and psychologically.

Caution: Coming off Clomid and/or hCG abruptly can cause hormonal imbalances or symptom return. Please consult with your GP or a doctor before coming off them.

17 – What do I do if I have an adverse reaction to Clomid/and or hCG?

If you experience:

• Chest pain, shortness of breath, or leg swelling (possible clot risk)
• Persistent vision disturbances
• Significant mood instability or depression
• Severe breast tissue growth or pain
• Severe testicular pain

Stop taking the medication and seek urgent medical help.

If you experience:

• Mood swings or irritability
• Mild acne or oily skin
• Breast tenderness
• Headaches
• Bloating or water retention

Contact your doctor or GP. Do not adjust your dose without medical guidance.