@daviddemesquita's fertility protocol claims need context

What did @daviddemesquita actually say?

David claims he got his partner pregnant while remaining on testosterone, using a scripted HCG and FSH protocol from a compounding pharmacy. His core argument: "It's not true" that men must come off testosterone to conceive. He says 400 IU of HCG three times per week worked for him personally, mixed with FSH from Revive compounding pharmacy, injected subcutaneously. He's transparent that this is his own experience and may not apply to everyone. He also claims any two water-based solutions can be combined in the same syringe.

To his credit, he repeatedly says he's under doctor supervision and tells viewers not to self-prescribe dosing. That framing matters when evaluating the rest of what he says.

Does the science back this up?

On the main claim, yes, mostly. Exogenous testosterone suppresses the hypothalamic-pituitary-gonadal (HPG) axis, reducing LH and FSH, which drives down intratesticular testosterone and sperm production. But that suppression is not always complete, and it is reversible in most men. The standard approach to fertility preservation on TRT involves co-administering hCG, which mimics LH, and sometimes exogenous FSH to stimulate spermatogenesis directly.

Wenker et al. (2015, Fertility and Sterility) demonstrated that hCG alone restored sperm production in a majority of hypogonadal men on testosterone therapy. Hsieh et al. (2013, Journal of Urology) found that combining hCG with FSH produced faster sperm recovery than hCG alone in testosterone-suppressed men. So the protocol David describes, hCG plus FSH while staying on testosterone, has real clinical support behind it. This is not fringe bodybuilding science. It is used in reproductive endocrinology practices.

What did they get wrong (or right)?

He got the big picture right, but a few details deserve scrutiny.

• The "trace sperm" claim is oversimplified. David says men on testosterone are "usually producing a trace amount of sperm still." That varies significantly by dose, duration, and individual. Coviello et al. (2005, Journal of Clinical Endocrinology and Metabolism) showed that higher testosterone doses suppress sperm counts more completely. Some men on long-term, high-dose TRT reach azoospermia. "Usually" is doing a lot of work here.
• The syringe mixing claim needs qualification. He says any two water-based solutions can be combined. In practice, hCG and FSH can be co-administered, and some fertility protocols do combine them. But compatibility depends on the specific formulation, diluent, and pH. Blanket statements about mixing injectable medications are the kind of thing that should come from a pharmacist, not a TikTok video.
• He correctly flags gynecomastia as an hCG side effect risk. hCG stimulates testicular aromatization of testosterone to estradiol. At higher doses, estrogen elevation is a real concern. His warning to stay under doctor supervision for this reason is accurate and appropriate.

What should you actually know?

If you're on testosterone and want to conceive, the conversation with your prescribing doctor should happen before you start any fertility protocol, not after. The clinical pathway typically starts with a semen analysis to establish baseline sperm count, because that determines whether hCG alone, hCG plus FSH, or a full testosterone cessation protocol is warranted.

Compounded hCG and FSH are options when brand-name products are unavailable or cost-prohibitive, but compounded drugs are not FDA-approved and quality can vary by pharmacy. That is not a reason to avoid them, but it is a reason to use a licensed, credentialed compounding pharmacy, ideally one that follows PCAB accreditation standards.

One success story, which David openly acknowledges is what he is sharing, is not a clinical outcome rate. The Ramasamy et al. (2015, Journal of Urology) review of testosterone-induced azoospermia found that recovery of sperm production after cessation took a median of 3-6 months and was not guaranteed in all men. Adding hCG and FSH improves odds and speed of recovery, but individual response varies considerably.