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you need to come off everything and begin hcg and arimadex. I would use arimadex at 1/2mg 3 x wk and hcg at 250iu twice wk every wk and attempt to restore any natural test I could. The adex and hcg should help elevate sperm count and natural test over time. I would also use clomid at 100mg/ day for a couple wks and then drop to 50mg day for 2 more wks after you quit everything. Its going to take awhile, possibly a year before you are fertile again. Even on trt there is still a 50% chance of being fertile, but the choice to come off totally or stay on trt depends on how long you have been on trt up until now. If its been a year then Id attempt to drop everything, if its been longer then Id revert to a minimum trt dose of 80-100mg wk and continue on hcg arimadex regimen. U really need a fertility specialist though but for now this is what Id do personally

Optimization of adjuvant systemic therapy in women with early-stage hormone receptor-positive breast cancer includes the consideration of chemotherapy and ideal type and duration of anti-hormone therapy. The use of gene expression profiling as a predictive marker for determining benefit to chemotherapy has become an important consideration when recommend-
ing chemotherapy in patients with early stage hormone receptor-positive breast cancer. Recent results from
the TAILORx and MINDACT studies provide the first prospective data, designed to give more conclusive guidance on assays. Defining the optimal adjuvant anti-hormone therapy, administered after the consider-
ation of chemotherapy, is a constantly evolving field, in which factors such as menopausal status, drug type, and duration of therapy are carefully considered. New data from the MA17R study and the 2016 San Antonio Breast Cancer Symposium (SABCS) provide early evidence
that demonstrates the benefit of extending the duration of aromatase inhibitors builds on previous studies in- vestigating extended tamoxifen or sequential therapies between these 2 drug classes. Indeed, modern breast oncology care for patients with early stage hormone receptor-positive disease involves individualizing recom- mendations based on clinical presentation and genomic assays to provide optimal chemotherapy, and anti-hor- mone regimens. This manuscript will provide updates on approaches to gene expression analysis and extended aromatase inhibitors in early breast cancer, focusing on several recent presentations and publications.

AJHO. 2016;12(12):18-23

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