Clomid and AI therapy help needed, low T, soft erections

[Coffeeguy]

Hello to everyone,
I have seen a lot of excellent info on the forum, but I would need some guideance on what to do next.
Where do I start:
Well, it can be a long story, but I will try to keep it as short as I can.
Almost 39 yo, non smoker, 1 or 2 of drinks a week. Started training year and a half ago. Beginning fat percentage 25.2.
One year ago, I have noticed a lack of a morning wood (actually it has been more since I do not have it every day, but sex life was fine, so I disregarded it ). I had a lack of energy, especially after some more vigourous training. I could barely move, like I had concreete shoes.
I swiched gym, and started working with a personal trainer. On a first measurement, he told me that my fat was largely accumulated around my chest. I have fat around my waist also, but the chest was reported by his software to be the largest area of fat accumulation. He suspected that there is something is going on. I never had that broad shoulders, I always had a bit of fat around my waist.
So in conjuction with my doctor I ordered my first labs:
Testosterone: on a scale 2.8-8, mine was 2.5
Cortisole: 239 (138-690)
Anyhow, I visited my doctor and told her about all of this, and he disregarded my low T findings and ordered a full blood panel, with some extra stuff:
ALL of the labs is done on the same laboratory, always fasted in the morning:
WBC 4.79 (4-10)
RBC 5.43 (4,2-5.7)
Hemoglobin 150 (140-180)
haematocrit 0.458 (0.4-0.5)
MCV 84.3 (80-100)
MCH 27.6 (27-31)
Thrombocites 175 (150-400)
There is some other values in the formula, if you think they are relevant, I will update.
Continuing:
Cholesterol 3.331 (0-5 recommended values, no risk)
Triglycerids 0.47 (below 1.7 is recommended, no risk)
ALT(SGPT) 20 (8-41)
AST(SGOT) 22 (0-37)
ALP alkaline phosphatase 58 (30-120)
Testosterone total 3,67 (2.8-8)
FT4 18.41(12-22)
TSH 1.440 (0.4-4)
Basically my doctor said, that everything is OK. I asked her about low T, and she was “it is in a good range. Maybe you just overtrained”
All this time my erections were, to say, sufficient, to get the job done. But if I was too tired, or it was late, I always flet like if the stimulation stops, my penis would deflate almost instantly.
I do not watch porn, or mastrubate.
So, I decided to try some natural testosteron boosters, and apart from one from which I got irritated nothing seemed to work, at least from erection standpoint.
I did labs at the end of 2017, only for Total, and free Testosterone
22.12.2017.
Testosterone 4.01 (2.8-8)
Free testosterone 10 (8.3-40)
I started reading about Clomid and decided to give it a try. Here, doctors are more keen on giving you T shots, and I would, really want to postpone that, untill it is absolutely necessary.
I started with 25 mg every day.
7 days later I did labs on Testosterone and Estradiol. I was told that this is an estradiol for male. The method of testing is imuno-hemiluminescence
Testosterone 5.67 (2.8-8)
Estradiol 28.7 (0-54)
A great result. I did feel better. One day I was sitting and drinking my coffe, and I was like “Oh how good I feel!!”
Erections were slightly better, but only marginally. Morning wood maybe once in a week or so.
So I decided to stay with this protocole for a while, but I started noticing I was hot, mainly around my face. So another digg, and it seemed to me like my estradiol is going up, also, which is a common thing with clomid.
After two months I decided to stop Clomid and see where I am. I didn’t know at the time about the half-life of Clomind, so I did labs after only 7 days
March 09.2018
Testosterone 6.78
I decided to put it to the rest, since I thought I have sorted it.
Well it turned out that all of the symptopms have returned, not so badly as the first time, but they were still there. Erection was still, sufficient, to say.
In the meantime, I started to train seriously, got a meal plan to get into shape. And I did manage to get my fat to 20%.
By the end of April I did another lab, to see where I am
April 23.2018.
Testosterone 3.67(2.8-8)
Estradiol 32 (0-54)
So, I was at the beginning.
Started Clomid 25 mg ED, and did a few labs in beginning of May
May 02.2018.
Testosterone 6.92
Estradiol 39.4
May 09.2018
Testosterone 7.85 (2.8-8)
Estradiol 34 (0-54)
Then at the beginning of June I did another labs
Testosterone 8.22 (2.8-8)
Estradiol 50.4 (0-54)
Free testosterone 20 (8.3-40)
This was a huge step from free testo of 10, few months ago. But now Estradiol was runnign high.
So I tried to lower my Clomid dosage, and introduce AI over the past few months
JUNE 02-10
Clomid 25 mg EOD
Arimidex 0.25 mg EOD
Labs:
Test 9.69
Estradiol 35.1
June 12-21
Clomid 12.5 mg EOD
Arimidex 0.25 EOD
Labs:
Testosterone 8.49 (2.8-8)
Estradiol 28 (0-54)
I continued this protocol, but in a while I did felt hot sensations around my face, and atributed it to the high E2. In conjuction with my erections, which were still weak.
I tried to change my protocol again in August, giving the half-life of Clomid being so large. I made an excel table in order to see how much of the drug I have in a given moment.
So, if the half-life of Clomid was 46 hours, taking it 1/8th of a pill (6.25 mg EOD) I was having about 30 mg of it on average.

​

I have tried to ease off Clomid and take 1/8th of a pill every 3 days:

​

And did labs this morning:

Testosterone 7,78 (2.8-8)
Estradiol 45 (0-54).

And now I do not know what do to.
Why is my estradiol going up?
I did notice some joints cracking, but I cannot be sure what is the cause. I thought that it is a symptom of low estrogen, but the labs says a different story.
I am inclined to get Clomid back to 12.5mg (1/4 pill) EOD, because it seemed to work the best, and maybe try 0.5 mg Arimidex on days I take Clomind,and 0,25 mg on rest days.
My goal was to get the most results with the least amount of drugs. Reasoning was, that if I do have too much testosterone produced, the body will convert the rest to estrogen. But my testosterone is falling, and the E2 is going up.
I still do not feel that, at least, my erections are strong. I know that I am not 20 anymore, but with this therapy, I should be at least perform as much as I want...
I would need some advice from you guys, who are more into this subject. I did contact Defy, but to be honest, the price of their consultation was a bit steep for me. And I am not sure what they can do in only one consultation.
Thanks

 

[Vince Carter]

Thats too much to digest how about the condensed version of what's going on NOW.

 

[Systemlord]

Whenever my estrogen is low my joints are loose and cracking, whenever my estrogen is too high, joints will have fluid retention and joints will feel tight as you try to rotate them.

Clomid isn't a long term solution for most men, a lot of men eventually transition to TRT and any TRT protocol needs SHBG measured in order to design a proper TRT protocol and will determine injection frequency.

A lot of men have perfect numbers while on Clomid and still feel mediocre.

SHBG directly affects how you hold onto testosterone and regulates your free testosterone, something a lot of doctors are just unaware.

Is your estrogen test the LC/MS/MS method designed for men? If not then your doctor has order the female estrogen testing and therefore you results could be overstated.

Defy Medical is a sane choice in an insane world, I'm a patient with Defy and the experience is quite a step up from garden variety endocrinologists.

Insurance doctor will always disregard your obvious symptoms simply because your levels are "in range", all discussions come to an end when you are "in range" even though you are showing all the classic signs of a testosterone deficiency.

 

[MarkM]

Hi Coffeeguy,

Forget testosterone boosters, they are just a scam. Save your money.

 

[Coffeeguy]

@Vince Carter

Sorry Vince,
I also do not like long posts, but I wanted to give you a broader view on the situation.
The situation now is: I don't get really firm erections, morning ones are present maybe once a week and also quite weak. I did try Cialis, and it does work nicely, but, I do not think that at the age of 39 I need to go this route. I get occasional hot flashes, and need to find a way to balance my hormones, or get to the bottom of this and find what is causing my symptoms.

@MarkM
Found that the harder way

@Systemlord
Thank you for your answer.
The E2 test is specifically designed for men.
I need to look into SHBG a bit deeper, I have some understand about its function. I have previously asked for SHBG test in my lab, but I was told that it was a part of some package. I might aswell go ahead and get it done.

 

[Vince Carter]

Well Clomid is notorious for E related problems, though it you use 12.5 EOD that should be substantially mitigated and the E problem that comes is usually guys that are on 25/D (or more).

I concur, SHBG needs to be known as the underlying issue is if your SHBG is low lets say <20, Free Estrogen could be the culprit.

 

[Coffeeguy]

@Vince Carter ,
Thank you for the info, and sorry for not replying you sooner. It was a crazy week and a half.
After taking a deep breath, and looking at the situation, I actually did what I wanted in the first place: find the lowest amount of Clomid and arimidex. 1/8 of a Clomid pill every three days is just too low. I do not feel anything, so I decided to focus on how I feel, and not rely so much on numbers. So it is time to up the dosage, and try to find my "sweet spot". From my last lab I have taken 1/8 of a Clomid EOD, along with Arimidex 0.25mg daily. I do feel marginally better, had one, kinda weak, morning erection. I have done lab this morning, and managed to get SHBG, and prolactin done, along with total T and E2. Results will be in a few hours. I had best results on 1/4 Clomid (12.5 mg), and 0.25 mg of Arimidex daily, so I will see how will I feel now. That is my next protocol, because the current one is giving me almost no change in how I feel. I somehow thought the change would be drastic, but the effects of this drug combo are more profound, it seems.
But I will update when my lab results.
I am really keen on getting to the root of this.

 

[Coffeeguy]

So, the lab is in and here are the results:
Total T 7.41 (2.8-8) ng/ml
Estradiol 41 (0-56) pg/ml
SHBG 34 (13-71) nmol/l
Prolactine 307 (86-327)mIU/l
If anyone can share some thoughts on this, or propose a route which to follow, I would gladly hear it.
As of today, I did increase my dosage of Clomid to 12.5mgEOD, in hope that I will feel better. I will do labs again in a week or two...

 

[Vince Carter]

Prolactin...did you orgasm/have sex in the ~48hrs preceeding your blood draw? If not high prolactin should be investigated as a pituitary problem thru an MRI. Yours is very high even if you did have sex the morning of your blood draw.

...and you're using the wrong Estrogen test, the only acceptable test for males in the Sensitive LC/MS/MS.

 

[Coffeeguy]

Prolactin...did you orgasm/have sex in the ~48hrs preceeding your blood draw? If not high prolactin should be investigated as a pituitary problem thru an MRI. Yours is very high even if you did have sex the morning of your blood draw.

...and you're using the wrong Estrogen test, the only acceptable test for males in the Sensitive LC/MS/MS.

I did have sex yesterday afternoon, took 5mg of Cialis on Sunday morning. I wasn't aware of the "no sex 48 hours before lab" rule. Also, the lab technician suggested that I rest at least 20-30 minutes before blood draw, and I declined it. Don't know if that made any difference.

About the estrogen test, will try to call this lab and verify with them what test they are using. On my lab results it says "estrogen for male", and the method is imuno-hemiluminescence, or competitive imuno-hemiluminescence.

I wasn't able to find any lab here, who is doing mass spectometry, or any other estradiol test, and, it is possible that it does not exist.

All of my tests are done in the same lab, all fasted, at the same time. The only thing I can do now is to go to a different lab, and see is there is a notable difference. But I have changed my protocol, and I expect results to be different. But I am guessing that double checking wont hurt.
Thank you for your response, I will keep updating.