Poor response to TRT, looking for ideas

Thread starter #1
I'm a 35 year-old with secondary hypo due to chronic illness. My symptoms are ED, fatigue, muscle pain, and low motivation. I hit a major obstacle when I became unable to take an AI due to adverse reactions, I'm now looking for other options.

Here's a summary of my treatment:
  1. Clomid, 12.5-50 mg, no ED, stopped due to psychological symptoms
  2. t. cypionate 100 mg weekly, ED
  3. t. enanthate 50 mg twice weekly, ED
  4. e. 50 mg twice weekly with 500 IU HCG, total ED
  5. 1/16-0.5 mg anastrozole added to #4, felt great, forced to stop due to neuropathy from the AI
  6. 12-14 mg t. enanthate daily, ED
Here's how I look without treatment:
  • Total T 226-390 (264-916)
  • Free T 11-12.5 (5-21)
  • Lh 3.4 (1.7-8.6)
  • FSH 2-2.7 (1.5-12.4)
  • Prolactin 6.1 (4.0-15.2)
  • E2 (never tested off treatment)
Clomid 12.5 mg E3D, up to 50 mg EOD:
  • Total T 520-890 (264-916)
  • Free T 17-25.9 (5-21)
  • Lh 6.8 (1.7-8.6)
  • FSH 3.2 (1.5-12.4)
  • Prolactin 6.2 (4.0-15.2)
  • E2 20.1-20.7 (7.6-42.6)
TRT was initiated last December, I settled on 50 mg twice a week with 500 IU hCG; 0.5 mg anastrozole was added due to symptoms of high E2, labs were in the lower 50s. After a week of this combination I felt great, but on the fourth dose of anastrozole I began having neuropathy that worsened with each dose (as low as 1/16 mg). My E2 had not crashed, it was never lower than 14.5, and was 32 (sensitive) the day of one of the reactions.

There are case reports of AIs causing autoimmunity. I've had rare autoimmune reactions to medications in the past, so it's likely that I've got bad luck and can't take them. I switched to daily doses of 14 mg for two weeks, which brought my T to 1047; for the six weeks since then I've been on 12 mg.

My muscle pain is good on daily dosing, but my sexual function isn't. I've got less sensitivity, difficulty reaching orgasm, more ED, and less libido than after just a week of T+HCG+AI. I don't want to cause primary hypo by staying on a protocol that has only mediocre benefit.

What are the chances that I could take Clomid with a low dose of TRT? Theoretically, my HPTA won't be suppressed by about 8 mg of T, and a low dose of Clomid could bring my level just high enough without causing side effects. I'm open to other ideas.
 
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#2
Have you had your shbg tested. I would definitely stop the dose of your AI and maybe even lower your dose of HCG. I would stick with your testosterone dose of 14 mg daily and do labs in about 6 to 8 weeks.
 
Thread starter #3
My uro didn't test SHBG, I'm going to ask about it. I tried taking as little as 70 IUs of HCG, it spikes my E2 without the AI. 25 mg of DHEA every day also appeared to raise my E2 several points.

I'm going to check progesterone and pregnenolone as well, are there any other possibilities to rule out? Thanks for the help.
 
#4
My uro didn't test SHBG, I'm going to ask about it. I tried taking as little as 70 IUs of HCG, it spikes my E2 without the AI. 25 mg of DHEA every day also appeared to raise my E2 several points.

I'm going to check progesterone and pregnenolone as well, are there any other possibilities to rule out? Thanks for the help.
How do you know your estrogen is too high? Didn't even have the right estrogen test. The Roche methodology isn't the right test, UltraSensitive LC/MS/MS is the proper E2 testing.
 
Thread starter #6
My treatment has evolved this way:
  1. Clomid, 12.5-50 mg, no ED, stopped due to psychological symptoms
  2. t. cypionate 100 mg weekly, ED
  3. t. enanthate 50 mg twice weekly, ED
  4. e. 50 mg twice weekly with 500 IU HCG, total ED
  5. 1/16-0.5 mg anastrozole added to #4, felt great, forced to stop due to neuropathy
  6. 12-14 mg t. enanthate daily, ED
On Clomid and T+HCG+AI I get morning wood and my sexual function is normal, on testosterone alone I have some ED and low libido. My thyroid levels are good, I take Synthroid, and Cytomel for FT3.
 
#8
Your endo is going about this all wrong, you are adding HCG to your TRT protocol which increases estrogen, then needing an AI to control estrogen excess, dump the HCG, decrease estrogen and you may no longer need an AI which is causing problem anyway.

You want to control estrogen while on TRT, inject smaller doses should lower estrogen, the smaller more frequent the injection, the better. When I was injecting 50mg twice weekly, Total T was 677 and estrogen was 70, when I inject 8-10mg daily, testosterone was higher and estrogen lower.

Adding HCG to my TRT protocol would ruin me.
 
#9
...
What are the chances that I could take Clomid with a low dose of TRT? Theoretically, my HPTA won't be suppressed by about 8 mg of T, and a low dose of Clomid could bring my level just high enough without causing side effects. I'm open to other ideas.
There are a few reports of successful HPTA activation when Clomid is combined with TRT. If you can get it, enclomiphene might be a better choice. More discussion of Clomid with TRT here.

Anastrozole isn't the only AI out there. Aromasin/exemestane is one alternative.
 
#10
This trial and error seems to be a mess, it is going in circles, not helping to narrow things down.

your shbg is probably low (based on your Total T to FreeT listed) and you may be aromatising quite a bit. Find out your shbg, you probably have it in your lab work already since it is typically needed to calculate free testosterone. if it is indeed low i would go with 9mg daily of enanthate or cypionate,nothing else. get labs (including SHBG and Sensitive e2!!!) after 4-6 weeks ( you need to wait this time before making any changes or evaluating). and reduce if needed.
 
#11
Ive often wondered if you could get down to a certain dose and still get shutdown. I know that that's the prescribed line of thought that any amount of T will shut you down.
my HPTA won't be suppressed by about 8 mg of T
I would pretty well concur with my friends, get down to using only Test, daily maybe 12mg, and nothing else. Also concur on needing SHBG values.
 
Thread starter #12
I decided to try 1 mg of Clomid yesterday by crushing a tablet and weighing out the powder on a milligram scale (the filler was about 5:1). My ED improved within an hour, and this morning I woke up with wood. This is not placebo, the morning wood hasn't happened in over a decade without meds. I'm on 12 mg of enanthate daily.

I'll put in a request for SHBG, it's not in my prior labs. I doubt my doc will consider compounded enclomiphene, but I'll ask. Thanks for all the feedback, I'm confident I'll be able to salvage TRT with the right changes.
 
Thread starter #16
No offense taken, I should have noted that the improvement wasn't equivalent to 12.5 mg. I took such a low dose because I didn't want to risk side effects, it was still enough for me to gauge whether it had an effect. I'll try it a few times over the next month to be sure.
 
Thread starter #17
My doctor didn't have an explanation for why my sexual function is vastly improved by hCG or Clomid. He goes by the book, and I can find no research on why testosterone alone is less effective for some of us. I've decided to lower my dose of T to 10 mg daily with a few mg of Clomid, if the side effects start again I'll try to put off TRT until my 50s.
 
#18
My treatment has evolved this way:
  1. Clomid, 12.5-50 mg, no ED, stopped due to psychological symptoms
  2. t. cypionate 100 mg weekly, ED
  3. t. enanthate 50 mg twice weekly, ED
  4. e. 50 mg twice weekly with 500 IU HCG, total ED
  5. 1/16-0.5 mg anastrozole added to #4, felt great, forced to stop due to neuropathy
  6. 12-14 mg t. enanthate daily, ED

And you did all this in 5-6 months?

Are you aware that you have never had the chance to reach a steady state on any single protocol? Look into half lives of medications on this forum and you will see that with esters like T cyp it takes at least 40 days to reach a steady state. Many symptoms come from transitions, but these can stabilize with time. Looks to me like you are not giving your body a chance for any protocol to be successful.
 
Thread starter #19
I've been on a steady protocol of enanthate for just under two months, not including the first two weeks of an extra 2 mg. How much longer should I wait? With T+hCG+AI my symptoms improved in 1 week, with Clomid it's the same day.
 
#20
My doctor didn't have an explanation for why my sexual function is vastly improved by hCG or Clomid. He goes by the book, and I can find no research on why testosterone alone is less effective for some of us. I've decided to lower my dose of T to 10 mg daily with a few mg of Clomid, if the side effects start again I'll try to put off TRT until my 50s.
Sometimes we might think that it's whether a guy is primary or secondary when HCG seems to work better. or Clomid. That stimulation can produce, something. Whereas if a guy is primary and the problem is the testes, there's not a whole lot of reason to stim the testes other than to prevent atrophy. Just a theory of mine.
 
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