Restart Update: Low Dose Clomid
- Thread starter Xerxes
- Start date
I realize that guys on TRT aren't always dialed in right away, but I've not heard many complaints about feeling horrible, or "very weepy" on normal TRT doses. Yes, Estradiol control (or lack therein) can cause those symptoms, but man...... I'm really sorry this is happening.
So, if you don't want children, and you are 35 where we know many guys HPTA begins to fall off by then, whether it be primary or secondary hypogonadism, what do you expect to achieve in the long term on Clomid?
Let me ask you this. Do you feel worse now, on LD CLomid, than you did on TRT??
I ask because you are describing to us some substantial, not insignificant suffering. I realize there are no quick fixes, but you need to consider if this is the best therapy for YOU. You are ultimately in charge of your health my friend. Please follow up with us when you've had a chance to discuss with Dr. Saya.
Meantime, hang in there, and all the very best. Happy Easter.
I felt good on LD clomid for a bit (but I'm only less than a month in). My ultimate goal is to be off TRT, deal with my natural levels and mental health issues. There were times on TRT that I felt okay or even good, but a lot of the time I felt pretty bad. The lifetime commitment just doesn't seem worth it for TRT.
My choice to try the LD clomid was to get off the TRT b/c I was feeling bad on TRT...
My choice to try the LD clomid was to get off the TRT b/c I was feeling bad on TRT...
O.k. You said you had 3 consecutive TT levels around 300 range and you were feeling bad before. Did you feel WORSE on TRT than on nothing, with low T?
At some point, you may just need to make the mental shift that, much like a blood pressure medication which you may need to take for a very long time (even for life), you may need TRT for life as well. Don't get hung up on that. Perhaps THINK about giving TRT another shot IF you continue to suffer as you are now. I'm not sure how much longer you can suffer this way and continue having a productive life.....
When beginning a therapy, and I know it takes time, you need patience. But, at SOME point, the suffering you are experiencing may/should be a sign that that intervention (LD CLomid) just simply isn't the right treatment for you.
I'll state again that this is a conversation I realize you will be having with your treating physician, very soon. I support that very much.
You elude to some mental health issues. Sorry for that. Realize that that is a major confounder for you, as well as for your physician. Try being realistic about your treatment goals. TRT can often show very modest benefits, but for others very substantial benefits as well. You should not feel WORSE on a proper TRT regimen than on 300 TT WITH hypogonadal symptoms, however.
Dr Justin Saya MD
Moderator
GA8314-
Also of significance is that he was placed on TRT by a physician initially without KNOWING if it was his only (or best) option for treatment...i.e. relatively young, no discussion/diagnosis of primary vs secondary, no attempt at stimulation/endogenous enhancement...add that all up with the subpar results he was having on his previous TRT regimen and it is easy for one to see how he might question/regret being on a lifelong treatment (TRT) for the next 40+ years when his INITIAL work-up, diagnosis, and treatment was suspect...consider also the fact that both he and his wife preferred to "start over" and you will understand his position. The anti-Clomid bias that permeates (all of) the forums makes it even tougher for these guys to give it a fair shake. Especially considering successful LD Clomid treatment is even MORE complex than successful TRT treatment (which about 50% or more of the guys that come to the forums are complaining of poor results on a poor TRT regimen). There have been a few days of negative symptoms in a treatment of only 30 days duration at this point...let's not rally the wagons to abandon ship just yet. Some regimen adjustments are clearly in the near future.
Think of it this way, Clomid therapy gets such a negative rap because of poor regimens (and poor results), but ALSO because there is a strong underlying bias that TRT is the "next step up" or a superior treatment. Thus, the MINUTE something goes wrong on a clomid regimen, it's easy to say --> jump on TRT. Now what if there was a "magic bullet" treatment that was presumed to be superior to TRT. What would one say to the 50-75% of guys that come to the forums having poor results on subpar TRT regimens (androgel, no E2 monitoring/management, q2week T cyp injections, etc)?.?.? Naturally one would say "abandon TRT...I've seen hundreds of reports of guys doing so much better on the "magic bullet" treatment", "why waste your time with the TRT when so many guys do so poorly", etc. However, since there is no "magic bullet" treatment assumed to be superior to TRT, the correct advice is given to those guys...to find a more competent physician, monitor E2 levels, change testosterone delivery methods, etc.
We achieve good results with a decent percentage of LD Clomid patients, but it takes a little more time than TRT and often a few more adjustments (as I stated, it's more complex than TRT). Unfortunately, we lose many of the LD Clomid guys before appropriate adjustments can be made as they succumb to the "perception" that the Clomid will never work for them and they need to progress (prematurely) to TRT...which BTW is no short-term guarantee either as many adjustments are also necessary for most guys in the TRT realm.
Patience is key with ANY treatment, unfortunately it is often not afforded to Clomid regimens as most guys come in the door with the pre-conceived notion that it will be a failure...and that there is a superior, fail-proof alternative.
We'll make adjustments and either the Clomid will or won't turn out to be the best option in his case...either way we will get him feeling better and whatever treatment he ends up on longterm it will be a little "easier to swallow" for both he and his wife knowing that the appropriate steps were taken.
Also of significance is that he was placed on TRT by a physician initially without KNOWING if it was his only (or best) option for treatment...i.e. relatively young, no discussion/diagnosis of primary vs secondary, no attempt at stimulation/endogenous enhancement...add that all up with the subpar results he was having on his previous TRT regimen and it is easy for one to see how he might question/regret being on a lifelong treatment (TRT) for the next 40+ years when his INITIAL work-up, diagnosis, and treatment was suspect...consider also the fact that both he and his wife preferred to "start over" and you will understand his position. The anti-Clomid bias that permeates (all of) the forums makes it even tougher for these guys to give it a fair shake. Especially considering successful LD Clomid treatment is even MORE complex than successful TRT treatment (which about 50% or more of the guys that come to the forums are complaining of poor results on a poor TRT regimen). There have been a few days of negative symptoms in a treatment of only 30 days duration at this point...let's not rally the wagons to abandon ship just yet. Some regimen adjustments are clearly in the near future.
Think of it this way, Clomid therapy gets such a negative rap because of poor regimens (and poor results), but ALSO because there is a strong underlying bias that TRT is the "next step up" or a superior treatment. Thus, the MINUTE something goes wrong on a clomid regimen, it's easy to say --> jump on TRT. Now what if there was a "magic bullet" treatment that was presumed to be superior to TRT. What would one say to the 50-75% of guys that come to the forums having poor results on subpar TRT regimens (androgel, no E2 monitoring/management, q2week T cyp injections, etc)?.?.? Naturally one would say "abandon TRT...I've seen hundreds of reports of guys doing so much better on the "magic bullet" treatment", "why waste your time with the TRT when so many guys do so poorly", etc. However, since there is no "magic bullet" treatment assumed to be superior to TRT, the correct advice is given to those guys...to find a more competent physician, monitor E2 levels, change testosterone delivery methods, etc.
We achieve good results with a decent percentage of LD Clomid patients, but it takes a little more time than TRT and often a few more adjustments (as I stated, it's more complex than TRT). Unfortunately, we lose many of the LD Clomid guys before appropriate adjustments can be made as they succumb to the "perception" that the Clomid will never work for them and they need to progress (prematurely) to TRT...which BTW is no short-term guarantee either as many adjustments are also necessary for most guys in the TRT realm.
Patience is key with ANY treatment, unfortunately it is often not afforded to Clomid regimens as most guys come in the door with the pre-conceived notion that it will be a failure...and that there is a superior, fail-proof alternative.
We'll make adjustments and either the Clomid will or won't turn out to be the best option in his case...either way we will get him feeling better and whatever treatment he ends up on longterm it will be a little "easier to swallow" for both he and his wife knowing that the appropriate steps were taken.
So I got blood work done this morning at primary care doc (Total T, Free T, SHBG, Estradiol[sensitive], LH, and FSH) as suggested by Dr. Saya. I look forward to scheduling a follow up consult with Dr. Saya to discuss them when I get the results back. I'll be sure to keep the board updated about the blood work results and my symptoms. I'll also be titrating down to 12.5 mg clomid M/W/F and DIM only on those days until consult with the good doctor to see if there are any changes in symptoms. I am so relived that finally I'll be getting blood work reviewed by someone who know what they are looking at! I am confident Dr. Saya will help me figure out what's going on and get me feeling better.
Just got blood results from Monday. I haven't had any cypionate since mid February, followed by 2 weeks of HcG and then three weeks of the Clomid. I had been on the Clomid 12.5 mg + 120 mg DIM indoplex per day for about 20 days. I have also been taking a capsule of 15mg DHEA + 25mg pregnenolone each night before bed since mid February when I ceased the cypionate. Felt good for the middle 8-9 days, but really felt like I fell off a cliff the last week. I have forwarded these to Defy and am setting up a consult with Dr. Saya to discuss what they might mean. As of now I am doing the 12.5 mg clomid + DIM on M/W/F at Dr. Saya's suggestion due to negative symptoms/side (NO libido, ED, lethargy, clicky joints, weepiness, depression).
Here are the results:
Total Test: 324 range: 160-853 (most recent test on 1/19/16 was 547)
Free Test: 6.6 range 3.4-15.5 (most recent test was 108, but no range given)
E2 (sensitive) : 14 range <40 (most recent test was 19.18 range 7.02-49)
LH: 6.5 range 1.5-9.3 (my LH before starting TRT in May 2015 was 2.2 range 1.7-8.6)
FSH: 8.1 range 1.4-18.1 (my FSH before starting TRT in May 2015 was 2.6 range 1.5-12.4)
SHBG: 29.8 range 10-57 (most recent test was 19 on same range from 1/19/16)
DHEA-S 468 range 80-560 (most recent test was 258 same range on 1/19/16)
Obviously I am eager to chat with Dr. Saya to see what he thinks, but any opinions about this bloodwork?
My E2 looks low, but my FSH and LH are coming up, which is good in terms of the restart, correct? Wish my Test was higher, but it's only been a short time on the Clomid. It's also interesting that my SHBG went up.
Here are the results:
Total Test: 324 range: 160-853 (most recent test on 1/19/16 was 547)
Free Test: 6.6 range 3.4-15.5 (most recent test was 108, but no range given)
E2 (sensitive) : 14 range <40 (most recent test was 19.18 range 7.02-49)
LH: 6.5 range 1.5-9.3 (my LH before starting TRT in May 2015 was 2.2 range 1.7-8.6)
FSH: 8.1 range 1.4-18.1 (my FSH before starting TRT in May 2015 was 2.6 range 1.5-12.4)
SHBG: 29.8 range 10-57 (most recent test was 19 on same range from 1/19/16)
DHEA-S 468 range 80-560 (most recent test was 258 same range on 1/19/16)
Obviously I am eager to chat with Dr. Saya to see what he thinks, but any opinions about this bloodwork?
My E2 looks low, but my FSH and LH are coming up, which is good in terms of the restart, correct? Wish my Test was higher, but it's only been a short time on the Clomid. It's also interesting that my SHBG went up.
thatoneguy
Member
I'm curious if your body just needs more time for the testosterone production to catch up with the LH and FSH.
As your testosterone levels increase your E2 will hopefully rise to a better range.
My E2 was around 15 with testosterone levels in the 400, and the Doctor said my E2 was were he expected it to be considering my lower T levels.
Your protocol is similar to mine, but I'm starting fresh with no prior TRT.
As your testosterone levels increase your E2 will hopefully rise to a better range.
My E2 was around 15 with testosterone levels in the 400, and the Doctor said my E2 was were he expected it to be considering my lower T levels.
Your protocol is similar to mine, but I'm starting fresh with no prior TRT.
So, you have NO libido, ED, lethargy, click joints, and you are weepy with depression??
Look, I'm gonna just come out and say this. You need to shift gears my friend. I would have a serious discussion with your physician.
I will caveat again that I do not have experience with LD Clomid therapy. It is not really the standard of care, although a few docs seem to champion it, and the standard of care leaves for a LOT of improvement. So, I'm NOT second guessing your doc from a distance. But, when is enough enough?
You have expressed no desire for further children. Yes, you are young, but you are 35, not 25.
Going almost one month with the symptoms you've described is enough to get passed up for a promotion, to make serious judgement blunders at work, to underperform in MOST areas of your life.
AGAIN, I don't have experience with treating with LD Clomid, but it seems like you may have a primary component to your hypogonadism. Your gonadotropins (LH/FSH) HAVE responded to Clomid, but your testicles seem not to be responding to your elevated gonadotropins.
At SOME POINT, my feeling is that you need to get on a good TRT regimen, and tweak it from there. I know it has NOT been a panacea for you in the past. I realize that patience is a virtue. But, what you describe is NOT progress. It is suffering.
I've felt as bad or worse on traditional TRT as well...I'm willing to be patient and wait. For about half of the time on this restart I felt very good. Now, not so much, but I'm willing to wait and see. Traditional TRT, even when I seemed to have good numbers never got me feeling good consistently, and in fact for probably more than half of the time I felt pretty terrible. I am happy to finally have a doctor that is an expert in hormones and TRT and actually cares enough to try different things to get me feeling better. Every other Doctor I've seen (primary, uro, endo) either had no clue how to read blood work outside of total test numbers, wanted me to stop the test cold turkey, or would let me guide my own care (but I am no doctor!). I'm grateful to be working with an expert and willing to be patient. What's a few months when I've been dealing with symptoms (anxiety, insomnia, depression, Ed) for almost two years and the TRT roller coaster for about about 10 months. I'm hopeful.
Like I said before you are a tough case. I agree that having a doc like Dr. Saya who cares enough to WORK hard on cases like you is a true testament to him as a person and physician.
I am wondering if you may benefit from a visit to a psychiatrist also. You MAY benefit from something like Wellbutrin, which could be temporary as you patiently work on more optimal hormonal balance.
Just wanted to provide an update. I'm actually feeling really good. Still on 12.5 mg per day of the Clomid, a multi-vitamin, and 4000 iu of vitamin D daily. Dropped the DIM. I also take a compounded 25mg preg/15 mg DHEA before bed each night. Mood, libido, erection, mental focus have been very good the last week and a half.
Also seeing a therapist once a week seems to be helping as well.
So far so good. I never thought I'd feel so normal being without any cypionate shots for almost two months.
Hopefully it sticks. I know this is still very early in the process and I need to be patient and cautiously optimistic, but I want to thank Dr. Saya and Defy for helping me begin this path the right way. Next follow up is in two weeks. I'll let you know how we proceed.
Also seeing a therapist once a week seems to be helping as well.
So far so good. I never thought I'd feel so normal being without any cypionate shots for almost two months.
Hopefully it sticks. I know this is still very early in the process and I need to be patient and cautiously optimistic, but I want to thank Dr. Saya and Defy for helping me begin this path the right way. Next follow up is in two weeks. I'll let you know how we proceed.
So had my consult with Dr. Saya today after about 5 weeks on the Clomid (12.5 mg) day with some DIM and Calcium d-Glucarate to manage E2. I am feeling really good right now - probably the best I have in 2 years on or off TRT.
The plan we've decided upon is to stay the course with low dose daily for 3 months and check blood and symptoms then and see if we start titrating down at that point.
I am actually scheduled to see my urology next Friday, so I will be getting some blood work done then. I'm curious to see what it looks like. I'll relay the info hear so anyone interested can see.
All in all I am very happy with Defy and very happy with the low dose Clomid.
The plan we've decided upon is to stay the course with low dose daily for 3 months and check blood and symptoms then and see if we start titrating down at that point.
I am actually scheduled to see my urology next Friday, so I will be getting some blood work done then. I'm curious to see what it looks like. I'll relay the info hear so anyone interested can see.
All in all I am very happy with Defy and very happy with the low dose Clomid.
Awesome results so far! Is your plan to stay on Clomid indefinitely or to titrate down and eventually off all together in hopes your system can stand on its own again?
Ultimate goal is to slowly titrate down and get off. From my discussion with Dr. Saya though, there is a place for long term low dose Clomid if the bloodwork and symptoms don't cooperate with the removal of Clomid altogether.
So hopefully, I'd be slowly weaned off and have no need for the Clomid, OR figure out what the lowest possible dosage would be to maintain symptom relief (and to a lesser extent bloodwork numbers).
So hopefully, I'd be slowly weaned off and have no need for the Clomid, OR figure out what the lowest possible dosage would be to maintain symptom relief (and to a lesser extent bloodwork numbers).
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