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It seems as if clomid raises SHBG in those who don't need it, and in those who do, it doesn't. I was chatting with a nurse practitioner friend who believes that the body adjusts SHBG due to some unknown reason beyond our understanding, potentially as some immunity related defense mechanism.

I do recall Dr. Saya mentioning something along those lines, Clomid in low SHBG guys on TRT. I haven't searched, though. Found it! https://www.excelmale.com/forum/showthread.php?9421-Clomid-Testosterone-Why-they-don-t-work-together-By-Mike-Gaiso&p=63621&viewfull=1#post63621

Hemolysis just means the blood sample for some reason was treated in a way to make the blood cells rupture. It could be from the phlebotomists technique or improper sample storage. It's not a state that you're in.

Hey man, I wish you the best in your transition, I'd give Defy a call and see how long it'll take approximately to transition. I know they need labs and a physical before scheduling, but not sure how long the wait time is now. Personally, I think you've made a good decision, and it may suck...

I just can't think of any other reason why you'd have morning erections, but ED during sex. That just screams psychological.

I find it odd you're having morning erections, but only during sex is it that you lose your erection. That seems oddly coincidental, and morning erections prove everything is functioning properly. While high range prolactin can cause issues, I doubt it's the culprit here. I'd say it's more...

That's how I prevent calcium build up.

The only way that would work would be to take exogenous estradiol. This is not an idea that will work though, as you are likely to grow breasts.

Stop taking AI. That's the only answer. Think about it like this, if a person is drowning because someone is holding their head underwater, the best way to stop them from drowning is to take your foot off of their head. A bit hyperbolic, but it gets the point across, albeit sarcastically.

I think it might be from the bike riding, 20 miles is a lot and putting all that pressure directly on the perineum might cause the PSA elevation.

SHBG would be good to have.

So the E2 test was done BEFORE you started smoking? If so, then nicotine is irrelevant. I also don't know how strong of an AI it is. It's possible the pesticides have something to do with it, but in reality, you're probably just a really really thin guy. I'm just perplexed by how low your...

Possibly a pimple? Either way, get new sheets.

Just be careful in the heat man, your body is not able to hold water as well as it did before. All of the symptoms you mentioned are dehydration, nausea and headaches. It's really tough to keep hydrated when your E2 is super low, I tried before, the water just went right through me.

Nicotine is an aromatase inhibitor. I suspect most guys who post super low T/E2 ratios are smokers but aren't willing to admit it.

Leaving out critical information to receive an "unbiased" response... is worse than receiving no response. Think about it, would you want a response not based on YOU? Your E2 is crashed, 1mg of IM anastrozole is going to likely tank your E2 faster than you can say "joint pain". Which brings up...

You smoke cigarettes? How much?

Are you on an AI? It's possible this is due to dehydration, since TRT can change the way your body holds and excretes water. If an AI is involved, then taking too much can explain the reduced penile sensitivity and dehydration. Or your dose is really high, which I suspect it is due to you...

I'm just a fellow guy who's on this rock orbiting a giant ball of fire, too. If my knowledge or opinion can help just one person, then that's all I can ask for. Having helped one person leaves the world a better place than when I woke up this morning. Just because something is "in your head"...

Vitamin E. Estradiol.

Wow, that is one LOW aromatization rate, holy crap. 550 with completely crashed E2. I don't know where you got the idea that you'd ever need an AI, but seriously, do not take one. Based on low E2 and high LH, I'd conclude you're primary, but there's no way your E2 should be THAT low with a...

You should be a bit down, if you weren't, that'd be abnormal. Loss of any sort, relationship or death of a loved one, almost always relates in a form of depression. One of the symptoms of depression is low libido. You'll slowly achieve normalcy eventually, the 7 stages of grief apply not just...

Not stupid at all, in fact, it's an extremely intelligent thought, and shows you're very self aware. Many guys on TRT want everything to be hormonally caused, but the reality is that most things are mental/psychological. I think that due to the large stigma against all things mental illness...

You should definitely get a full sleep study performed.

Unfortunately these aren't very useful, and I believe that was my miscommunication. I apologize for that, I assumed you were not on anything at the time, and had natty labs. TRT labs aren't going to be able to be used to predict hCG or clomid's efficacy. I'm going to assume you're not feeling...

Something else is causing this then. You said it was high normal prior to clomid and hCG. I'd suspect you do have sleep apnea, if you have the sleep study results I'd suggest a second opinion. If you don't, request them. Either that or you live at altitude or smoke cigarettes.

You have the hot flashes that itch?

Joint pain is a symptom exclusive to low E2 for the most part. Any others? Excessive urination, excessive thirst, anhedonia, anxiety, hot flashes that itch, or depression?

You're going to need to post the rest of the labs. Chances are you have something else going on that is causing the erythropoiesis. Sleep apnea is most likely. Or testosterone is super high. 3 donations in under 1 year is a lot. Your ferritin is tanked, donating blood at this point is a...

Their efficacy will depend upon your clinical presentation, there isn't a single person here who can speculate how these "alternatives" will work for you without labs, symptoms, and basic information. Sermorelin is not a testosterone alternative, it's a GH releaser. If you want more advice...

I wonder if the dose increase just happens to coincide with an enlargement of the tumor. I really don't know much at all about prolactinomas, but it's certainly interesting that this is happening. I mean no disrespect by that of course, not trying to make light of your condition, I just enjoy...