Not Happpy With Clomid - Baseline Labs and Future Options

I'm 34, 6', and 200lbs around 25% body fat. I've dealt with depression, inability to gain muscle mass and lose body fat regardless of diet and exercise my entire life. In fact, any type of exercise puts me in a catabolic state where I actually lose lean body mass.

Below are my baseline labs, and as expected my T is extremely low for my age, well any age actually at 119. I have been working with a urologist and have had both a prostate exam, and a pituitary MRI, both of which have come back perfect.

Before starting TRT injections, we are trying clomid to hopefully kick start my system. I have been on 25mg of clomid EOD for 6 weeks. After 10 days, my T increased to 426, and my free T increased to 13. Unfortunately we didn't test any other levels. After 6 weeks I'm feeling slightly better, however far from good. I've started experiencing pretty bad night sweats, sometimes they're so bad I think I may have peed the bed...thankfully I haven't . My Dr. had planned on running on clomid until the fall then retest labs, but I don't think I can wait that long.

Based on the labs, and brief narrative, what future options should I consider? Thanks for your time and insight.

Baseline Labs:

Glucose, Serum 88 mg/dL 65 - 99
BUN 20 mg/dL 6 - 20
Creatinine, Serum 1.15 mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 83 mL/min/1.73 >59
eGFR If Africn Am 95 mL/min/1.73 >59
BUN/Creatinine Ratio 17 9 - 20
Sodium, Serum 144 mmol/L 134 - 144
Potassium, Serum 5.2 mmol/L 3.5 - 5.2
Chloride, Serum 103 mmol/L 96 - 106
Carbon Dioxide, Total 23 mmol/L 18 - 29
Calcium, Serum 9.8 mg/dL 8.7 - 10.2
Protein, Total, Serum 7.1 g/dL 6.0 - 8.5
Albumin, Serum 4.9 g/dL 3.5 - 5.5
Globulin, Total 2.2 g/dL 1.5 - 4.5
A/G Ratio 2.2 1.2 - 2.2
Bilirubin, Total 0.5 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 124 High IU/L 39 - 117
AST (SGOT) 20 IU/L 0 - 40
ALT (SGPT) 20 IU/L 0 - 44
Testosterone, Serum 119 Low ng/dL 348 - 1197
Free Testosterone(Direct) 5.5 Low pg/mL 8.7 - 25.1
LH 1.2 Low mIU/mL 1.7 - 8.6
FSH 1.5 mIU/mL 1.5 - 12.4
Hemoglobin 17.1 g/dL 12.6 - 17.7
Hematocrit 51.3 High % 37.5 - 51.0
TSH 1.480 uIU/mL 0.450 - 4.500
Prolactin 7.3 ng/mL 4.0 - 15.2
Estradiol 12.6 pg/mL 7.6 - 42.6
Prostate Specific Ag, Serum 0.6 ng/mL 0.0 - 4.0

Welcome to Excelmale. Some quick observations.

Your doctor ordered the incorrect estradiol test in the labs reported here. Men should only be tested with the sensitive (also called ultrasensitive) assay. The test you had conducted is unreliable. This is particularly important over the course of Clomid therapy. Estradiol, a necessary hormone, can climb quickly during Clomid protocols. This contributes to some of the unwanted side effects that are encountered. Always test e2 with the sensitive lab test.

While your TSH is in a good spot, that's the only thyroid test that was run. Given what you presented with, it is important to evaluate full thyroid function (t3, t4, rt3, antibodies). DHT and DHEA weren't captured? Your hematocrit is at the top of the range. Should you start TRT it will likely rise higher. I'd donate blood now and try to get ahead of this challenge.

How is your sleep? Any chance you have apnea? Head or testicular injury?

You seem to be responding well to Clomid so just give it more time before thinking you need TRT. However, it is already evident that is not the answer if your T has gone into the 400's after only 10 days treatment. In men, Clomid dosing can be tricky to dial in, too much of it in your system seems to negate its benefits.

I spoke with my Dr. and I'm going to have labs redrawn tomorrow morning. For many reasons I would like the clomid option to work, but I'm starting to feel desperate to begin feeling better.

Getting things dialed in seems so hard. I know I don't feel well, which could mean T too high or low, E too high or low, plus a million other variables. One great thing about my Dr. is he emphasizes how I feel over a number on a lab. Really appreciate the approach and hope we can make things work.