26 Year Old - Clomid or HCG?

Hi all,

I hope this thread may develop into something of value for the members of this forum.

I will soon have a follow up meeting with a Private Andrologist to decide whether I will move forward with Clomid or HCG Treatment.

I would greatly appreciate any member feedback to help make my decision!


Background info
Age - 26
Weight - 67kg
Height - 5 foot 10
Bodyfat - approx 15%

Body & Facial Hair:
- Modest amount on arms, legs & chest
- No back hair
- Thick head of hair
- Ability to grow a (somewhat whispy) beard

Health Conditions
- Dyspesia // Gastritis on and off since 2010. Most severe symptoms abated since cutting alcohol and improving diet & supplementation

Diet:
- No alcohol since 2012
- No smoking since adolescence
- No recreational drugs
- No junk or processed foods consumed for a number of years
- No Gluten, Dairy and Soy since 2016
- Consume a balanced diet of wholefoods, organic where possible. A typical meal would be: Fish / Meat, Green vegetables, Starchy vegetables and Fruit
- Experimented with Intermittent Fasting since 2016

Nutritional Deficiencies:
Vitamin B12 (minor)
Iron (minor)


Supplementation:
1 tsp Collagen
1-2 caps Turmeric
12mg Iron
Vitamin B12
1-2x Probiotics capsules
2x Enzymes capsules
Vitamin D3 & K2
1 cap Fish Oil

STATS


- Testosterone - 11.5 nmol/L [7.6 - 31.4]
LOW-NORMAL
- Free Testosterone - *0.184 nmol/L [0.3 - 1.0]
ABNORMALLY LOW
- SHBG - 46 nmol/L [16 - 55]
HIGH-NORMAL
- Oestradiol - 50 pmol/L [0 - 191]
MID-RANGE

FSH - 4.2 IU/L [1.5 - 12.4]
LH - 5.5 IU/L [1.7 - 8.6]
Prolactin - 151 mIU/L [86 - 324]

DHEA-S - 6.9 umol/L [0.44 - 13.4]

TSH 0.838 mIU/L [0.27 - 4.20]
FREE THYROXINE 14.3 pmol/L [12.00 - 22.00]
TOTAL THYROXINE(T4) 82.5nmol/ [59.00 - 154.00]
FREE T3 3.54 pmol/L [3.10 - 6.80]
THYROGLOBULIN ANTIBODY 14.100 IU/mL [0.00 - 115.00]
THYROID PEROXIDASE ANTIBODIES 9.65 IU/mL [0.00 - 34.00]

HAEMATOLOGY

HAEMOGLOBIN (g/L) 141 g/L 130 - 170
HCT 0.419 0.37 - 0.50
RED CELL COUNT 4.68 x10^12/L 4.40 - 5.80
MCV 89.5 fL 80 - 99
MCH 30.1 pg 26.0 - 33.5
MCHC (g/L) 337 g/L 300 - 350
RDW 12.6 11.5 - 15.0
PLATELET COUNT 272 x10^9/L 150 - 400
MPV 9.9 fL 7 - 13
WHITE CELL COUNT 5.94 x10^9/L 3.0 - 10.0
Neutrophils 63.8% 3.79 x10^9/L 2.0 - 7.5
Lymphocytes 25.3% 1.50 x10^9/L 1.2 - 3.65
Monocytes 8.9% 0.53 x10^9/L 0.2 - 1.0
Eosinophils 1.7% 0.10 x10^9/L 0.0 - 0.4
Basophils 0.3% 0.02 x10^9/L 0.0 - 0.1
ESR 10 mm/hr 1 - 10

BIOCHEMISTRY
URIC ACID 399 umol/L 266 - 474
C Reactive protein 0.6 mg/L <5.0
Rheumatoid Factor Turbidimetry <10.0 IU/mL <14.0

AM body temperature: 36.1 Celsius (96.98 Fahrenheit)
(NB. I have noticed a marked decrease in my ability to handle my morning cold shower, which I have practised since 2011. I now get a chill afterwards)

Symptoms
- ED and lack of libido (both sex and masturbation). Since 2013 with increasing severity
- No Morning Wood. Flatline since 2015
- Episodes of Depression. Since 2012, with increasing frequency & severity
- Low Normal T-Levels and low energy. Since mid 2017

Private UK Andrologist Consultation & Suggestions:
1) Urologist Scan
2) Therapeutic trial prescription of my choice of one of the following:
- HCG
- Clomid
- Testosterone Spray
3) Separate psychiatric treatment in conjunction with T treatment

Concerns

- He did not ask for my Thyroid stats. My understanding was that Thyroid levels should be a first port of call, at least to check, before prescribing a T treatment?

- He claimed I would have no need for an Aromatase Inhibitor with Clomid / HCG - "because you are not overweight". Surely either treatment could have a potent Estrogen boosting effect nonetheless?

- He was only interested in follow up checks of Blood Count & Total Testosterone levels. He did not believe that there was any need for tracking Estrogen or SHBG, for example.

I had imagined that there would be, particularly as I have higher levels of SHBG already, and therefore abnormally low Free T levels?

Questions:

1) Does anyone have any thoughts as to whether Clomid or HCG would be an appropriate treatment, considering my age and stats provided?

2) Are there any other diagnostic tests I should run in order to find a potential causal factor?

Thank you in advance!

Nelson has a good thread you read.

Is Clomid (Clomiphene) Effective to Increase Testosterone, Fertility and Sperm Volume?

https://www.excelmale.com/forum/sho...rease-Testosterone-Fertility-and-Sperm-Volume

I don't think clomid would be a great idea for you, for a few reasons. LH is mid range with total testosterone fairly low(really low when you consider that your high SHBG is artificially inflating your total testosterone level) and your SHBG is fairly high and clomid will only increase this.

You don't need an AI until you need one. Your E2 is NOT mid range, it's at 12ish pg/ml when converted, and considering this is a standard E2 test you're most likely lower.

Your doctor doesn't seem the most knowledgeable, since he's only going to be checking your CBC and total testosterone, doesn't believe in checking E2, and isn't considering clomid's impact on SHBG.

hCG might be worth a shot, but there's not really a significant advantage over TRT. Both are suppressive and hCG monotherapy is much more difficult to titrate, it's a rather inconsistent treatment, and is often less effective IMO.

I'm also not sure what "testosterone spray" is, I assume the nasal spray?

I'd get another opinion.

Your Thyroid labs look a little bit suspect, but I'd wait for someone else here to comment on those, as I am not as knowledgeable with thyroid.

Thank you Vince and johndoesmith for your replies - much appreciated!

Regarding my Thyroid labs, I have had a suggestion on another forum that my Free T3 levels are a bit suspect, so I may look to Iodine supplementation

I believe the Testosterone Spray in question is called Tostran.

Do you think it might be prudent to trial Clomid or HCG, if not only just to see whether they have any positive/negative effect? I am hesitant to move to TRT considering my age, and so I figure it would be sensible to first confirm that the issue is definitely primary, rather than secondary hypogonadism.

I may look to get a second opinion from a US doctor, as options for private doctors in the UK are limited (and the public National Health Service's only course of action is to repeatedly offer me anti-depressants...)

Thank you for your comment regarding my E2 levels, I appreciate that I did mislabel them

My plan of action:
1) Look into Iodine Supplementation
2) Raise concerns with my Doctor at our next consultation

If you think there are any other avenues to explore, do let me know!

Thank you again for your feedback

I wouldn't try TRT without trying Clomid first at age 26. You have too much to lose like injecting yourself for life and it's hard to remain fertile on TRT.

Are guys that do well on low dose clomid unicorns...or do they really exist?

https://www.excelmale.com/forum/sho...-dose-clomid-unicorns-or-do-they-really-exist

Vince said:

I wouldn't try TRT without trying Clomid first at age 26. You have too lose like injecting yourself for life and it's hard to remain fertile on TRT.

Are guys that do well on low dose clomid unicorns...or do they really exist?

https://www.excelmale.com/forum/sho...-dose-clomid-unicorns-or-do-they-really-exist

Click to expand...

this is great advice because it is the most conservative action to take. You can always go the TRT route later. Having said this, the month I was on Clomid was horrible (but I was 49, coming off long term TRT, and on a higher dose).

which is cheaper to do?

BayArea said:

this is great advice because it is the most conservative action to take. You can always go the TRT route later. Having said this, the month I was on Clomid was horrible (but I was 49, coming off long term TRT, and on a higher dose).

Click to expand...

what do you mean by horrible?

Jomer said:

what do you mean by horrible?

Click to expand...

Night sweats, hot flashes, complete loss of libido. It didn't restart me either.

Hi all,

To give an update, I had my second appointment with the Andrologist on Monday.

I requested the least invasive option - Clomid. I was initially prescribed a 50mg EOD prescription, but I requested for this to be at least lowered to 25mg EOD. I have heard reports that anything higher increases the chances of ramping up E2 and or SHBG. I particularly want to avoid increasing the latter. I may cut down the pills further and do 12.5mg EOD

Before I begin the treatment, I first want to properly address existing issues with my Gut. I will be starting an elimination diet and testing for SIBO and fructose malabsorption

Even if the gut protocol does not increase my T, at least I can then strike it off as a causal factor. Aside from that, any gut healing I imagine will also be beneficial to negate any gastric side-effects from the Clomid

I will update with further progress soon. In the meantime, if anyone has any further suggestions on Clomid and/or dealing with Gut problems, I would be all ears!

Thanks in advance

penguinwoolf said:

Hi all,

To give an update, I had my second appointment with the Andrologist on Monday.

I requested the least invasive option - Clomid. I was initially prescribed a 50mg EOD prescription, but I requested for this to be at least lowered to 25mg EOD. I have heard reports that anything higher increases the chances of ramping up E2 and or SHBG. I particularly want to avoid increasing the latter. I may cut down the pills further and do 12.5mg EOD

Before I begin the treatment, I first want to properly address existing issues with my Gut. I will be starting an elimination diet and testing for SIBO and fructose malabsorption

Even if the gut protocol does not increase my T, at least I can then strike it off as a causal factor. Aside from that, any gut healing I imagine will also be beneficial to negate any gastric side-effects from the Clomid

I will update with further progress soon. In the meantime, if anyone has any further suggestions on Clomid and/or dealing with Gut problems, I would be all ears!

Thanks in advance

Click to expand...

I think you're smart to go with 12.5mg ED or EOD. Clomid can cause e2 to skyrocket, so using the lowest possible effective dose is a good idea.
.
Regarding gut issues, I've followed a low FODMAP diet on and off for several months. I'm not strict with it, but it has helped me identify a few foods that do not sit well with me. For example, garlic and onions really don't sit well with me, apples are to be avoided for the most part, and I can handle gluten and lactose in moderation, but too much of either cause some distress.