Decision Time: T-Cyp or Clomid

I was given two choices for treatment of low T:

Option 1:
Testosterone Cyp 200 mg/ml – 0.35 ml IM/SQ TWICE A WEEK (140 mg/week)
HCG 400 iu SQ 2x/week
Anastrozole 0.125mg 2x/week – h/o elevated E2, titrate on follow-up
Vitamin D3 5000 iu daily
Fish oil 3-4 g po q day for HDL support

F/U in 3 months with full labs with FT3

Option 2:

Clomid 12.5 mg po EVERY day X 6 weeks Anastrozole 0.125mg po EVERY other day X 6 weeks
Vitamin D3 5000 iu daily
Fish Oil 3-4 g po EVERY day for HDL support

F/U in 6 weeks with LABS: T, T free, LH, E2 on week 5

My primary numbers:

Total Testosterone: 156
Free Testosterone: 9.8
Estradiol: 10.4
SHBG: 30.6

Age: 55 years

I haven't read of too may people having success with Clomid so I'm guessing T-Cyp is the best option. Does 140mg weekly sound like a good starting dose, or should it be lower? Seems like some guys are starting at 100 mg weekly.

What is it that you wish to accomplish at your present age? Is fertility an issue? If it's not, I'd opt of a traditional TRT protocol...which raises another question. Why is an AI included at the initiation of therapy? It is much easier to manage elevated estradiol, if elevated it becomes, rather than pull back on the anastrozole and wait for it to recover. The standard operating premise for many doctors and patients is an AI only if elevated levels are detected on the sensitive test AND symptoms are presenting.

As for your initial cypionate dose, 100-120mg per week in divided doses is a reasonable starting place.

Are you sure you want to take anastrozole with an E2 of 10.4? That sounds like a recipe for disaster and months of wishing you hadn't done so. I would recommend not taking any anastrozole until you begin having symptoms of high E2.

Starting off I would recommend a dose of 100 mg weekly and with your SHBG of 30.6 I would recommend injecting every 3.5 days; example - Monday AM and Thursday PM.

CoastWatcher said:

What is it that you wish to accomplish at your present age? Is fertility an issue? If it's not, I'd opt of a traditional TRT protocol...which raises another question. Why is an AI included at the initiation of therapy? It is much easier to manage elevated estradiol, if elevated it becomes, rather than pull back on the anastrozole and wait for it to recover. The standard operating premise for many doctors and patients is an AI only if elevated levels are detected on the sensitive test AND symptoms are presenting.

As for your initial cypionate dose, 100-120mg per week in divided doses is a reasonable starting place.

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Right now I just want to feel normal again and get back my sense of well being. I've had brain fog, anxiety, and fatigue for the past 7 months and it's really wearing me down to the point that I can't even function normally. I don't care about the fertility at all, and honestly ED and libido aren't at the top of my list to regain. I just need to get to a point where I don't dread getting up every morning.

MarkM said:

Are you sure you want to take anastrozole with an E2 of 10.4? That sounds like a recipe for disaster and months of wishing you hadn't done so. I would recommend not taking any anastrozole until you begin having symptoms of high E2.

Starting off I would recommend a dose of 100 mg weekly and with your SHBG of 30.6 I would recommend injecting every 3.5 days; example - Monday AM and Thursday PM.

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That's also what I gathered about the anastrozole from reading posts on here -- don't take it unless numbers/symptoms show that you should. What would be some symptoms of high E2?

Part of the reason you might feel like you do is because you have low estradiol....not high estradiol. Have you had your thyroid tested as it can give you low T symptoms. A good thyroid panel will include TSH, Free T4, Free T3, Reverse T3, and the ATA and TPO Anti-bodies.

An estradiol level of 10.4 is considered very low. Symptoms of low estradiol can be:
Fatigue
Oversleeping
Sleeping all the time
Water retention
Erectile dysfunction
Anxiety
Depression
Lack of Libido
Irritability

If you take anastrolze with an estradiol of 10.4 these symptoms above are only going to get worse.

On the other hand, high E2 will give you many of these same symptoms with the added symptom of being very emotionally and potentially have you crying all the time.

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callebs said:

Right now I just want to feel normal again and get back my sense of well being. I've had brain fog, anxiety, and fatigue for the past 7 months and it's really wearing me down to the point that I can't even function normally. I don't care about the fertility at all, and honestly ED and libido aren't at the top of my list to regain. I just need to get to a point where I don't dread getting up every morning.

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If you are going to get on TRT, then go all in. You might not need to care about fertility at your age, but you should care about libido and ED because if you just stick your toe in the water you are not going to feel better because those things you say you don't care about you will end up caring about down the road. It's hard enough as it is on TRT getting it right, so get it right going into it. If you don't care about your own well being then none of these half-ass doctors are going to care.

MarkM said:

Part of the reason you might feel like you do is because you have low estradiol....not high estradiol. Have you had your thyroid tested as it can give you low T symptoms. A good thyroid panel will include TSH, Free T4, Free T3, Reverse T3, and the ATA and TPO Anti-bodies.

An estradiol level of 10.4 is considered very low. Symptoms of low estradiol can be:
Fatigue
Oversleeping
Sleeping all the time
Water retention
Erectile dysfunction
Anxiety
Depression
Lack of Libido
Irritability

If you take anastrolze with an estradiol of 10.4 these symptoms above are only going to get worse.

On the other hand, high E2 will give you many of these same symptoms with the added symptom of being very emotionally and potentially have you crying all the time.

Click to expand...

Right, I kind of figured if TRT raised my estradiol level, that might actually be a good thing, since it's so low to begin with, as long as it didn't send it off the charts and give me symptoms of high E2. Right now I definitely have the fatigue, anxiety and too much sleep issues, but I attributed that more to the low T than the low E2. I do need to get a full thyroid panel done, my last bloodwork only included TSH which was at .98

MarkM said:

If you are going to get on TRT, then go all in. You might not need to care about fertility at your age, but you should care about libido and ED because if you just stick your toe in the water you are not going to feel better because those things you say you don't care about you will end up caring about down the road. It's hard enough as it is on TRT getting it right, so get it right going into it. If you don't care about your own well being then none of these half-ass doctors are going to care.

Click to expand...

I do care about ED and libido, and of course I want to benefit from TRT as much as possible, but the first thing I need to address is this brain fog, fatigue and anxiety, which are keeping me from being able to function normally. Just getting back to the way I felt a year ago would be a huge step in the right direction.

Your doctor didn’t run LH/FSH?? You need to know if you are primary or secondary to even consider clomid therapy.
At your age however i would just go straight to testosterone injections. Clomid doesn’t work for many. It works for some. You might give it a try if you want but you need to know of you are primary or secondary first.

At 55yo, I wouldn't even put Clomid on the table as an option. Run with the cypionate, and as the wise ones stated, skip the Anastrozole. If E2 is a problem you can always include an AI down the road, and this is one of the reasons you will want to run labs in six (6) weeks after starting TRT. Run the thyroid labs as noted, we will have more to talk about. Good luck going forward ...

HealthMan said:

Your doctor didn’t run LH/FSH?? You need to know if you are primary or secondary to even consider clomid therapy.
At your age however i would just go straight to testosterone injections. Clomid doesn’t work for many. It works for some. You might give it a try if you want but you need to know of you are primary or secondary first.

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LH is 1.4 (low), FSH is 1.9 (low normal). I had an MRI that showed no pituitary tumor so I think I am primary. Will most likely go the T Cyp route but I wanted to see what people had to say about the Clomid.

You can still be secondary even though there is no pituitary tumor.

callebs said:

LH is 1.4 (low), FSH is 1.9 (low normal). I had an MRI that showed no pituitary tumor so I think I am primary. Will most likely go the T Cyp route but I wanted to see what people had to say about the Clomid.

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Low LH is Secondary, whereas it would be primary if the testicles/leydigs were not able to produce endogenous testosterone.

callebs said:

I was given two choices for treatment of low T:

Option 1:
Testosterone Cyp 200 mg/ml – 0.35 ml IM/SQ TWICE A WEEK (140 mg/week)
HCG 400 iu SQ 2x/week
Anastrozole 0.125mg 2x/week – h/o elevated E2, titrate on follow-up
Vitamin D3 5000 iu daily
Fish oil 3-4 g po q day for HDL support

F/U in 3 months with full labs with FT3

Option 2:

Clomid 12.5 mg po EVERY day X 6 weeks Anastrozole 0.125mg po EVERY other day X 6 weeks
Vitamin D3 5000 iu daily
Fish Oil 3-4 g po EVERY day for HDL support

F/U in 6 weeks with LABS: T, T free, LH, E2 on week 5

My primary numbers:

Total Testosterone: 156
Free Testosterone: 9.8
Estradiol: 10.4
SHBG: 30.6

Age: 55 years

I haven't read of too may people having success with Clomid so I'm guessing T-Cyp is the best option. Does 140mg weekly sound like a good starting dose, or should it be lower? Seems like some guys are starting at 100 mg weekly.

Click to expand...

I'm new to TRT but a few months in and I feel fantastic. Age 46. If your test is low, get some test in your body instead of looking for other drug options. Knowing what it's like on the "other side" so to speak, no way would I ever even consider touching Clomid.

Vettester Chris said:

Low LH is Secondary, whereas it would be primary if the testicles/leydigs were not able to produce endogenous testosterone.

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Hmm, neither of the doctors I consulted mentioned that to me when looking at my labs. What is the difference in treatment between the two types if using T-cyp?

Dave B. said:

I'm new to TRT but a few months in and I feel fantastic. Age 46. If your test is low, get some test in your body instead of looking for other drug options. Knowing what it's like on the "other side" so to speak, no way would I ever even consider touching Clomid.

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It's always encouraging to hear success stories. What is your protocol, and how long before you started seeing improvement in symptoms?

callebs said:

Hmm, neither of the doctors I consulted mentioned that to me when looking at my labs. What is the difference in treatment between the two types if using T-cyp?

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Primary hypogonadism means a testicular issue. All the Clomid in the world won't do a thing for a primary patient. Secondary hypogonadism points to a pituitary problem, or an idiopathic cause (of unknown origin). In a secondary patient Clomid MIGHT work.

CoastWatcher said:

Primary hypogonadism means a testicular issue. All the Clomid in the world won't do a thing for a primary patient. Secondary hypogonadism points to a pituitary problem, or an idiopathic cause (of unknown origin). In a secondary patient Clomid MIGHT work.

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I remember the difference between primary and secondary, but thought Clomid was for primary (stimulating the testicles to produce more T than they already were). I guess the doctors knew I was secondary, though neither one actually said that. Can that be determined just by looking at lab results?

callebs said:

I remember the difference between primary and secondary, but thought Clomid was for primary (stimulating the testicles to produce more T than they already were). I guess the doctors knew I was secondary, though neither one actually said that. Can that be determined just by looking at lab results?

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Normal / high normal LH and low testosterone would point to primary.