31 Years Old: Clomid or TRT plus HCG?

[ZoomyR6]

Hey Guys,

I have been on TRT for 2 weeks now and had my 3rd shot yesterday. Just some quick numbers before starting TRT:
First test done in afternoon (3pm)- TT 332
Second test done 3hrs after waking (7am)- TT 421
Third test Early evening (5pm) TT 213

31 years old

I was having all the common low T symptoms so my doc put me on 100mg/wk. He wasn't all that knowledgeable about different protocols (wanted me to do 200mg eow, said a small amount of trt wont cause infertility, etc...) so it led me to seek out another Doc who understood it better.

I just left this new Docs office frustrated and confused. He is a urologist and deals with fertility as well. He said he would have never put me on T and if I wanted to be under his care, I would have to come off and he would start me with Clomiphene. He said he likes his patients to be in the 400-500's range. He said he likes to treat younger guys (I'm 31) who don't have children with it so there is still a chance of fertility. He used the analogy of giving someone my age TRT is like giving a 20yo a vasectomy....he just wouldn't do it.

He seems very knowledgeable and relates to a lot of stuff in Nelsons book. However, after we spoke and he told me this, he says we spent a lot of time talking and he has to go to other patients. I told him this is a HUGE issue because one doc put me on and now this one is telling me to come off.

I apologize for bitching but I don't know what to do at this point. He said the 421 TT in the morning wasn't bad and it naturally declines at the end of the day, hence the other lower numbers and clomiphene could help raise it a little more.
I would love to here some feedback and opinions from others because this is leaving me with unnecessary anxiety now...

 

[Will Brink]

Hey Guys,

I have been on TRT for 2 weeks now and had my 3rd shot yesterday. Just some quick numbers before starting TRT:
First test done in afternoon (3pm)- TT 332
Second test done 3hrs after waking (7am)- TT 421
Third test Early evening (5pm) TT 213

31 years old

I was having all the common low T symptoms so my doc put me on 100mg/wk. He wasn't all that knowledgeable about different protocols (wanted me to do 200mg eow, said a small amount of trt wont cause infertility, etc...) so it led me to seek out another Doc who understood it better.

I just left this new Docs office frustrated and confused. He is a urologist and deals with fertility as well. He said he would have never put me on T and if I wanted to be under his care, I would have to come off and he would start me with Clomiphene. He said he likes his patients to be in the 400-500's range. He said he likes to treat younger guys (I'm 31) who don't have children with it so there is still a chance of fertility. He used the analogy of giving someone my age TRT is like giving a 20yo a vasectomy....he just wouldn't do it.

He seems very knowledgeable and relates to a lot of stuff in Nelsons book. However, after we spoke and he told me this, he says we spent a lot of time talking and he has to go to other patients. I told him this is a HUGE issue because one doc put me on and now this one is telling me to come off.

I apologize for bitching but I don't know what to do at this point. He said the 421 TT in the morning wasn't bad and it naturally declines at the end of the day, hence the other lower numbers and clomiphene could help raise it a little more.
I would love to here some feedback and opinions from others because this is leaving me with unnecessary anxiety now...

From what you have said so far, I don't understand how you'd come to that conclusion. I don't think there's anything above Nelson will agree with because it's nonsense to use a science term.

 

[CoastWatcher]

Hey Guys,

I have been on TRT for 2 weeks now and had my 3rd shot yesterday. Just some quick numbers before starting TRT:
First test done in afternoon (3pm)- TT 332
Second test done 3hrs after waking (7am)- TT 421
Third test Early evening (5pm) TT 213

31 years old

I was having all the common low T symptoms so my doc put me on 100mg/wk. He wasn't all that knowledgeable about different protocols (wanted me to do 200mg eow, said a small amount of trt wont cause infertility, etc...) so it led me to seek out another Doc who understood it better.

I just left this new Docs office frustrated and confused. He is a urologist and deals with fertility as well. He said he would have never put me on T and if I wanted to be under his care, I would have to come off and he would start me with Clomiphene. He said he likes his patients to be in the 400-500's range. He said he likes to treat younger guys (I'm 31) who don't have children with it so there is still a chance of fertility. He used the analogy of giving someone my age TRT is like giving a 20yo a vasectomy....he just wouldn't do it.

He seems very knowledgeable and relates to a lot of stuff in Nelsons book. However, after we spoke and he told me this, he says we spent a lot of time talking and he has to go to other patients. I told him this is a HUGE issue because one doc put me on and now this one is telling me to come off.

I apologize for bitching but I don't know what to do at this point. He said the 421 TT in the morning wasn't bad and it naturally declines at the end of the day, hence the other lower numbers and clomiphene could help raise it a little more.
I would love to here some feedback and opinions from others because this is leaving me with unnecessary anxiety now...

Given your age, and depending on your pre-treatment labs, a Clomid restart is something that should have been raised as an option for you to consider. What were your LH, FSH, and SHBG levels before you started your injections?

However, as you know, fertility can be maintained while on a TRT protocol with the appropriate use of HCG. How much HCG has been prescribed by the doctor you initially spoke with? To liken TRT to a vasectomy, as the second doctor you spoke to did, along with telling you that your total testosterone values aren't that bad, well...he's not a doctor I would have a lot of confidence in.

 

[Vince Carter]

100% with CoastWatcher.

 

[ZoomyR6]

Given your age, and depending on your pre-treatment labs, a Clomid restart is something that should have been raised as an option for you to consider. What were your LH, FSH, and SHBG levels before you started your injections?

However, as you know, fertility can be maintained while on a TRT protocol with the appropriate use of HCG. How much HCG has been prescribed by the doctor you initially spoke with? To liken TRT to a vasectomy, as the second doctor you spoke to did, along with telling you that your total testosterone values aren't that bad, well...he's not a doctor I would have a lot of confidence in.

Before injections
LH - 3.9 mIU/Ml (1.5-9.3)
FSH - 8.3 mIU/mL (1.6-8.0) HIGH
SHBG - 20 nmol/L (10-50)

HCG wasn't prescribed. My first Doc (the one that started me on TRT) said fertility isn't a problem with a low dose of TRT. That among other things made me want to seek out a better qualified Doc.
The second Doc (The one that I just left and told me to come off TRT) said HCG will lower LH and possibly shut it down so its pointless. So both docs don't believe in HCG, and tbh, i'm ok with that at this point as I don't really want kids anyway.

I just don't know what the right thing to do is. Stay on T or come off and try the clomid. This last doc doesn't seem to want anyone being anywhere in the 7,8, or 900's anyway because he scoffed when I even mentioned those numbers...

How much can colmiphene actually raise levels anyway?

 

[Vince Carter]

I think that your LH/FSH might suggest that you're secondary meaning the problem is the testes and not the pituitary. My opinion. And given your age, a restart attempt would be entirely advisable but I wouldnt trust either of those two to manage that, or TRT. And it would seem though untested that the Free T isn't a problem as your SHBG is low enough to not suggest a Free T problem.

 

[ZoomyR6]

I think that your LH/FSH might suggest that you're secondary meaning the problem is the testes and not the pituitary. My opinion. And given your age, a restart attempt would be entirely advisable but I wouldnt trust either of those two to manage that, or TRT. And it would seem though untested that the Free T isn't a problem as your SHBG is low enough to not suggest a Free T problem.

Thanks.
My Free T was:
79 pg/mL (46-224)
10.6 pg/mL (8.7-25.1)

Unfortunately, I am fed up with being unable to find a doc that can correctly deal with this so I am going to wind up using the Doc I just seen. It just bothers be that he finds 400-500's normal...
How would I go about doing a restart attempt? Just stop with the injections just like that? Is the raise in T with clomiphene going to have the same effect at injecting T as far as energy, libido, etc? What ranges can I achieve?

 

[Vince Carter]

Id suggest in your frustration that you consider a site sponsor, Primebody, or Dr Saya with Defy medical. You can't go wrong with either Clinic. I know that Dr Saya is really up to speed with Clomid restarts.

 

[CoastWatcher]

Thanks.
My Free T was:
79 pg/mL (46-224)
10.6 pg/mL (8.7-25.1)

Unfortunately, I am fed up with being unable to find a doc that can correctly deal with this so I am going to wind up using the Doc I just seen. It just bothers be that he finds 400-500's normal...
How would I go about doing a restart attempt? Just stop with the injections just like that? Is the raise in T with clomiphene going to have the same effect at injecting T as far as energy, libido, etc? What ranges can I achieve?

Clomid is a tricky ride. Spend some time with this discursive thread that Dr. Saya started. It's all to common for guys to go through a number of unsatisfactory discussions with doctors before finding a man or woman who will work with them as a partner. Don't simply settle...you deserve better than that.

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

 

[Will Brink]

Thanks.
My Free T was:
79 pg/mL (46-224)
10.6 pg/mL (8.7-25.1)

Unfortunately, I am fed up with being unable to find a doc that can correctly deal with this so I am going to wind up using the Doc I just seen. It just bothers be that he finds 400-500's normal...
How would I go about doing a restart attempt? Just stop with the injections just like that? Is the raise in T with clomiphene going to have the same effect at injecting T as far as energy, libido, etc? What ranges can I achieve?

If you want to settle for sub standard care, that's your business. But, you're on the forum that can make sure you don't have to, via several national level outfits mentioned already and or someone in your area via searching for docs here, etc. Finding a good clinician can take some patience and leg work, but some never find a site like this and suffer for years.

 

[Vince]

This may help.

Yes, thanks. Doctors want to see "credible studies" (large, double-blind, placebo-controlled, etc.)...

These are the ones I've already emailed them...

Clomiphene studies are linked as follows:


1. Oral Enclomiphene Citrate Stimulates the Endogenous Production of Testosterone and Sperm Counts in Men with Low Testosterone: Comparison with Testosterone Gel
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12116/abstract

2. Clomiphene citrate is safe and effective for long-term management of hypogonadism.
http://www.ncbi.nlm.nih.gov/pubmed/22458540

3. Outcomes of clomiphene citrate treatment in young hypogonadal men
http://www.ncbi.nlm.nih.gov/pubmed/22044663

4. Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: efficacy and treatment cost.
http://www.ncbi.nlm.nih.gov/pubmed/19694928

5. Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?
http://www.nature.com/ijir/journal/v15/n3/full/3900981a.html

6. Hypogonadism, ADAM, and hormone replacement
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126089/


Human Chorionic Gonadotropin (hCG) studies as follows:


1. Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression
http://press.endocrine.org/doi/full/10.1210/jc.2004-0802

2. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy.
http://www.ncbi.nlm.nih.gov/pubmed/23260550

3. Exogenous testosterone: a preventable cause of male infertility
http://www.amepc.org/tau/article/view/2249/3145

4. Maintenance of spermatogenesis in hypogonadotropic hypogonadal men with human chorionic gonadotropin alone.
http://www.ncbi.nlm.nih.gov/pubmed/12444893

5. Effects of three different medications on metabolic parameters and testicular volume in patients with hypogonadotropic hypogonadism: 3-year experience.
http://www.ncbi.nlm.nih.gov/pubmed/23278834

 

[ZoomyR6]

So after more research, I have decided that yesterday was my last injection and will be starting CC tomorrow at 25mg ed.
Thank you everyone for the help. I will be updating this thread periodically to help others who are in the same boat as me, just as you guys have helped me.

I will be getting blood drawn in a month, just to let this last injection diminish and the CC to take effect.

Thank you guys again, much appreciated.

 

[Nelson Vergel]

ZoomyR6

I think you made the right decision. Hopefully you will be one of the unicorns that are definitely out there. 25 mg/day is a good dose. Some docs even transition people to 12.5 mg after a few weeks.

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

 

[ZoomyR6]

Thanks for the response. I already read all of these studies so it seems promising. I just hope my E2 doesn't go sky high. How long until you experience sides from high E2 (ie; gyno, moodiness, libido issues, etc)? Can Gyno be reversed if it is from high E2 resulting from clomid?

Just curious how my thread title changed.

 

[Vince]

Thanks for the response. I already read all of these studies so it seems promising. I just hope my E2 doesn't go sky high. How long until you experience sides from high E2 (ie; gyno, moodiness, libido issues, etc)? Can Gyno be reversed if it is from high E2 resulting from clomid?

Just curious how my thread title changed.

Gynecomastia: Clinical evaluation and management

https://www.excelmale.com/forum/showthread.php?1816-Gynecomastia-Clinical-evaluation-and-management

Your title was edited.

 

[ZoomyR6]

Alright so here is a 1 week update.

I took my first pill last Wednesday (1/2 pill- 25mg), two days after my last shot of 100mg Test Cyp. The first two days I felt amazing. Loads of energy and just a great overall sense of well being. I am going to attribute this to my already elevated T levels from the injection plus the Clomid. I did have an issue sleeping on days 3,4, and 7 (last night). Actually, I didn't sleep at all. Just tossed and turned all night. I might have even turned and tossed at one point. My heart seemed slightly elevated on those days throughout the day and carried into the evening (85-95bpm). Terrible insomnia. However, still not tired much throughout the day.

Performance in the gym so far is still in the air. I took a 1 week break from the gym last week and did some conditioning. Monday (This week) was overhead press day (my weakest lift) and i felt stronger than normal considering my lifts seem to have went down over the past 2 months and was always tired. I still have 3 weeks left before blood gets drawn and am going to assume my estradiol is high because I feel a little sluggish compared to being on injections for 3 weeks but still no where near as sluggish as before therapy. Been getting a little snippy with people as well.

I may call the Doc to report the insomnia if it happens again. 25mg ed may be too much...

 

[ZoomyR6]

I am now 2.5 weeks in on 25mg ED clomid and my libido is officially shot. It was better before starting therapy at all. I was going to get blood drawn at 5 weeks but this is killing me. Is it too soon to test yet? How much longer for my hormones to stabilize for a more accurate reading. I am getting hot flashes at night and I snap on people very easily. No depression or anxiety.

Is it elevated E2 that kills libido in men on clomid therapy?

 

[Vince]

I am now 2.5 weeks in on 25mg ED clomid and my libido is officially shot. It was better before starting therapy at all. I was going to get blood drawn at 5 weeks but this is killing me. Is it too soon to test yet? How much longer for my hormones to stabilize for a more accurate reading. I am getting hot flashes at night and I snap on people very easily. No depression or anxiety.

Is it elevated E2 that kills libido in men on clomid therapy?

Part One: Clomid Introduction
- Selective estrogen receptor modulator, which occupies e2 receptors acting as a weak estrogen

- Two parts/isomers, 30-50% zuclomiphene(estrogenic) and 50-70% enclomiphene (non-estrogenic) (1)

- Inhibits negative feedback of e2 primarily at the hypothalamus/pituitary, thus stimulating the following: GnRH-->LH/FSH-->Leydig Cells-->Testosterone

- Antagonist at Hypothalamus and pituitary

- Agonist (increased estradiol) in the liver, hippocampus, brain stem, neocortex, fat, blood plasma (2)

Part 2: The Zuclomiphene Threshold
It seems that most Clomid patients experience some positive results before Zuclomiphene, the estrogenic isomer, accumulates and begins agonizing (pun intended) brain centers associated with mood/libido (2). Thus, it follows that these patients, the majority, are hitting a threshold accumulation of Zuclomiphene and it's primarily this, not e2 levels, which leads to therapy failure. e2 is a red herring, Zuclomiphene appears the culprit.

Doc Saya on Zuclomiphene:


Why is dosage a MORE powerful tool than any estrogen management ancillary in Clomid treatment? The LONG half-life of the zuclomiphene isomer, it's corresponding threshold (different for each individual), and the novel effects it has upon brain regions. This, you will find is the mechanism to Clomid therapy failure in the treatment of Low T symptoms.


For the "great 1st week, bad 2nd week" responders @25mg ED, the threshold appears around 50-75mg (assuming 11day HL pg.49). Although as seen in the introduction, the wildly non-standard quantities of each isomer makes calculations difficult.

Let's hear some patient experiences who had a great first week on Clomid before the Zuclomiphene threshold began negating the benefits of the Enclomiphene isomer.

Part Three: to follow

https://www.excelmale.com/forum/showthread.php?6781-Why-Clomid-Fails-The-Zuclomiphene-Threshold

 

[equel]

He said he likes to treat younger guys (I'm 31) who don't have children with it so there is still a chance of fertility. He used the analogy of giving someone my age TRT is like giving a 20yo a vasectomy....he just wouldn't do it.

What the F, from all studies Ive read (including one where males were put on testosterone only for 3 years), 99% got their sperm back, some after 3 months, a few after 24.

Also every endo I spoken with - even tho many of them seem retarded - have said they have never ever had a TRT patient who couldnt concieve when the time came for it, after going off trt for a while.

 

[CoastWatcher]

I am now 2.5 weeks in on 25mg ED clomid and my libido is officially shot. It was better before starting therapy at all. I was going to get blood drawn at 5 weeks but this is killing me. Is it too soon to test yet? How much longer for my hormones to stabilize for a more accurate reading. I am getting hot flashes at night and I snap on people very easily. No depression or anxiety.

Is it elevated E2 that kills libido in men on clomid therapy?

It's too early to draw any conclusions at this point in your journey. Your body is going through a significant number of adjustments and serum levels take a while to reach a stable state. Vince has posted some very good points.