Another new guy here with questions

[BillS]

I just had my first consult with an urologist for low-T. I was surprised - the visit seemed rushed, and the doc seemed to want to start me on injections right away. I asked about Clomid and he was saying he only uses it for fertility and that it wouldn't provide any benefit for someone with secondary hypogonadism (which he suspected I had). Frankly, I thought secondary hypogonadism was when one tried Clomid.

He also doesn't use HCG unless for fertility related issues in younger guys.

He was receptive to my asking about trying Androgel first before going into injections, and he was okay with that.

He seemed to be steering me towards periodic injections of Aveed. In office injection only, once every 10 weeks, blah blah. Looks like that may not get my T-levels high enough, but who knows?

I mentioned my previous episode of problems with DHEA, and that the last couple of months I felt worse than before trying DHEA. He said it was possible that the DHEA had impacted my natural T production, and when I stopped levels crashed.

He ran little in the way of labs, just a PSA/rectal exam, CBC, and a new T-level as a baseline. None of the other tests I would have expected.

Just wasn't really impressed, but all the other urologists around here have backlogs until July for new patients. What is everyone's thoughts on this doc? Should I stick with him for a while, or make an appt with anothe doc in July/August?


I really wanted to start off with Clomid, then go to T-injections if necessary. If I go with this doc's advice and try the Androgel and don't get good results, will I have any problems if I were to find another doctor and try Clomid first before going with injections?

 

[xqfq]

Hi BillS, welcome to the forum! I'm also new here, and new to TRT. But I've done a lot of research over the past couple of years so hopefully I can be a little helpful.


Clomid:
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From what I've read, most guys don't have success with clomid long term. There are outliers who do have success, though. Clomid will boost your total testosterone levels if you're secondary, but often does not provide long-term symptom relief. This may be because clomid, as a SERM, raises SHBG. As a SERM, it also has estrogenic effects in the body and in the brain. Clomid also has two isomers each with their own half life, and the secondary isomer (called Zuclomiphene), is highly estrogenic. So some guys feel good for a little while until the secondary isomer builds up in their system. You can see this graph for some information:

https://www.reddit.com/r/Testosterone/comments/59ceh2

There was a trialed drug that contained only the enclomiphene isomer of clomid, but it failed in trials as it didn't improve clinical endpoints the way that testosterone did. But for guys that find some success in clomid, they're likely to find more success in this cancelled drug (IMO).

Aveed:
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Your doctor probably doesn't know whether or not you'd be comfortable doing 1x-3x / a week injections at home. Aveed makes this a bit easier for the doctor. I have read that there is a risk of a lung issue called pulmonary oil with this product, as the injection is very large.

My worry would be that it would be hard to 'dial in' my dosage over the first year on TRT given the long half life of the drug.

If you're comfortable doing home injections, you may want to tell the doctor that. He's probably pushing Aveed just because it's easier.

General thoughts:
--------------------

At least your doctor wants to treat your testosterone issues! So you've got that going for you. As far as alternatives, there are many specialized testosterone services (e.g. telemedicine, which is what I use), but they have out of pocket costs that may be a consideration.

 

[Vince]

If it was me I would continue looking for a better doctor. I think you will have a hard time succeeding in trt with this doctor. I don't believe you stated your age, I would agree that younger men have a better success rate with clomid.

Did you have a complete thyroid panel, so many men with low testosterone also have issues with their thyroid. You should run TSH, free T4, free T3, reverse T3 and both antibodies.

Before I started my trt journey, I read 5 books on a subject and saw a number of doctors and clinics in my area. Do it right.

 

[fifty]

Clomid 25mg every day for trt is about as smart as taking aveed every day.

Do 25 eod or every 3 days or every 4 days or every 5 days. Almost no one does this. Think.

 

[BillS]

Vince, I'm 53. I have had no labs for thyroid, other than one about 2 years ago, and that was a really basic one, and it was "normal".

Xqfq, that was really informative; I had no idea.
I wanted to start with some non-injection therapies first. My wife is a pharmacist/licensed immunizer, so she is okay with giving me injections at first until I can do it myself. I did mention this to the doc, but he then went and got the literature for Aveed and some other weekly injectable (which I shouldn't take because I am sensitive to the sesame oil contained in it).

I am definitely not comfortable with the idea of the large Aveed injection in the gluteal muscle. Small bi-weekly injections ought not to be that bad.

 

[BillS]

I did some quick looking around about Zuclomiphene, and this study looked interesting:

Testosterone restoration using enclomiphene citrate in men with secondary hypogonadism: a pharmacodynamic and pharmacokinetic study

The drug Androxal that contained Enclomiphene seems to have been withdrawn from FDA approval, unfortunately. That might have been pretty handy to be able to try.

 

[TLR]

I started with a family doc 8 years ago and did not educate myself about what I was diving off into. You got some good advice from Vince above. DO NOT do what i did. Find a good doctor and educate yourself. Dont listen to anyone who speaks in absolutes in this realm, and dont get in a hurry to get started due to unrealistic expectations.

 

[BillS]

Vince, what books did you read, and what in particular should I be looking to do, other than read up here?

 

[Rabbit91476]

my endo was the same. cold, no explinations for his protocol. I took his script and instantly searched for a new md. found a local pcp that also does mens health thought I give him at try. he even increased the endos dose over a text message. if that doesn't work ill go defy. im on week 5 and feeling ggood