Can't take exogenous testosterone, Clomid isn't helping

[shadowpatterns]

Hello all,
I am at my wit's end and need some direction. I was taken off of shots/gel because hemoglobin went too high. Saw an endocrinologist and he put me on 50mg of Clomid 3 times per week. After follow-up labs, I was placed on 100mg of Clomid 3 times per week. The follow up lab after the dose increase showed an increase of 9 points after being on 100 mg 3 times per week for a month for a total free testosterone of 289. I've been on this medicine for approximately 5 months. Is this the best I can hope for from Clomid?? Also, since my dosage was doubled I have continued to gain weight despite exercise and diet change. I'm just looking for help. My libido is non-existent, and I feel almost asexual, which isn't at all normal.
Thank you.

 

[fifty]

What was your dose on gels/shots?

100mg clomid is too much. Can you post labs or at least LH, SHBG, estrogen?

 

[shadowpatterns]

It was 200 mg/ml IM every ten days, then switched to one pack of gel (generic testim) a day. Not sure what the dosage was for the gel. Only on it for one month, before my PCP stopped it b/c of elevated hemoglobin. The only things they test for in my labs is total testosterone and LH. As of 4-17-2020, my total testosterone was 298 and LH was 6.8. On 10-29-2019 my total testosterone was 197 and LH was 6.2 Thank you for any insight you may have.

 

[fifty]

@Gman86 @Systemlord @Cataceous
@Vince

 

[Cataceous]

The general recommendation is that guys should avoid taking more than 25 mg of Clomid per day. High doses of Clomid are potentially bad in many ways. You can actually end up making less testosterone than at lower doses. You can get estrogenic effects from both the additional estradiol production and from the estrogenic zuclomiphene component of Clomid. There's also speculation that Clomid isn't selective enough when it comes to the brain, and may be antagonizing locations apart from the hypothalamus and pituitary, leading to a loss of libido.

What's puzzling is to see only mid-range LH on such a high dose. Possibly there's still some signaling difficulty, and SERMs may simply not be effective. In this situation I would probably revert to TRT, ideally with frequent injections and very low doses, particularly at the start. The low-and-slow approach may help with avoiding elevated hemoglobin. It's necessary to measure SHBG along with total testosterone so that free testosterone can be estimated and used to aid in dose adjustments.

 

[swoops36]

What was your hemaglobin? You said high but didn’t give a number.

also 1 shot every 10 days isn’t an ideal protocol. Maybe you can take exogenous test, it just has to be the right way

 

[shadowpatterns]

The general recommendation is that guys should avoid taking more than 25 mg of Clomid per day. High doses of Clomid are potentially bad in many ways. You can actually end up making less testosterone than at lower doses. You can get estrogenic effects from both the additional estradiol production and from the estrogenic zuclomiphene component of Clomid. There's also speculation that Clomid isn't selective enough when it comes to the brain, and may be antagonizing locations apart from the hypothalamus and pituitary, leading to a loss of libido.

What's puzzling is to see only mid-range LH on such a high dose. Possibly there's still some signaling difficulty, and SERMs may simply not be effective. In this situation I would probably revert to TRT, ideally with frequent injections and very low doses, particularly at the start. The low-and-slow approach may help with avoiding elevated hemoglobin. It's necessary to measure SHBG along with total testosterone so that free testosterone can be estimated and used to aid in dose adjustments.

Thank you for your input. I mistakenly had 4.8 for LH on latest lab. It is actually 6.8. Sorry for the confusion.

 

[shadowpatterns]

What was your hemaglobin? You said high but didn’t give a number.

also 1 shot every 10 days isn’t an ideal protocol. Maybe you can take exogenous test, it just has to be the right way

I do not have the number but it was sufficiently above the upper limit for my PCP to refer me to another endo. The shots worked great when I took them weekly.

 

[Vince]

If you going to use clomid, I believe the best dose is 12.5 mg everyday or every other day. It seems at that dose. You get less symptoms and better results.

 

[Vince]

I believe you may get better results with Enclomiphene - Tailor Made Pharmacy results

 

[Paul M]

Just switch to more frequent smaller doses of testosterone, say 50mg or so twice weekly.

Large infrequent doses of T put my hematocrit through the roof.

 

[Golfboy307]

Yes, my hematocrit was borderline high on a weekly dose. I am 3x per week now, and it is in the 46.0 range. Big difference.

 

[shadowpatterns]

I'm getting some great suggestions and I certainly appreciate everyone who took the time to respond. One issue I am running up against is the challenge of speaking to an endocrinologist, who has probably forgotten more about these matters than I will ever know.

 

[Golfboy307]

Actually your assessment might be off considerably. Most of us who have had experience with endocrinologists would disagree. For male HRT most of them seem stuck on ineffective protocols from 30 years ago (for instance 200 mg of Test once every 2 weeks). Not saying that is true about your doctor necessarily. However, there is wealth of up to date knowledge on this site (notably Nelson's ebooks). You might be better off with a men's clinic or urologist.

 

[fifty]

I'm getting some great suggestions and I certainly appreciate everyone who took the time to respond. One issue I am running up against is the challenge of speaking to an endocrinologist, who has probably forgotten more about these matters than I will ever know.

Clomid doesn't appear to be working for you. At that dose, I would expect your LH to be above 10. Your estrogen and shbg are probably now through the roof which is part of the reason you don't feel good.

I believe the answer for you is back to TRT with a modified dosing schedule. I would start relatively low maybe 50mg twice per week or something similar. Adjust from there. That should get your T levels way above what they are now and keep hematocrit under what it was at 200mg/wk.

Remember sleep apnea can also raise hematocrit. You can mess around with things like SnoreLab app, pulse oximetry, breathe right strips, mutesnoring, etc. Many people jump from nothing to CPAP but there are lots of potential solutions in between.

 

[M.J]

I do 25mg Clomid on restart, but forget about libido, guys usually don’t feel good in clomid, for injection most take 100 weekly or maximum 140, some even below 100.
Testosterone cream can have less affect on hematocrit if any. And better than injection for some.

I will that a try cream soon as even with injection libido and erection are not the best.

 

[shadowpatterns]

Actually your assessment might be off considerably. Most of us who have had experience with endocrinologists would disagree. For male HRT most of them seem stuck on ineffective protocols from 30 years ago (for instance 200 mg of Test once every 2 weeks). Not saying that is true about your doctor necessarily. However, there is wealth of up to date knowledge on this site (notably Nelson's ebooks). You might be better off with a men's clinic or urologist.

Thank you, Golfboy307. I live in a somewhat rural area in western Indiana and my experience is exactly as you described: two general practitioners and two endocrinologists have pretty much stuck to the script you mention. I may need to look outside my area for some different expertise.