Clomid and Lower Results??

[davidandrade]

Hello Dr. Saya,

Have you ever seen total testosterone levels go DOWN from being on clomid? I was on enclomiphene (generic androxal) for exactly one month and taking 12.5MG every third day. Here are my before and after results:

Before:
Total Testosterone: 564
Free Testosterone: 9.4
LF: 2.5
Estradiol Sensitive: 18.5

After:
Total Testosterone: 380
Free Testosterone: 15.1
LF: 3.4
Estradiol Sensitive: 18.7

So my free testosterone went up, LH up a little bit, estradiol unchanged, and total testosterone DOWN. So confusing. As I mentioned I used enclomiphene instead of clomiphene but the results should be similar....an increase in total testosterone. Why would my free testosterone go up and my total testosterone go down?

 

[Dr Justin Saya MD]

Hello Dr. Saya,

Have you ever seen total testosterone levels go DOWN from being on clomid? I was on enclomiphene (generic androxal) for exactly one month and taking 12.5MG every third day. Here are my before and after results:

Before:
Total Testosterone: 564
Free Testosterone: 9.4
LF: 2.5
Estradiol Sensitive: 18.5

After:
Total Testosterone: 380
Free Testosterone: 15.1
LF: 3.4
Estradiol Sensitive: 18.7

So my free testosterone went up, LH up a little bit, estradiol unchanged, and total testosterone DOWN. So confusing. As I mentioned I used enclomiphene instead of clomiphene but the results should be similar....an increase in total testosterone. Why would my free testosterone go up and my total testosterone go down?

Yes, I've seen this as well as just about every other combination of changes.

Your results suggest your SHBG has come down significantly (although the free T test can sometimes seem erratic). I suggest checking your SHBG and other factors that can impact SHBG - full thyroid panel, insulin sensitivity parameters (hemoglobin A1C, fasting serum insulin), metabolic panel to check liver function, IGF-1 to assess growth hormone production, vit D3...as a start.

Also, what is your DHEA level? This can play a role with free T levels.

 

[davidandrade]

Thank you so much for getting back to me Dr. Saya! I am so confused. So clomid itself can cause a lowering of SHBG and thus a decrease in total testosterone (less bound) and an increase in free testosterone? But I thought free testosterone was part of the total testosterone number so you would think a higher free testosterone number would correlate with a higher total testosterone number? Could my lower total testosterone number have anything to do with fact that clomid can actually decrease the pituitary sensitivity to GnRH….so my body is actually producing less testosterone than before taking the clomid because my pituitary is less sensitive to the GnRH vs taking no clomid all?

I have never taken any sarms before the one month of enclomiphene. I am 42 and my total testosterone levels have consistently been around 564 over the past few years. I would like to get my total testosterone levels to around 850 so I tried the enclomiphene. I chose enclomiphene over clomiphene because I read it had fewer side effects than clomiphene. I took 12.5MG every third day.

I am wondering if the enclomiphene I bought online is fake since the place I bought it from calls it a “research chemical” but says it's >98% pure. Although, if anything you would think my total testosterone levels would have stayed the same if it were fake…..but for it to go DOWN??? Although you said you have seen this with regular clomid as well.

So now I am wondering what to do. Should I try regular clomid which I have a prescription for at the exact same dose of 12.5MG every third day for a month and see if the results are any different? Or do you think my body obviously doesn't like enclomiphene/clomiphene since it makes things worse and maybe instead I should try Novladex? How much Novladex would I take to equate to 12.5MG of clomid every third day?
Regarding the tests you suggested I take, I recently had a complete physical and all of those things are normal. So the drop in my total testosterone is specifically related to the one month of enclomiphene I took since my total testosterone levels were consistently around 564 over the past few years prior to using the enclomiphene.

Thank you so much for your thoughts!!!

Yes, I've seen this as well as just about every other combination of changes.

Your results suggest your SHBG has come down significantly (although the free T test can sometimes seem erratic). I suggest checking your SHBG and other factors that can impact SHBG - full thyroid panel, insulin sensitivity parameters (hemoglobin A1C, fasting serum insulin), metabolic panel to check liver function, IGF-1 to assess growth hormone production, vit D3...as a start.

Also, what is your DHEA level? This can play a role with free T levels.

 

[Dr Justin Saya MD]

Thank you so much for getting back to me Dr. Saya! I am so confused. So clomid itself can cause a lowering of SHBG and thus a decrease in total testosterone (less bound) and an increase in free testosterone? But I thought free testosterone was part of the total testosterone number so you would think a higher free testosterone number would correlate with a higher total testosterone number? Could my lower total testosterone number have anything to do with fact that clomid can actually decrease the pituitary sensitivity to GnRH….so my body is actually producing less testosterone than before taking the clomid because my pituitary is less sensitive to the GnRH vs taking no clomid all?

I have never taken any sarms before the one month of enclomiphene. I am 42 and my total testosterone levels have consistently been around 564 over the past few years. I would like to get my total testosterone levels to around 850 so I tried the enclomiphene. I chose enclomiphene over clomiphene because I read it had fewer side effects than clomiphene. I took 12.5MG every third day.

I am wondering if the enclomiphene I bought online is fake since the place I bought it from calls it a “research chemical” but says it's >98% pure. Although, if anything you would think my total testosterone levels would have stayed the same if it were fake…..but for it to go DOWN??? Although you said you have seen this with regular clomid as well.

So now I am wondering what to do. Should I try regular clomid which I have a prescription for at the exact same dose of 12.5MG every third day for a month and see if the results are any different? Or do you think my body obviously doesn't like enclomiphene/clomiphene since it makes things worse and maybe instead I should try Novladex? How much Novladex would I take to equate to 12.5MG of clomid every third day?
Regarding the tests you suggested I take, I recently had a complete physical and all of those things are normal. So the drop in my total testosterone is specifically related to the one month of enclomiphene I took since my total testosterone levels were consistently around 564 over the past few years prior to using the enclomiphene.

Thank you so much for your thoughts!!!

Hi David - Clomid (and likely enclomiphene - although not FDA approved for use in the US yet so nowhere close to as much data) typically INCREASE SHBG. However, since your SHBG appears to have DECREASED (wouldn't know conclusively without before/after levels, but change in free T implies a decrease in SHBG) it likely decreased from a different factor/variable.

It is always "use at your own risk" with the research chemicals and, as such, I would generally advise against their use from a medical perspective. If you have Clomid prescribed for you by a treating provider, I would follow their recommendations or seek another provider. I, personally, wouldn't recommend any direct changes to your treatment regimen without you being under my care as a patient.

 

[davidandrade]

Thank you so much for your reply Dr. Saya. Isn't total testosterone made up of bound and unbound (free) testosterone? So isn't the free testosterone number part of the total testosterone number? So wouldn't it stand to reason that if the free testoesterone number went up that the total testosterone number would go up too? I just can't wrap my head around the inverse relationship on my lab results. Is it possible the lab made a mistake and maybe I should have them retested? Have you ever heard of labs making mistakes like this?

On a side note, not asking for personal advice, but just a general question. Have you seen men who do poorly on clomid do better on Nolvadex? When do you typically use Nolvadex instead of clomid? Thank you!!!

 

[Dr Justin Saya MD]

Thank you so much for your reply Dr. Saya. Isn't total testosterone made up of bound and unbound (free) testosterone? So isn't the free testosterone number part of the total testosterone number? So wouldn't it stand to reason that if the free testoesterone number went up that the total testosterone number would go up too? I just can't wrap my head around the inverse relationship on my lab results. Is it possible the lab made a mistake and maybe I should have them retested? Have you ever heard of labs making mistakes like this?

On a side note, not asking for personal advice, but just a general question. Have you seen men who do poorly on clomid do better on Nolvadex? When do you typically use Nolvadex instead of clomid? Thank you!!!

Do some reading about the role/function of SHBG. It is entirely possible for total T to go down and free T to go up *IF* SHBG levels go down.

It is also entirely possible for labs to make errors...have seen it many times as they are run by humans and, as such, can be error prone.

I've actually seen better results with Clomid alone or Clomid+Nolvadex as opposed to Nolvadex alone.

 

[DaveK22]

OP- Since you were on Enclomiphene, was that was part of a research study by Repros Therapeutics? If so, isn't it possible that you may have been receiving a placebo which is a control requirement in the clinical studies.

 

[davidandrade]

Thank you Dr. Saya. I really appreciate your feedback.

 

[davidandrade]

Hi Dave,

I was not part of the Repros trial. I purchased the enclomiphene from an online peptide company that calls it a "research chemical". It could in fact be real and just that my body reacts they way it does to it because I might have low SHGB for whatever reason. I am going to have my SHBH tested.

 

[DaveK22]

Hi Dave,

I was not part of the Repros trial. I purchased the enclomiphene from an online peptide company that calls it a "research chemical". It could in fact be real and just that my body reacts they way it does to it because I might have low SHGB for whatever reason. I am going to have my SHBH tested.

Holy cow...how did I miss this! I didn't realize the research chem companies were making this. Very interesting.

 

[davidandrade]

Hi Dr. Saya,

When making a dose adjustment either up or down on Clomid, how long should I wait before getting labs done after the dose adjustment to see the full effect of the dose change? Is it 2 weeks, 4 weeks, etc.? Thank you!