Clomid Experiment - Is Less Sometimes More?

[Varner]

I have posted on here before, but here's the basics:

* Low T last January
* Clomid prescribed at 50mg/day last February
* After a little over a month at 50mg/day: unimpressive Total T (went from 300s to low 500s); unimpressive LH numbers (went from 2.5 to 3.5).
* Dropped down to 25mg/day for a month while I was at the tail end of a 3-month diet. Total T dropped to 420, LH went up to 4.7.
* Went back up to 50mg/day while eating normally again. Total T went back up to 550, LH went to 6.0, free T at 137pg/ml.

Given the weak LH response to such high-dose Clomid, I have speculated that I've got a thyroid issue (my TSH last February was high at 4.7, supporting this hypothesis). But....my uro has no interest in thyroid stuff, all the endos here require referrals ----- my uro "referred" me to a doctor who, it turns out, has retired. So I need to go BACK to my uro or a GP with bloods and then seek a referral again.

I've been at 50mg/day again for like 8 months now. Subjectively, just feel "meh." So I'm going to go back down to 25mg/day. I'd like anyone's thoughts. This time, I will not be dieting as I experiment with the lower dose. I know caloric deficits can absolutely wreck testosterone levels, so I'm going to see if maybe the 420 reading last year was a result of the diet rather than the dosage.

Anyone have any idea of how long after beginning this before I can test bloods to check efficacy? I was thinking of doing it in about 6 weeks.

Any other thoughts? Dr. Saya wrote last year that less MIGHT BE more and then speculated as to why that might be - zuco buildup or a bell-curve response to SERMs, etc.

 

[Dr Justin Saya MD]

I have posted on here before, but here's the basics:

* Low T last January
* Clomid prescribed at 50mg/day last February
* After a little over a month at 50mg/day: unimpressive Total T (went from 300s to low 500s); unimpressive LH numbers (went from 2.5 to 3.5).
* Dropped down to 25mg/day for a month while I was at the tail end of a 3-month diet. Total T dropped to 420, LH went up to 4.7.
* Went back up to 50mg/day while eating normally again. Total T went back up to 550, LH went to 6.0, free T at 137pg/ml.

Given the weak LH response to such high-dose Clomid, I have speculated that I've got a thyroid issue (my TSH last February was high at 4.7, supporting this hypothesis). But....my uro has no interest in thyroid stuff, all the endos here require referrals ----- my uro "referred" me to a doctor who, it turns out, has retired. So I need to go BACK to my uro or a GP with bloods and then seek a referral again.

I've been at 50mg/day again for like 8 months now. Subjectively, just feel "meh." So I'm going to go back down to 25mg/day. I'd like anyone's thoughts. This time, I will not be dieting as I experiment with the lower dose. I know caloric deficits can absolutely wreck testosterone levels, so I'm going to see if maybe the 420 reading last year was a result of the diet rather than the dosage.

Anyone have any idea of how long after beginning this before I can test bloods to check efficacy? I was thinking of doing it in about 6 weeks.

Any other thoughts? Dr. Saya wrote last year that less MIGHT BE more and then speculated as to why that might be - zuco buildup or a bell-curve response to SERMs, etc.

Hi Varner,

Clomid is a VERY tricky and unpredictable treatment (due to the various E receptor interactions), but success can be found when the "stars" align.

These "stars" I speak of are many, but include most importantly a very capable and functional HPTA. Some of the other "stars" that need to align, as you hinted at, are optimization of all of the other factors that can INHIBIT the HPTA. I often tell my patients that when we are attempting to STIMULATE the HPTA, all of the factors that can INHIBIT the HPTA are still in play (a fundamental difference from HPTA suppressed TRT patients). In other words, sleep, exercise, diet, medications, STRESS, and countless other variables are STILL in play and will STILL play a role and, thus, need to be concurrently optimized to truly achieve the best results. Clomid merely helps, but won't do it all.

 

[Varner]

Thanks, Doc.
After reading a bit more in this forum (there's always something new to learn here) I've changed course a bit.

1) Levothyroxin @ 150mcg/ED
2) Pregnenolone @ 25mg/ED
3) Enclomiphene @ 25mg/ED
4) Diet shift - major reduction in simple sugars

[the T4 and Enclomiphene are "research chemicals." Not ideal, but....]

My reasoning here:

1) Levothyroxin - As I've mentioned before, my LH response to high-dose Clomid seems to be weak: a high of 6.0 and a low of 3.5 while on that dose. Unsurprisingly, my TT has only gone from 350ish pre-Clomid to 500-550ish on Clomid. After reading, it looks like one possible reason for a weak LH response is a bad thyroid. My TSH is high and I have a lot of hypothyroid symptoms. Maybe if I get that thyroid fixed, I can just solve the whole testosterone thing.

2) Pregnenolone - Hormone support, to give my body the building blocks if it's lacking any. Can't hurt, right?

3) Enclomiphene - Like most, I had a Clomid high within the first month of beginning therapy. Then it was subjectively mostly gone: good changes to body composition over a period of several months, but libido returned to basically where it was pre-Clomid. More energy but did not feel like a Viking king again after that first little high. Did I hit the Zuclomiphene threshold? https://www.excelmale.com/forum/showthread.php?6781-Why-Clomid-Fails-The-Zuclomiphene-Threshold. Only way to find out would be to reduce/eliminate Zuclomiphene. So I'll try to do that with the Enclomphine. If it doesn't work, I can always just start taking Clomid again after this trial run.

4) Diet - My blood sugar is pretty high. As Dr. Saya points out, there are tons of things that can inhibit testosterone production, and I'm fairly sure out-of-whack glucose levels are among them.My diet is pretty poor with a ton of junk food.

I think I'll do 6 weeks on this routine and then get thyroid and testosterone tested. I will update as I go.

 

[AbsoluteZ3R0]

The issue with clomid is that it has an exceptionally low maximum effective dose for most guys. As Dr Saya mentioned, it has various interactions with the E2 receptors in the body, many of which are unknown. Additionally, clomid has a tendency to significantly boost endogenous estradiol, a factor which also needs to be taken into consideration. Taking too much clomid simultaneously causes a high/low estrogen state, which is a uniquely uncomfortable feeling. With conventional trt, a patient might feel better with a total testosterone of 1000 than 700. The protocol can then be adjusted (usually) to facilitate this higher total. With clomid, once you find your maximum effective dose, going any higher is likely going to worsen symptoms. That said, most men with healthy testicles respond well to even very low doses of clomid, often doubling or tripling their total testosterone with far less than 50mg ED. Based on your labs, it seems to me that you're not much of a responder, considering your LH did not even move towards the upper range or past it.

 

[Varner]

Update:

Actually splitting Clomid and enclomiphene days, so taking my 50mg Clomid on one day, 25mg enclomiphene the next, etc.

No bloods yet. I've had a minor acne breakout since I began this regime.
I've had an absolutely remarkable shift in my mental energy/ability to focus. I've had ADHD all my life but hate taking meds for it. I don't appear to need them anymore. Not sure if this is actually something thyroid related or placebo, but I enjoy it.

My libido is totally gone. Worse than it was a few weeks ago by a long shot.

After I get my bloods and, assuming they show decent T improvement because of improved thyroid function, I plan on dropping to a more conservative Clomid or enclompihene plan - maybe 12.5mg a day or something similar.