Clomid only for secondary hypogonadism

[HealthMan]

My understanding is that clomid works by blocking estrogen at the pituitary. I am secondary that had "normal" LH and FSH levels (a touch above the low end of the normal range) before TRT. However my estrogen levels were extremely low close to undetectable prior to TRT. So if i quite TRT and use clomid only (for the main purpose of maitain fertility) will that work to raise my testosterone levels given i had very low estrogen levels to begin with (so the rationale is given i had very little estrogen and clomid works by blocking estrogen... So there is little to block to make it work). On TRT i have been at 600ng/dl TT and close to 1,000ng/dl TT. I only feel better close to 1,000ng/dl can this level be achieve with clomid only? Or i will better off adding HCG to my protocol? I am 34 years old

 

[CoastWatcher]

My understanding is that clomid works by blocking estrogen at the pituitary. I am secondary that had "normal" LH and FSH levels (a touch above the low end of the normal range) before TRT. However my estrogen levels were extremely low close to undetectable prior to TRT. So if i quite TRT and use clomid only (for the main purpose of maitain fertility) will that work to raise my testosterone levels given i had very low estrogen levels to begin with (so the rationale is given i had very little estrogen and clomid works by blocking estrogen... So there is little to block to make it work). On TRT i have been at 600ng/dl TT and close to 1,000ng/dl TT. I only feel better close to 1,000ng/dl can this level be achieve with clomid only? Or i will better off adding HCG to my protocol? I am 34 years old

Welcome to Excelmale. At your age, not yet 35, am I correct that you are considering Clomid for a full axis restart, so as to avoid having to maintain a TRT protocol for life? Or are you specifically looking to maintain fertility (which HCG can assist with while still administering exogenous testosterone)?

Clomid may may help you reboot your hormonal axis, this thread details the process.

https://www.excelmale.com/forum/sho...o-Reset-Hormonal-Axis-After-Anabolic-Steroids

This thread, an extensive one, initiated by Dr. Justin Saya discusses various factors that contribute to Clomid's success as a restart element.

https://www.excelmale.com/forum/sho...rns-or-do-they-really-exist&highlight=Unicorn

 

[HealthMan]

I am currently on TRT with no HCG (just Tcream + anastrozole). I am feeling great but I would like to maintain fertility. So i am debating what would be the best approach. Add HCG or drop TRT and use clomid only. I used clomid a while back and didnt feel great as I do on TRT. Tamoxifen also makes me feel awful

 

[CoastWatcher]

I am currently on TRT with no HCG (just Tcream + anastrozole). I am feeling great but I would like to maintain fertility. So i am debating what would be the best approach. Add HCG or drop TRT and use clomid only. I used clomid a while back and didnt feel great as I do on TRT. Tamoxifen also makes me feel awful

HCG strikes me as a no-brainer choice (and provides benefits to your overall health beyond the fertility angle). How long have you been on TRT? Would you care to post up your protocol and lab results?

 

[HealthMan]

I have been on TRT for roughly 8 months. 200mg Testosterone cream 2x a day, 0.25mg anastrozole twice a week, 100mg DHEA, 30mg pregnenolone and 45mg thyroid.
Total T 906 ng/dl, free T 235 pg/ml, estradiol 36 pg/ml.
i feel great specially when total T goes slightly above 1,000 ng/dl. I tried clomid and tamoxifen and didnt feel good. With TRT i became infertile (was fertile before). Not sure if i want more kids but want to be fertile in case i do (not planning to have kids in 1 year from now).
i will have a consultation with doctor Saya next week. Just afraid he wants to go the clomid route. It has been a long time since i felt this great. For me ideally i would just add HCG to my protocol and maybe HMG if needed.

 

[HealthMan]

I also recently added 10mg tamoxifen a day to get rid of a small lump in my right nipple that didnt go away with anastrozole. Tamaxifen makes me feel VERY tired, low libido etc. it has a been a while since i last tried clomid but given both are SERMs i am afraid a clomid only approach might make me feel terrible again even if satisfactory testosterone levels are achieved

 

[HealthMan]

Before TRT labs (had 2 done)
Total T 1)333 ng/dl 2)230 ng/dl
Free T 1)69 pg/ml 2)47 pg/ml
Estradiol 1)5.5 pg/ml 2) <5pg/ml

note very low estradiol before TRT. My joint were miseracle, high cholesterol despite being fit and eating very healthy. After 8 months on TRT cholesterol is normal and joint dont hurt anymore. Everything is good again.

 

[CoastWatcher]

I have been on TRT for roughly 8 months. 200mg Testosterone cream 2x a day, 0.25mg anastrozole twice a week, 100mg DHEA, 30mg pregnenolone and 45mg thyroid.
Total T 906 ng/dl, free T 235 pg/ml, estradiol 36 pg/ml.
i feel great specially when total T goes slightly above 1,000 ng/dl. I tried clomid and tamoxifen and didnt feel good. With TRT i became infertile (was fertile before). Not sure if i want more kids but want to be fertile in case i do (not planning to have kids in 1 year from now).
i will have a consultation with doctor Saya next week. Just afraid he wants to go the clomid route. It has been a long time since i felt this great. For me ideally i would just add HCG to my protocol and maybe HMG if needed.

I feel certain that Dr. Saya is not going to strong-arm you onto the "Clomid route" as you put it. It may well be discussed, it probably deserves to be, but his goal is yours: to adopt the most rational protocol possible to help you achieve all your goals.

 

[Dr Justin Saya MD]

For me ideally i would just add HCG to my protocol and maybe HMG if needed.

HealthMan - In your specific case this sounds like the best option, but we will indeed discuss all options.

I look forward to our chat!

 

[HealthMan]

Thanks Dr Saya! Looking forward to our chat too! I have heard nothing but great things about you. My current doctor is not willing to add HCG because he is not familiar with its use (he treats mostly older guys). He also only prescribes testosterone cream which is less than ideal for me because i had zero absorption and had to apply it in the perianal are in order to get it absorbed. However absorption is very fast and so is the elimination of T from my system. So after a few hours my T levels start to drop dramatically and i start to feel my old self again. So i really would like to switch to subq injections. Plus add HCG and HMG if needes to keep the factory running! Talk to you this wednesday!

 

[johndoesmith]

HealthMan - In your specific case this sounds like the best option, but we will indeed discuss all options.

I look forward to our chat!

Would you be able to answer healthman's original question?

If his estradiol levels were extremely low, along with low testosterone and lowish LH and FSH, would clomid even be able to work?

From what I understand, clomid blocks estrogen to make the pituitary think there's not enough testosterone, thus producing more LH and FSH. Healthman already had that naturally, so I'm guessing it may work, or it may just be a pituitary failure somewhat?

 

[Dr Justin Saya MD]

Would you be able to answer healthman's original question?

If his estradiol levels were extremely low, along with low testosterone and lowish LH and FSH, would clomid even be able to work?

From what I understand, clomid blocks estrogen to make the pituitary think there's not enough testosterone, thus producing more LH and FSH. Healthman already had that naturally, so I'm guessing it may work, or it may just be a pituitary failure somewhat?

With regards to this question, the answer would be yes...at his age (barring a true anatomical/physiologic hypothalamus or pituitary problem) Clomid would have a decent chance of working as intended.

The untreated HPTA can be suppressed by MANY factors and simply "low" estradiol or "low" testosterone (depending on the definition of each) may not be enough to fully stimulate the suppressed HPTA. Clomid is powerful enough to overcome many of those suppressors and gives valuable info about the integrity of the HPTA in doing so.

 

[johndoesmith]

Thank you for the reply.

I am just curious how this all works. I understand clomid acts as an estrogen antagonist, and I guess the antagonist effect must be strong. I just cannot wrap my head around how an antagonist can be stronger than NO stimulation from agonists.

As in if there's no agonist activity(low estradiol levels for example) how can you have less than no activity, if all an antagonist does is block the agonist(estradiol) from binding to the receptor. In my head it's like sealing shut a door that no one ever uses, how can you have less than zero people going through the door? Or am I just misunderstanding advanced endocrinology?

 

[Dr Justin Saya MD]

Thank you for the reply.

I am just curious how this all works. I understand clomid acts as an estrogen antagonist, and I guess the antagonist effect must be strong. I just cannot wrap my head around how an antagonist can be stronger than NO stimulation from agonists.

As in if there's no agonist activity(low estradiol levels for example) how can you have less than no activity, if all an antagonist does is block the agonist(estradiol) from binding to the receptor. In my head it's like sealing shut a door that no one ever uses, how can you have less than zero people going through the door? Or am I just misunderstanding advanced endocrinology?

To your question, I have never in clinical practice seen an Estradiol level of absolute zero ("no stimulation from agonist" as you put it). However, with the ANTAGONIST (Clomid) blocking receptors (as you point out) it may very well create the "illusion" for the hypothalamus that estradiol is zero (or otherwise very low).

 

[johndoesmith]

Okay that makes sense. I understand what you're saying about there never being an absolute zero estradiol level, if you've never seen it, it probably hasn't happened or is extremely rare.

Thank you for taking the time to explain this, especially since it's just for curiosity!