Clomid or Testosterone - Please Advise

[theodore1983]

Hello, Im 33 yo male and I have had a rough time lately. In early November I was having testicular pain and in the general area. After many trips to the Doctors/ER all they could find was some minute varicose. By this time I was so worked up my PCP prescribed me with Ativan. I had several family issues come up during that time as well which were very stressful. The ativan did not seem to help. I was on it for 2.5 months with a 3 week taper. I have been off of it for 8 weeks now. I had many issues while on it and off of it. I am still having issues with brainfog, insomnia, energy, drive to do things, anxiety/depression, appetite and poor sex drive. I have been using sleeping aides off and on a very low doses. I have not used them for a few weeks now and my sleep is still not what it used to be. I also saw a psychiatrist during that time and did not think i was a candidate for an anti-pyscotic which was good news to me. I have also been going to therapy once a week since this all started and it doesn’t seem to help but it is nice to talk to someone without criticism. After being off the ativan and still feeling symptoms I started to find that my symptoms were symptoms of low-t. I then sought out an endocrinologist. I had all the proper blood work done as follows. My PCP did prescribed me Testim I have not used it yet due to the end saying hold off until the test results come back. The doctor gave me two choices of injections/w AI or climid. He prefers the injections because of all the problems he has had with the use of clomid. He even calls me daily to see how I'm doing and talk for 45 minutes. What should I do?


REE T4 1.33 ng/dL 0.82 - 1.77 ng/dL
HEMOGLOBIN A1C 5.7 % 4.8 - 5.6 %
Vitamin D,25-Hydroxy,Serum 49.8 ng/mL
TSH 2.690 uIU/mL 0.450 - 4.50 uIU/mL
FSH 3.1 mIU/mL 1.5 - 12.4 mIU/mL
LH 1.6 mIU/mL 1.7 - 8.6 mIU/mL
PROLACTIN 7.2 ng/mL 4.0 - 15.2 ng/mL
TESTOSTERONE, TOTAL 267 ng/dL 1st test
TESTOSTERONE, TOTAL 222 ng/dL 3 days later
VITAMIN B12 527 pg/mL 211 - 946 pg/mL
CORTISOL - AM 15.9 ug/dL
TSH PM 3.770 uIU/mL 0.450 - 4.50 uIU/mL
Estradiol 13.5NORMAL Reference Range: 7.6-42.6 pg/mL
Prostate Specific Ag, Serum 0.3NORMAL Reference Range: 0.0-4.0 ng/mL
Triglycerides 156HIGH Reference Range: 0-149 mg/dL
HDL Cholesterol 38LOW Reference Range: >39 mg/dL
LDL Cholesterol Calc 127HIGH

 

[CoastWatcher]

Hello, Im 33 yo male and I have had a rough time lately. In early November I was having testicular pain and in the general area. After many trips to the Doctors/ER all they could find was some minute varicose. By this time I was so worked up my PCP prescribed me with Ativan. I had several family issues come up during that time as well which were very stressful. The ativan did not seem to help. I was on it for 2.5 months with a 3 week taper. I have been off of it for 8 weeks now. I had many issues while on it and off of it. I am still having issues with brainfog, insomnia, energy, drive to do things, anxiety/depression, appetite and poor sex drive. I have been using sleeping aides off and on a very low doses. I have not used them for a few weeks now and my sleep is still not what it used to be. I also saw a psychiatrist during that time and did not think i was a candidate for an anti-pyscotic which was good news to me. I have also been going to therapy once a week since this all started and it doesn’t seem to help but it is nice to talk to someone without criticism. After being off the ativan and still feeling symptoms I started to find that my symptoms were symptoms of low-t. I then sought out an endocrinologist. I had all the proper blood work done as follows. My PCP did prescribed me Testim I have not used it yet due to the end saying hold off until the test results come back. The doctor gave me two choices of injections/w AI or climid. He prefers the injections because of all the problems he has had with the use of clomid. He even calls me daily to see how I'm doing and talk for 45 minutes. What should I do?


REE T4 1.33 ng/dL 0.82 - 1.77 ng/dL
HEMOGLOBIN A1C 5.7 % 4.8 - 5.6 %
Vitamin D,25-Hydroxy,Serum 49.8 ng/mL
TSH 2.690 uIU/mL 0.450 - 4.50 uIU/mL
FSH 3.1 mIU/mL 1.5 - 12.4 mIU/mL
LH 1.6 mIU/mL 1.7 - 8.6 mIU/mL
PROLACTIN 7.2 ng/mL 4.0 - 15.2 ng/mL
TESTOSTERONE, TOTAL 267 ng/dL 1st test
TESTOSTERONE, TOTAL 222 ng/dL 3 days later
VITAMIN B12 527 pg/mL 211 - 946 pg/mL
CORTISOL - AM 15.9 ug/dL
TSH PM 3.770 uIU/mL 0.450 - 4.50 uIU/mL
Estradiol 13.5NORMAL Reference Range: 7.6-42.6 pg/mL
Prostate Specific Ag, Serum 0.3NORMAL Reference Range: 0.0-4.0 ng/mL
Triglycerides 156HIGH Reference Range: 0-149 mg/dL
HDL Cholesterol 38LOW Reference Range: >39 mg/dL
LDL Cholesterol Calc 127HIGH

I'm puzzled. You've posted here twice before with these labs - what has changed in the time that's passed? Don't misunderstand, we're glad you're here, but it seems as if you're circling the same territory. I am concerned that the doctor who ordered these labs requested the incorrect estradiol test for men and you're describing a protocol using an AI when one is clearly not called for at this point.

 

[theodore1983]

I'm puzzled. You've posted here twice before with these labs - what has changed in the time that's passed? Don't misunderstand, we're glad you're here, but it seems as if you're circling the same territory. I am concerned that the doctor who ordered these labs requested the incorrect estradiol test for men and you're describing a protocol using an AI when one is clearly not called for at this point.

Sorry! I thought it got deleted! I just don't know what to do! This brain fog, fatigue and non motivation is really getting to me! I am set up to get an injection tomorrow morning and am a lottle nervious I just want this to go away! What should my first weekly units be of tc? Why not start an ai right away? What e2 test should I ask for? He is very open to order any test i ask for! Please advise me as I'm going to tomorrow morning! Thank you!

 

[CoastWatcher]

Sorry! I thought it got deleted! I just don't know what to do! This brain fog, fatigue and non motivation is really getting to me! I am set up to get an injection tomorrow morning and am a lottle nervious I just want this to go away! What should my first weekly units be of tc? Why not start an ai right away? What e2 test should I ask for? He is very open to order any test i ask for! Please advise me as I'm going to tomorrow morning! Thank you!

Your anxiety is leaping off the screen, and I'm sorry you're having to deal with that. But I will be candid: you're not ready to start TRT. You have had an incomplete workup. You lack SHBG, free testosterone, DHT, and had the standard rather than the sensitive (LC, MS/MS) estradiol test run. Your thyroid may well require further investigation.

You don't know what sort of protocol is in place, but it includes an AI. How can an AI be ordered prior to therapy commencing when the wrong value for estradiol was obtained? More importantly, the leading doctors in this field never include an AI when starting therapy. Many, perhaps most, men don't require one. Should e2 rise it can frequently be dealt with via a protocol adjustment.

How often and how much testosterone are you going to be injecting? A good starting protocol is 50mg twice weekly, every 3.5 days. You plan to inject at home, on your own? What have you been told?

Im glad you have a compassionate doctor, but I wonder how much he is going to help you.

 

[theodore1983]

I will be on 120 of tc weekly and .5 ai thought the week! I will request the tests that you suggested! Anything else I should cinder? T3, t3f, too, Lyme, cortisol x4, ferritin, iodine???

 

[CoastWatcher]

I will be on 120 of tc weekly and .5 ai thought the week! I will request the tests that you suggested! Anything else I should cinder? T3, t3f, too, Lyme, cortisol x4, ferritin, iodine???

Well, I believe you are making an enormous mistake including an AI in your protocol when it is not called for. Crashing your estradiol is a distinct possibility, and that is a particular kind of misery. You saw the tests I believe that were missed. To that I would add t3, rt3, and thyroid antibodies, along with the four-point cortisol test. Were a CBC and CMP run?

 

[theodore1983]

Yes they were twice!

 

[theodore1983]

Well, I believe you are making an enormous mistake including an AI in your protocol when it is not called for. Crashing your estradiol is a distinct possibility, and that is a particular kind of misery. You saw the tests I believe that were missed. To that I would add t3, rt3, and thyroid antibodies, along with the four-point cortisol test. Were a CBC and CMP run?

So I'll request the test! Then what should I do from there? I just want to feel feel better!

 

[CoastWatcher]

You wrote that you were going to see your doctor and start therapy yesterday. What are the details of your protocol?

 

[theodore1983]

Tc 120 and .33 ai then start hgc! Should I ditch the ai or get tested first?

 

[theodore1983]

You wrote that you were going to see your doctor and start therapy yesterday. What are the details of your protocol?

I feel hot today still with a back of the brain headache! More energy but slept bad! Still feel Stacy!

 

[CoastWatcher]

I feel hot today still with a back of the brain headache! More energy but slept bad! Still feel Stacy!

You have not begun TRT, is that correct?

 

[theodore1983]

I got an injection yesterday at 8 am did I make a mistake can I just go off of it with just one injection?

 

[CoastWatcher]

I got an injection yesterday at 8 am did I make a mistake can I just go off of it with just one injection?

Ok, once again: specific details, please.

How much testosterone was injected? When will you next inject? What are the other details of your protocol? How much HCG is being injected, was an AI given, when will your doctor run follow-up tests?

 

[theodore1983]

Tc 120mg .33ai no hcg yet. Weekly injections! It is too late to quit it? Or stick with it? Follow up whenever I want them!

 

[CoastWatcher]

Tc 120mg .33ai no hcg yet. Weekly injections! It is too late to quit it? Or stick with it?

That is your decision. All any of us can do is point out things you should consider. You are highly anxious, and received a less than complete workup. You are taking an AI with an estradiol value that was determined by the incorrect lab test (even so, your estradiol is on the very low side, which causes even more wonder about the AI). Your dose is a large, once weekly amount of testosterone. But all of these things have been pointed out in earlier posts.

If you feel you and your doctor are on the same page...

 

[theodore1983]

If I do get an injection next week what dose would be more appropriate? Will it hurt me to just quit it after just one injection?? One more question! I sometimes feel perfectly normal! Is that common with a low t person????

 

[CoastWatcher]

If I do get an injection next week what dose would be more appropriate? Will it hurt me to just quit it after just one injection?? One more question! I sometimes feel perfectly normal! Is that common with a low t person????

Why aren't you injecting on your own, at home? Should you stop after an injection or two it should pose no problems. But then, what would you do?

Its as if you're responding in the moment, without a plan. There is no question you are hypogonadal.

 

[theodore1983]

Doc want me to do it on the office the first couple of times. Can hyporgonald come on all the sudden with stress and never recover? Can adrenal fatigue have a key role in it??

 

[CoastWatcher]

Doc want me to do it on the office the first couple of times. Can hyporgonald come on all the sudden with stress and never recover? Can adrenal fatigue have a key role in it??

It would help you to spend time here reading the sticky posts in the Forum in each respective folder. The more you come to understand your situation the better advocate you'll be.