Combining Clomid and HCG?

[Varner]

I'm just curious about whether this might work for a subset of secondary hypogondal guys who aren't responding strongly to Clomid alone but want to maintain at least some of their natural LH production.

I know TRT will shut you down, full stop. My limited understanding of HCG is that, as an analogue for LH, it will at least reduce the amount of endogenous LH produced by the pituitary. But will it totally shut it down at every dosage?

I don't understand all the mechanisms at play here, so someone please swoop in and help me if anything I've said is way off. I'm imagining a few different ways of doing this:

* Alternating days - HCG M-W-F; Low dose Clomid Tu-Th-S-Su
* Blasts of HCG - 1 week HCG every day, followed by two-three weeks of Clomid
* Mini-blasts - 2 days HCG followed by 5 days of Clomid, etc.

I definitely do not want to make this thread about me, but using me as a case study...
I'm secondary, with baseline LH levels of around 2.5. 50mg Clomid/ED brought my LH to somewhere between 4.5 and 6.0 - a fairly weak response. My speculation is this is due to hypothyroidism reducing pituitary response to GNRH, but that's irrelevant to the larger point. I won't be able to see an endo about my thyroid for 6-12 months.

If I could maintain some amount of endogenous LH while getting the benefits of what amounts to exogenous LH for a year, until I'm able to attack the thyroid directly, I'd be happy. There may be other guys in a similar situation.

 

[johndoesmith]

I think you are over complicating this. I am not too familiar on the addition of HCG with clomid, but I have a gut feeling it would be a bit contradictory to have them taken together.

Plus I don't think stopping and starting clomid will work the way you think it will, it has a half life of 5-7 days. Even if it didn't, I don't think clomid is one you want to stop then start quickly, it defeats the purpose of it.

Not to mention how would you ever get labs? There's very little consistency with this protocol, so therefore way too many variables and you'd not know what is causing what, and making it hard to dial in.

An LH response of 4.5-6 isn't bad, that's 2-3 times what you were, and is mid range. Although LH itself doesn't matter as much as the response your testes have to it. How is your response so far?

Having untreated thyroid issues will delay or mitigate most of the benefits of clomid or TRT. You may need to get that taken care of first.

 

[Varner]

I'd love to get the thyroid taken care of, but all the endos in my area have waiting lists of 6-12 months. So I'm stuck for a year to half a year. I guess I should just suck it up, as your analysis seems mostly right.

My testes response to the LH is, I think, basically fair. My Free T is at 13.0 ng/dl, Total T at 550 ng/dl. Those numbers are not bad in relation to mid-range LH but not great either. My Free T was initially much higher - 17.0 after 1 month of Clomid - and has been mostly declining for 8 months.

 

[MikeXL]

I am supposing that you have Low T but are not on TRT.

If that is the case I think that you are overcomplicating things.

I would run the clomid first. That should be enough to get the LH kicked out.

 

[Nelson Vergel]

I know TRT will shut you down, full stop. My limited understanding of HCG is that, as an analogue for LH, it will at least reduce the amount of endogenous LH produced by the pituitary. But will it totally shut it down at every dosage?

HCG will shut down your LH just as T does.

There is nothing wrong with your protocol and it would be a good experiment for us to learn something. What doses are you thinking to use? What are you doing about your thyroid?

 

[Varner]

HCG will shut down your LH just as T does.

There is nothing wrong with your protocol and it would be a good experiment for us to learn something. What doses are you thinking to use? What are you doing about your thyroid?

Re: thyroid - simply waiting to see an endocrinologist (6-12 months from now). From my reading, it appears that Synthroid would be right for me. If my GP were willing to write me a script for it, I'd just go see her right now. But my guess is that's a little outside of her comfort zone, so I'm stuck in a waiting game.

 

[Varner]

My other option is just buying synthetic T4 at a "research chemicals" site and seeing if it works.

 

[johndoesmith]

I'd love to get the thyroid taken care of, but all the endos in my area have waiting lists of 6-12 months. So I'm stuck for a year to half a year. I guess I should just suck it up, as your analysis seems mostly right.

My testes response to the LH is, I think, basically fair. My Free T is at 13.0 ng/dl, Total T at 550 ng/dl. Those numbers are not bad in relation to mid-range LH but not great either. My Free T was initially much higher - 17.0 after 1 month of Clomid - and has been mostly declining for 8 months.

Reference ranges are needed.

Free test goes down because clomid will cause SHBG to increase.

I do agree with you that your response to the LH increase isn't that great, 550 total is nothing great.

How do you feel though?

 

[Varner]

Reference ranges are needed.

Free test goes down because clomid will cause SHBG to increase.

I do agree with you that your response to the LH increase isn't that great, 550 total is nothing great.



How do you feel though?

Subjectively, about the exact same as I did before beginning Clomid. Like many (perhaps most) I had an initial high for the first month of use. Now, 8 months later, my sex drive is back to zero and my energy is low.

 

[johndoesmith]

Subjectively, about the exact same as I did before beginning Clomid. Like many (perhaps most) I had an initial high for the first month of use. Now, 8 months later, my sex drive is back to zero and my energy is low.

Reference ranges needed.

It's a really common issue with clomid, look into zuclomiphene management. I don't think HCG will help with this as it's most likely either an estradiol or estrogen agonist issue and HCG will probably add more aromatisation, although I imagine LH from clomid induces aromatisation just as HCG does so I am not sure. I don't see how it could though.

 

[Varner]

Results and reference ranges:
Pre-TRT
Total T: 362 ng/dl (250-1100)
Free T: 79 pg/ml (35 - 155)
LH: 2.5 mIU/mL (1.5-9.3)
FSH: 1.9 mIU/mL (1.6-8.0)
E2: 14 pg/ml (< or = 29)
[SHBG: 28 nmol/L] (Calculated from Test + 5.2 albumin]
TSH: 4.7

Began Clomid @ 50mg/day late February

April
Total T: 518 ng/dl (250-827 ng/dL)
Free T: 170 pg/ml (46-224)
[SHBG: 10 nmol/L] (calculated from Test + 4.4 albumin)

June
Total T: 522 (250-1100)
Free T: 148 (35 - 155)
LH: 3.5 (1.5-9.3)
[SHBG: 17 nmol/L] (calculated as above)

Dropped to Clomid @ 25mg/day at end of July

August
Total T: 420 (250-1100)
Free T: 105 (35 - 155)
LH: 4.7 (1.5-9.3)
[SHBG: 23 nmol/L] (calculated as above)
Back up to Clomid @ 50mg/day right after August Test

October
Total T: 550 (250-1100)
Free T: 130 (35 - 155)
LH: 6.0 (1.5-9.3)
[SHBG: 24.5 nmol/L] (calculated as above)

 

[CoastWatcher]

Am I correct in thinking you may not have discussed the thyroid issue, at least the question of a prescription, with your primary care physician? The wait time to see an endocrinologist in your area is astonishing - if you've not raised the issue, I would urge you to. A prescription may be offered. The wait time you describe is unreasonable given symptoms that you are dealing with.

 

[Varner]

Am I correct in thinking you may not have discussed the thyroid issue, at least the question of a prescription, with your primary care physician? The wait time to see an endocrinologist in your area is astonishing - if you've not raised the issue, I would urge you to. A prescription may be offered. The wait time you describe is unreasonable given symptoms that you are dealing with.

I haven't discussed the thyroid with my PCP. I mentioned it to my urologist and he gave me the referral to an endo.
I didn't know if PCPs tended to write prescriptions for thyroid medications.

 

[CoastWatcher]

I haven't discussed the thyroid with my PCP. I mentioned it to my urologist and he gave me the referral to an endo.
I didn't know if PCPs tended to write prescriptions for thyroid medications.

You won't find out if you don't ask. I'd ask. That wait is ridiculous.

 

[johndoesmith]

I haven't discussed the thyroid with my PCP. I mentioned it to my urologist and he gave me the referral to an endo.
I didn't know if PCPs tended to write prescriptions for thyroid medications.

Is there only one endo in your area? I imagine there is at least one other endo who may be able to get you in sooner.

Have you called the office and asked the front desk staff to please notify you of ANY cancellations? Front desk staff love filling cancellations and people cancel ALL the time.

 

[ERO]

Have you considered Defy Medical or Prime Body? Waiting 6 months for an Endo is ridicules.