ED with Enclomiphene and HCG

[genotrd]

Hi all,
I've recently come off TRT in an efort to concieve, but am experiencing something I never have before either whiel on TRT or even before that - ED.

Currently I'm taking Enclomiphene 25mg daily, HCG 500IU EOD, and Anastrozole 0.5mg EOD. I tend to be a high aromatizer. My recent bloodwork shows a total T around 550, free around 110 and E2 ultrasensitive at 12.

Could either the Enclomiphene or HCG be causing the ED I'm experiencing? I'm thinking of dropping one or the other as I'm struggling, even with 20mg of Tadalafil on board. It's almost as if something in my brain just isn't turning on so to speak to trigger an erection. Also wonderng if I should decrease my AI dose to increase my E2. I don't have any other crashed E2 symptoms like joint pain.

I'm 37yo and in good shape otherwise. Thanks for any advice - I'm really struggling.

 

[JmarkH]

I'll bet dollars to donuts it's the AI. I'd quit the AI altogether. You'll know when you wake up with wood.

 

[Simbarn]

I'll bet dollars to donuts it's the AI. I'd quit the AI altogether. You'll know when you wake up with wood.

I threw my AI's in the bin a long time ago...

 

[CKO]

To answer your question, it looks like you just taking too much of all those medications. Enclomiphene covers the e2 receptors in your brain, which in my experience can cause symptoms similar to high E2. For me this includes ED or loss of libido. Maybe consider 25mg EOD and 300 hgc EOD and 1/8 anastrozole 3x week.

I'm on the other side, AIs work great for me

 

[Jay Ara]

I would stop with Anastrozole.

You need estrogen to have libido.

The issue here is that HCG also inhibits your HPTA, therefore there is something missing here = FSH.

If you can add Menopur or GonalF on top of HCG.

I took 2000 iU HCG EOD and 300iU GonalF for 3 months until I could find sperm.

After 4 months I was able to concieve.

Good luck!
Cheers
Jay

 

[rimster]

Hi all,
I've recently come off TRT in an efort to concieve, but am experiencing something I never have before either whiel on TRT or even before that - ED.

Currently I'm taking Enclomiphene 25mg daily, HCG 500IU EOD, and Anastrozole 0.5mg EOD. I tend to be a high aromatizer. My recent bloodwork shows a total T around 550, free around 110 and E2 ultrasensitive at 12.

Could either the Enclomiphene or HCG be causing the ED I'm experiencing? I'm thinking of dropping one or the other as I'm struggling, even with 20mg of Tadalafil on board. It's almost as if something in my brain just isn't turning on so to speak to trigger an erection. Also wonderng if I should decrease my AI dose to increase my E2. I don't have any other crashed E2 symptoms like joint pain.

I'm 37yo and in good shape otherwise. Thanks for any advice - I'm really struggling.

Hcg gives me Ed. Tested it multiple times because i wouldn't believe it due to all the positive reports here on HCG but after many experiments for me that was the culprit. Tried lowering to a very low dose but the same results happened.

 

[Systemlord]

Could either the Enclomiphene or HCG be causing the ED I'm experiencing?

Both can cause ED, especially clomid. Clomid isn’t well tolerated. Clomid binds to estrogen receptors in the brain and blocking the ability of estrogen to bind to those receptors.

For you at least, TRT, hCG and FSH would have been better.

 

[Swilsondc]

Back several years ago I went completely off Test to try to get my sperm count back up. First I went on only Clomid for 3 months. It definitely killed my libido & erections. My total went down to 91. Even if my sperm count was super high I couldn’t have or didn’t want to have sex. Stopped that & went to HCG only. I can’t remember exactly but it was a couple thousand ius a week. Count eventually came back up to normal but it took 6-9 months. I didn’t know this years ago when I started Test but if you can get your count back up then go back on Test and keep taking HCG(much lower dose 500-1000/week it will keep your count up or at least prevent it from going to zero) if having another kid is any where a possibility in the future.

 

[rfranco]

I would stop with Anastrozole.

You need estrogen to have libido.

The issue here is that HCG also inhibits your HPTA, therefore there is something missing here = FSH.

If you can add Menopur or GonalF on top of HCG.

I took 2000 iU HCG EOD and 300iU GonalF for 3 months until I could find sperm.

After 4 months I was able to concieve.

Good luck!
Cheers
Jay

did you have any clomiphene in that mix? can HCG and Clomiphene be used conjunctively to achieve a better result in increasing sperm count on top of the GonalF

 

[Jay Ara]

did you have any clomiphene in that mix? can HCG and Clomiphene be used conjunctively to achieve a better result in increasing sperm count on top of the GonalF

I did use for while before GonalF.

I'm not a doctor, but I believe they will fight against each other.

Clomiphene should help to speed up the HPTA adjustment, helping to increase LH and FSH signals to the testes.

But HCG inhibits also LH signal so I guess it is too much medication for nothing.

HCG and GonalF does the job regardless your HPTA access situation, sends the required signals to your testes to produce Intra Testicular Testosterone and Sperm.

Good luck

Cheers
Jay

 

[aneuman]

I'm not a doctor, but I believe they will fight against each other.

Clomiphene should help to speed up the HPTA adjustment, helping to increase LH and FSH signals to the testes.

But HCG inhibits also LH signal so I guess it is too much medication for nothing.

There's seem to be a misunderstanding regarding "suppression" and "inhibition" of LH and the supposedly cancellation of benefits of enclomiphene or clomid and HCG.

hCG (human Chorionic Gonadotrophin) does not "suppress" the pituitary or "inhibits" LH production. hCG mimics LH which causes the testicles to produce more testosterone, as a result, the level of estradiol in the blood increases due to a process known as aromatization. As a result, this level of estradiol send a negative feedback signal to the Hypothalamus and the Pituitary which interpret this increase of estradiol as "there's too much testosterone, we need to back down" and that's how LH decreases, in a failed attempt to regulate the amount of estradiol in the blood. If the levels of testosterone are too high, then the level of estradiol are also higher, which could eventually result in the Pituitary completely stopping production of LH. If this situation persists for a very long time, eventually the pituitary could be "suppressed" (atrophied) . As you can see, it's a dynamic process, not that hCG goes and obliterates the pituitary, or takes it hostage so it cannot produce LH

Based on the above, and understanding that the Pituitary produces LH in inverse proportion to the levels of estradiol, wouldn't it be possible to fool the pituitary by making it blind to that increase in estradiol, so it continues to produce LH?

Enter Enclomiphene (or Clomid) which is a Selective Estrogen Receptor Modulator (SERM). What it does is that (and this is a very metaphorical and simplistic way to describe it) it plugs the estrogen receptors in the hypothalamus and pituitary so they become "blind" and think "hey, there's no estradiol, so we ned to produce more LH to increase testosterone production"

That's why hCG and Clomid don't "fight" each other, on the contrary, they could be synergistic, particularly for fertility reasons and they are frequently used together for that purpose.

hCG will cause direct testosterone production (assuming the Leydig cells are in good condition, that is, no primary hypogonadism) and increase intra testicular testosterone which is required to produce sperm. Clomid, will also keep production of LH from the pituitary, but more importantly, ramp up FSH production which is necessary for sperm as well.

Hope this helps dispelling the whole "hcg is suppressive and fights clomid" myth. As an anecdote simply, I along many others, have been on an doctor supervised enclomiphene + hCG protocol and can attest to the results.

I know many would ask if the same principle applies to TRT + Clomid. In principle it should, yet it seems that there's also androgenic feedback on the hypothalamus/pituitary that is too strong for the SERM to overcome, or some other mechanism that at least I am not aware of, but many have tried it without success. I do not have practical experience, but it could be, just maybe, that perhaps if you inject less than 5mg of testosterone per day, Clomid/Enclomiphene could still do something to keep the HPGA working. Just a hypothesis.

On the other hand, it's well recognized that hCG while on TRT would help prevent the Leydig cells from atrophy and could in some cases, help preserve fertility, depending on dose and protocol, and genetics.

 

[Cataceous]

...
That's why hCG and Clomid don't "fight" each other, on the contrary, they could be synergistic, particularly for fertility reasons and they are frequently used together for that purpose.
...

On the other hand, it's arguably redundant to use hCG with Clomid because Clomid alone is capable of putting LH at or above top-of-range. Having serum LH/hCG levels elevated for prolonged periods is already somewhat suspect due to the link to Alzheimer's disease. I have also not seen any definitive evidence that using hCG with Clomid is better than using Clomid alone. One study that's frequently cited found that hCG+Clomid is effective for improving fertility, but did not compare it to Clomid monotherapy.

 

[aneuman]

On the other hand, it's arguably redundant to use hCG with Clomid because Clomid alone is capable of putting LH at or above top-of-range.

I guess this is absolutely a possibility, which can happen with Clomid alone, by the way.

When I was on enclomiphene monotherapy ar 12.5 mg/day, after 3 months my LH was 20.8mIU/mL (range:1.5 - 9.3), however, when I was using Enclomiohene 12.4 + HCG 300 IU M-W-F-S, my LH was 2.7 IU/mL. Switching to Enclomiphene mono therapy alone, this time 12.5 mg M-F-S put my LH at 9.3

FWIW, neither my urologist or my PCP showed any concerns regarding LH at very high levels. I have my doubts.

But I get your point, even though SERM + HCG produced a lower LH labs levels than SERM alone, the labs were only searching for LH, not HCG, which mimics the effects in the body of LH, so the actual phuysiological effect was that of much higher equivalent LH, which I agree, could create unwanted and unknown risks, including Alzheimer's, although the link is not clear.

Having serum LH/hCG levels elevated for prolonged periods is already somewhat suspect due to the link to Alzheimer's disease.

An this is one of the reasons I decided to switch to TRT. At least with T, we know where the effect is being produced, and we can manipulate the amount we put it, which SERMS and hCG, there are a lot of unknowns, particularly long term.

Granted, exogenous T may have influence in the hormone cascade that we don't understand yet

I have also not seen any definitive evidence that using hCG with Clomid is better than using Clomid alone. One study that's frequently cited found that hCG+Clomid is effective for improving fertility, but did not compare it to Clomid monotherapy.

Agree as well. My urologist is treating someone I know for Low T, but been much younger than me, he wants to preserve fertility, so he puts him on Clomid 50 mg every day. His LHis at 9.x but his FSH is past 20. When my friend showed concern about the value he replied: "that's where we like it to be"