Is My Doctor Right?

[Varner]

I went in to see my urologist yesterday. 8 months into Clomid monotherapy. Labs:

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
Free T: 148
LH: 3.5
[SHBG: 17 nmol/L] (calculated as above)

Dropped to Clomid @ 50mg/day at end of July

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

October
Total T: 550
Free T: 130
LH: 6.0
[SHBG: 24.5 nmol/L] (calculated as above)

I went in because I didn't feel good. My sex drive is back to my pre-Clomid days; which is to say nonexistent. Doctor looked at August and October results I brought and said "Looks like you're averaging around 500. 500 is great. You don't like being at 500?"

I told him that it wasn't the numbers themselves that brought me in - it was that I did not feel anywhere near like I felt in the beginning of clomid (though I'm also concerned about the fact that the trend is mostly downward since April for my Free T).

He said there was nothing he could do, because he wasn't going to prescribe TRT because I want more kids. I asked about a combination of HCG + Clomid and he said HCG (which he repeatedly referred to as "BCG" - not sure why) was too expensive and I wouldn't be able to afford it. He also told me that Clomid takes 100 days to work, and switching up my dosage (50 to 25 to 5) delayed that further.

I asked for a referral to an endo, so I could look into thyroid issues. He gave it to me - but the endo won't be able to see me for 6-8 months.

1) Is my doctor right about my numbers being "great"? I know 500 is decidedly not great for total t, but I'm not sure how my free t measures up. I know I felt better at 170 free t than at 79, 105, or 130.

2) Is HCG cost-prohibitive? I'm really feeling tempted to just buying some and experimenting with it.

3) Why would my doctor call HCG "BCG"?

4) Does Clomid really need 100 days to get to full strength? Subjectively (sex drive, alertness) and objectively (Free T), it appears I peaked at a little over a month in.

 

[Vince]

I went in to see my urologist yesterday. 8 months into Clomid monotherapy. Labs:

Pre-TRT
Total T: 362
Free T: 79
LH: 2.5

Began Clomid @ 50mg/day late February

April
Total T: 518
Free T: 170

June
Total T: 522
Free T: 148
LH: 3.5

Dropped to Clomid @ 50mg/day at end of July

August
Total T: 420
Free T: 105
LH: 4.7

Back up to Clomid @ 50mg/day right after August Test

October
Total T: 550
Free T: 130
LH: 6.0

I went in because I didn't feel good. My sex drive is back to my pre-Clomid days; which is to say nonexistent. Doctor looked at August and October results I brought and said "Looks like you're averaging around 500. 500 is great. You don't like being at 500?"

I told him that it wasn't the numbers themselves that brought me in - it was that I did not feel anywhere near like I felt in the beginning of clomid (though I'm also concerned about the fact that the trend is mostly downward since April for my Free T).

He said there was nothing he could do, because he wasn't going to prescribe TRT because I want more kids. I asked about a combination of HCG + Clomid and he said HCG (which he repeatedly referred to as "BCG" - not sure why) was too expensive and I wouldn't be able to afford it. He also told me that Clomid takes 100 days to work, and switching up my dosage (50 to 25 to 5) delayed that further.

I asked for a referral to an endo, so I could look into thyroid issues. He gave it to me - but the endo won't be able to see me for 6-8 months.

1) Is my doctor right about my numbers being "great"? I know 500 is decidedly not great for total t, but I'm not sure how my free t measures up. I know I felt better at 170 free t than at 79, 105, or 130.

2) Is HCG cost-prohibitive? I'm really feeling tempted to just buying some and experimenting with it.

3) Why would my doctor call HCG "BCG"?

4) Does Clomid really need 100 days to get to full strength? Subjectively (sex drive, alertness) and objectively (Free T), it appears I peaked at a little over a month in.

It would be nice to know your age, you probably would do better on a TRT protocol. Nelson and Defy both offer (paid) consultations.

 

[Varner]

I'm 32. I definitely want a few more kids, though I'm looking forward to adopting after I have one more biological one. So really, the main holdup on TRT is getting my wife pregnant. We got pregnant when I was Low T and had an FSH of 1.9, so I think it'll be easy once we start trying again.

 

[Sean Mosher]

1. Your numbers can't be great or you wouldn't have had a follow up with him. Obviously not a good doc.
2. I think it depends on how/where you get it. It comes as part of my TRT through PrimeBody so the cost is factored in along with Cypionate and Anastrozole.
3. No good answer for that LOL.
4. I believe for PCT's, if recovery is going to happen, it happens between 45-60 days. Obviously everyone is different, but if this continues to not work for you, TRT with hCG should be your next route. Is your estradiol being monitored at all?? Any idea what it is?

 

[ERO]

HCG costs like $70 for a couple of months' supply at Defy Medical, so if your doctor is telling you it is expensive, he is either making a very high margin on it or he does not know where to source it.

 

[johndoesmith]

Yeah with those limited tests it's hard to see how you're really doing. No FSH, e2, shbg, prolactin, or dhea-s. Also can you post the reference ranges please?

Clomid doesn't always work for everyone. You've given it some time, it's possible with a more experienced physician you'd get better results.

500 isn't a great level, and even if it was, you don't feel well. Saying because you are at 500 there's nothing more to do is ridiculous, it's barely even average assuming you're under 40.

Also from what I understand trt + hcg is enough to maintain fertility.

Free test is decreasing because clomid increases shbg.

 

[Varner]

1. Your numbers can't be great or you wouldn't have had a follow up with him. Obviously not a good doc.
2. I think it depends on how/where you get it. It comes as part of my TRT through PrimeBody so the cost is factored in along with Cypionate and Anastrozole.
3. No good answer for that LOL.
4. I believe for PCT's, if recovery is going to happen, it happens between 45-60 days. Obviously everyone is different, but if this continues to not work for you, TRT with hCG should be your next route. Is your estradiol being monitored at all?? Any idea what it is?

I haven't bothered with getting my E2 numbers, just because I'm on a budget. I'm low bodyfat, probably about 10% now, and don't get any sides that I'd consider estrogen sides.

Pre-Clomid, my E2 was at 14 pg/ml. I understand that to be on the lower side.

 

[Varner]

Yeah with those limited tests it's hard to see how you're really doing. No FSH, e2, shbg, prolactin, or dhea-s. Also can you post the reference ranges please?

Clomid doesn't always work for everyone. You've given it some time, it's possible with a more experienced physician you'd get better results.

500 isn't a great level, and even if it was, you don't feel well. Saying because you are at 500 there's nothing more to do is ridiculous, it's barely even average assuming you're under 40.

Also from what I understand trt + hcg is enough to maintain fertility.

Free test is decreasing because clomid increases shbg.

johndoe: I added a few results to my original post - E2, calculated SHBG, FSH from initial workup. Sorry I don't have more.