Is this a reasonable protocol?

[abcdef]

Last year DH was showing many signs of low T. After months of nudging on my part he finally went to see his doctor. He was 45 at the time. His Total T was 508. His free tree was in range but on the low end. His Vitamin D was unreadable and his cholesterol was very high (an ongoing issue for years). Doctor told him to take a Vitamin D supplement and fix his cholesterol and the ED issues would go away. We made changes to his diet and he's taking various suppliments to help with the cholesterol. Blood tests 6 months later showed improvement. The vitamin D did help with tiredness and lethargy for a while but this winter things got bad again. I increased his D dose but it didn't seem to help. His primary doctor has left and since getting him to the doctor is an ordeal, I convinced him to do a T test and Estradiol test through discounted labs after reading about it here. His total T came back at 329 (range 348-1197), free T was 4.9 (range 6.8-21.5) and Estradiol is 16.7 (range 8-35). Tired to get in to see the new primary and they told him he could be seen in September. So he made an appointment to see a Urologist, wait was a week and half (not sure what the deal with the primary is but 5 months is crazy). So urologist saw only the Total T, free T and estradiol tests and they discussed symptoms. Dr did not request any additional bloodwork which I found odd. He prescribed 50 mg of chlomid every other day for 3 months and to come back and see him.

So from what I've read chlomid seems like a reasonable idea but I have no idea if he should have done other labs first, also should he be taking anything else with it (I've seen some mention of DIM and DHEA but don't know enough yet to know if DH should take that or not), also does retested in 3 months seems reasonable?

Thanks for any feedback you can offer.

 

[ERO]

I would only wait 4-6 weeks and re-test, and be sure to get the sensitive E2 test along with Free and Total T & SHBG at a minimum. Some guys convert a LOT to E2 on a clomid dose that high. A common clomid dose is often 12.5 mg daily. At age 45, he may do a lot better with Test injections twice weekly as well. You will have a better idea after 4-6 weeks - if his Total and Free T are significantly improved, then clomid is working, but if you see little improvement, its time to switch to Test and HCG injections.

Oh, and save yourself some grief - seek out a TRT specialist as the run of the mill Endo or Urologist tends to be decades behind the TRT curve. We see the worst possible TRT protocols on this forum from your everyday Endo and Urologists. A lot of us here use and recommend Defy Medical. They do great work and they are very cost effective as well.

 

[Vettester Chris]

Who is DH?? I'm lost

 

[abcdef]

Who is DH?? I'm lost

DH = Dear Hubby

I'm the researcher of the family so I'm investing for him.

 

[Vettester Chris]

DH = Dear Hubby

I'm the researcher of the family so I'm investing for him.

Excellent, thanks for clarifying! I agree with ERO 100%. I think the doctor took the lazy road by offering Clomid and come back in 3 months. Especially with someone in their mid 40's.

If you want the best care for him, call a specialist (someone like Dr. Saya at Defy for example), who can provide a competent HRT program for him.

 

[abcdef]

I tried to find a TRT in our area and couldn't find any. This urologist is part of a men's health clinic and says he has a special interest in ED. So we were hoping that he had some clue what he was doing. But I figured I would use this board as a check point if he was anywhere close on what he was prescribing. I've heard that urologists aren't always the best but some do seem to get it so we thought we'd at least try because DH was more comfortable with that than going over the internet. Since getting him to the doctor at all is an ordeal, I didn't want to push so hard on who to go. Clomid seemed like a reasonable start from my previous research so I was hopeful that the guy new what he was doing. But the three months seemed really long to me as well. DH gets free labs through his work so the doctor is suppose to mail us a lab work request sheet. I figured the next test of him would be to see what labs he actually wants done. If it's seems really off base, I will push DH more to consider Defy.

 

[Dr Justin Saya MD]

First of all, it is great that you are researching for your husband! Chris and ERO offer sound advice (and I appreciate the endorsement as well

I have seen Clomid work for males his age and even older, although the odds are better for younger guys. The fact that the Uro prescribed Clomid without knowing your husband's LH (Luteinizing hormone) level raises valid questions. You would want to check his LH level before starting the Clomid and also monitor the LH level with his follow-up labs to assess how his pituitary gland is responding to the Clomid (this is how Clomid works - it stimulates the pituitary, which in turn stimulates the testes). In fact, if he already has a high LH on labs BEFORE clomid, then he has PRIMARY Hypogonadism (vs secondary) and Clomid would be a worthless treatment in that case. Keep us posted and good luck.

 

[Vitamin_C]

509 TT is respectable for someone his age, I was in that range as baseline, and I'm in my early 30's . Clomid may be a good option, but I would work on lifestyle changes first. Is he active in the gym? deadlifts and squats and some HIIT cardio will up TT a bit which could put him back in the 500 range. Diet is a key factor too, as well as abstaining from alcohol. I take Nettle, it has lowered by SHBG and upped my Free T, and I can back that up with labs.

 

[abcdef]

Dr. Saya, Thanks so much for the feedback. He took one dose of clomid last night before I got home. I'm trying to get him to see the doctor at his work (visits there are free) and see if he will order LH, FSH and SBHG at a minimum. I told DH if Dr. is receptive to see if he could get the Dr. to order some other baseline stuff as well. Monday is the earliest he could get that done but I figure the one clomid couldn't have too much impact on baseline numbers.

 

[abcdef]

509 TT is respectable for someone his age, I was in that range as baseline, and I'm in my early 30's . Clomid may be a good option, but I would work on lifestyle changes first. Is he active in the gym? deadlifts and squats and some HIIT cardio will up TT a bit which could put him back in the 500 range. Diet is a key factor too, as well as abstaining from alcohol. I take Nettle, it has lowered by SHBG and upped my Free T, and I can back that up with labs.

DH is not a gym guy. He's never been to the gym in his life. He's a bookworm type. I don't see him ever lifting weights. Last year he was walking quite a bit (3-5 miles at a times 3-4 days a week) but work got hectic and now he is so exhausted that mustering the energy for even short walks is hard. He's pretty much getting through the days on caffeine and crashing when he gets home at night.

I know 508 is in range for his age but he was having symptoms even back then. They have just got much worse with the drop of T. I think he would need to be shooting for something above the 500 mark before he will start to feel better. He doesn't drink or smoke at all. His diet was pretty decent the last year. We had cut carbs down and was eating lots of fresh veggies and protein everyday. But when his energy crashed this winter, he has added soda and sweets back in just to get through his work days. I'm sure it's not helping but right now that's how he is surviving.

 

[Jackie Treehorn]

I know 508 is in range for his age but he was having symptoms even back then. They have just got much worse with the drop of T. I think he would need to be shooting for something above the 500 mark before he will start to feel better. He doesn't drink or smoke at all. His diet was pretty decent the last year. We had cut carbs down and was eating lots of fresh veggies and protein everyday. But when his energy crashed this winter, he has added soda and sweets back in just to get through his work days. I'm sure it's not helping but right now that's how he is surviving.

I think it's great that you're doing all this legwork for DH, but honestly...he needs to take an interest in his own health and well being.

His 508 test level may very well be "in range," but it's nowhere near optimal. He need a full lab workup, to include a full thyroid panel, to see what's really going on here.

You couldn't ask for any better medical care than he will receive from Defy Medical. Dr. Saya and Dr. Crisler are experts in this field, and DH could definitely benefit from their knowledge.

DH adding soda and sweets to his diet just to get through the day is doing him more damage than good. I'll bet he gets a nice sugar high for a couple of hours, then crashes harder than ever, doesn't he?

Help is available for DH if he wants it. You need to get him off his butt, and call Defy. If he won't do it for himself, then get him to do it for you and your family. Good luck.