Monotherapy: HCG v. Clomid

Thread starter #1
Hi all. 26 y/o male with no history of anabolic use and no identified causes of low T despite rigorous diagnostics at age 21 or so. I responded positively to 250iu Pregnyl every other day, and have used that for about 4 years. With Pregnyl, my testosterone levels went from lower to the upper middle parts of the ranges on the lab work. They have stayed consistent.

The only time I’ve ever had estrogen issues was when I was briefly taking both HCG and test cyp. I briefly experimented with Arimidex and it worked, but my doctor was worried about long-term health effects from Arimidex. So I discontinued test cyp and Arimidex and have been fine on HCG alone since. I have never tried Clomid or anything besides test cyp, HCG, and Arimidex.

Recently moved and switched insurance so I had to see a specialist to keep receiving Pregnyl. I was referred to an endocrinologist who recognized that Pregnyl works for me but worried that it was not a feasible medication for life given it’s relatively high cost and sometimes limited availability. I’m aware of the high cost aspect: I had to twist my work and new health insurance servicer to agree to cover Pregnyl after having coverage for years on another plan. And as for unavailability, I’d had Pregnyl go on backorder twice while taking it. Luckily, I had back stock both times. Both now and with my old plan, I get 90% coverage of Pregnyl after I hit my deductible. Otherwise, it’s about $100. I work as an attorney so I anticipate always having some respectable health coverage tied to my employment. Although who is to say what Pregnyl price and access will look like with looming healthcare reforms in the next two decades or so.
Here’s the issue: my endocrinologist has agreed to continue prescribing me HCG if I want it. It’s a pain having a medication that requires refrigeration (esp. for travel), regular refills via specialty pharmacies, and injection. However, he has offered to put my on Clomid to address his long-term cost and availability concerns. This would entail some workups, etc. It would be Clomid monotherapy.

My questions:
  1. Are his concerns about price and availability relative to Clomid monotherapy valid?
  2. Knowing I can always switch back to HCG monotherapy, should I try Clomid with the intention of using it long-term?
  3. What would be the most effective way to transition from my 250iu HCG every other day to Clomid? And what target dose/frequency should I be at for Clomid?
Any advice would be appreciated. I’m inclined to try his suggested Clomid monotherapy.

*Apologies but this was posted on another forum and got minimal engagement. Looking for advice soon before I follow up with my doctor next week
 

Cataceous

Active Member
#2
If you're insisting on the Pregnyl brand then price and availability could be problematic in the future. Otherwise I wouldn't be overly worried about generic hCG.

I would certainly give a SERM a try knowing I could revert to hCG monotherapy. However, I would do my best to see if I could get enclomifene instead of Clomid/clomifene. A recent post here said that a compounding pharmacy has it now, implying that a prescription might be possible if you can persuade your doctor. The problem with Clomid is that the zuclomifene isomer, about a third of the total, is estrogenic and has a very long half-life. This makes it harder to succeed long-term.

For the transition I would just drop the hCG and then start the Clomid or enclomifene, low-and-slow on the dosing, meaning a starting dose of maybe 12.5 mg EOD or at most 12.5 mg ED. The dose is adjusted upward very slowly, and only if needed.
 
#3
I have done both clomid and HCG mono-therapy and have used both Pregnyl and compounded HCG. Several thoughts:1) This sounds like a case of changing for no reason based on what might possibly happen but which also might not happen 2) I would be very hesitant to change if your sex drive and mood are in a great place. Many here struggle to achieve that and I have seen posts from people who went off on an experiment of some sort and then couldn't get back to where they were. 3) Clomid is very hard to dial in for the reasons stated above and probably others that we don't really understand. 4) I am in the same camp as some others here who have found Pregnyl to be more effective than compounded HCG 5) If you try clomid, I would start with 12.5mg every other day. Clomid is very frequently overdosed and in my experience you have to come off of it completely for several weeks and then restart if too much builds up in your system. 6) Just because clomid will raise your T levels doesn't mean you will get the symptom benefits that you get with HCG at the same level due to varying affects on SHBG and other things.
 
Thread starter #4
Hi all,
Met with my endocrinologist. Currently on a 2-week no HCG period followed with labs to establish what my “baseline” currently is. My endo says he’ll prescribe me Clomid if my levels are low enough at baseline. He has indicated that as long as I’m anywhere in the “normal” range (remember, I’m 26 y/o), he won’t prescribe Clomid. It appears that he won’t prescribe HCG again either if that’s the case.
Is there any literature for me to use that would establish what level should be considered “low” for my age group? When I started HCG monotherapy years ago, my chronic fatigue issues disappeared and my body composition improved markedly. I’ve still had mood issues since. The endo (and the more seasoned specialists he consults) think that TRT provides me no relief besides increased TRT levels leading to better body composition. They think any energy boost is in my head and that I should have normal energy at age 26 with testosterone levels in the 300s on the 300-1000 scale.
Please give me any thoughts as to what I can show the endo that would make them not accept my low baseline. I anticipate the test will show I’m just below 400. With HCG, I’m 600+
 
#5
I'd ask the endo why a 26-year-old should accept the testosterone level of an average 80-year-old. In your favor, two weeks might not be long enough to restart decent LH production. And though I'm not advocating it, a guy can easily push down his testosterone level for a test with some simple techniques, such as sleep deprivation, alcohol consumption, licorice root supplementation, etc. One time I reduced my levels from low-300s ng/dL to more like 130 ng/dL.

In the end though it's not worth it when you're still going to be dealing with a doctor who doesn't understand the nuances of hormone replacement therapy and is as reluctant to treat as yours is. The much better option is to go with a place like Defy Medical, even if it does involve some modest out-of-pocket costs.
 
#6
If you want to manipulate your natural T to appear to be lower on a test have the blood draw at about 5pm or as late in the day as you can.

One thing not mentioned with Clomid along with the Estrogenic factor is that it tends to push SHBG higher which will negatively impact your Free T. Which is what you should focus on with your Dr, Free T. But it's the Total that they use to make the diagnosis with so you may be in a tough spot there.
 
#7
Your T levels will almost certainly be very low after only 2 weeks off Hcg if you have been on it for 4 years prior . I would not worry about that.
 
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