Protocol for Fertility/Low Testosterone Questions

Worthy

New Member
I recently had my initial consultation with Defy. It went really well and I'm very pleased to be working with them. As is usual after any doctor appointment, I always think of questions later. I'm a 32 year old male that is currently trying to conceive with my wife. Over the past several years I've experienced issues with low libido and frequent ED, as well as typical low testosterone symptoms such as constant fatigue, brain fog and weight gain. After trying to conceive for about 6 months with no luck, I finally decided to look into getting my hormones checked. My labs are as follows:

Total Testosterone: 325 ng/dL
Free Test: 11.0
DHEA-S: 172
LH: 2.2
Estradiol: 19.2
SHBG: 24.0

So doctor thinks I have secondary hypogonadism and put me on a protocol of 15mg clomid every day, 0.125 anastrozole every other day, and 50mg DHEA per day. That all seems fine. My question is in regards to drug interactions, which the doctor briefly talked to me about. I've been on mirtazapine (brand name remeron) 15mg a day, for the past 7 or 8 years for anxiety and sleep issues. He stated during the appointment that this drug is known to damper hormones in the body. I didn't know anything about that so after the appointment, I looked into it and it seems that mirtazapine has been shown to significantly reduce ones cortisol and DHEA levels in the body. I went ahead and tried 25mg of DHEA last night to see how I reacted to it before I started on the rest of the protocol. Today I've felt very sluggish and somewhat irritable. I felt pretty "off" from my usual self. I even felt some anxiety today. My question is, with mirtazapine suppressing cortisol so much, will it affect how I will feel while doing this protocol? I guess I'm asking if anyone would know how this drug will interact on a hormonal level with clomid, DHEA, and anastrozole?
 

hCG Mixing Calculator

HCG Mixing Protocol Calculator

TRT Hormone Predictor Widget

TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

Predicted Hormone Levels

Enter your total testosterone value to see predictions

Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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