Regarding Testosterone Cypionate and Clomid for Opiod Induced Hypogonadism

[Kngpin1111]

Hello. I am a 34 male and have been on Methadone for 10 years but Suboxone before that. Over the last 5-8 years I have noticed that my sex drive, motivation and overall well being has tanked. My friend got tested and began TRT with cypionate and been on for 6 months and it has benefited him a lot.

Got my blood work and I had 78 Ng/dl total test and 6 estradiol and the doctor prescribed 200mg/.5 anastrazole shot IM once per week (taken Thursday), and 25mg Enclomifene one pill on injection day and one 3 days later.

My first shot and pill I felt HORRIBLE. It subsided after 2-3 days and after my second clomid pill I felt fine.

Second shot I felt horrible but it subsided about 1.5 to 2 days later and I felt better than I had in a long time (for the remainder of the week)

On the Friday after my second shot I felt horrible and call the clinic. Couldn't get the Dr but the assistant said to start shot splitting but didn't say 2x or 3x per week. I figured the lower and less mg the better. So on the Tuesday after my second shot of 100mg (taken on previous Thursday), I dropped to 67mg. After the first shot of 67mg I felt WAY better but not quite right since I still had some of the 100mg shot in my system and took the 67mg a day early taken Tuesday but should have waited until Thursday to take it. But I also didn't take Clomid on that day though.

It's convoluted and confusing I know. So on the Thursday (would have been 2 full weeks on trt) I got a hold of the Doctor and he dropped me to .4ml (80mg) twice a week (160mg total per week) instead of .5ml (100mg) twice a week for (200mg per week) that he had me on. He kept the Clomid though: 25mg on injection day and supposedly 3 days later but I am going to clarify since I am on 2 shots per week, don't know if I just take on the shot day.


Either way, on my second 67mg dose on my 14 day mark of being on TRT (prior to me talking to the Dr and him dropping the dose) I forgot to take my Clomid so I took it the day after I felt like absolute crap. Tired sad and a bunch of stuff.

From here on out, I am doing the .4ml (80mg) twice a week. They had me on Clomid to allow me to still be fertile but me being at 78ng/dl I was probably infertile before. I feel like the high dose of test cypionate starting out (200mg per week) and the high Clomid dose, made me feel horrible.

Today (day 18 of TRT), I just took my .4 (80mg) test and took my methdone and I do feel good, but I want to stop Clomid cause I think it's just boosting my testosterone dose even higher and making me feel weird tired and everything. Cause right now I feel great but haven't taken my Clomid. I don't even have a GF right now so if I want kids it will be in the future. I just want to feel better.

A few questions I have

-could the Clomid and high test doses making me feel weird cause of the Clomid and the test dose being high in the past? The weekly dose just dropped so I should see it reflect how I feel in the next week, plus I am on week 3 of TRT anyway. I do feel better with energy today (day 18 and haven't taken the Clomid yet)

-can I stop Clomid and continue the .4 of test/anastrazole and see how I feel in a few weeks and then if I need or want any to, start Clomid again to be fertile?

-if I am still emotional and tired in a few weeks should they give me additional AI? My pecks hurt but I see that as a side effect of Clomid. Dr said my body is just in hormonal changes.

- when I take Clomid while on test cypionate is it boosting my test as if I am on a higher dose of test? Is it boosting my estradiol? Cause I get tired after my 100mg test shot and Clomid pill but I get better after a few days.

All I need is to feel better. I don't mind have a longer time frame to get my test up. I don't need a high test dose and clomid to get there. I will wait for kids anyway, so I will stop Clomid if needed to feel better.

On the Friday I took the Clomid late and forgot to take it with my test dose, I felt like shit all weekend. It's not worth it to me. But today I took thetest only (the lower 80mg) and no Clomid yet, and I feel good.

Just want to get some help. Thanks again

 

[Vince]

Are you still a methadone?

 

[madman]

Hello. I am a 34 male and have been on Methadone for 10 years but Suboxone before that. Over the last 5-8 years I have noticed that my sex drive, motivation and overall well being has tanked. My friend got tested and began TRT with cypionate and been on for 6 months and it has benefited him a lot.

Got my blood work and I had 78 Ng/dl total test and 6 estradiol and the doctor prescribed 200mg/.5 anastrazole shot IM once per week (taken Thursday), and 25mg Enclomifene one pill on injection day and one 3 days later.

My first shot and pill I felt HORRIBLE. It subsided after 2-3 days and after my second clomid pill I felt fine.

Second shot I felt horrible but it subsided about 1.5 to 2 days later and I felt better than I had in a long time (for the remainder of the week)

On the Friday after my second shot I felt horrible and call the clinic. Couldn't get the Dr but the assistant said to start shot splitting but didn't say 2x or 3x per week. I figured the lower and less mg the better. So on the Tuesday after my second shot of 100mg (taken on previous Thursday), I dropped to 67mg. After the first shot of 67mg I felt WAY better but not quite right since I still had some of the 100mg shot in my system and took the 67mg a day early taken Tuesday but should have waited until Thursday to take it. But I also didn't take Clomid on that day though.

It's convoluted and confusing I know. So on the Thursday (would have been 2 full weeks on trt) I got a hold of the Doctor and he dropped me to .4ml (80mg) twice a week (160mg total per week) instead of .5ml (100mg) twice a week for (200mg per week) that he had me on. He kept the Clomid though: 25mg on injection day and supposedly 3 days later but I am going to clarify since I am on 2 shots per week, don't know if I just take on the shot day.


Either way, on my second 67mg dose on my 14 day mark of being on TRT (prior to me talking to the Dr and him dropping the dose) I forgot to take my Clomid so I took it the day after I felt like absolute crap. Tired sad and a bunch of stuff.

From here on out, I am doing the .4ml (80mg) twice a week. They had me on Clomid to allow me to still be fertile but me being at 78ng/dl I was probably infertile before. I feel like the high dose of test cypionate starting out (200mg per week) and the high Clomid dose, made me feel horrible.

Today (day 18 of TRT), I just took my .4 (80mg) test and took my methdone and I do feel good, but I want to stop Clomid cause I think it's just boosting my testosterone dose even higher and making me feel weird tired and everything. Cause right now I feel great but haven't taken my Clomid. I don't even have a GF right now so if I want kids it will be in the future. I just want to feel better.

A few questions I have

-could the Clomid and high test doses making me feel weird cause of the Clomid and the test dose being high in the past? The weekly dose just dropped so I should see it reflect how I feel in the next week, plus I am on week 3 of TRT anyway. I do feel better with energy today (day 18 and haven't taken the Clomid yet)

-can I stop Clomid and continue the .4 of test/anastrazole and see how I feel in a few weeks and then if I need or want any to, start Clomid again to be fertile?

-if I am still emotional and tired in a few weeks should they give me additional AI? My pecks hurt but I see that as a side effect of Clomid. Dr said my body is just in hormonal changes.

- when I take Clomid while on test cypionate is it boosting my test as if I am on a higher dose of test? Is it boosting my estradiol? Cause I get tired after my 100mg test shot and Clomid pill but I get better after a few days.

All I need is to feel better. I don't mind have a longer time frame to get my test up. I don't need a high test dose and clomid to get there. I will wait for kids anyway, so I will stop Clomid if needed to feel better.

On the Friday I took the Clomid late and forgot to take it with my test dose, I felt like shit all weekend. It's not worth it to me. But today I took thetest only (the lower 80mg) and no Clomid yet, and I feel good.

Just want to get some help. Thanks again

Hello. I am a 34 male and have been on Methadone for 10 years but Suboxone before that. Over the last 5-8 years I have noticed that my sex drive, motivation and overall well being has tanked.

Got my blood work and I had 78 Ng/dl total test and 6 estradiol and the doctor prescribed 200mg/.5 anastrazole shot IM once per week (taken Thursday), and 25mg Enclomifene one pill on injection day and one 3 days later.


Most definitely as use/abuse of opioids can cause dysfunction of the hpta/ hypogonadism.

*Opioids can induce several hypogonadism-related signs and symptoms, including sexual dysfunction, mood impairment, fatigue, obesity and cardiovascular disease, osteoporosis, and sexual dysfunction.

*OPIAD can have a profound effect on health and quality of life, and it can hinder a clinician’s ability to effectively treat chronic pain and manage complex comorbidities, but it often goes unrecognized and untreated

As you can see your testosterone level 78 ng/dL is horribly low and more importantly your free testosterone which is the active unbound fraction of T responsible for the positive effects would be in the gutter.

Smart move to seek help as your levels are critically low which will have a negative impact on your overall health (physically/mentally).

The big mistake here was it sounds like you ended up at one of those dime a dozen run of the mill T clinics that jack everyone up on high dose T from the get-go and it gets even worse as they are known for throwing in an AI off the hop which can lead to more problems like driving down/crushing your estradiol in some cases.

200 mg T let alone split into 100 mg T twice weekly is overkill as such a dose will have your trough FT level high/very high.

To top it off running too high a trough FT level will drive up your RBCs, hemoglobin, hematocrit, and estradiol levels which can cause issues for some men.

Most men on TRT are injecting 100-200 mg T/week whether once weekly or split into twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Even then the majority of men would never need the high-end dose 200 mg T/week.

Are there outliers sure but they are far and few.

Most men can easily achieve a healthy/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

The common starting dose is 100 mg T/week injected once weekly or split into twice-weekly injections.

Yes, there are some men who choose to inject more frequently.

Always best to start on a T-only protocol as we want to see how the body reacts and where such a dose will have your trough TT, FT, estradiol, and other important blood markers such as RBCs, hemoglobin, and hematocrit.

The use of ancillaries such as hCG or AI can eventually be added if need be but even then I would try to avoid the use of an AI!

Keep in mind that when first starting TRT or tweaking a protocol (dose T/injection frequency) hormones will be in FLUX during the weeks leading up until blood levels have stabilized (4-6 weeks when using TC/TE) and it is common for one to experience ups/downs during this transition as the body is trying to adjust.

Even then once blood levels have stabilized (4-6 weeks) it will still take the body time (a few months) to adapt to the new set-point and this is the critical time period when one should gauge how they truly feel overall regarding relief/improvement of low-T symptoms and overall well-being.

Every protocol needs to be given 12 weeks in order to claim whether it was truly a success or failure.

Blood work is always done once steady-state is reached which is 6 weeks after starting a new protocol (TC/TE).

Labs should be done a the true trough (lowest point) over the week just before your next injection.

If you are injecting once weekly then the true trough would be 7 days post-injection, and if you are splitting your weekly dose by injecting twice-weekly then the true trough would be 3.5 days (84 hrs) post-injection.

The dose of T you start on should only be increased at the 6-week mark if labs show that your trough FT level is too low which is highly unlikely in the majority and if anything many end up with too high a trough FT level as they are started on that high-end dosed T protocol 200mg/week pushed by those with that more T is better mentality!

Trust me when I tell you it's always best to start low and go slow.

There is lots of time to increase your dose down the road if need be.

Patience is key.

Clear as day that your doctor has no clue what he is doing seeing as he is starting you off on a high dose of T, throwing in an AI off the hop let alone recommending you take clomid along with your high-dosed TRT protocol since exogenous T will result in shut-down of the hpta.

If one is concerned with maintaining fertility or minimizing/preventing testicular atrophy while on exogenous T then hCG (human chorionic gonadotropin) which mimics LH would be used.




Couldn't get the Dr but the assistant said to start shot splitting but didn't say 2x or 3x per week. I figured the lower and less mg the better. So on the Tuesday after my second shot of 100mg (taken on previous Thursday), I dropped to 67mg.

From here on out, I am doing the .4ml (80mg) twice a week. They had me on Clomid to allow me to still be fertile but me being at 78ng/dl I was probably infertile before. I feel like the high dose of test cypionate starting out (200mg per week) and the high Clomid dose, made me feel horrible.

This says it all how about we just split up the absurd weekly dose rather than lowering it?

LOL, time to run.

Smart move on your part to lower your dose but you will most likely fare better dropping it much lower for the time being.

Keep in mind every time the dose of T is increased/decreased you will need to start over as it will taake another 4-6 weeks for blood levels to stabilize.

Labs will be done 6 weeks in.




It's convoluted and confusing I know. So on the Thursday (would have been 2 full weeks on trt) I got a hold of the Doctor and he dropped me to .4ml (80mg) twice a week (160mg total per week) instead of .5ml (100mg) twice a week for (200mg per week) that he had me on. He kept the Clomid though: 25mg on injection day and supposedly 3 days later

Again clear as day that your doctor let alone nurse is clueless as going from a whopping 200 mg T/week--->160 mg T split into 80 mg T every 3.5 days is still a high-end starting dose and will most likely have your trough FT level too high off the hop.

Still telling you to stay on the clomid LOL!




All I need is to feel better. I don't mind have a longer time frame to get my test up. I don't need a high test dose and clomid to get there. I will wait for kids anyway, so I will stop Clomid if needed to feel better.

Run from this clinic!

Lower your weekly dose to 100-120 mg T/week split (50-60 mg T every 3.5 days).

Drop the AI and the clomid.

Give it 6 weeks then get your blood work done.

Then you can decide what your next move will be.

Keep us posted.

Opioid-induced hypogonadism

Testosterone deficiency, the unrecognized consequence of the opioid epidemic in men (2022) Janine David, GP and Associate Specialist in Andrology; Mike Kirby, Editor Testosterone deficiency resulting from chronic opioid use can have a profound effect on health and quality of life, but it often...

www.excelmale.com

*The impact occurs rapidly, often within one week, and the highest risk appears to be among patients receiving significant dosages for longer than one month. The use of the more potent opioids is more likely to cause a greater risk of hypogonadism, but the effects seem to be reversible after a few days of withdrawal. As one might expect, long-acting opioids have a greater risk compared with short-acting drugs. There is a significant correlation between increased dosage and the development of opioid-induced androgen deficiency (OPIAD).14

*The prevalence of OPIAD ranges from 19% to 86%, with most studies reporting an overall prevalence higher than 50%, confirming the significant impact of opioids in reducing testosterone levels.14,17,18 Figure 3 shows the prevalence of low testosterone among chronic opioid users and men with other conditions.19

*A systematic review and metaanalysis of testosterone suppression in opioid users concluded that testosterone level was suppressed in men with regular opioid use regardless of the opioid type and found a mean testosterone difference of 5.7nmol/L between opioid users and controls. Opioids were found to affect testosterone levels differently in men than women, and testosterone was not found to be suppressed in studies examining opioid-using women.20

Opioids can induce several hypogonadism-related signs and symptoms, including sexual dysfunction, mood impairment, fatigue, obesity and cardiovascular disease, osteoporosis, and sexual dysfunction.




Summary

OPIAD is common and can impair satisfactory pain relief. OPIAD also impairs sexual activity, mood, and bone metabolism and is a risk factor for cardiovascular disease and obesity.

Guidelines support screening for testosterone deficiency in this situation. Consideration should be given to screening for testosterone deficiency prior to an opioid prescription, to provide a baseline. From a clinical point of view, the effect is reversible and if the opioid is removed, the deficiency is reversed, usually within a month.

Wherever possible consider alternative pain management strategies, as per NICE guidance, but if treatment is necessary consider using an opioid with a lower MOP affinity such as buprenorphine or tramadol, and enquire about relevant low testosterone symptoms, with testosterone measurements at subsequent follow-up

Current evidence suggests testosterone replacement might be beneficial and synergistic with analgesics to improve pain control in hypogonadal men.

OPIAD can have a profound effect on health and quality of life, and it can hinder a clinician’s ability to effectively treat chronic pain and manage complex comorbidities, but it often goes unrecognized and untreated.

 

[Kngpin1111]

Thank you for the indepth reply! Yeah I will most likely be on Methadone for a while to be honest, already been 9years. Yeah I am going to call the clinic today and let them know I am dropping the Clomid for now, just feel weird when I take it. Right now, the anastrazole is in the test cypionate oil mixed in but when I call them today, I plan on telling them that I want to do plain testosterone with my next prescription and try it like that first. He does have me down for a blood work 6 weeks from when he dropped me to .4ml shot, twice per week (160mg total). They charge 124 a month, and ups it to 270 if I need HCG which is too much for me honestly but I am going to reach out to my insurance to see. I know they cover testosterone cypionate injections, and since my testosterone levels were so low, I am sure that they will cover it. Does anyone have a clinic that is better? I like that they just send me the syringes and medication which makes it really convenient. Just wish they weren’t so gung ho off the bat with prescription level. From my info I found online, exactly what you are saying is the best route to go. Plain testosterone at first. If this clinic is willing to do plain testosterone for my next prescription (if I still feel weird after dropping Clomid in 6 weeks and doing 160mg split up to 80 per shot, but I think I will feel good. Already starting to feel better 18days in, just not when I was taking 200 mg at once, and when I took Clomid)

 

[Systemlord]

Does anyone have a clinic that is better?

Defy Medical.

I know they cover testosterone cypionate injections, and since my testosterone levels were so low, I am sure that they will cover it.

Two morning tests showing low-T, if you only have one, you would have to stop TRT to qualify for TRT.

Most men get TRT through private cash only doctors/clinics, because TRT and insurance companies don’t mix well.

Too many restrictions, hoops to jump through, poor treatment protocols and a lack of knowledgeable doctors.

 

[Junk]

Opioids totally crashed my Adrenals. This is a known consequence that doesn’t get enough attention in my opinion. Maybe get ACTH, Cortisol, DHEA checked if you haven’t already. TRT is tough on guys with weak adrenal function. Good luck.

 

[Jerry33]

Thank you for the indepth reply! Yeah I will most likely be on Methadone for a while to be honest, already been 9years. Yeah I am going to call the clinic today and let them know I am dropping the Clomid for now, just feel weird when I take it. Right now, the anastrazole is in the test cypionate oil mixed in but when I call them today, I plan on telling them that I want to do plain testosterone with my next prescription and try it like that first. He does have me down for a blood work 6 weeks from when he dropped me to .4ml shot, twice per week (160mg total). They charge 124 a month, and ups it to 270 if I need HCG which is too much for me honestly but I am going to reach out to my insurance to see. I know they cover testosterone cypionate injections, and since my testosterone levels were so low, I am sure that they will cover it. Does anyone have a clinic that is better? I like that they just send me the syringes and medication which makes it really convenient. Just wish they weren’t so gung ho off the bat with prescription level. From my info I found online, exactly what you are saying is the best route to go. Plain testosterone at first. If this clinic is willing to do plain testosterone for my next prescription (if I still feel weird after dropping Clomid in 6 weeks and doing 160mg split up to 80 per shot, but I think I will feel good. Already starting to feel better 18days in, just not when I was taking 200 mg at once, and when I took Clomid)

Hey what’s the update on using testosterone 80mgs twice a week (160 total)? I’ve read this whole thread and in the same exact situation you are even starting at 81ng/dl total testosterone and on methadone for 2 years. I’ll be starting try today just waiting on my script 100mgs twice a week of cyponate 200mgs a week total

 

[madman]

Hey what’s the update on using testosterone 80mgs twice a week (160 total)? I’ve read this whole thread and in the same exact situation you are even starting at 81ng/dl total testosterone and on methadone for 2 years. I’ll be starting try today just waiting on my script 100mgs twice a week of cyponate 200mgs a week total

Run from whoever is treating you!

They have no clue what they are doing.

This is your standard cookie-cutter protocol pushed by those dime-a-dozen run-of-the-mill T-clinics, so-called gurus, or worse yet those blast n cruisers littered on those Mickey Mouse forums polluting the internet.

Bad move getting caught up in that more T is better mentality.

200 mg T/week let alone split twice weekly (100 mg every 3.5 days) is a ridiculous dose to start someone on.

Even then the majority of men would never even need such a dose to hit a healthy let alone high FT.

Start low and go slow.

Lots of time to increase your dose if need be.

Need to do your homework here.