Weird FSH/LH Numbers on High Dose Clomid

[Varner]

Hi, all

I'm 31 and have been on Clomid since late February 2016. My urologist started me at 50mg/day and said we could decide how much lower to move the dose after we met again in June.

Pre-Clomid:

January:
Total Testosterone: 305 ng/dl (test was at noon)

February :
Total Testosterone: 362 ng/dl (250-827)
Free Testosterone: 79.7 pg/mL (46-224)
FSH: 1.9 mIU/ml
LH: 2.5 mIU/ml
E2: 14 pg/ml
TSH: 4.71 mIU/L (HIGH)

Post-Clomid:

March:
Total Testosterone: 518 ng/dl
Free Tesosterone: 170.5 pg/mL

June:
Total Testosterone: 522
Free Testosterone: 170 pg/mL
LH: 3.5 (1.2-7.8)
FSH: 4.0 (1.3-11.4)

I'm rather surprised that my LH/FSH numbers were in the middle-low of the ranges, especially given my Free T results and the high dosage of Clomid. Does anyone have any explanation?

Since Clomid's role is stimulating LH/FSH production - and if my free T levels indicate that I've got quite a bit of T at hand - I would have thought it would be from significantly elevated LH/FSH. My LH went up by 70%, but it's still not very high and I don't think as high as one would expect with that free T level.


I've decided to drop down to 25mg/ed for a month and am re-testing on August 1. On some other forums people suggested that high dose Clomid might have worse results than medium-low dosage. After about 3 weeks of 25mg/ed, I can't say I feel remarkably different. Sex drive has probably dropped some, actually.


EDIT:

More info - zero sustained side effects, even at the high dose. I had some testicular discomfort at the beginning but it went away fairly quickly.

I'm 5'8. Before starting, I was about 160 lbs and 11-13% body fat (visible 6-pack but not totally cut up). Now I'm 148 and 7-9% (defined 6-pack, vascularity showing on arms, shoulders, legs, etc).

 

[CoastWatcher]

https://www.excelmale.com/forum/sho...rns-or-do-they-really-exist&highlight=unicorn
An excellent thread initiated by Dr. Justin Saya on low-dose Clomid.

 

[Varner]

https://www.excelmale.com/forum/sho...rns-or-do-they-really-exist&highlight=unicorn
An excellent thread initiated by Dr. Justin Saya on low-dose Clomid.

Thanks, I actually was reading that one before you even linked it.


I found this quote interesting:

You should ABSOLUTELY monitor LH levels when on a Clomid regimen, as without LH levels one cannot ascertain the degree of primary vs secondary hypogonadism by correlating the LH response with the resultant testosterone response. One should generally aim for mid to upper-normal LH levels typically 6-10mIU/mL. It is fine if there is a robust response and LH levels shoot above this range initially, but appropriate adjustments should be made thereafter to attain LH levels in this approximate range if continuing Clomid therapy for a significant duration (>30 days).

I'm at half to a third of that optimal range.

There are primary guys whose nuts don't respond to LH/FSH
There are secondary guys whose pituitary doesn't produce sufficient LH/FSH naturally.
And then there's me - I apparently have a weak pituitary response to Clomid?

 

[Nelson Vergel]

Varner

Did you explore your thyroid (TSH above 3.5) free T3 and free T4?

Low thyroid function can impair clomiphene response. Heck, if you could balance your thyroid you probably did not have to start Clomid.

 

[CoastWatcher]

Thanks, I actually was reading that one before you even linked it.


I found this quote interesting:




I'm at half to a third of that optimal range.

There are primary guys whose nuts don't respond to LH/FSH
There are secondary guys whose pituitary doesn't produce sufficient LH/FSH naturally.
And then there's me - I apparently have a weak pituitary response to Clomid?

How experienced is your doctor with Clomid therapy?

 

[Varner]

How experienced is your doctor with Clomid therapy?

I can't tell. He's not a talkative guy but stresses often that he's all about subjective wellness - he wants to do whatever he can to improve his patients' lives, he says. He prescribed me 5mg daily Cialis for that reason (though I can't afford to actually take it daily).

I asked him if my 50mg/day dosage would cause out-of-control estrogen. He said:
"Probably not, you're lean - happens to fat guys."

I haven't tested E2 since beginning Clomid but I don't FEEL any estrogenic sides.

 

[CoastWatcher]

I can't tell. He's not a talkative guy but stresses often that he's all about subjective wellness - he wants to do whatever he can to improve his patients' lives, he says. He prescribed me 5mg daily Cialis for that reason (though I can't afford to actually take it daily).

I asked him if my 50mg/day dosage would cause out-of-control estrogen. He said:
"Probably not, you're lean - happens to fat guys."

I haven't tested E2 since beginning Clomid but I don't FEEL any estrogenic sides.

Let me stress the importance of testing. Trying to navigate your protocol on the basis of subjective response can lead you down a blind highway. Please don't misunderstand me - how you feel must guide you. However, testing must help you. Self testing (Discountedlabs.com) is a valuable tool that puts that power in your hands.

 

[Varner]

Varner

Did you explore your thyroid (TSH above 3.5) free T3 and free T4?

Low thyroid function can impair clomiphene response. Heck, if you could balance your thyroid you probably did not have to start Clomid.

From February:
Free T4: 1.2 (0.8-1.8ng/dl)

No T3 though.

Other February results that may be of interest:

HDL Cholesterol: 37 LOW (> or = 40mg/dl)
LDL Cholesterol: 94 (<mg/dl)
Glucose: 100 HIGH (65-99 mg/dl)
Triglycerides: 78 (<150 mg/dl)

Then, some more numbers post-Clomid (from life insurance blood draw)

May:
Glucose: 78 (50-99 mg/dl)
Hemoglobin A1C 5.6 HIGH (2.0-5.6%)
Cholesterol Total: 143 (140-200 mg/dl)
HDL Cholesterol: 27.2 LOW (40.0-999.0 mg/dl) [This was shockingly low, to me]
LDL Cholesterol: 98 (80-200 mg/dl)
Triglycerides: 86 (10-150 mg/dl)
Cholesterol/HDL Ratio: 5.25 HIGH (1.50-5.0)

 

[Varner]

Let me stress the importance of testing. Trying to navigate your protocol on the basis of subjective response can lead you down a blind highway. Please don't misunderstand me - how you feel must guide you. However, testing must guide you. Self testing (Discountedlabs.com) is a valuable tool that puts that power in your hands.

Thanks. I'll be testing on August 1. I'll give Discountedlabs a shot.
I plan on including:

Total Testosterone
Free Testosterone
E2
LH
FSH
TSH
DHEA

 

[CoastWatcher]

Thanks. I'll be testing on August 1. I'll give Discountedlabs a shot.
I plan on including:

Total Testosterone
Free Testosterone
E2
LH
FSH
TSH
DHEA

Thyroid (TSH, T3, T4, rT3, antibodies), SHBG would be good to evaluate. A quick note: you know to request the sensitive estradiol test (LC,MS/MS), right?

 

[Varner]

Thyroid (TSH, T3, T4, rT3, antibodies), SHBG would be good to evaluate. A quick note: you know to request the sensitive estradiol test (LC,MS/MS), right?

Yes. My 14 score from February was the sensitive

 

[Dr Justin Saya MD]

With Clomid, sometimes "less is more".

 

[trt4me]

Ditto what dr saya said.
I took clomid 12.5 3x a week. Put my lh at the upper range and less "clomid" sides that way.
Definitely test shbg too.

 

[Varner]

Thanks for the feedback, guys. Like I said, I look forward to posting results so we have something to compare (keeping in mind that n=1 here).

Any idea of what the mechanism at play would be that would give you "more" at "less" on Clomid?
Oversaturation of the pituitary with the clomiphene, somehow causing some negative feedback?

Very curious about this.

 

[Dr Justin Saya MD]

Thanks for the feedback, guys. Like I said, I look forward to posting results so we have something to compare (keeping in mind that n=1 here).

Any idea of what the mechanism at play would be that would give you "more" at "less" on Clomid?
Oversaturation of the pituitary with the clomiphene, somehow causing some negative feedback?

Very curious about this.

Possible explanations for "less is more" (not universally by the way) phenomenon with Clomid:

Symptomatically - the zuclomiphene load with higher doses.

Physiologically - not yet known. Possibly as suggested a saturation effect, a ""bell curve" response pattern to E antagonist at hypothalamus, etc, etc...

 

[Varner]

Possible explanations for "less is more" (not universally by the way) phenomenon with Clomid:

Symptomatically - the zuclomiphene load with higher doses.

Physiologically - not yet known. Possibly as suggested a saturation effect, a ""bell curve" response pattern to E antagonist at hypothalamus, etc, etc...

Thanks, Dr. Saya.