T Nation

25 Y/O with Low T and ED. Currently Prescribed Clomid

Hello everyone,

I’ve been browsing these forums for quite some time and I thought I would finally post my own story.

For most of my teen/adult life I have suffered from erectile dysfunction.

I’ve been active in sports for most of my life and picked up a healthy weight lifting addiction after playing college football.

I’ve had little to no health issues outside of some ADD I battled as a child.

Long story short, I am a healthy in shape guy in his mid 20s who has little to no libido and outside of the occasional morning wood,erections are non-existent.

My first attempt at getting this issue figured out involved a doppler test at one of our local urology clinics here in Omaha, NE. The test came back revealing no physical issues in terms of my “gear” down there.

They did take some blood work and the results of said blood work are what brought me here.

Below is a brief description of my overall health including the lab results

(I apologize if I am not following normal protocol here, not sure if I am following the stickies mentioned in multiple threads)

Ht, 6ft 2in

215-220lbs depending on the day

Athletic/Muscular build

Plenty of facial/body hair

No real visual signs of Low T

Supplements: Fish Oil, GNC Sport Multivitamin, Whey Protein, and ZMA

Low T symptoms: Low Libido, ED

(I have never had an issue with lack of motivation or energy, only thing that has me depressed is a non-existent sex life outside of cialis use)

Labs:

TESTOSTERONE, TOTAL 398 ng/dL 285-950

TESTOSTERONE, FREE 108 pg/mL 50-247

TESTOSTERONE, % FREE 2.7 % 1.8-3.2

SEX BINDING GLOBULIN 15 nmol/L 10-74

ALBUMIN 4.8 g/dL 3.7-5.0

FREE T4 1.3 ng/dL 0.8-1.6

PROLACTIN 10.5 ng/mL 2.1-17.7

FSH 2.2 mIU/mL 1.4-18.1

GLUCOSE 87 mg/dL 70-99
UREA NITROGEN SERUM 17 mg/dL 6-24
CREATININE SERUM 1.08 mg/dL <1.31
GFR NON-AFRICAN AMERICAN > 60 mL/min/1.73m2 >60
GFR AFRICAN AMERICAN > 60 mL/min/1.73m2 >60
BUN/CREAT 16 Ratio
BILIRUBIN TOTAL 1.1 mg/dL 0.1-1.4
AST (SGOT) 38 IU/L <45
ALT (SGPT) 37 IU/L <50
ALKALINE PHOSPHATASE 61 IU/L <170
CALCIUM 9.6 mg/dL 8.5-10.5
SODIUM 142 mmol/L 135-146
POTASSIUM 4.2 mmol/L 3.5-5.2
CHLORIDE 103 mmol/L 96-109
CO2 30 mmol/L 23-32
PROTEIN SERUM 7.4 g/dL 6.4-8.2
ALBUMIN 4.8 g/dL 3.7-5.0
GLOBULIN 2.6 g/dL 2.1-4.0
ALBUMIN/GLOBULIN 1.8 Ratio

After doing a fair amount of research on my own, turns out 398 is well below the average level of total T for a guy my age.

That number was shocking to see, especially since my natural manly physique always led me to believe this libido/ED issue was all in my head.

These lab results caused me to take action. Luckily there is a very reputable university med center next door to my place so I immediately called them up to set an appointment with one of their Low T specialists.

I brought my labs from the local urologist and described my symptoms to the doc. I was told that my levels were definitely treatable but since I am a young man with aspirations of one day starting a family, complete TRT replacement therapy wouldn’t be advisable due to issues with fertility

So he prescribed me 25mg of Clomid to be taken 3 days a week before bed.

Ill be doing this for the next month and will be taking another set of labs after said month has passed.

I understand what the goal of clomid therapy is. We are basically trying to kick start my hypothalamus in order to increase my natural ability to produce these hormones.

I am currently 3 pills in and am a little wary of some the side effects of the drug.

Granted none of them have hit me since its so early in the ball game, but with clomid being potentially estrogenic i’m worried ill start needing to wear a bra…

My first set of labs didn’t measure my estriadol levels which is unfortunate so I don’t have much of a base to begin with there.

I am also hearing that clomid can completely eliminate a man’s libido. Which I know I already suffer from but still, it completely defeats the real purpose behind taking the drug.

Basically gents I am here for some advice.

Is clomid the right way to go here? Does anything in my labs point towards a specific reason why I might be going through these issues?

I know only time will tell if clomid therapy is effective or not, but any extra advice from people who have been through similar issues would be greatly appreciated.

You have no thyroid labs, no Free T3, TSH, Reverse T3 or antibodies tested only Free T4 which by itself means nothing. SHBG is typically low when thyroid function is low, when Free T3 is low or Reverse T3 is high it slows down every cell in your body, including SHBG which is made in the liver.

Testosterone is low and at a levels seen in elderly people, Clomid fails most men and has a very small chance of success, it’s a drug and not natural to the body = side effects. There are men on TRT together with HCG and having babies. Men with low SHBG require frequent injections usually multiple micro doses a week, once weekly injections isn’t optimal so you won’t feel optimal.

Again too many men are started on TRT with low thyroid function and wonder why they never feel better, the fact that these were missed is a red flag. Estrogen labs are important and were also missed, another red flag you should seek treatment from a competent doctor. These blunders are telling me this doctor doesn’t normally prescribe TRT, endocrinologist and urologist usually stink at TRT.

Very few doctors have enough knowledge on what labs tests to order or have to manage a guy on TRT. The ones that do have enough knowledge, don’t take insurance. Hormone specialists don’t really exists inside insurance networks.

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Any other symptoms I should be wary of when it comes to a dysfunctional thyroid?

I’m a little concerned that the thyroid wasn’t even mentioned.

Ill definitely bring it up to the doc.

A big theme it seems when it comes to hormone replacement is finding a doc worth his salt.

Any advice on finding one?

There are multiple advertisements in my area for clinics like numalemedical.com and limitlessmalemedical.com.

My family and I are a bit wary of these because they aren’t your typical run of the mill clinic and I’d rather avoid a “snake oil salesmen” or someone who permanently damages my already dysfunctional body just to make a buck.

Also, could you please make a list of what I should be getting tested next time I go in for a blood draw? I am having a hard time finding them anywhere.

I wan’t to make sure I cover everything.

Thanks for being so prompt!

Your welcome,

You can play the doctor lottery, go to these T-mills who are only interested in ripping you off and staff incompetence or you can go to an anti-aging clinic staffed by real doctors who have left the sick care model years ago and have the knowledge to balance all the other hormones affected by TRT. These clinics don’t typically take insurance, they couldn’t do their job if they did.

You can check thyroid status by checking oral body temperatures, morning (97.8) and afternoon (98.6). If you can at least hit 98.6 by 2pm constantly for weeks, you can forgo the thyroid panel. However I have excellent thyroid numbers with one exception, high antibodies which suggests Hashimoto’s disease. Now I can act upon the results.

I have great insurance and I’ve gone through many doctors and was ready to pull my hair out, then I found Defy Medical, and anti-aging clinic that offers telemedicine services. Dr. Saya is the best and can diagnose and treat complex medical conditions.

Total T
Free T
SHBG
Estradiol Sensitive (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
IGF-1
Cortisol
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

It’s good to try clomid. Clomid should block any man boobs even if estrogen goes up.

25 EOD is a good protocol. At least your doctor knows something and is having u take it 3x a week - which is great. Some Drs have insane protocols likeb50 mg a day. Doing it for short term should be fine. Some get the severe side affects of visual disturbances. If you get that then of course cease taking it.

I would take 4-6 weeks and redo labs. Include estradiol sensitive test too.

At your age it’s good to try clomid even if u may end up on injections later on.

And with clomid you should be able to confirm primary or secondary hypogonadism.

If clomid raises your numbers to a good level then you stop to see if you can maintain, and if you don’t maintain, you will feel much better starting lifelong trt.

Keep us posted man. And it’s ok to use Cialis or Viagra while figuring this out.

Ill definitely make sure to include these in my next round of bloodwork .

To be clear about my base labs, they were done at a local urologist with the intent that my ED was a physical problem only. Probably the reason behind the lack of estrogen/thyroid info.

The new doc I am seeing did believe the results taken from those labs were an efficient base though. Which is concerning because they clearly aren’t according to your info.

I take it you live in the Tampa, FL area? Or do you participate in Defy’s telemedicine services?

Their sight seems legit but I’m a bit wary of receiving treatment from leagues away.

I haven’t experienced any side effects so far.

I will stick with the clomid for now and see what happens.

Thanks for the reassurance.

I will definitely keep you posted.

Imo - especially at your age you should see an Endocrinologist first before a trt place. Dude you want to cover your bases. Each doctor specialty sees things in a different light, and you need that. What if you have a pituitary or adrenal tumor??

My first clueless endo who later I found out doesn’t normally do TRT on a regular basis tried to convince my I had receptor insensitivity since I wasn’t responding to his 200mg every 3 week protocol, imagine had I believed him. Would I have accepted defeat? Always get a second option is a doctor give you bad news.

Low Free T and or low thyroid hormones can cause ED.

I’m am using Defy Medicals telemedicine services, I’m in So Cal and they are in Tampa Bay, FL.

No problem man. I actually took clomid my self before trt but am 41. It actually raised my numbers pretty good but still had some ED. I got massive ejaculation loads on clomid. It only raised my t to 500. At your age you may benefit from it better.
Be careful of folks that give you advice NOT based on their own experience. My Endo took a brain MRI to rule out tumors which I dont have.

I believe the only people that should give you advice not based on their personal experience is a MD! But many in this forum have experienced a lot on our journeys.

For now, It may be early in the ball game to rule this second doc as clueless considering he was the one who actually took notice of my low T.

How he responds to my labs after 4 weeks of clomid will be the real determining factor

Especially now that I know the thyroid plays a huge role.

But I will definitely view Defy as an option if things go south.

I can’t thank you enough for the advice. This has eased my anxiety about all this tremendously and have a great game plan going forward.

Most doctors are in the sick care model. Hormone optimization (thyroid / TRT) is only a risk to them, even though it could greatly benefit you.

Please take a look at this.

It is a long read, but will answer many your questions in regard to fertility. I believe the study (which is a meta analysis) states that something like 97% of men on long term TRT got back to normal sperm production without any drugs given a long enough time (something like a year off). The drugs will speed up that time for most.

I think if not using HCG, one will become infertile. However, even those who didn’t use HCG have a really good chance of getting it back if wanted (if they give it enough time). So fertility (or lack of) is probably a temporary side effect for most men. I think similar for females and birth control.

I definitely plan on covering all my basis before diving into trt. Including checking for any pituitary or adrenal tumors (yikes).

There is no silver bullet to this stuff from what I’m seeing and patience is really key.

The good thing is I’m young and time is in my favor.

Thank you again for your input. I’ve been on my own here for a while and its a blessing to here from others going through similar issues.

I’m about to board a plain and will definitely give this a read.

That’s a HUGE relief considering my ultimate goal here is to raise a relatively healthy family.

Can you explain to me what you mean by the “sick care model?”

I’m not familiar with it.

It is more that they are focused on treating different symptoms, but are not really interested in optimizing health, and finding the root cause (if it is a risk to them).

I believe in men often times ED, or depression are related to low T or thyroid issues (that is the root cause). They are mostly given ED and depression drugs. There is also more money in this model.

When is your appointment? Cant want to hear what they say and do for you.

@skoltrain98 Just read about your situation and I am also wondering how things turned out for you on Clomid.