T Nation

26, UK, Just Prescribed Clomiphene - Opinions?

So finally got an appointment with the Urologist. He’s written me a prescription for Clomiphene 50mg 1 per 2 days as he’s concerned about affecting fertility with TRT at my age. Sent me for blood tests for pituitary function and told me not to take Clomids until results are back on Friday.

I don’t have test ranges but was told my test level was 10, range was 10-40 and someone my age should be at least 20 (not sure if that helps)

I’m wondering if any of you guys have any experience with Clomiphene? I’m reading a lot of mixed reviews. Some are saying it’s more effective for younger men, some are saying that felt great at around the 2 week mark then crashed.

Doc seemed willing to entertain the idea of Sustanon 250 injections 2x per week but wanted to try this first.

50mg EOD may be too much, LH levels can be excessive and then one can get high T–>E2 inside the testes and serum E2 gets high. SERMs generally increase E2. High E2 is probably the “crash”.

A few guys feel horrible with clomid, others are fine. Do not take 50mg as a first dose! For those affected Nolvadex works well and does not have those mood side effects.

pre-TRT labs should be:
FT or FT calculated in UK
LH/FSH - must be done prior to any form or TRT

You need LH/FSH to determine is the problem is in your testes or pituitary output. If pituitary, elevated prolactin from a pituitary adinoma, not rare, can be a cause that is correctable/managed with 0.5mg/week Dostinex/cabergoline.

Most docs do not do proper diagnostics and these are critical for young men when low-T must be regarded as a symptom and not the disease.

Many guys who come here have thyroid problems, see the last paragraph in this post. Making things worse is that the lab ranges are very insane which means that your doctors will not see anything wrong.

Many in UK have low iodine levels because iodized salt is generally not on the shelf in the shops. And if you do not consume a lot of dairy food, you are in trouble because that is where the government expects you to get iodine, even though iodine in dairy foods has dropped a lot.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Thanks KSman, some really great info here and a lot to digest, I’m still learning all the terms too so doing my best to interpret.

I’ll get my pituitary blood test back tomorrow, if this is the issue the doc will call and ask me to start on the Clomephene - are you saying I should request he changes me to Nolvadex to avoid sides? And at what dose?

If he insists I take the clomid 50mg should I take it once every 3/4 days to lower the daily dose?

I had my thyroid checked, as well as diabetes, vitamin D etc, all readings were within the “normal” range" - but as you say, these ranges aren’t accurate.

As far as managing the conditions myself:

  • I’m around 12% BF
  • Weight train 3x week, run 2x
  • Track all food for proper macros (plenty of good fats)
  • Gave up smoking a year ago
  • Decreased alcohol intake
  • Get at least 7 hours sleep most nights

Not sure what else I can do? Could a history of heavy cannabis and cocaine use in my late teens/early 20s be a factor?

I’ll try to get proper test results tomorrow when he calls so I’ve got a bit more to show you.

I started Clomid yesterday. Ill be 25 mg for a week and then 25 mg EOD and on the 3rd week and afterwards i’ll be on 12,5 MWF.
I added Arimidex 0,25 twice a week for estrogen control
For long term (that’s my idea) i rather prefer Clomid over Nolva… If all u want is a restart i think you should try Nolvadex.
Follow KSMan advices and get as much instructed as posible … I lost a lot of time and health thinking that endos were right and were reasonable.

Thanks for sharing, best of luck with the treatment.

I’m really in two minds about clomid - my uro is suggesting using it long-term but I am concerned about a raise in E2 levels and the symptoms (some of which I already have bouts of experiencing pre-treatment). The doc I was referred to did however seem pretty knowledgeable on the subject and has treated 100s of guys here in the UK.

There’s a lot of varying reports out there about clomid (or similar drugs) but most seem to agree it should be the first thing to try before TRT.

Hopefully labs tomorrow should shed some light on my current levels.

I wonder if anyone has been successful in using clomid to “kick-start” their natural production then coming off?

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Try clomid and see if you feel OK, most do.

Nolvadex 20mg can be substituted for 25mg clomid.

When taking a SERM, test TT, FT[not in UK], LH/FSH and E2.
If LH/FSH are >~6 and E2 is high, too much SERM for you.

If LH/FSH are good and TT, FT are low, looks like primary hypogonadism, stop SERM and go to TRT. If LH/FSH tested in the beginning and one is primary, SERMs are not going to help, but might used in low doses preserver fertility and avoid testicular atrophy as a substitute for hCG.

Clomid is good but most likely you’ll need some arimidex along with it to keep E2 in 20s.

Are you on this combination yourself?

Doc didn’t call back on Friday as agreed so I’ll chase him on Monday and post an update.

Yes. 25mg Clomid ED and .5mg Arimidex ED

How long did it take to Clomid kick in (producing T value > 500)?
What are your current numbers? Do you have numbers with different dosages?
How did u decide the dosages?
I suppose targeting T between 600 and 700 and E2 20-25 right ?
Did u had any sides? How is libido and body comp/ gym gains?
(Since low T I’ve lost more than 10 kgs and gained a lot of fat , and even i go to the gym everyday and have a nice diet it’s imposible to stop body deterioration … regained morning wood three weeks ago …)
Sorry for the number of questions :slight_smile: I started clomid terapy 5 days ago and i am " by my self" since doctor were useless.
Jw90, Sorry for invading the your post, but since we are all in the same boat, this ansewrs will help you aswell.
many many thks to all

At current dose total T is 721, E2 at 25. I need .5mg Alex ed to keep E2 at 25. I kept all my gains from TRT. I am still lean and libido is good. Clomid and Addx for well for me.

Use the search function, I have all of this detailed in former posts. Let’s not hijack this mans thread anymore.

I don’t mind, it’s good to hear of some success stories with Clomid, there’s a lot a of horror stories out there.

Quick update - still waiting to hear back from the Doc as he hasn’t looked at my bloods yet. Starting to suspect I may have deeper pituitary problems as I’ve been researching the link between this and vision problems I have experienced since childhood. Other things like sugar-crash-like symptoms with a negative result for diabetes furthers my suspicion.

Will post update when I hear from the doc.

Update - I got a call from the Doc’s secretary this morning.

He’s had a look at the results of my pituitary bloods and has told me not to take out my clomid prescription. Didn’t hear anything about the results but he wanted me in for an MRI scan. Hospital called shortly after and booked a scan for Friday.

Guess I will have to wait until at least next week to hear results of the scan.

What were your prolactin, ACTH and GH values ?

Apologies for the delay, work’s been killer. Had an MRI last Friday so waiting to hear results soon hopefully. In the meantime I have results of both bloods here.

FSH: 3.4 IU/L (1.4 - 18.1)
LH: 2.9 IU/L (1.5 - 9.3)
Oestradiol 168 pmol/L (0 - 145)
Prolactin: 153 mIU/L (45 - 375)
Testosterone 15.7 mnolI/L (8.4 - 28.7)

Results of a previous test (6 months ago):

Serum T: 9.9 nmol/L (8.4 - 28.7)
Free T: 0.175 nmol/L (0.169 -0.588)
Serum Sex Hormone Binding Glob (?) 37.6 nmol/L (17.3 - 65.8)

Units are UK if that makes any difference. Been doing a lot of research and believe problem is with pituitary gland as symptoms are not limited to those of low T. I also suffered a fractured skull on 2 separate occasions in childhood.

What do you guys make of these results? My E2 levels seem pretty high

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Vision: A growth on the pituitary gland can press on the optic nerves. What is frequently seen with that is a reduction of width of peripheral vision that should be near 180 degrees. We know that you do not have a prolactin secreting pituitary adinoma or one that secretes LH or FSH.

Blows to the head can damage the pituitary!!! MRI may detect that. Nothing can fix that.

That is an unusually high amount of anastrozole [Adex]. Do not take that as a suggested dose.

Clomid can work great for most guys, Nolvadex works for all if any SERM will work. Docs are in a rut about Clomid.

So knowing that removal will be required if a tumour is found, what will be the course of action if they find nothing? Are hormone deficiencies caused by damage to the pituitary correctable?

Will clomid still be the best option for me? And will this raise my already high levels of E2?

Removal is avoided if at all possible.

Pituitary regulates many hormone systems:
GH status checked via IGF-1
sex hormones
and more functions

Would only remove if a pituitary was creating toxic high levels or size threatens vision. Physical damage is static.

With low FT, FT–>E2 is lower and then higher E2 labs suggest a problem with E2 liver clearance. Liver screen for AST/ALT may be helpful. Also, some drugs/meds Rx or OTC [prescription or over the counter or off the shelf] impede E2 liver clearance by competing with the same enzyme pathways that metabolize estrogens.

Using a SERM will increase E2. You need to try to find the cause of elevated E2. A AI would be useful, 0.5 mg anastrozole per week in divided doses then adjust later to seek E2=80pmol/L and watch how LH/FSH, TT, FT also respond. Good luck with that in UK :frowning:

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