T Nation

29 YO, Low Libido and ED During TRT [Low SHBG, High E2, High Fluctuating PRL]


If you read the thyroid basics sticky you will see that AM should be 97.7F or better and mid-afternoon you also need to hit 98.6F

AI dose needs to match FT/Bio-T levels. TT=954 was good, TT=552 unexplained. 2x0.125 would be good to try for the lower TT number. I also suggested that perhaps you need more T and that will change the equation.


I am facing another shift of the predictable date of hCG returning to the market in my country. after 4 months waiting it turns out that it will return probably but not for sure in three months.

I shall kindly ask whether in this case 10/20 mg of tamoxifen EOD would be a viable option?
I have previously planned to include hCG and AI to my current TRT protocol.

My current goals - returning of fertility and normal libido. I suppose that SERM and AI on the same time is pointless.

thanks in advance


PS interestingly moving on 40 mg EOD (from E3D) is accompanied by significantly diminished acne.


anyone could share some experience considering TRT + SERM (tamoxifen) regimen?

PS seems that I should (A.) get AI perscription and (B.) go abroad looking for hCG


I have performed another labs

I think I am good with 40 mg Test EOD - blood was taken 24h after subQ injection.
with IM injections I had TT@954 ng/dl and E2@ 82pg/ml
now subQ injections TT@958 ng/dl and E2@ 56pg/ml - there is a progress but it still way to much.

I had also another high PRL@27ng/ml. I wonder if PRL or E2 (or maybe both) are involved in my low libido. I am afraid DOC will push for some dopamine agonist in order to push down PRL.

PS TSH is also pretty high @KSman. when it comes to blood morphology both HCT (55%; ref.: 40-54%) and HGB (18.4; ref.: 12-18) are little bit elevated.

PS2 I have re-tested PRL and suprisingly it was @ 52.56 ng/ml. Pituitary MRI (with contrast) should be the next step? However I am not sure whether PRL secreting tumor could be associated with 30-50 ng/ml values.


I have asked doctor for AI due to high E2 levels. He was a little bit confused and started to talk about finasteride (5-alfa-reductase inhibitor). I tried to direct him to anastrozole, and as a result, the doctor adviced me to look for an andrological clinic.

So it’s time for fourth doctor. It’s really hard struggle to find a doc having any knowledge on male hormones.


I have found a doc which propose following regimen for regaining fertility within 6-12 months:

  1. continuing TRT
  2. hCG 500 IU EOD (maybe it should be divided in half? Anyway it is still unavailable in my country)
  3. clomid 25mg ED

I am wondering about LH receptors on such regimen? will the receptors be damaged or maybe few months of such therapy would be harmless?

another thing I have found about SERM (tamoxifen rather than clomid) that it could effectively decrease prolactin (outperforming bromocriptine) and increase SHBG levels.

Recent publication:
“There is evidence that SERMs and AIs can be used in combination with human chorionic gonadotropin (hCG) for spermatogenesis recovery in azoospermia or severe oligospermia that is due to exogenous testosterone therapy.”


I have started iodine (Kelp - 225 mcg) and selenium (220 mcg) supplementation. Oral body temperatures increased immediatly by half celsius degree.

I am wondering how it will affect TSH, SHBG, and PRL levels.


PRL jumped in a short amount of time. Seems odd.
These things should be avoided before PRL labs:

  • orgasm
  • cuddling {babies | puppies | kittens or other warm furry things}

Higher E2 drives up SHBG.

You can use hCG or a SERM, but should not use at same time. SERM is better for fertility as it increases FSH and hCG does not. But many here have made babies with hCG.

Higher SERM or hCG doses will increase E2, sometimes a large increase which will drive up SHBG.


I took care of the right conditions before PRL measurement. Now I am wondering about the influence of hypoglycemia on PRL level. there is a plenty of studies in PubMed on this topic.

PRL increases with:
a) hypothyroidism
b) high E2
c) hypoglycemia

currently I have no other options than adding SERM to TRT. I am curious about it’s influence on gonadotropin levels.


New doc stated that @ my age TRT should be only an option.
I have never tried to unlock HPT axis, therefore doc recommended clomid for ~3 months.
I have quit TRT and started HTPA restart (16/03/2018) with somewhat high doses of SERM. Doc recommended 100 mg ED for 10 days, followed by 50mg ED for another 70 days.

I am aware that dosage is quiet high therefore I will control gonadotropin levels. I assume that besides ‘kickstart phase’ both LH and FSH levels should fall into lab reference ranges.

PS with selenium and iodine from seaweed I can easily reach 98.6F on the afternoon. In the morning it’s 97.16F.


Anything past 25mg is all estrogen, if you really want to risk man boobs please continue.


I am currently during clomid trial (10 days of 100 mg clomid ED, followed by 50 mg ED - CC taken before breakfast, 30 min after 50 mcg L-thytoxine) and surprisingly it makes barely no difference on gonadotropin and testosterone levels.
I have done blood test after 3 weeks on clomid (24h after last dosage). I suppose that it is sufficient amount of time to pull all desired effects on HPT axis.

have anyone ever heard about clomid-resistance? could it be caused by some kind of hypothalamus and/or pituitary damage? or maybe it is simply too early for any noticeable effects?

PS on the 5th day of 50 mg clomid ED, I’ve got significantly enlarged testes (with a sense of increased activity) and very good libido/mood. Next day I have developed really bad acne - one week later both acne and libido are gone (low T level). Am I some kind of T->E hyperconverter due to low SHBG?

  1. does gonadotropins levels increase proportionally to SERM dosage?
  2. does high PRL will compromise SERM influence on GnRH release from hypothalamus?
  3. does GnRH and LH/FSH release is still pulsatile under SERM therapy? or maybe it becomes constant?


update 13/04/2018 - after 4 weeks the restart begins
LH @ 7.26 IU/l [1.7-8.6]
FSH @ 2.81 mIU/ml [1.5-12.4]
TT @ 404 ng/dl [280-800]
E2 @ 32.99 pg/ml [27.1-52.2]


update 05/05/2018 - after 7 weeks of the HPTA restart
LH @ 11.05 IU/l [1.7-8.6]
FSH @ 5.41 mIU/ml [1.5-12.4]
TT @ 724 ng/dl [280-800]
E2 @ 48.83 pg/ml [27.1-52.2]
PRL @ 14.36 ng/ml [4.04-15.2]

OGTT (t0 - t60 - t120)
76 - 90 - 87 mg/dl [65-100; <160; <140]


How do you feel?


pretty good, way better than TRT which was a big rollercoaster for me. libido could be better, however during TRT it was next to zero for long periods.

I’m struggling with water retention retention and acne due to high E2, therefore I will attempt to decrease clomiphene dosage and/or add some AI (as long as the doc has mercy).


Keep us updated. Good luck


06/05/2018 - i have decreased clomid dosage. its currently 25 mg ED, i hope that LH will go down into the reference range.

10/05/2018 - i have added 1 mg anastrozole weekly - 0.5 mg on monday and thursday.


SERMs leading to high LH/FSH cause a lot of T–>E2 inside the testes and serum E2 gets high. Anastrozole is only effective in peripheral tissues and is not effective inside the testes and E2 may not be manageable.