T Nation

31 on Clomid, Looking to Transition to T Cyp


#1

31 YEAR OLD CASE

-age: 31 years old, turning 32 in June

-height: 5’11”

-waist: 32”

-weight: 165lbs

-describe body and facial hair
minimal leg hair, no chest or abdominal hair, sparse facial hair (improved on Clomid), can go weeks without shaving.

-describe where you carry fat and how changed: abdomen, love handles

-health conditions, symptoms [history]: hypogonadism (DX in 2015), Vitiligo (thyroid issues?), anxiety, depression

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
- clomid 12.5mg MWF
- DHEA 25mg QD
- optimumum nutrition multivitamins
- fish oil
- Vitamin d3 5000u QD
- DIM 200mg QD
- Lexapro 10mg QD since June 2017

-describe diet [some create substantial damage with starvation diets]: conscious of what I eat, but am not strict by any means

-describe training [some ruin their hormones by over training]: gym about 3x per week, consisting of weights & basketball

-testes ache, ever, with a fever?: left has ached after clomid use, with no fever associated. Have had ultrasound on testes done in past 2 years, with thankfully unremarkable results. Urologist stated my left testicle is significantly larger than my right. No expert on testicles but I’m sure mine would qualify as “small.”

-how have morning wood and nocturnal erections changed: sporadic, at best. Libido average, at best. Erections would be considered weak, 7/10 at best if measured on a scale.

Most recent documented labs, taken in May of 2017.

GLUCOSE 79 Reference Range: 65-139 mg/dL
SODIUM 142 Reference Range: 135-146 mmol/L
POTASSIUM 4.0 Reference Range: 3.5-5.3 mmol/L
CHLORIDE 106 Reference Range: 98-110 mmol/L
CARBON DIOXIDE 25 Reference Range: 20-31 mmol/L
UREA NITROGEN 18 Reference Range: 7-25 mg/dL
CREATININE 1.00 Reference Range: 0.60-1.35 mg/dL
ALBUMIN 4.5 Reference Range: 3.6-5.1 g/dL
GLOBULIN 2.5 Reference Range: 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.8 Reference Range: 1.0-2.5 (calc)
BILIRUBIN,TOTAL 0.4 Reference Range: 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 69 Reference Range: 40-115 U/L
AST 22 Reference Range: 10-40 U/L
ALT 17 Reference Range: 9-46 U/L
CHOLESTEROL,TOTAL 2.7 Reference Range: 125-200 mg/dL
HDL CHOLESTEROL 51 Reference Range: >=40 mg/dL
CHOLESTEROL/HDL RATIO 2.7 Reference Range: < = 5.0
LDL CHOL, CALCULATED 71 Reference Range: <130 mg/dL
TRIGLYCERIDES 72 Reference Range: <150 mg/dL
NON HDL CHOLESTEROL 85 mg/dL
TSH 1.83 Reference Range: 0.40-4.50 mIU/L
T4,FREE 1.3 Reference Range: 0.8-1.8 ng/dL
LH 4.2 Reference Range: 1.5-9.3 mIU/mL
PSA,TOTAL 0.5 Reference Range: <=4.0 ng/mL
HEMOGLOBIN A1C 5.3 Reference Range: <5.7 % of total Hgb
TESTOSTERONE,TOT,LC/MS/MS 845 Reference Range: 250-1100 ng/dL
TESTOSTERONE,FREE 109.0 Reference Range: 35.0-155.0 pg/mL
DHEA SULFATE 511 Refrence Range: 85-690 mcg/dL
SEX HORMONE BINDING GLOB 53 H Reference Range: 10-50 nmol/L
ESTRADIOL,LC/MS/MS 34 H < OR = 29 pg/mL QNI

Will post the results of my labs which were drawn last week as soon as they’re available.

Hello all. I’m 31 years old, and was diagnosed with hypogonadism In June of 2015. Hesitant to go straight to t-shots, I opted to begin with Clomid therapy. Initially I had decent results, mostly objectively. Objectively my numbers were great. Subjectively my results were initially better, I had more energy, less mood swings.

However, these improved feelings were inconsistent as best. I’ve still had terrible mood swings, feelings of depression, anxiety, and borderline panic attacks. Struggling, I decided to seek psychiatric help and eventually was prescribed Lexapro 10mg in June of 2017. Things were okay again until about October, when I relapsed and had my Lexapro dosage increased to 15mg. It didn’t really help, I was & still am living a poor quality of life. Difficult to build muscle & keep off fat. Always in a constant state of worrying. Avoiding social situations I used to embrace. Being brought down by the slightest things. Low moods & poor self esteem crushing my energy & desire to live my life (adrenal fatigue?). Pushing people close to me away, for thinking I was crazy and a lost cause. My mind is always wandering, I’m unable to complete simple tasks. I’ve always felt emasculated, and have always seemed to feel like a real man. I’ve decided that I cannot live in this way anymore, and have decided it’s time to move to the next step.

After reading more about Clomid, I realized that maybe possibly it was making things worse. I read other testimonials of men getting good lab values, but missing the subjective benefits.

I think I’ve reached a point in my life that it’s time to move on to T-shots. After reading all of the great information on this site, I think it’s the best route to take. I have already gotten my labs drawn for Defy Medical, who have been managing my care since I’ve started. I am now waiting for those results & my next consult. I initially was working with Dr. Saya, but am considering scheduling with another provider as there’s a minimum wait of 2 weeks for Dr. Saya at this time.

My plan is to try T-cyp 100mg, initially once per week. I also want HCG to prevent testicular hypertrophy, and preserve my fertility. I will probably start with Arimidex .5mg per week, in divided doses. Then I will tune up from there.

How do you all feel about my plan? Should I explore the option of trying HCG by itself? I don’t think I’m interested in it, but will consider it a possibility if recommended. If I’m going to start poking myself for the rest of the life, I might as well include the good stuff. I see most people alternate days pinning themselves with T & HCG. Ideally, I would like to combine both the T & HCG in one syringe. At least in the beginning.

Also, I am concerned about the vitiligo, which initially was 2 spots on the left side of my face, but now has extended to most of my back. I suspect that this autoimmune disorder is caused by my thyroid. Now is my thyroid issue caused by low T? Or my low T the cause of my thyroid? My numbers have been tested before and Defy didn’t seem alarmed by any of them. Could T shots potentially fix my vitiligo?

I’m open to all comments, criticisms, and suggestions. Hopefully my log will not just help me, but help others seeking information like myself. This is a difficult thing to deal with, but can’t give up! Life is a big puzzle, and there will always be a search for answers. I’m ready to continue finding mine!

Happy New Year everyone.


#2

Still waiting on my results, but in the meantime ive been checking my temps orally as I am concerned for hypothyroidism.

8am: 97.5
4pm (just woke up, work 7p-7a night shifts) : 96.1
8pm: 97.3
[/details]

Midnight: 98.0

Recent TSH of 1.83 seems to be more on the high side.

I’m interested in doing IR. Would it be a good idea in my case? I’ve looked into some iodine 50mg supplements and they’re very expensive. I saw some other thyroid supplements which are cheaper which include lower amounts of iodine (150mcg), but with selenium (200mcgs) as well as other ingredients. I am willing to buy the iodoral if it may make a difference.


#3

Lab results are in.

Couple causes for concern. BUN has never been elevated. Not sure what’s going on with that, but maybe it means I was dehydrated at the time of the test.

Next issue is my lipid panel is all out of wack. My exercise regimen as well as diet hasn’t really changed much at all in the past 6 months. The only thing that has changed is the addition of Lexapro, which I’ve read may cause people to gain weight. My weight, as far as I know, has not changed. Nothing drastic anyways. I am still relatively fit, I just can’t pack muscle or lose stubborn fat in my stomach or love handles. Come to think of it, my physique was definitely much better prior to starting Clomid therapy.

Biggest issue to me is the rise of my TSH level to 3.61. Prior to this test I’ve been at about the 1.8 range. I have been taking my temps recently and I average around 97.7. When I wake up from sleep it’s 96.1. I’m considering doing an iodine replenishment therapy. Also, I intend to get a full thyroid panel workup. Should I do this through defy? Probably not is my guess. I also have issues with vitiligo which I suspect are related to my rising TSH levels. My autoimmune system seems to be messed up.

TT, FT, and SHBG are around where I expected them to be.

Plan: I intend to call Defy and get the next available consult with whomever is available first. It’s been an inconsistent 3 years, and it’s time to say goodbye to clomid. I intend to ask for it to be d/c’d, and initiate T-Cyp therapy 100mg in 2 split doses per week(q3.5d), and HCG 500 in 2 split doses as well(q3.5d). I intend to put both medications in the same syringe. On pinning days I also plan on taking .25mg of Arimidex, totaling .5mg per week.

Next thing I want to do is taper off my Lexapro. I’m hoping that TRT will help relieve this depression & anxiety. I feel that this medication is disrupting my cholesterol levels.

I also plan on treating my therapy as mentioned above. Do you guys feel that I should go through with the iodine 50mg daily?

I’ve tried to avoid it, but I think it’s time to proceed with TRT. I look forward to getting myself dialed in, and hopefully living a better quality of life. I hope that this thread can not only help me, but help others who have similar cases.

I look forward to all comments, criticisms, suggestions, and more. Thanks for reading!


#4

Thyroid seems unrelated to skin condition.

Your vitamins had good iodine and selenium levels, if you take them. That would be on top of iodine from iodized salt.

Have you ever not used iodized salt and not been taking a vitamin with iodine?

Your AD medication may be addressing issues that are low-T and thyroid related. Address those and get off of Lexapro later.

Cholesterol and lipids are good, fixing T, E2 and thyroid will improve.

Your body temperature is determined by fT3 and rT3 can oppose fT3. There is no T4 receptor, but docs skip T3 labs all of the time. Your body temps say it all.

Thyroid labs:
TSH
fT4
fT3
rT3
thyroid auto-immune panel

It would have been a lot more useful to test LH and FSH.

For most men, 1/2mg anastrozole per week will not be optimal. Target is E2=22pg/ml which for most seems best for mood, libido, sexual function and energy.

Thyroid is more complex than TRT and most guys who come here have some thyroid issues.


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

  • advice for new guys - need more info about you
  • 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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

With night shift work you might need more than 5000iu Vit-D3 to be optimal.

Panic attacks in some other guys here have resolved with thyroid and IR work.

Clomid can make E2 too high and that can affect guys in many ways.

IR expense: IR is ~ two weeks loading then a maintenance dose of ~0.5mg or less per day.

“I saw some other thyroid supplements which are cheaper which include lower amounts of iodine (150mcg), but with selenium (200mcgs) as well as other ingredients.”

  • optimumum nutrition multivitamins has those now…

#6

Thank you @KSman for taking the time to reply. I sincerely appreciate your words and intend on heeding your advice.

I have taken Adex before 1mg per week with clomid, but did not enjoy the way that it made me feel. I think that it tanked my E2 and I really just felt off overall. I have instead been taking DIM, and occasionally Calcium D Glucarate to combat elevated E2. Generally, however, I think that I felt better with E on the higher scale than the lower.

With introducing exogenous T to the play, I plan on returning to Adex & dropping the DIM & CDG. However, I am weary of starting at 1mg initially, but will probably go forward with it if you think it’s the right move.

I’ve purchased Lugol’s 5% iodine drops from Amazon, and will begin with 2 weeks of 5 drops each into a drink. I will continue to monitor my temps as well as moods/function to see if I’m responding to it.

I have my consult with Defy with a PA on Tuesday, the 9th. I am excited, and nervous of course to begin TRT. With my SHBH numbers I am thinking I can get away with starting with 1 T injection of 100mg per week. HCG I will inject 2x per week.

Thanks again for your help! Greatly appreciate & value your respected advice.


#7

Hey guys, here’s an update.

So I’ve been on T-Cyp 140mg per week (70mg q3.5d), HCG 250u 3x/wk (MWF), and ADex .125mg PRN since. I also completed IR-therapy for 1 month taking Lugol’s 8 drops per day.

After doing plenty of my own research, I didn’t necessarily agree with the ADex protocol but eager to begin I said whatever and went with it. Decided I would take the .125mg every Monday and Thursday, which are my pinning days.

So these past 2 months have gone okay I’d say. I’ve initiated this new protocol, while also stopping clomid as ordered & also d/c’d myself from Lexapro. Symptoms have improved. Happier, more upbeat, more of a go get it attitude. However, erections & libido have been spotty at best.

Did a pretty a comprehensive blood panel, but here are the labs that matter most:

Estradiol Sensitive: 99 (<= 29pg/mL)
Testosterone Total: 1159 (250-1100 nG/dL)
Testosterone FREE: 171.5 (35.0-155.0)
TSH: 1.46 (0.40-4.50mIU/L)
T4, FREE: 1.3 (0.8-1.8 ng/dL)
T3, FREE: 4.1 (2.3-4.2 pg/mL)
T3, REVERSE: 14 (8-25 ng/dL)
LDL: 113 (<100mg/dL)
NON HDL CHOLESTEROL: 130 (<130 mg/dL)

Couple questions:

  1. What are your interpretations of these labs? Does anything other than the ADex dosage have to be changed? Obv my test levels are through the roof, and I’m not sure if that can be dangerous. Would dropping it down to 110mg/wk be okay? I intend on taking 1mg of Arimidex weekly (.5mg x2 on pin days) based on research that I’ve done.
  2. Is there any reputable pharmacy I can order ADex from online? It’s a huge waste of money to order these measly .125mg caps. I want to order 1mg pills and just split them up. Next available consult with Defy isn’t until April 11th, and frankly I cannot wait that long to make changes to my treatment plan.

Any further comments, criticisms, questions, feedback, etc. are more than welcomed. I will do my best to post the full lab panel when I get a chance, kinda/sorta in a rush right now.

Thanks for reading!