T Nation

31, Secondary Hypogonadism. Enclomiphene Test Run


#1

Symptoms: Low libido over a year, irritable, depressed mood weight training one year with little muscular growth, poor sleep quality.

31
6” 80kg 176lbs
Waist 36
Thick body hair and facial hair
Fat tends to store on midsection and face, no change recently.
No steroids
Accutane as a teenager. Experienced minimal side effects
Don’t eat breakfast. Diet has plenty of animal fat, veggies, and carbs.
Rarely drink
Weight training x3 a week. Mostly compound movements
Testes feel normal. Varicocele left testicle since 14 years old
Morning wood sometimes. Sexually I can still preform but recovery is over a week.

Note:
Elevated Bilirubin due to Gilberts syndrome. Aug test, I slept very poorly for the two nights prior which may have impacted glucose and T levels further.

1


Average basal temp over the week was 35.6c/96.08F. Afternoon temp will rise to 36.6/97.88F.
Feel quite warm, eyebrows are thick. I do not use iodised salt.

GP has been helpful but ultimately unable to do much due to regulation (Australia).
Endocrinologist admitted that whilst my TT was low my FT was “quite good” and suggested that if MRI comes back fine we won’t do anything. I did ask about Clomid and got the spin around “it affects lots of other different hormones” and got the impression he didn’t know much about its off label use with men.

Proposed treatment

My initial focus is on thyroid and adrenal function, despite bloods being normal, temps seem to suggest overwise. I have introduced kelp and Brazil nuts into my diet and will watch for any changes. I have stopped drinking coffee in the morning and I am already sleeping much deeper at night which is promising.

I have ordered enclomiphene and hope to start within the month. As the drug is not an actual prescription med (yet) I am able to import it without issue. After reading the studies I am thinking a conservative 12.5mg dose M/W/F will be a good start.

Any advice or insight is appreciated!


#2

Your low SHBG is going to be a problem, TRT will push it down further to the point where you might feel nothing from TRT unless you can increase it. I would start by improving fasting glucose and also Bilirubin. Diabetes and fatty liver can decrease SHBG. So let me get this right, your doctor will only treat your testosterone deficiency if your free testosterone is low and TT is alright, but will treat you if the reverse is true? If you doctor doesn’t believe you have a testosterone deficiency your doctor is an idiot! A lot of doctors focus too much on lab work and don’t pay any attention to the symptoms.

Your endocrinologist is unfamiliar with clomid, he’s an idiot and therefore can’t help you. He doesn’t have the skill set to treat you and sadly a great majority don’t understand how to treat men with testosterone deficiencies.


#3

Read the HPTA restart sticky for a general protocol using a SERM. I personally use Clomid and start with 25mg E3D. I felt less than great. I dropped to 12.5mg E3D added an AI, and am starting to feel much better. In general with Clomid less is more.


#4

Your low SHBG could be part of insulin insensitivity aka diabetes and one glucose test was high and assumed fasting. You should request A1C lab work that provides a good measure of average glucose.

With low TT, your HTC=0.50 [hematocrit] there is concern that increases T levels will increase HTC. Drink water during your per-lab fasting to avoid dehydration.

Thank you for a great informed post!

TT is low because low SHBG means that there is less non-bioavailable SHBG+T contributing to TT.

FT is tricky because it is released in pulses with a short half-life and lab results are a snapshot of a moving target.

LH/FSH is low, cause of that is unknown. Prolactin is not a cause, but that does not rule out physical damage to the pituitary or an other type of adinoma.

FT may become lower later on, Clomid could cloak that.

E2 was not tested and low SHBG and low FT suggest that E2 is probably low and not a factor in LH/FSH suppression.

Thyroid: TSH is quite a crude evaluation of thyroid function. Your fT3 is either low, or rT3 is interfering with fT3 at T3 receptors. Both thyroid and T can reduce energy, mood, libido etc. Training with these deficits often involves adrenalin compensating for energy when training and the result can be adrenal fatigue. We see this combination of factors quite often here.

Do you consume commercially produced breads and dairy products?

http://www.nutritionaustralia.org/national/resource/iodine-facts

http://www.saxa.com.au/products_2.html

Please also read the HPTA restart sticky.

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

Thanks for your help guys. Here is an update on my progress so far.

  • MRI came back good with only an ‘incidental’ finding in the pituitary of 3mm which they said is no problem.

  • Thyroid function has improved. Basal is now 36.1c with afternoon high of 36.7c. Thyroid panel results seem normal

  • Diabetes doesn’t seem to be an issue from HbA1c results

  • Sleep study did not reveal sleep apnea

Here are my latest labs. November results are post 1 month enclomiphene citrate 12.5mg M/W/F



Honestly I’m not sure what to make of my results. LH and FSH appear unaffected so I am uncertain of my response to enclomiphene. Yet testosterone has increased and as Systemlord predicted SHBG has further dropped suggesting something is indeed happening.

The biggest change I have noticed is my physical composition, my muscle mass has increased which is quite exciting as until now I have never been able to gain mass. Libido is largely unchanged, no surge or testicle size increase like some guys on climid report, as you guys pointed out low SHBG may be to blame.

Concerning lifestyle I have made some adjustments. I’m sleeping really well now due to sleep hygiene improvements and cut a lot of excess sugar out of my diet. KSman noted my hematocrit could increase so I am now donating blood regularly.

So my main question, is the enclomiphene working or has T improved due to lifestyle changes I’ve implemented.

Going forward

I’m pretty happy with my initial results. Now that most of the common causes of low T have been ruled out I’ll focus on improving my low SHBG. I may also increase my enclomiphene dose to 25mg EOD and gauge my response. As there aren’t many anecdotal reports on enclomiphene online I’ll continue to update this thread so that others interested may benefit.


#6

Hi guys quick update for those interested in Enclomiphene

I have increased my dosage to 25mg ED and its certainly doing something.

(note I’ve had to change labs so ranges are slightly different)

08 pm

Lots of red results this time but I’m pretty pleased overall.

There has been an increase of muscle mass and body hair.

Initially I was having some acne but this has subsided.

Overall feeling pretty good.

This month I will drop my dose to 12.5mg ED and see what affect that has on my T-E2 ratio.

SHBG, I have been taking liver supplements and drinking lots of green tea, but no effect.

Do I need to be concerned with my elevated E2 levels if I am not experiencing side effects?

@KSman @systemlord


#7

You won’t notice E2 sides right away, there’s a big lag in the time it takes your body to notice. If genetically low SHBG you may not be able to move it much, TSH looks great. If clomid doesn’t move your SHBG perhaps TRT won’t either if you eventually end up on it. In that case low doses of T otherwise your FT and E2 will skyrocket out of control.


#8

Thanks guile for your detailed documentation. Very interesting to read. Would like to know where do you get the enclomiphene from? do you take pills, softgels or liquid? Not sure if it is allowed to say where to buy (probably not), how could i get in contact with you?

I am also considering to go on enclomiphene. I got some sides from clomid and hope it will be better with enclomphene. But i am not sure where to get the good stuff bacause many offers online but not many reviews on them in forums etc.

@guile


#9

It is a Pharma grade pill from India. They use enclomiphene the same way as Clomid to induce ovulation. I’ll admit ordering from India is not very straight forward but with a bit of research you can figure it out.


#10

thx guile
I did some research and have ordered some of these pills.
do you consider to use any AI or do you feel completely good on higher e2?


#11

I felt fine with high e2 but I did experience body acne, slight thinning of hair, sweat started to smell like vinegar. In hindsight with my low SHBG I should have used an AI from the start. For normal SHBG guys I’m guessing the rise in e2 would not be as extreme as mine

I dialed back my dose to 12.5 EOD to get E2 under control and this happened

The lab stuffed up and didn’t test e2, but its clear dosing EOD isn’t enough in my case.

I am now doing 12.5 ED with 0.25 Arimidex MWF.

New bloods in about 3 wks, will report back then.


#12

I figured this is the best place to post about my personal experience with Enclomiphene. I too have gotten enclomiphene from India. Like guile said, ordering from India is not straight forward but the product you receive is legitimate. I train 2x day and usually 4-5x per week. Here are my findings while using enclomiphene.

28 yo male
6’0
192

Testosterone level in September 2017
292 Total Testosterone

Needless to say I was upset with findings and ordered Enclomiphene from India. I’ll admit I was very skeptical at first and actually thought it was fake. YOU DO NOT FEEL ANYTHING PSYCHOLOGICALLY IN REGARDS TO USING ENCLOMIPHENE. The reason I say this is because a lot of guys take enclomiphene thinking they’re going to feel similar effects/side effects as using clomid.No anxiety, no brain fog, no depression, all the things you experience with clomid. With that being said here are my results.

March 16 2018
Reference Range

Testosterone, Serum 838ng/dl. 264-916
Testosterone, Free. 31.09 ng/dl High 5.0-21.00
Prolactin 5.3 ng/dl 4.0-15.2
Estradiol, Sensitive 39.3 pg/ml High 8.0-35.0

I feel great! Stronger, more energy, better sleep, better mood. Any advice on my results or suggestions would be appreciated.


#13

Hi nice to hear your story. Would be interesting to know how much do you take? Also did you try clomid before?


#14

I started off taking clomid 12.5 mg MWF however the side effects were bad so I stopped. With enclomiphene I bumped it up to daily dosing of 12.5mg. I’ve had zero side effects except for some acne on my back. I’m very prone to acne though. Would anyone suggest I start dosing Arimidex?


#15

Thanks for posting your experience burch278, really interesting to hear the account of someone who has experienced Clomid side effects and then had a positive experience with Enclomiphene. Makes me glad I went Enclomiphene from the start.

I too experienced increased acne on my back at 25mg ED. I have been on 12.5 ED and 0.25 Arimidex MWF, and working really hard on improving my sleep quality for about a month now. My back acne has improved heaps as a result.

Will be posting labs next wk


#16

With higher dose SERM E2 was very high, and with little SHBG to blunt its effects as systemlord would observe.

E2 high because testes were overstimulated and if you had used anastrozole to control that it would not be expected to work.

With low SHBG, SHBG+T is low and TT will be lower. TT understates your T status and you should not be seeking high range TT. FT is then also strong as expected.

When increasing T with more SERM, the increased T needs a proportionate increase in anastrozole.With target of E2=22pg/ml you could increase anastrozole dose by a factor of 39.3/22. To get arbitrary anastrozole doses dissolved anastrozole in vodka 1mg/ml and dispense by volume or by the drop. A dropper bottle is good, and if the tip has markings - better. Be sure to shake to dispense. Vodka is for the alcohol as a preservative and to dissolve anastrozole that will not dissolve in water.


#17

KSman so you’re saying I should increase my dosage by multiplying .25mg of Anastrozole by 39.3/22? That puts me at a .45 mg dose of Anastrozole.


#18

Hello everyone!
I’m not a native English speaker, so forgive me for the language errors.
I’m so glad I come across this thread!
I’m 46 years old and have a secondary Hypogonadism. My T is below 250.
My doctor suggested TRT, but I would like to maintain my fertility (I did not find any doctor who would prescribe HCG).
I decided to try Enclomiphene and I did not find any doctor who would agree to support me in this process or has any experience with it.
I ordered Enclomiphene from India (en-clofert), and received it today.
I would be grateful if you guys could help me through this process.
Like Guile and Burch278 I will also post my experiences here so that others may benefit from it. I understand that the dosage suggested is 12.5mg every day. Should I start at this dose or start at a lower dose and increase the dose slowly? Maybe 12.5 EOD?
I got 50mg pills, can I dissolve it somehow to get an exact dose?
Any other suggestions?
What blood tests should I run? when should I do it? (in a week? in a month?)
I would appreciate any help!

Thank you guys (-:
Jordan


#19

I believe the best dose would be 12.5mg ED. Get yourself a pill cutter and cut them into quarters and that’ll give you 12.5 mg. Definitely don’t take the whole 50mg pill. 12.5 ED will be enough to see and feel results.

As far as the tests go you should atleast get
Total and Free Testosterone
Estradiol sensitive

You could also get your prolactin, LH and FSH tested if you have the extra cash. Keep an eye on E2. Mine crept up just a little bit but I felt great. Like an idiot I used way too much Arimidex trying to bring my E2 down and crashed. .75mg over the course of 3 days. Definitely won’t do that again.


#20

Thanks for your answer Burch278!
I started taking the Enclomiphene today. I desided to start with 12.5 EOD and run a blood test. I would like to start slowly – EOD, and then - depending on the blood test - raise it if necessary.
I would like to have your opinion, guys, about the lowering side effect of the enclomiphene on IGF-1.
On all 3 stages of the trials of Androxal (enclomephene citrate) they observed that serum IGF-1 has been decreased.
(http://cancerres.aacrjournals.org/content/73/8_Supplement/1326)
IGF-1 is very important hormone as it is linked to the growth hormone.
I think that in my physical codition, Low IGF-1 could have bad affect
and I explain why:
Probably due to the fact that I was low on T for years (I don’t know how long, I was diagnose only recently with low T after a long period of suffering from weakness), my bone density is very low (the tests shows that I’m close to Osteoporosis) and IGF-1 supposed to help building the bones.
Do you think it will be wise for me and others to supplement with IGF-1 (dear antler) ?
Does anybody know how to dissolve the Enclomiphene pills? In the future I would like to find the exact dose that suits me and not be stuck on 12.5 or 25 mg.

Thanks!

Jordan