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.