31 y/o, Low Test, Looking for Advice

I’m also surprised that he didn’t have me test E2 now, based on what I’ve read about it. I’ll ask him about this the next time I see him (in April).

He wants me to do the 25 mg/day of Clomid for around 6 weeks, then have more labs done. He told me that if we don’t seem to be getting results, we’ll try upping the dose to 50 mg/day and test again after a few weeks. If that doesn’t work, we’ll start considering other options. If it does seem to be working (either at 25 mg or 50 mg), we’ll eventually begin the tapering-off process and seeing if my body can then pick up the slack on its own. At least, I think that’s the plan.

I haven’t read about Clomid/SERM restarts, so thanks for mentioning that. I’ll look into it. So far, I haven’t had many side effects from the Clomid that I’ve read about. No vision problems, dizziness, nausea (except for the little bit I mentioned in my first post, but that seems to have gone away), or anything like that.

How much of an effect can low Vit-D25 have on testosterone levels? I know the two are related, but I don’t know how strongly. One worry I do have is that the source of the problem may simply be Vitamin D deficiency, perhaps making the Clomid unnecessary.

Oh, it looks like the plan I described (taking Clomid for a few weeks, then tapering off to see if my body can pick up the slack) is a SERM restart. Sorry, I’m new to the terminology. :slight_smile:

I don’t think you should worry about Vit-D too much. I’m sure it’s a small component, but if fixing Vitamin D fixed Test you’d see it blasted all over the internet.

However, I just noticed this comment from TheMatrix over at Anabolic Minds.
“With out vitamin D optimal 60-80 ng/dl one will not be able to use clomid to its full potential”

Good luck to you man… I would do some research on the effect of SSRIs on test too. Google like SSRI HTPA AXIS, SSRI HPA AXIS. I hope you keep sharing - it will help others with your problems.

nomadic, thanks for your reply. Sorry for my delay in responding, but I only just noticed it.

I’m working on getting my Vitamin D up to an acceptable range, so hopefully the issue you mentioned there will be taken care of. I may even increase my daily Vitamin D dosage a bit, based on some of what I’ve read about acceptable intake levels.

I’ll look into the information about SSRIs and testosterone, too. Thanks! I had googled a bit about this previously (but only something like “Zoloft and testosterone”) and couldn’t find any evidence that Zoloft had any effect on testosterone; however, I didn’t have the terms you mentioned available to me, so I’ll be looking into them. Thanks again. Zoloft has drastically helped me in many ways, so attempting to come off of it (always with doctor’s supervision) will not be one of my first choices, though it is a remote possibility that I’ll consider if other things just do not seem to be working and if (very, very slowly) coming off of it seems feasible.

You have secondary hypogonadism.

Your FSH is low.

Prolactin looks ok, but not all adenomas secrete prolactin. If you can get an MRI do it just to know for sure.

Test other pitutiary hormones

ACTH and cortisol
GH
IGF1

TSH indicates a possible problem.

Get FT3 and FT4 begin logging temps. What is your iodine intake?

Here is a good product that addresses one deficiency you have and one you may have.

I’m certainly not suggesting you go off your meds, but worth reading up on what’s going on.

Here’s a thread that KSMan already replied to in 2011.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ssriinduced_hypogonadism

He says:
"Yes, Docs treat the symptoms of hypogonadism with SSRIs, which is mal-practice and common.

Otherwise, SSRI’s increase E2. The SSRI competes with E2 for clearance by rate limited liver pathways. Many other meds [Rx, OTC] can do this too. Which can confound studies like the one above. Increased E2 lowers LH/FSH and T.

One should try to find alternatives to SSRI’s or get off of AD meds completely. Too many side effects. "

Fox news, dumb article but just to prove that it’s mainstream thought that SSRIs might cause problems:

Thanks to both of you (Tuna and nomadic). Sorry for my delay in responding to the replies. I keep thinking that I’ve got this thread set to alert me when someone replies to it, but that doesn’t seem to happen. (Ah, I figured it out! Hopefully I’ll be better able to keep up with the thread from now on!)

Tuna: I will look into testing the other things that you mentioned. As for the MRI, I will ask about it. I had an MRI for something else about 4 years ago and there were no issues – and I had the symptoms of Low T then, but hadn’t had it diagnosed as Low T – so I’d be surprised if an issue turns up there. Do you still think I should have it checked even given the fairly recent MRI I had?

I think my iodine intake is probably okay, but I know little about the requirements. My salt is not iodized. However, I eat about 1-1.5 cups of Greek yogurt daily, drink about 3 cups of milk, and regularly eat fish and bananas (not together!), all of which are supposed to be food sources of iodine. I have also started taking a multivitamin (NOW Adam) that contains 225 mcg of iodine per serving, but that is a new addition to my diet. (I am also taking Vitamin D3 and Vitamin K-2 supplements, but thanks for the link to the supplement in your post.)

Why do you think TSH indicates a possible problem, if you don’t mind explaining? It’s right in the middle of the range.

nomadic: Thanks a lot for that link to the other thread. The study cited there is certainly eye-opening, and I will be bringing it up with my urologist when I next meet with him. Since my E2 has not yet been checked, I think I now have more than enough reason to get it tested.

Just a small update: I have been taking my temperature recently in order to check for possible thyroid issues. So far, it’s only been four days. My temperatures on waking have been 97.5, 97.3, 97.6, and 97.1, for an average around 97.4. This is a little bit low, isn’t it? In case it matters, it is usually very cold in my room when I take these temperatures, and there is a fan blowing on me; I may try to take a few temperatures when the room temperature is a bit more “normal” to see if this matters. During the day, my temperature has no problem getting to 98.6. It usually stays around 98.6 or 98.7.

Any thoughts about this?

I am meeting with my urologist again today to find out whether the Clomid he has had me on has been helping my testosterone levels. I’ll update the thread with results when I get them. I haven’t experienced much of a change in my symptoms; in fact, lately, I’ve just been more irritable and depressed than usual.

Well, I got my most recent blood test results back. They tested only my total T and free T, and here are my levels (the ranges are different than in my earlier results because these tests were done by Quest rather than LabCorp):

-Total Testosterone 992 ng/dL (Range: 250-1100)
-Free Testosterone 187.0 pg/mL (Range: 35-155)

All I can say is “WOW.” The urologist said that this is the best response to Clomid that he’s ever seen.

Okay, but now what? I am not yet experiencing any significant subjective results (better mood, better libido, less fatigue, etc.). Perhaps my SSRI is the culprit, but I’m not sure. As I mentioned in my last post, the only real subjective change I (and my wife!) have noticed is some increased irritability and depression. Not sure what to make of that. I suppose that I have noticed some slight increase in muscle mass while taking the Clomid, so perhaps it is helping with at least some of my issues.

The urologist wants to keep me on Clomid, at least for a while. I asked him if I should have my E2 checked given the rise in testosterone but non-alleviation of most symptoms. He asked me if I had noticed any fat gains or breast tenderness, and I told him no. He said that I’m not a fat guy (true), and that he doesn’t usually test E2 unless there is a concern like gynecomastia or unexplained weight gain.

You can get E2 checked on your own here

For me, E2 is a HUGE factor in my emotional well-being. I have tested various aromatase inhibitors, and have learned my best indicator of elevated E2 is my emotional state. When my E2 is elevated, I am unpleasant to be around and am constantly depressed. It would be wise to get yours tested.

Just posting with an update. Thanks to Kaynon311’s post (thanks!), I decided to get my E2 tested. It came back high. Here are the results:

Estradiol: 61.1 pg/mL (Reference Range: 7.6-42.6 – Flag: High)

What’s my next step? An AI? Should I now take this result to my urologist, who did not want to test me for it (I’m wondering whether doctors get ticked off about that sort of thing)? Any other thoughts?

I’ll be reading through the stickies in the meantime. Also, I took a break from testing my temperatures and the morning and started again recently. Some of them have been below 97 – 96.7, 96.8, etc. This is causing me concerns about my thyroid, as well. More blood tests? I’ve started supplementing with extra iodine (a few grams a day), but when should I expect that to possibly take effect?

Thanks again for any help!

Still looking for input about the above, if anybody has some. Is an AI my next best option, or should I maybe step back the Clomid? If an AI is my next best option, is a natural one like resveratrol worth anything, or do I need a prescription? How best to approach the doc, who didn’t want to test my E2 and thus made me do it on my own dime?

Thanks!

Updating after a longer-than-expected silence, still looking for advice. I met with my urologist recently and he didn’t seem concerned about the E2, though he did say that he’d look into it and get back to me; he said he wasn’t sure whether it was typically an issue with Clomid. I have scaled back the Clomid a bit (now taking 25mg every other day) and also got my testosterone tested again, and the results were:

-Total Testosterone 800 ng/dL (Range: 250-1100)
-Free Testosterone 152 pg/mL (Range: 35-155)

Now considering tapering off the Clomid (the doc thinks I should try this). I am feeling better than when I initially started this thread (more energy, less tiredness, generally better mood), but I still have difficulty putting on muscle (though this has gotten a little bit better, too) and am a bit worried about the E2 levels (see above; my E2 was a 61.1 pg/mL on a reference range of 7.6-42.6).

I’ve been supplementing with iodine after mega-dosing with it for a week or so. Will probably start taking my morning temperatures again soon and post those results.

EDIT to add: I cut my weight back to 180 lbs. (at 6’0"), btw, in case that matters. I didn’t have much of a problem doing this, really. My bodyfat % is now somewhere around 13.5-14%.

Were you taking 12.5 mg per day of Clomid for long before you tested at 800 ?

12.5 is a nice dose for low side effects. Maybe you can get by on less. You could try 25 mg every third day, and then see how it goes from there. With numbers like yours you might end up with a successful restart.

[quote]Freddy77 wrote:
Were you taking 12.5 mg per day of Clomid for long before you tested at 800 ?[/quote]
Yes; for a couple of months, actually. It wasn’t supposed to be that long, but I kept putting off the bloodwork.

[quote]Freddy77 wrote:
12.5 is a nice dose for low side effects. Maybe you can get by on less. You could try 25 mg every third day, and then see how it goes from there. With numbers like yours you might end up with a successful restart.[/quote]
Trying out 25mg every third day is actually exactly what my urologist has suggested. We’ll test again at that level after about 6 weeks or so. I hope you’re right about the restart! Thanks for the reply.

You could try anastrozole. But effect will be limited if T–>E2 in testes is high.

Anastrozole is mission critical as you taper off of SERM.

[quote]KSman wrote:
You could try anastrozole. But effect will be limited if T–>E2 in testes is high.

Anastrozole is mission critical as you taper off of SERM.[/quote]
Thanks, KSman. I’ll look into that.

I’m a bit concerned/confused about my doctor now. I showed him my high E2 tests last week (which he didn’t want to have me tested for in the first place), and he said that he needed a week to “do his homework” to see whether it was something that I should be concerned about (I tested E2 at 61.1 pg/mL). I thought that was a little weird in itself. But anyway, now he got back to me and said that I don’t need to be concerned, because E2 is a metabolite of testosterone, so my E2 rose because my testosterone rose.

…Isn’t that common knowledge? Isn’t that exactly why people take an AI when attempting to increase testosterone? I’m very confused about whether I should be concerned about my E2 levels at this point. Isn’t E2 a receptor agonist with testosterone? Is a high E2 in some way already mitigated by my Clomid, or do you guys think an AI is still needed?

Thanks!

Im not too knowlageble but ill share my expirience: took clomid 50mg every other day for 3 weeks, test and estrogen went sky high, but libido down. Then took some letro and libido went back again, so i think controling estrogen has benefits. Dosing and witch ai to use, don`t know.

My Estrodiol was in the 60s after starting TRT - I added 1mg of anastrozole and brought it to 21 . My ED issues and low libido got fixed