T Nation

Clomid Challenge Question


Whats up everybody. Im new here, I was hoping someone could help out. Basically, I did a clomid challenge a few weeks ago. my total was 178 (<240). The Clomid took me only to a 284, which is normal, but still lower normal. LH went from 5 to 11.2 during the clomid (25mgs for 7 nights). I thought if you didnt get a response it meant primary hypogonadism, and a response meant secondary. I got a response, although a small one it still put me into normal range, but nowhere near a normal range for a 28 year old male.

Does this seem like primary to a certain degree? I'm having a real hard time understanding all of this, because even after a barrage of blood work i still dont know for sure whether Im primary or secondary. My total T was 178 last lab, seven months off injections, but my free and biological T are normal, and my SHBG is a ten. Id like to get more input before I commit to TRT the rest of my life. Can someone fill me in a little, or is anyone in a similar situation? Do you think I should see a urologist again? Last time I went to one he didnt think an ultrasound or anything was neccesary.

Id reall appreciate any help, thanks!


It would appear that you are primary...have you gotten your DHEA-Sulfate levels tested? I haven't seen this documented anywhere (but again I haven't really looked) but I have a theory that low DHEA levels can mimic primary hypogonadism because your body doesn't have enough master hormone to make the secondary ones (DHEA->T).

I would test this...if it is nice and high, I would suspect testicular failure (primary).


yes, I did have DHEA tested, it was a 447 (110-510). I've read alot of your posts VTBalla just by googling stuff and somehow alot of things I was searching took me to this forum, and so i signed up. Do you know if there any ways to raise DHT to help libido? My DHT is 16 (25-75), Im not trying to use T for the time being until after I get my amalgram fillings out and see if i have any improvement. Ive seen LH be a 5, and Ive also seen it at a 2.2, which are normal. Is it even worth going back to a urologist again do you think? Last time he didnt want to do ultrasound, even though he said i may have a small epidydimal cyst, but he was confident it didnt need looked at.


Snap, please read the advice for new guys sticky. We need more info.

There can be cases of mixed primary/secondary. One age is part of that.


Epidydimal cyst makes things a bit more complicated in my opinion. I am of the mindset that two conditions (low T and cyst) should be looked at as if they were symptoms of the same condition. Could it be a coincidence that you just happen to have a cyst in your balls while also having Low T? Yes, but I don't really like to play the coincidences game.

To me that leaves two options: ignore it and treat with exogenous T (you need it) or treat the cyst, which poses complications of its own, and hope your T recovers...that will be a decision you will have to make with your medical professional adviser.

I think there are some threads from the past on here about epidydimal cysts (I can think of at least 2). You may want to do a search and see if you can dig them up for reference. I don't remember them being followed to conclusion though, but I could be wrong.

What we do know is that under your current condition, your testicles are not able to produce adequate amounts of T. At LH = 11.2, you have more than enough to stimulate a proper functioning set of testicles...your DHEA is also good, so there shouldn't be any raw material shortage issues...I would consult with my medical professional adviser to begin a TRT regimen to restore my levels to optimum...

Are you concerned that your amalgram fillings may be exposing you to toxic levels of mercury and resulting in your low T? Easiest way to address this other than the wait and see approach is to run a tox screening to rule this out...what makes you suspect this anyway?


The clomid challenge results indicates primary to me. At the very least, it shows us that even with adequate pituitary output, his boys aren't up to the task...does it matter at that point if its mixed primary/secondary? I'm not sure what pulling the string further actually tells us since we have already determined (?) that he likely needs to be on TRT.


KSman-i will take a look @ the sticky notes and provide more info after work. Vtballa I think I there are some issues with mercury because I have like 8-9 fillings, I also smoke-so toxins could be a real issue, as well as the fire retardants I work with at work. I also think we see the same doctor if you still go to conshohcken, pa. I'm loolking forward to posting my labs to get your opinions because for a while I was looking at secondary-but now I'm shifting my focus to primary or a combination. Thanks


ok, i read the sticky, thank you. Hope you guys might be able to tell me what you think is going on.

Height 5-9

Symptoms were mainly fatigue and lack of libido, inabilty to really concentrate, felt like I was spinning my tires all the time.

Most recent labs:

total T- 171 (250-1100)
free T- 45 (35-155)
bioavailable T-112 (110-575)
SHBG - 10 (7-49)
estradiol (ultrasensitive)-18 <29
DHT- 16 (25-75)
LH-2.3 (1.5-9.3)
DHEA- 447 (110-510)
Prolactin 6.4 (2-18)
t4 total 7.3 (4.5-12)
t3 reverse 26 (11-32)
TSH 3rd generation 1.21 (.4-4.5)
Albumin-5 (3.6-5.1)
AST 24 (10-40)
ALT 44 (9-60)
Vitamin D 36 (30-100)
Zinc-110 (60-130)
Glutamine-20 (21-182) (i havent been working out, could this 2 all be related to low T?)
Total LDL-111 <130
total HDL-42 >40
GLucose-96 (65-99)
Lyme test-negative
urea nitrogen 14 (7-25)
creatinine .94 (.8-1.3)

Now this lab is from April, I have been off injections since November. I look forward to hearing from you guys, and thanks for pointing me towards the sticky. Take care


I know initally LH looks like it could be higher, but I have also seen labs where it's at 5 with same low total T, and with the clomid cranking LH to 11.2, i still only got to 284.... I dont see a smoking gun to really say secondary or primary-any thoughts?


Your clomid challenge indicates primary--or at least to a large degree...you got some production but not much...why are you harping on that so much? Your clmoid challenge showed you that treating with SERMs is not an option, so what's the other alternative? A: TRT

You need more thyroid tests (free t3, free t4) and cortisol (do the 4x saliva test now offered at both Quest and Labcorp), as well as cortisol serum (8 am) to paint the whole picture...you can possibly have adrenal insufficiency which is downregulating your T output, but given your fairly decent TSH, I would think the chances of this are low but you need to rule it out before commencing TRT.

I'm surprised Dr. O and HAN didn't order these for you to rule out other possibilities.

What do they have to say about your condition and labwork?

I would be very surprised if the fire retardants and smoking and mercury filligns are to blame...mercury can be ruled out by a simple blood test, so I wonder why they haven't given you a workup for that...


I didnt event think to post the results of my saliva test. I had low cortisol reading in the am and at night, but it was normal during the day. DHEA remained the normal each test.

"A pattern showing one or more decreased cortisol levels, while the level of DHEA is within reference range, is
clinically significant. This pattern suggests adrenal hypofunction of the zona fasciculata (the primary source of cortisol).
At this time there is no evidence of hyperfunction of the zona reticularis (the primary source of DHEA). A degree of
adrenal hypofunction is suggested, which has been noted in fatigue disorders, physiological or psychological stress,
anxiety, hypotension, and/or hypoglycemia."

My blood cortisol tests were normal.

Im not trying to harp on the clomid test, its just for like 8 months i believed i was secondary and now im trying to piece this together thinking maybe its primary, but if it were primary, why wouldn't the LH be cranking? ...I was put on TRT after my old physician only did one total T test, and i was hoping to restart through Dr. O and HAN. I haven't been told if I am primary or secondary, I dont think it's very conclusive. That's why Im hesistant to start T cyp again, because I'd really like to keep digging, I think the toxins angle may be just be another attempt to dig, I do have a slip for metal test.

As for the adrenal saliva test results, they were slightly low first test and last test of day, they said they could definitely be better, but that they dont think thats the issue.

I appreciate your inout VT, thank you.