T Nation

Clomid, Good Numbers but Still Feel Bad Even on Diff Doses. Do I Need TRT?

New member here, just looking for advice. Here’s some background.

At 23 years old I developed serious cystic acne. Never had acne as a teen. Started having problems with erections, no morning wood, no energy, brain fog, needed naps every 5 hours, etc.

Got my thyroid checked out and was over the normal range. Got put on thyroid meds and it is now in range, but symptoms persisted. Tried everything to get rid of the acne for 2 years (cut out dairy, tried doxy, retin a, tazorac, etc) until I had enough and took accutane. It got rid of my acne but still wonder if there is some hormonal issue going on.

Decided to get my testosterone checked. I was 25 years old at the time. Here were my results:

testosterone: 348-1197; mine is 395
Test Bioavailable: 110-575; mine is 184
Test Free: 46-224; mine is 85.8
LH: 1.7-8.6; mine is 4.6
FSH: 1.5-12.4; mine is 3.5
Estradiol: 1.5-42.6; mine is 13
SHBG: 10-50; mine is 22
DHEA: 110-510; mine is 350

Went to a few endos but nobody wanted to treat me because I was in normal range. Something wasnt right though. I shouldnt be needing naps after a full night sleep and having erection and libido problems. Anxiety and depression. I couldnt put on muscle. I just couldnt figure it out. Did full blood panels and everything was in range nothing out of the ordinary.

Finally found a dr to put me on clomid at a mens clinic. For the first little while I felt better then all symptoms came back. I was on 50mg ED. My numbers looked good on paper but I felt like crap. Literally the only positive was bigger ejactulation. Bloods:

Here is my bloodwork after 6 months of 50mg ED

LH (1.5-9.3): 16.8 (HIGH)
Estradiol (< OR = 39): 51 (HIGH)
Testosterone Total (250-1100): 1188 (HIGH)
Free T (35-155): 270.9 (HIGH)

He didnt test SHBG or anything. Decided to lower my dose. This was my bloodwork after a year on 25mg ED:

DHEA-S: (362.0) Reference range: 160.0-449.0
Estradiol: (43) Range: 27-52
Test: (873) Range: 249-836
Test Free: (19.82) Range: 4.5-25
Test Bioavailable: (496) Range: 108-500
SHBG: (32.1) Range: 16.5-55.9

The rest of my bloodwork was in range. Cholesterol, thyroid, etc all in range. I’m at a loss. The only morning wood I’ve gotten in the past 5 years is when my clomid dose first started. I have no drive, no motivation, all symptoms still the same.

He wants to put me on 37.5mg ED and see how I feel after 2 months. And he prescribed me LGD 4033 to give me a “boost”. After looking it up that’s basically a steroid that will shut me down further so I dont want to use it. It also made me now think the dr has no idea what hes doing.

I’m at a loss idk what to do. I’ve heard clomid can look good on paper but symptoms still persist idk if that is the case though. I put off TRT for so long because I didnt know if I needed it and I know it’s a lifelong commitment. I also possibly want kids someday and didnt want to go infertile. I know HCG can help preserve me but I’ve heard it can cause a lot of side effects so if I go the TRT route I want to do just test to start. I’ve gotten to the point where I dont even care anymore about becoming sterile. If I have no sex drive and dont care about getting a gf why even care about being able to have kids.

Any ideas? Would 125mg test per week with no hcg and no ai be a good idea? I’m just lost and looking for help.

Clomid blocks estrogen in the brain which is why libido is virtually nonexistent, there is no way around it. Your T might have been in range, but don’t think for a second that it translates in to healthy levels.

Your pre-clomid E2 levels are low enough to cause osteoporosis. I find most of my docs are out in left field as far as hormone knowledge is concerned and western medicine isn’t behind the 8 ball as far as hormones are concerned.

Accutane can screw with your sexual health and is linked to sexual dysfunction and libido issues which don’t resolve after quitting the drug which is similar to Post Finasteride Syndrome. These drugs block the enzyme for converting testosterone to DHT causing brain damage and neuropathy within the brain.

You can inject once or even twice weekly if you start to feel a crash days after an injection. Some are sensitive to hormonal fluctuations and need multiple injections per week.

So what options do I have moving forward?

I’m assuming you’re talking about fertility, you can add HCG and FSH while on TRT to increase sperm. You can find a private doc to prescribe TRT and pay out of pocket because sick care docs usually follow guidelines which state TRT <300.

So basically you have to match up with the hormones of someone in their 70-80’s to get TRT from sick care docs.

I’m talking about treatments in general. Should I go with testosterone replacement or will it be useless? Is there something else I should try before resorting to TRT?

You say your thyroid labs are all normal, normal doesn’t mean healthy. I would post all other labs because it would be a disservice to recommend TRT to someone with questionable thyroid labs or other stuff going on.

I will say your testosterone isn’t terrible, not the best either and there might be room for improvement, but your estrogen is terrible and if thyroid is holding you back…

His estrogen is terrible? What does that mean?

His testosterone isn’t the best? What does that mean?


The guy is taking clomid and is wondering why he doesn’t feel good. How many guys do you know who feel like million bucks on clomid?

But it’s always the estrogen and high testosterone with you. Simply unable to learn anything and spouting the same nonsense over and over with zero evidence.

You should be ashamed of yourself.

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There’s been quite a few folks that have come here on Clomid that switched to TRT. Do a search and you can find their stories.

So I wouldnt seem crazy to want to try TRT? I dont want to mess myself up but i honestly feel like this is the best route

The issue is that at your age a lot of docs won’t want to treat you. I see it all the time. You’re clearly on the low end, this much is true. Where are you located?

Maryland. No endos would help me. I found a mens clinic an hour and a half away and with the protocols they’ve been giving me they almost seem like they’re just in it for the money.

My dad has test issues and takes 250mg test e a week and feels great. He gets it illegally though and has been for years he has a lot of connections. He was going through a clinic but the price was too high so he gets it elsewhere but gets bloods still through a doctor. From the clinic it was over $500 a month. For some reason his insurance wont cover it. So it is definitely possible for me to get my hands on it and hes been telling me for a few years now to do so. I just put it off because I was scared to mess myself up or do something wrong. I didnt want to shut myself down if I didnt have to.

I can put you in touch with the clinic I use. $150/month including the testosterone shipped to your house. If your dad is paying $500/month then tell him about it. Email in bio.

There is no evidence whatsoever that clomiphene is having a negative effect on libido or ED. Essentially all studies done showed a significant improvement in both parameters.

Clomiphene is a selective estrogen receptor modulator, it does not only block estrogen in the brain.

At your pre clomiphene levels you are not at risk for developing osteoporosis. Levels would have to be lower.

With clomiphene it’s a delicate question about dose especially when it comes to side effects like irritability, anxiety and depression.

I would recommend you to reduce your clomiphene dose to 25 or 12.5 mg eod since your levels were still on the high side with 25 mg ed. Reducing the dose will improve your symptoms.

Go to excelmale and search for an entry of Dr Saya on clomiphene and T in young men.

It can well be that your symptoms are unrelated or only partially related to T according your history with thyroid disease.

What exactly was out of range and what was the diagnosis? What is your treatment?

Unfortunately it was so long ago I can’t remember exactly. I just remember my TSH was a good bit over the top of the range. I’ve been on Levothyroxine 88mcg. The most recently labs I got with my 25mg ed clomid have my thyroid on it but only TSH and free T3.

TSH scale 0.4-4.5 : mine is 3.5
T3 Free scale 2.0-4.4 : mine is 3.3

Most likely Hashimotos disease than.

You want to get TSH below 2 so talk to your doc to increase the LT4 dosage to at least 100 or even more. I think you are undertreated thyroid wise.
And maybe you are one of those 15% who do not respond to LT4 therapy only.

I would recommend you the following which needs to be of course discussed with your physician.

Increase LT4 to 100 mcg per day and reduce clomi to 25 mg eod.
If you don’t feel any improvement after 3 to 4 weeks go up to 125 mcg of LT4 and stay for another 4 weeks on that protocol, check TSH and reassess (TSH <2 and symptom improvement).

If you still haven’t improved it’s time to consider switching to a T4/T3 combo therapy.

@systemlord imagine if these were his natural levels (highly possible). Would you tell the guy his E2 is too high and needs an AI? If a guy had 1500 total T natural with E2 at 100 at 18 years old doing amazing would you insist he needs to start controlling his estrogen?

Do you have any idea how ridiculous that would be?

Why aren’t we running around blocking estrogen levels in teenage boys with ‘sky high’ testosterone levels? It’s self regulating! We don’t even measure their damn estrogen levels! Then we get older, get on TRT to get those same levels back, and suddenly you go apeshit over estrogen?

Logically speaking, do you realize how crazy that is? Do you? All good for teenagers (high T included) but now you’re afraid of it as an adult.

It’s lunacy. Do you get it? Lunacy.

Nope, I wouldn’t. If there were symptoms I would tell him to inject more frequently and if he was already doing so (daily,) I would tell him to lower his dosage.

Why the hell would you tell him to lower dosage?? Based on what?? So he can be like you? Deficient??

You pitched me a hypothetical question without any real symptomatology. If his levels were above ranges and symptomatic I would tell him to lower the dosage if breaking up his shots didn’t do the trick.

You’re being childish.