T Nation

Clomid/HCG to Fix Hypogonadism. Low Free T, High SHBG and High Prolactin

Age: 33
Height: 6”1’
Weight: 172 lbs
Waist: 31 inches
Body hair: a lot of it, but thin relative to most people
Facial hair: also, a lot but thinner hair than most guys with a full beard
Body fat: I am 16.0% body fat per DXA scan.

Diet: never skipped meals or did any crazy low-carb diets. I eat clean/healthy 80%+ of the time. I consume 200+g of protein per day, and have experimented with daily caloric intake between 2,400 – 4,200 per day. I don’t really gain or lose much weight (167-174lbs), but I always carry some fat around my mid section.

Training: I have been lifting consistently for 16+ years and am at the same weight as when I graduated college. I work out quite intensely lifting ~75 min 6 times per week plus maybe 3 HIIT sessions per week and some basketball. Spent 8 years in the Navy and trained pretty hard over that time. I’ve tried every training program out there to add size. Nothing works At one point, I got down to 162lbs from intense military training and still didn’t have any ab definition. I suspect I lost mostly muscle and not fat.

No testes ache

Definitely less frequent morning wood / nocturnal erections but couldn’t tell you when it happened. 3 years ago? 10 years ago? Not sure.

In addition to not being able to put on muscle, I’ve always been very tired. I can fight through it, but I have always slept 8 hours+, can nap on command, and rarely feel refreshed/wide awake.

I thought I might have digestive issues or something preventing me from putting on size, but I’ve now tested low on T twice, but am hesitant to inject because I want to have kids in the next 6 months. I also don’t like the idea of injections for life if there is something else that could fix it.

1st doctor I saw just did basic blood tests and wanted to give me a t-patch until I told him I wanted to have kids and he said there was nothing he could do for me for another 3 years when I am done with kids. I don’t want to wait that long to feel less tired. 2nd doctor is an LA hormone replacement doctor who tried to inject me with T 1st time I saw him before even getting the more detailed labs back. I worry he like a man with a hammer who will treat everything with T-shots rather than finding what is underlying cause. He wants me to do chlomid+ T shots immediately. He also wants to start me on HGH for $1,400-1,600 per month.

Any thoughts on clomid by iteself? Can that “fix” the low-T issues? Do I need T-replacement? Do I need HGH?

Labs with ranges in ()
TT: 264 (250-1,110 ng/dL)
FT: 24.8 (35.0-155.0 pg/mL)
E2 – 14 pg/mL
LH/FSH – 4.0 (2.0-12.0 mIU/mL)
prolactin – 5.3 (3.8 – 18.9 ng / mL)
White Blood Cell Count 5.03 (4.16-9.95)
Red Blood Cell Count 4.97 (4.41-5.95)
Hemoglobin 14.3 (13.5-17)
Hematocrit 44.7 (38.5-52.0)
Mean Corpuscular Volume 89.9 )79.3-98.6)
Mean Corpuscular Hemoglobin 28.8 (26.4-33.4)
MCH Concentration 32.0 (31.5-35.5)
Red Cell Distribution Width-SD 42.0 (36.9-48.3)
Red Cell Distribution Width-CV 12.7 (11.1-15.5)
Platelet Count, Auto 207 (143-398)
Mean Platelet Volume 10.4 (9.3-13.0)
Nucleated RBC%, automated 0.0 No Ref. Range %

AST/ALT: n/a
DHEA-S – 2,000 (1,000 – 5,500 ng/mL)
TSH: 1.8 (0.3 – 4.7 mcIU/mL
fT3: 285 (222-383 pg / dL)
fT4: 1.5 (0.8 – 1.6 ng/dL)
IGF-1: 176 (132-333 ng/mL)

thyroid basics -
Date Time Temperature
5/28/2017 9:39am 96.5
5/28/2017 12:16pm 96.9
5/29/2017 1:19pm 96.5
5/29/2017 9:30pm 97.4
5/30/2017 7:00am 96.8
5/30/2017 11:00am 97.9
5/31/2017 6:10am 97.1
5/31/2017 9:43pm 97.5
6/1/2017 6:15am 96.5

Are your outer eyebrows sparse? No: my eyebrows are quite thick
Have you used iodized salt for years? No
Do you get cold easily? No, I am usually warmer than people around me
When did problems start? Any blows to your head before that? No blows to the head. Problem could have started 10+ years ago or I might always have had low T.
Were things better earlier? No
More hair before? No

LH/FSH are not low enough to explain low-T. Problem then appears to be your testes. DHEA is suboptimal, but not low enough to suspect that DHEA–>T is rate limited by low DHEA. Low thyroid function affects all cells, tissues and organs in the body and testes might be slow because of this.

AM body temps are low. fT3 is below mid-range, but not by much. This situation is a bit gray. But I do suspect adrenal fatigue from over-training with low-T and low thyroid function where you have been overcoming your low energy with adrenalin. In the thyroid basics sticky, please find references to:

  • stress
  • over training - >>>>> YES <<<<<
  • injury, surgery - no blows to head
  • adrenal fatigue - suspected
  • starvation diets
  • Wilson’s book <-- please read to see if it speaks to your experiences

TSH should be closer to 1.0

Please explain your history of using iodized salt, which may be an important issue for your wife and pregnancies.

  • Not using iodine long term.

Eyebrows do not indicate long term low thyroid function.
Part of TSH elevation can be from rT3 also blocking what fT3 the hypothalamus can see.

Get back on iodized salt.

Also check wife’s body temperatures. Hard to see what women’s eyebrows look like. Does she feel cold easier now. Women need more iodine, gets stored in and is important for breast health and support of breast fed babies. Low iodine status also associated with miscarriages [and retardation when severe].

AM and PM body temps seem low. Please repeat for when you wake up and mid-afternoon. If temperatures are erratic, that can be an adrenal issue.

You could start TRT today and use hCG injections or [Clomid | Novadex] to maintain testes and fertility. Many guys here have had babies this way.

IGF-1 and GH: I think that you should address other issues and see if IGH-1 improves. Premature consideration given the costs. But more like $6000/year with correct pharmacy.

Self inject 50mg T twice a week
0.25mg anastrozole at time of injections, test in 3 weeks, adjust to get near E2=22pg/ml
12.5mg clomid EOD/E2D

Injected T is the gold standard.

After 3 weeks test LH/FSH to see where LH/FSH are. Do not want high, near where you are now.

For small doses of anastrozole, dissolve in dropper bottle 1mg/ml with vodka and dispense by volume or by the drop.

Warning: With the increased/restored metabolic demands of TRT, you may feel worse if thyroid problems do not allow your body to keep up.

Vitamin D3 is very important. Most need 5000iu per day. Needs vary by climate, sun exposure and skin tone/color.
Vit-D is mission critical for proper gene expression, affects everything.

You did not post cholesterol. Can be a problem if low [<180]. Cholesterol is the foundation for all of your

Also do labs:
AM cortisol - one hour after waking up

That is enough to choke on for one day!

Thank you for all of your effort and study behind your post.

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.

Thank you for the quick reply! I got Wilson’s book in the mail today and will read it over the weekend.

Just to add to testes problem, I also had my sperm count check to see if there was an issue, and the count was high which is good.

I’ve been taking 5,000 mg of Vitamin D daily for months, and I also live in LA and get a decent amount of sunlight per day. I also take 2,400 mg of fish oil and 1,500mg of Glucosamine HCl with MSM

As for iodized salt, I have no idea how much I consumer. I eat 90% of my meals as take in or out. LA has lots of healthy prepared meals, but I’ve also noticed most have high sodium so I had cut out adding any extra salt to anything. I just ordered NOW Kelp pills to take daily.

Just to add some info as I have, it:

Temperature this AM was:96.5 and right now in the mid-PM 97.6

Cholesterol is 181 with 62 HDL and 119 LDL

As for cortisol and rT3, I’ll probably have to wait until the end of the month. The guy I am seeing thinks he’s the most knowledgeable person in the world on this stuff, and he’s already told me to stop reading the internet and trust him twice. I’m seeing a UCLA endocrinologist at the end of the month, and I will ask him to put orders in for AM cortizol and rT3.

My wife and I are both nervous about me starting T-shots. For now, I am going to start on clomid and the iodine pills as well as pairing back my workouts a bit and will see how levels test in 30 days + how I feel. If that doesn’t improve the problem, we agreed to talk more about the T-shots. Ideally I’d like to avoid starting something that I have to do for life.

"meals as take in or out"
Probably no iodized salt in those. Its all up to your cooking and salt shaker.

" The guy I am seeing thinks he’s the most knowledgeable person in the world on this stuff, and he’s already told me to stop reading the internet and trust him twice."

I wish that were true, but if so, why are you here? I am eternally skeptical because with good doctors, this forum would not exist. Anyways, we are here to help in anyway we can.

A UCLA endocrinologist gave me a VERY strong “Must avoid” on iodine tablets because I have the antibodies that are a precursor to Hashimoto’s and he said taking iodine could trigger it.

I have been taking clomid (25mg EOD) for ~5 months now, and my T-levels are up on the 2 labs I’ve had since, but my DHT is still below the range. I’m also on Armour Thyroid. I have been eating clean and lifting 5-6 days per week. However, I noticed I am putting on more fat, not getting any stronger, not adding any muscle, and my libido dropped back down (fat gain and no lean muscle verified by DEXA). My wife and are are trying to have kids, and I have promised not to do TRT until she is pregnant, so for now I am stuck with a SERM.

I wanted to get your thoughts on my most recent lab results. Should I add HCG and/or Anaztrozole? The doctor also recommends HGH, but I’m not sure I need it. Is there a better alternative to clomid I should ask about?

Here are my labs with ranges in () and out of range measurements with a *:

Thyroid Studies:
T3 Reverse 16.4 ng/dL (9.4-24.1)
TSH: 1.391 ulU/mL (0.340-5.600)
Free T4: 1.4 ng/dL (0.8-1.9)
Free T3: 2.9 pg/mL (2.3-4.2)
*Thyroglobulin 0.7 ng/mL (1.6-59.9)
TPO antibody 377.0 IU/mL (<35)

Cortisol 6.7 ug/dL (pm measurement)
IGF-1: 133.0 ng/mL (41-246)
IGFBP-3: 3055 mg/L (2,610 - 5,977)
VIT D: 33.6 ng/mL (>30-100)
Estradiol 34.3 pg/mL (<39.8) up from 14 pre-clomid
T-total: 553 ng/dL (240-950)
T-Free: 10.24 pg/mL (4.25-30.37)
DHEA-Sulfate: 344 ug/dL (80-560)
Estrone: 66 pg/mL (12-72)
*DHT: 26 ng/dL (30-85)

Your testosterone looks a lot better. Your E2 is higher than you should want it… look to keep it in the low 20s. You can do this by backing off some on the Clomid or adding in Anastrazole (although anastrazole may not have a large impact with Clomid).

You could use some Vitamin D - target above 50. Get 5,000 iu per day.

Your Free T3 / RT3 ~ 290/16.4 = 17.7. If you look around online a lot of the recommendations are to have rt3 below 15 and your ratio above 20. Since you are on Armour (Mostly T4 and some T3), the best way to improve this ratio is with T3 only (eg Cytomel).


I wanted to see if anyone has any suggestions. I just got my next round of blood work back after making some changes to my meds. My T levels all seem good now, but my Estradiol is still high, and now my Estrone levels increased to above the range. Any suggestions? Should I increase my Anastrazole over 1mg per week?

Also, he suggested iodine, which I have also read could trigger Hashimoto’s for someone like me who has the precursor. I haven’t taken it.

Also, if Clomid is so effective at rasining my T, is there any reason to switch to TRT after my wife and I have kids? Is it bad to stay on Clomid for more than a few years?

Changes made:

  • Increased Vitamin D to 10,000 iu/day from 5,000
  • Started taking 1 mg anastrazole (0.5mg twice per week)
  • Increase Clomid from 25 mg 3x per week to 50mg 3x per week
  • Increased DHEA from 25mg to 50mg daily

New results:
Thyroid Studies:
T3 Reverse 20.9 ng/dL (9.4-24.1)
TSH: 2.040 ulU/mL (0.340-5.600)
Free T4: 1.33 ng/dL (0.8-1.9)
Free T3: 2.9 pg/mL (2.3-4.2)

Cortisol 10.7 ug/dL (am measurement)
IGF-1: 170 ng/mL (88-246)
IGFBP-3: 3,206 mg/L (2,610 - 5,977)
VIT D: 57.3 ng/mL (>30-100)
**Estradiol 35.2 pg/mL (<39.8) up from 14 pre-clomid
T-total: 1,226 ng/dL (240-950)
T-Free: 23.2 pg/mL (4.25-30.37)
DHEA-Sulfate: 555.7 ug/dL (80-560)
** Estrone: 75 pg/mL (12-72)

I was hoping to get some further advice. I don’t totally trust my doc as he seems willing to just keep prescribing things without thinking through interactions and long-term issues, and we just keep stacking. I’ve been taking 50mg of clomid EOD recently, and have been on it for ~10 months. He doesn’t want to give me TRT because I’m still having kids, and also don’t have any issues producing with clomid. We just switched to HCG for 2 months and will go back to clomid after.

The good news is that my total T has come up from <300 to high 900’s on all my tests. But a whole host of other issues have been coming up, and I keep getting new prescriptions added. I’m now taking 1 mg of anastrazole 2x per week which has helped bring E2 down. However, my SHGB and prolactin are now high, and my free T has stayed fairly low. The doc prescribed me Selegiline (5mg daily) as a fix. Is this something I should be taking? Is the dosage a good starting point? Am I risking screwing up my system will all the stuff he keeps adding? I’m wondering if it’s time to switch docs. Here is the info from my most recent lab.

Thyroid Studies:
T3 Reverse 20.9 ng/dL (9.4-24.1)
TSH: 2.040 ulU/mL (0.340-5.600)
Free T4: 1.33 ng/dL (0.8-1.9)
Free T3: 2.9 pg/mL (2.3-4.2)

Cortisol 17.9 ug/dL (am measurement)
IGF-1: 158 ng/mL (88-246)
IGFBP-3: 2,791 mg/L (2,610 - 5,977)
VIT D: 59.9 ng/mL (>30-100)
**Estradiol 25.7 pg/mL (<39.8) up from 14 pre-clomid
T-total: 969 ng/dL (240-950)
T-Free: 18.4 pg/mL (4.25-30.37)
DHEA-Sulfate: 384.1 ug/dL (80-560)
DHT 56 ng/dL (30-85)
** Estrone: 44 pg/mL (12-72)
**SHBG 75.0 nmol/L (16.5-55.9)
**Prolactin 15.4 ng/mL (4.0-15.2) it was 8.3 prior to clomid

Total Cholesterol 185 mg/dL (100-199)
HDL 85 mg/dL (>39)
LDL 91 mg/dL (0-99)

How did you feel on this treatment of Clmoid with Hashimotos? Your T #'s look great for Clomid only, but how was libido and other things at those levels? I am considering a Clomid regimen and have Hashimotos antibodies present just like you.

I am not sure my libido has ever fully recovered. I am taking 700 units of HCG 2x per week now, and have been for maybe 11 months at this point. I am taking Anastrazole 6 days a week to keep my estrogen levels down. My free T has been in the high teens. I’m planning to alternate back to clomid in a month or two. No big difference in how I feel in either, but I dont know how long I should be taking either one and I like the idea of cycling.

I’m planning to try to have a second child mid next year, and after that I may consider regular TRT, but I’m not sure if I need to if my body will produce the T on it’s own when it gets the signal.

What is your E2 with that anastrazole dosing? That sounds like a heavy dosing regimen. Looking at your labs from April of last year, IMO adding an AI was premature then if it was based off those.

Reference range is: 7.6-42.6 pg/mL

I started 1x per week and went up to 3x per week, I was 48.9, 42.7, 42.9. I went off completely and had a reading at 71.7. Then I went to 4x per week and was still at 41.9 then 44.7. I just started 6x per week and haven’t had blood work yet to see if that works.

My Free T (8.7-25.1 pg/mL reference) has ranged from 17.6 to 23.7, so it’s not like I am getting to abnormal levels.

Ahhh…I was just looking at your estradiol measurement you put up in April of 2018 that was at 25.7 (<39.8). After looking again and realizing your just on HCG it makes more sense as AI supposedly does not affect intra-testicular aromatization. According to your numbers you just posted it validates that claim as it looks like that heavy dose of AI barely touches it.

Do you feel good otherwise on HCG alone besides the libido issue?

Yes. My main symptom was being exhausted all the time. Even with 9 hours of sleep. Now on 7 I feel better than I used to on 9. I’ve also seen good progress at the gym (nothing crazy). More than I’d seen in the last decade which is nice.

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Were you experiencing any high E2 symptoms at that level?

I’m not sure what high E2 symptoms would be. The only frustration I’ve had is my sex drive still doesn’t feel like it is normal. That could also be the function of stress from my job though.

Elevated E2 signs/symptoms: fluid retention, tender, puffy, nipples, gynecomastia, moodiness, overly emotional, sexual dysfunction (usually if E2 high while test is low) and decreased libido (same).

Low E2: joint pain, stiffness, decreased bone density, poor lipid profiles, emotional, sexual dysfunction and decreased libido.

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Definite no to any of the symptoms even when. I was in the 70s.

I would not use an aromatase inhibitor.

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Any reason? What’s the risk?