T Nation

Clomid Monotherapy or with Tostran Gel?

#1

Hi guys,

Written on these forums before, so doing my best to keep it brief! 24 years old, 63kg, 170cm in height. About three years or so ago now, I began suffering from ED and low libido. Around about the same time, I developed mild Gyno and acne. Symptoms got progressively worse; lost my morning erections, began getting hot flushes and gaining weight etc etc, so went to GP who reluctantly agreed to do some blood tests for me.

Cut a long story short, total and free testosterone came in at 13mnol and 15mnol respectively. Reference range goes from 10-30mnol, so it is almost universally agreed that levels like that in a man who is my age and otherwise healthy, are low and likely to impact my physical and mental health. Further tests showed high prolactin, and I am now on Cabergoline 0.5mg tablet once a week to bring these levels down, as apparently high prolactin levels can impair libido and erectile function/ quality.

My doctor has however, in view of my symptoms and borderline low testosterone levels, indicated that he would be happy for me to try a TRT regime in the form of Tostran gel. Now, given my age and the risks that TRT poses, I said to him that I was unsure about this. He then suggested Clomid as an alternative. I don’t know if any of you guys on here are familiar with it, but apparently it is used off label to raise LH and FSH and can even encourage fertility, whereas TRT of course actually shuts down your body’s natural production and can reduce sperm count significantly. Any guys on here have any experience of using Clomid? If so, what happened whilst you were on it? Did you notice a substantial improvement in your symptoms and what dosage did you use?

I am reluctant to do TRT, especially as HCG is not being offered/ is not available, but if my symptoms persist and I continue to suffer then I suppose I will have no choice. I would however like to try the Clomid first, so any advice regarding doses and symptom improvement etc from anybody with any experience of using it would be very useful at this stage. Also, anybody on here used Viagra/ Cialis and found that they did not really improve or strengthen your erections? If so, what alternative treatments did you then decide on?

Look forward to hearing from you!

#2

Clomid isn’t a problem, it’s the doctors that are the problem often prescribing 50mg everyday. 12.5mg and even 25mg every other day can be effective.

#3

I am assuming u tried Viagra and Cialis and did not help?
I hear that when your estradiol is low they don’t work well. They work for normal and high estradiol. I suspect your estradiol is very low along with your testosterone.

When my estradiol was low with t low also it was even difficult to jerk off.
Need to get blood labs

Lh
Fsh
Tsh
Free t3
Free t4
Estradiol sensitive
Shbg
Complete metabolic panel

#4

Where are you? UK?

Labs should be in list format with ranges.
Nothing else tested?

You need to test LH AND FSH to see if testes or pituitary are at fault.
If LH/FSH are elevated and T is not, testes are the problem and Clomid or hCG will not restore good T levels.

You need to be on cabergoline for a while then do labs again to see if problem is resolving.

Also see the HPTA restart sticky.

Most who come here have some thyroid issues, please evaluate via oral body temperatures - see below.

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 numbers 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

Hi,

Have you used Clomid? I read that it can relieve symptoms and be a good short term substitute for TRT. My tablets are in 50mg, so would half of that be 25? How many days per week should I take half a tablet for optimum symptom improvement? Oestrogen is very high, so on a 1mg Anastrazole tablet once a week to control this.

#6

Hi Charlie12,

Thank you for your message. I have tried 100mg generic Viagra and it did very little for me in improving erectile strength or duration. I got weird tinges to my vision and felt a bot dizzy after using it! Have tried Tadalafil 10mg and find this works a little, but still not enough as to be a massive improvement.

Actually my oestrogen was/ is very high 180pmol/L on a reference range that went from 72-160, so I am on 1mg Anastrazole once a week to try and bring this down. Blood tests play their part, but for me my symptoms matter more, and so far I have no symptoms suggestive of low oestrogen.

Getting bloods done Friday, so will post labs and ranges when I’ve got them for analysis.

#7

Interesting. You can try 20 mg Cialis. My t was low and Viagra and Cialis both work like a charm for me.
I tried clomid. It did increase my t but my lh and fsh we’re low normal so clomid worked. Am 41 so clomid got my t up but not enough. Testes are older lol. For you 25 EOD should work fine. Be advised some guys report t going up really well on clomid but they don’t feel good on it. Just something with clomid. But you should try. Must get lh and fsh first.

#8

Never used clomid, but know first hand if E2 is high erections become difficult. The problem is you don’t have the proper E2 labs in your country so it will be tough to balance E2 levels. The female E2 test is pointless to draw any conclusions.

#9

Also I would not take 1mg at once if on clomid. Maybe .50 every 2 x a week. I did clomid and did not need arimidex. Kept my e2 great. So you do not want to crash estradiol.

If you did not try to reduce your estradiol yet you can try that without clomid. You may not being producing T because hpta senses high estradiol. Lowering estradiol is a type of mono therapy you may want to consider

#10

Charlie12,

So you’d say give Clomid a good go before jumping on Tostran or any other TRT only regime? My symptoms are very bad: low libido, ED, loss of morning wood, acne, Gyno, hot flushes/ depression, so I really am needing to try and get it under control.

In terms of Clomid, have you ever used it? If so, did it improve libido and erections and mood etc? What dose were you on and did you get any side effects? Oestrogen is high hence the Anastrazole, but will see what latest blood test says and then taper the Anastrazole depending on how the Clomid works.

#11

Your 24 dude. Dont worry you will get your d up and have plenty of fun. You will fix this. This is temporary. Trust me I know. As soon as I could not maintain an erection i was driven to fix this. Most of us guys love sex and our D’s.

I was on clomid as I said. Only difference is I knew my lh and fsh was low normal. So I knew clomid should work. Some have symptoms on clomid. You will have to try it.

I also had very low estradiol along with my low t when I started clomid. Different than you.

Maybe you should try to bring your estradiol in range FIRST before doing anything else. Then retest total t, free t, shbg, lh, fsh, and thyroid numbers, prolactin.

I have no knowledge on how your high prolactin impacts this and the medication you are taking.

I only speak about what I know or experienced.

Others may way in.

Edit. Clomid did help with my hair growth , libido. Had huge loads to. lol. I ended switching to injection because of my age and what my body could do with clomid is limited.

Also I had hot flashes, no sweat, while my estradiol and t was very low. This was before any treatment

#12

Hi Charlie12,

Thanks for the detailed reply. I’ve had these issues for years and given how young I am have had to FIGHT to be taken seriously by doctors, most of whom told me it was mental and to pop some Viagra! I’m sure many younger guys on here with hormone/ ED related problems have experienced this sort of crap, so good to know I am not alone!

In terms of Clomid, do you think half a 50mg tablet every other day is a good dose? As I mentioned before, on Anastrazole total of 1mg a week for my high oestrogen, so hopefully once this is in range certain symptoms will improve. Have you got any thoughts on why I might not be responding to the 10mg Cialis or the 100mg Viagra? Could it be that I have damaged blood vessels or impaired blood flow to the penis itself, or is it more likely to be hormonal and mental at my age?

ED and low libido at my age sucks haha, so any advice or guidance guys can offer would be really useful, as I am determined to find the root of the issue and get it sorted! ;

#13

Once you get your lh and fsh numbers you can see better if your primary or secondary hypogonadism. If primary may want to get an ultrasound of testicles.

I think Viagra not working because of hormones. But you day had problems for years. Any puberty issues? That could help you determine what’s wrong.

Like I said get estradiol under control. Not sure when you started anastrozole but if you did without taking testosterone or clomid may have crashed your estradiol. If u crashed it, Viagra will not work usually. You need to confirm this. Bringing down your estradiol may increase your t without anything else.

Regarding clomid Endocrinologist had me on 25mg ever other day. Then went to a urologist and he says would have done 25 everyday. I would do 25 every other day when you decide to go on it

I would check your estradiol and see if bringing that to range helps your t.

You really should have complete blood work. Like CBC and complete metabolic panel, lipid panel also just in case there is something unforeseen.

Good luck. Keep us updated.

#14

Let’s keep it together. I don’t like to waste my time repeating myself