I went to see another Dr about fertility issues while on TRT and he said that I should come off Testim and replace it with Clomid to avoid shutdown and infertility. He said he can bring my T levels to normal with Clomid and if needed Adex. Is clomid enough to restore T for long term use?
Some doctors do use clomiphene as TRT monotherapy for young men, and have reported some success. I am aware of patients that have been on clomiphene for 8 years and have had a positive treatment outcome. With that said, there are no studies on efficacy of clomiphene for TRT and no long-term studies on safety.
There is an Italian company that is in phase 2 trials using enclomiphene, the trans-stereoisomer of clomiphene, for TRT monotherapy. The results of their studies will elucidate the unknown efficacy and safety of enclomiphene for TRT. Clomiphene is a mixture of ~40% enclomiphene and ~60% zuclomiphene (cis-stereoisomer).
to the best of my knowledge there are no studies on the effect of long term CLomid use. Plus isn't there a possible floaters issue about the eyes?
HCG can maintain fertility while on HRT.
You are correct on both accounts. The "floaters" in the eyes are protein aggregates that typically clear up upon cessation of clomiphene use.
If enclomiphene is effective and safe for long-term use, it provides advantages over Testerone + hCG in terms of fertility. Men using enclomiphene have normal-high levels of LH and FSH to stimulate spermatogenesis and to mature the spermatids in the Sertoli cells. While sperm count can be maintained on hCG, the number of motile sperm typically decreases, but can be recovered with FSH stimulation either through clomiphene (other SERMs work also) or hMG.
With that being said, given the current state of knowledge, some are not comfortable taking clomiphene long-term without knowing the safety; the choice is up to you. If you begin clomid treatment, you can decide at any point that it is not right for you if any issues arise and discontinue treatment.
HCG IS NOT AN OPTION, I've been to 2 Dr's now and the first one put me on Testim 2 tubes daily and .25 Adex E3D and quite honestly my symptoms seemed to have gotten worse so I went to another Dr to see if he could put me on HCG. The second Dr said that Testim will cause testicular atrophy and shutdown and he told me we should stop the Testim and Adex and he put me on Clomid 25 mg ED. Second Dr said that if we can't get my numbers high enough then he would add Adex. I'm currently self medicating 50 mg Clomid for a few weeks to get my numbers back to normal while off the Testim, if i still feel like crap I will call him and let him now. I'm very frustrated right now, it seems like everyone on here has been able to find the correct meds/dosages and I still can't seem to find the sweet spot, and when i did find the sweet spot, it only lasted a few days. I'll keep you guys posted.
Why are you spreading your details across multiple threads! This is not a chat room. Read the advice for new guy's sticky.
Floaters are nolvadex [sort or rare]. Emotional problems and Ed are a problem for some [few] using clomid. Doctors do not know that. I recommend nolvadex. But if you feel OK on clomid, you are good to go.
Do not take high dose hCG or SERMs. Do not take hCG+SERM. No need to stack SERMs - note the too much.
I'm taking 50 mg of clomid daily, i tried taking 25 mg daily and I felt like shit. I still feel like there is something missing.
Half life of clomid is 6 days, so taking 25 mg daily requires nearly 3 weeks to hit a full dose. Taking too much (and some juicers take 100 mg or more when trying to recover) can cause vision issues because of swelling of the pituitary gland, which is located almost on top of the optic nerve. Since it is a weak estrogen, taking too much and having it accumulate too fast in the blood can give you a whole bunch of unwanted side effects (mood swings, breast enlargement, decreased libido).
Using clomid to fix T levels takes time. Normally a low dose for 3 - 4 weeks followed by a blood test ("clomid test") to look at T and estradiol ratios. Then the assessment is made (along with whether you are having serious side effects) about continued use. A stint of a minimum of 4 months is indicated for long-term testicular growth/changes. Some people report being on it for a year or two with no ill effects.
Unless you understand things like dosages, half-lives and interaction you should not be discarding/altering your doctor's advice.
Your first stop on a new medication is figuring out why s/he prescribed it they way they did. Discuss the particulars with them once you understand it and be engaged. So far my experience with doctors is when I do this and am an informed, active patient, they are more than willing to chat me up about all sorts of things. Don't ever let your doctor fly blind. That said, it may also turn out your are better informed than your doctor, in which case you should seek out another one.
My doctor is a TRT specialist. He says that a few months on Clomid can produce long-term gains in T levels and symptoms in some men with secondary low T, but that it generally works best in cases where the cause of the problem is easily identifiable. (e.g. steriod use, painkillers, etc.) He estimated the long-term success rate for this treatment to be 40%.
Supposedly it can be hard to see what the long-term effects of the Clomid will be while you're on it, because the side effects can mask the effects of the T gains. It affects the way that estrogen is used by the body, so your estradiol levels can be misleading while on the drug. You can tell if it's raising T levels within a few weeks, but you can't really know if it will relieve the low T symptoms until you taper off after six months or so.
Not an expert, so take this for what it's worth.
Fertility: TRT puts that at risk. The options are SERM or hCG. There is no reason why you cannot do T+SERM. SERM can lead to high E2 that cannot be managed via AI if dose is too high. T levels from SERM monotherapy depends on the testes and age is a large factor. If T levels are not high enough, increase of SERM dose may backfire with high E2. If you need more T, then T+SERM or T+hCG is needed.
Clomid works fast.
My TT went from 300 to 750 ng/dl from 25 mg/day for exactly 7 days. I can’t imagine what the heck everyone is talking about when they use 50-100 mg numbers and estimates of weeks.
Sorry to bump this old thread, but I wanted to bring this comment to the front again. I don’t understand either, why people feel that they need to take Clomid for so long. Even two weeks. Three weeks. Four weeks.
The stuff works quickly. Is there some benefit to getting yourself into the 700s, and then keeping yourself there for prolonged periods of time on the meds? Or is the goal simply to kickstart the machine again?
Depends on why you are using it. I had a vasectomy reversal and needed to kick start the entire system again. I got remarried and we now have two kids and just found out the wife is expecting again, so heck yeah this works as billed. I have been taking 25mg/day for over 3 years as well as anastrozole (aromatase inhibitor) to keep E levels low. Last blood test I had E levels of about 20 and T levels of 850. Counts are acceptable too (one actual complication is scarring on the vas deferens so making lots of little swimmers is important to keep counts in the right range for conception). I offer this as a case study. YMMV…
The problem with coming off it though is serious mood swings and my levels may drop as well as sperm production, so the plan is that I stay on it until we are done with kids. I would stress that I respond well to clomid and this is why we went with this route. Some people respond very poorly to it.
I believe there are some Doctors that are experimenting with long term low
dose use of clomid instead of HRT. Some people have had great success with
clomid only, and others, like myself, haven’t had great results. It’s also
used to check and see if your HPTA can be kickstarted, I believe Dr Crisler
uses this method to determine which protocol to put his patients on.
@jj_dude - See here’s the thing.
Clomid’s half-life is insanely long. Nearly 7 days.
That means if you take even one 25mg tablet, that tablet is going to be both:
- In your system and
- Working to stimulate LH …
For nearly a month.
From one tablet. A whole month of therapy. One tablet.
Therapeutic doses for most guys are anything over 6mg in my experience.
You will be over 6mg for literally 3-4 weeks from just one tablet. And that stuff wont be fully out of your system for nearly 4-5 weeks.
Why would any doctor dose anyone at 25-50mg daily?
Why would anyone trying to do a restart take more than one 25-50mg tablet?
My doctor used 12.5mg EOD, which is close to 6mg per day, for what it’s worth.
Regarding the elimination, I agree with your logic, but there must be a missing element, like the actual effective dose. Why do you say 6 mg? A normal clomiphene citrate challenge per traditional endocrinology is 100 mg for 7 days, and that leaves months worth of clearing the drug to follow, but I’m not so sure that the effect of the drug lasts for months.