T Nation

Debating with Endo on Clomid vs. TRT - 30 Y/O, Low T / Low SHBG

Hi all - first of all thanks to all of you for reading this and for all the help you provide on this forum. Its amazing how many knowledgeable and helpful people are on here! I’ve gone from knowing nothing on this topic to feeling good about having an (almost) heated discussion with my doctor.

For maybe the last two years I’ve been feeling fatigued more often than I used to, lack of motivation, very low sex drive (no morning wood), struggled to put on muscle even on 5x5 type programs and trouble with memory/concentration. Previously I’ve always been extremely high energy and very motivated, so I didn’t think more of it than this is just how getting older feels like. Then randomly I saw an instagram add for a testosterone test and decided to do it after reading a bit about the symptoms of low T. After what was basically like reading my story the last two years I went for the package (which I know realise didnt have all the right components).

I am 30 y/o, 6’ 2", 220lbs, not very fit, these days do mostly cardio based exercising (2/3 wk). Not a lot of facial or body hair (but evenly distributed), always had some love handles, but last two years gained a lot around belly and inner thigh. No health conditions or history to speak of, no Rx/drugs and no previous use of AAS. No real pain in testes. Have checked temperatures for three days now and they are spot on according to the sticky. Live and work in London.

Test Results:

After getting these results my endo (top notch London private clinic type) thinks my T is low, but not sure if its low enough to warrant TRT. He suggests Clomid, which thanks to this forum I told him I dont really want due to side effects and often low efficacy of helping against symptoms. He got really defensive, especially when I asked about HCG, which he said wasnt for me without wanting to discuss further. I ended up just accepting the clomid, which he prescribed 50mg per day (again sounds like a lot). I dont necessarily want to do TRT, quite scared about fertility issues down the road, but I want to fix symptoms.

Long story short, what I would love to hear peoples perspectives on are:

  1. my test results
  2. Clomid - is it the right Rx for me?
  3. If yes to Clomid what is the right dosage?

I was able to barely read your labs as letters are to small. I have to say men don’t recover being as low as you are, you’re hitting the levels of a 90 year old at 30.

We are under constant bombardment by chemicals, diseases are rampant and there are an unknown number of endocrine disrupters in the environment, disinfectants are changing the gut bacteria causing all sorts of chemical changes within our bodies.

The majority of men who take Clomid do see levels elevated, but feel no better given perfect numbers, Clomid blocks estrogen in the brain in order to further increase LH. Successful restarts are “very rare” and do not occur often, doctors like to use it first to justify TRT later to the medical board, it’s called self preservation and is why your doctor got defensive.

A low of doctors start men out on large Clomid doses, 12.5mg EOD can work, even 25mg every 3-4 days can work. Everyday dosing seems to increase side effects, spreading the doses out over days can minimize sides effects. An AI will likely be needed to manage estrogen sides, low dose anastrozole or aromasin.

Sometimes SHBG is low do to genetics, other times do to hypothyroidism. Excessive carbs/sugar lowers SHBG. Your thyroid numbers look good. Given your SHBG I wouldn’t target high normal testosterone levels, low SHBG men have more free hormones (free testosterone/free estrogen) than midrange and high range SHBG men who require more total testosterone to achieve the same free testosterone as low SHBG man.

Adding HCG and especially FSH (game changer) to a TRT protocol can greatly improve sperm production.

Thanks very much Systemlord - appreciate the feedback. I’ll start on Clomid then and will keep you all posted. Also reattaching my tests

Hi all - thought I’d give everyone an update and maybe get some further input.

Been doing daily 12.5mg of Clomid for four weeks and just got my new bloodwork back (in purple at the end). As expected Estrogen levels are very high. Endo thought it was encouraging, didnt seem that worried about estrogen, but when I told him my sex drive wasnt improving he suggested I get some Anastrozole to combine with and see if that helps. Prescribed me with a generic Anastrozole tablet with 1mg content. He recommended I do half a pill per day ie. 0.5mg daily - from what I’ve read on here that sounds like a lot so wanted to check if you all agree or not. Maybe its because my E2 levels are so high.

Thanks in advance for your help!


Without knowing how you respond to anastrozole, I would cut it into 1/4 and take it once or twice weekly and see how you respond to it. We have a lot of AI over-responders here. If you over-respond to anastrozole, you might try aromasin and cut it up into smaller pieces.

I would not take the anastrozole at all. The low sex drive could be from the actual clomid. Do you have several high e2 symptoms?
Like nips ithcy, bloating, etc

You estradiol not that high considering your free testosterone is up there too.
You can even try 12.5 EOD.