T Nation

Doc Wants to Add Clomid


#1

Hi all,

I saw my doc about 4 months ago. Since then, I made some small test dosage changes to my protocol per my docs request and I feel great. I’m getting labs done in a few weeks and will update with those numbers.

However, when I saw her last, she wanted me to start taking Clomid because my LH and FSH were too low.

I’m 27 and I definitely want to have kids when I’m about 30 years old. I figured the HCG (Despite my LH and FSH being low) would be fine and I wouldn’t need to add in the Clomid.

I discussed this with a few of you on here and was advised to stay off the clomid for the time being, but my follow up appointment is coming up next week. Any tips on how to approach this conversation with my doctor? I feel good right now and don’t want to make any changes to my protocol really.


#2

Standard practice is to take HCG together with TRT to remain fertile. I’m starting to think your doctor doesn’t have HCG in her toolbox, if she did she would be using it. You could start using HCG with your TRT protocol when you are ready for kids keeping things the way there are for now.


#3

What is your current protocol? What is your hesitation regarding Clomid? Does your doc recommend taking Clomid and HCG simultaneously or simply replacing the HCG?

Clomid works well for a lot of guys, and you can take it along with T. I was on Clomid alone for close to 9 months and glad I gave it a test run. What I liked about it was that it stimulates the HPTA to work naturally. Test is only one part of hundreds of functions the entire system performs so there’s possible upside in other areas too. Ultimately it wasn’t the long term solution for me, however I wouldn’t have known without first trying. As you’re only 27 you’re a prime candidate to try a restart…I say this knowing nothing about your background so take it with a grain of salt.

Please share more of your background so we can better understand your situation, and I wish you the best of luck while you dial in your treatment.


#4

Yeah that was my general understanding. I’ve been on the combination of Test/HCG/Arimidex for going on 2.5 years now. A new doctor took over my old doc’s practice and the new one was the one who suggested I start taking Clomid as well.


#5

I am currently taking the following 2x per week:
40mg test cyp
500 iu HCG
.25mg Arimidex

I have been on test going on over 2 years now with this mix. It has been a hassle getting my dosages nailed down with E2 fluctuating constantly. I finally feel settled and don’t want to introduce something else to the equation to further complicate things. My doc (who is new, took over my old doc’s practice about 6 mo. ago) suggested I add on Clomid about 4 months ago but I never did…

I would be open to going off the test/HCG while I try to have children (if it’s necessary) but I figured HCG/TEST would be sufficient in the meantime.

Here is more background of myself if it’s helpful. Also, I added in my labs from several months ago - something to note is that I have since reduced my test dosage since those labs so I think my E2 is now lower and my test should be lower as well. I’m also about to start subq test injections so I will be interested to see if that changes anything.

I started TRT when I was just about to turn 26. I got sober from heroin and alcohol about 2.5 years ago and became more aware of my low energy levels, insomnia, zero libido, ED, depression, anxiety, etc. Not sure if the drug and alcohol abuse had any long term effect on hormone levels, but I definitely had low libido and all the above symptoms starting around 18 years old, I just didn’t care at the time.
I got my T levels tested and immediately began T injections, HCG and arimidex (can’t remember if this was added later but I’m on it now)

Here are my initial levels (I don’t have the full labs) about 2.5 years ago, prior to starting TRT:
Testosterone, Serum: 159 mg/dL Low (348 - 1197)
Free Testosterone: 4.0 pg/mL Low (9.3 - 26.5)
DHEA-Sulfate: 420.5 ug/dL (164.3 - 530.5)
Estradiol: 10.7 pg/mL (7.6 - 42.6)

After starting TRT, I noticed an improvement pretty quickly. Got my levels tested every 3 months and then just every 6 months the past year.

-27 y/o
-5’7
-30" waist
-168 lbs
-Muscular/lean build, stocky thighs/calves; full beard
-my body fat% is consistently low; no noticeable areas where I carry my fat

Diagnoses/history:
Hypogonadism
OCD, major depression, general anxiety disorder at age 21
Substance use disorder - daily alcohol/oxy/heroin use for several years; currently >3 years clean
Degenerative disk disease and spinal stenosis in my C4 vertebrae (result of head-head collisions in football I was told)
Compression fracture @ L2 vertebrae
ACL replacement surgery
Lateral meniscus tear
Fractured both elbows, both ankles

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
*Wellbutrin (depression), Trazodone (insomnia) currently but trying to come off of these; I have been on/off AntiD’s for OCD/depression/anxiety over the past 5 or 6 years but often have relapse of symptoms when I try to come off - TRT has helped with anxiety/depression a little bit
*Have used Lexapro in the past but discontinued eventually due to ED and returned to normal functioning once discontinued

*Minoxidil/Rogaine 3-4x per week; Began losing my hair at age 16-17 and have continued slow balding since then; I tried propecia for like 2 or 3 days but discontinued after reading more about it - never got any side effects or changes in libido/sexual fx

Supplements
Morning: Fish oil, orange triad multivit, ginkgo biloba, , Vit D
Night: Magnesium citrate + agmatine
I sometimes take like 50 mg pycnogenol + arginine pre-sex which makes a pretty big difference in performance
*any thoughts on Maca powder? I have used it in the past but I’m unsure of the benefits if it was placebo or what.

Lab results with ranges (note these are 4 months old, getting labs done next week)
image
image
image

Diet
*Breakfast: Smoothie every day (kale, banana, cinnamon, chia, MCT oil, peanut butter, oatmeal, protein, yogurt, almond milk); I drink 2 - 3 cups of coffee/day but trying to decrease to 1 cup/day
*Lunch: homemade turkey or chicken wraps with spinach/kale with granola bar and yogurt
*Snacks: banana, pumpkin seeds, granola
*Dinner: Turkey/chicken/fish with vegetables (maybe caluiflower, carrots, broccoli, sweat potatoes, etc.) or eggs with ham and vegetables
*I drink a good bit of green tea everyday

Training: Has been modified as a result of C4 spinal stenosis; can no longer do much heavy lifting
Strength training 3-4x per week: low weight/high rep full body lifting; a lot of body weight exercises (push ups, pullups, etc.)
Cardio: 3x per week: running ~ 2 miles or stationary bike (never sit down on bike though longer than first 5 minutes); jump rope up to 20 minutes almost every work out

No symptoms related to testicles/aching genitals

Libido is pretty good

Morning wood and nocturnal erections:
Almost a nightly occurance, not always though
Trazodone taken at night sometimes induces erections I think


#6

It’s not wonder your E2 has been fluctuating constantly, your using the wrong E2 labs designed for females. These female E2 labs overstate your true E2 levels which you’re using to determine AI dosing. Most doctors are unaware that there is an E2 test specifically for males, you need the LC/MS/MS sensitive method designed for males.

Your doctor has been making this harder on you than it needs to be. Also I don’t see any SHBG labs, nothing is more important that SHBG when replacing androgens.


#7

image

sorry about that, must have forgotten that one.

So What specific test should I tell her I need for E2? LC/MS/MS sensitive?
Is that something I can go and get done on my own and if so, where is the best place? The labs they ordered last time cost me well over $400


#8

$400 for labs is absurd, discount labs is the place to go.


#9

Your Dr is an idiot or willfully ignorant. You’re on Test. Your LH and FSH are going to be zero as you’re shutdown. Your Dr has to and doesn’t know this. Also, adding Clomid to Test is just not done. Again, you need a Dr with competence to what they’re prescribing to you and this is a glaring problem.


#10

And why was doc even ordering LH/FSH when they–>zero. Waste of money to find out what is expected.

fT3 is well above mid-range.
TSH well above 1.0

I think that your rT3 is interfering with fT3 and that your lab range is at fault. We see some lab ranges with high limit near your rT3=18.3

You also could be iodine deficient. Using iodized salt?
See below re oral body temperatures and report both sets of oral body temperatures and outline your use of iodized salt.

With your high E2, you will feel a lot better with more anastrozole to get near E2=22pg/ml which seems optimal for most guys.

New anastrozole dose is 0.25mg twice a week X 40.1/22 = 0.45mg twice a week. That is near the typically expected dose of 1mg/week. Try 0.5mg twice a week and see how you feel in 5-10 days.

rT3 can be elevated by:
day to day stress which can be over-training
stress events that can be injury, illnesses, surgeries

In the thyroid basics stick see terms: fT3, stress, adrenal fatigue, Wilson’s book.

DHEA-S: We you taking DHEA? If not that suggests that adrenals are not beaten down too much.

You can also lab:
AM Cortisol, at 8AM or 1 hour after waking up. No caffeine and try to have a calm drive to the lab and be mellow.


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 number 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.


#11

Yeah I’m having a difficult time finding a new dr at the moment with my insurance… it’s quite a pain


#12

Thanks for the response. One thing to note is these labs are 3 or 4 months old so I will be getting some new labs done next week. I will update with those numbers. I was not taking any DHEA.

I added in an iodine supplement initially following my lab results due to feeling cold all the time. I have since tapered off that (I still get iodine from my Multivit) and now use iodized salt in my meals.

With the E2 labs, would it be beneficial to get the sensitive test done even though I had the standard done last time? My thought is that switching the test up may cause a little confusion over whether or not lowering my T dosage was sufficient to decrease my E2 since I’ll be using two different tests…


#13

Is 500 IUs of HCG 2x per week enough to preserve fertility?

I was at 600 IUs 2x per week but decreased due to estrogen spikes.


#14

Met with doc today and she did labs. She said she has multiple male clients on hcg/test/clomid all together in order to maintain fertility. I figured I would be ok with HCG to do this. Now she has me worried that my ability to stay fertile is at a huge risk.

What do you all think? If I was to get a semen analysis, would labcorp be the best option?


#15

Most recent labs are attached and looks like my test is still pretty high even though I lowered my dose to just 40mg bi-weekly; note that I was on an anti-inflamm at the time for a knee injury which I think is why my liver enzymes are up which I have since discontinued

protocol:
40mg test 2x/wk
500iu HCG 2x/wk
.25mg arimidex 2x/wk

I’m getting a semen analysis done next Friday so that should be interesting…


#16

Sperm analysis results:

Count: 51 million per mL
Motility: 3
Viscous
Incomplete liquification at 60 min (likely dehydration as I did this at 8 am without much water beforehand)
Everything else normal

Saw a new doc today and she wants me off test because I’m too young according to her


#17

Your doctor is clearly against TRT, did she offer you Viagra or an SSRI? How about finasteride?


#18

her “reasoning” was the long term effects of trt for someone my age according to her as blood clots, stroke, DEFINITELY no kids… she was very insistent upon that.

She said she would prefer to take me off test but leave me on HCG for now.

She said that my levels are too high (>1295) esp for the small dose I’m on, that maybe I can get by with either 40mg per week or none at all.

I mainly went to get the sperm looked at, not necessarily follow her recs. Although being on TRT for the next 40 years is not my first choice since I’m only 27


#19

Your doctor is wrong about stokes and clots, there is 2% who have clotting disorders, so unless you’ve been diagnosed with a clotting disorder then her statements are foolish and short sighted. Unless you are 60 years and already have heart problems a stroke is unlikely.

This doctor is ill informed and incompetent in her knowledge. TRT is not the devil, it’s a natural hormone our body evolved to process, whether naturally produced or injected, it poses no risk either way. There are tons of guys having babies who are on TRT and I believe this doctor is being a little overly anxious.