T Nation

Doctor Gave Me Some Options for Fertility

So I have been battling Low T for about 4 years. I was originally indicted by my PCP of 200 test cypionate once a month. I felt good but would crash about 19 days later. I was 27 at the time and my initial reading was 199. So I decided to see a urologist for this and the first doctor gave me arimidex 1x a week for 4 weeks. So my number got into the 300’s and he said I was fine. Still get awful so I seen another urologist at the clinic. He game me clomid 50mg ED. I’ve been on that protocol for 2-3 years now. Felt good for about 4-6 weeks when starting them things just went downhill again. I was told I need to do this because of fertility. I’m tired of feeling like shit all the time and busting my tail in the gym to no results. So I decided to take action. I seen a urologist who specializes in fertility and low T. I have high SHBG of 65.5 and TT of 528 on clomid. He said my estraidol does say normal but it is at 17. He went over how TRT injections can cause fertility issues. He prescribed me 50mg of clomid a day and .5 arimidex on Monday and Friday. He said try this for a month and see how you feel. He went over that if I don’t feel well he will let me start injecting but I needed to talk to my wife because the HCG and Clomid is not 100% of saving fertility. Anyway I have an appointment with him on the 31st for follow up. It feels like this is a more precautionary route or to maybe say to the insurance we tried all these things. He also said that if we can solve it with then I won’t have to prick myself or draw bloods constantly. So does HCG and Clomid help with fertility? My understanding is it does and that the clomid would only be taken when trying to conceive? Also is this doctor just trying to prove something to insurance since I’ve been on both and still feel like crap?

(Also I do have a 10 month old so I am able to have kids)

Thank you!

Testosterone injections + HCG will allow you to use testosterone for replacement while retaining fertility. HCG mimicks leutinizing hormone. Leutinizing hormone is one of the hormones that stimulates production of intratesticular testosterone and spermatogenesis. Granted if you have primary hypogonadism this won’t help, but given that you’ve responded to clomiphene therapy suggests you have secondary hypogonadism.

HCG used alone will shut as it is supressive to the HTPA, using Clomid with HCG is like pissing in the wind. The protocol your doctor gave you (200mg 1x/month, is not effective. The peaks and troughs from such a schedule are terrible.

As to being on clomiphene for 2-3 years, I don’t believe there is any data on long term safety with regards to clomiphene when taken by men, however I could be wrong. Clomiphene many times doesn’t help symptoms with hypogonadism as it raises SHBG and can send E2 through the roof, however if it works for you then great. Your TT with your SHBG indicates your free T is probably still low.

I might be wrong about HCG and clomiphene together but from what I know there’s no point.

That’s what I’ve heard about clomid. And I’m just pissed because clomid is pricey and hasn’t made an improvement. Yeah it’s raised my total T but that’s all it did. Felt good for 4-6 weeks and it went back to normal for clomid. I almost don’t even want to take it until the 31st because of the sides with it. I get really sore muscles and not like blinding vision or anything but like I’ll see a little blurry and see zig zags sometimes. It’s awful!!! I think I’m just going to use the arimidex so my estraidol levels drop. Yeah I think the HCG may be my option. I know he said I have hypoganidism but not sure if it’s secondary but I assume it is from my understanding. Any ideas why he prescribed clomid and arimidex even though I already used it?

Clomid raises total T but also raises SHBG, testosterone is bound to SHBG and albumin right, the higher your shbg and albumin the less free testosterone your body has. While it’s true that too low of an SHBG is a bad thing as total testosterone is required for various bodily functions (more than previously thought), adequate levels of free testosterone are also vital for adequate libido and sense of well-being and whatnot. The actions of clomiphene and why it makes people feel shit is a bit complicated, I can put a detailed explanation if you want but I don’t see the point in doing so. Also low shbg is correlated to a variety of health issues like insulin resistance, however high shbg is linked to symptoms of androgen deficiency (due to low free T, you can have a total testosterone of literally 1500 but have a super high shbg causing one to still have symptoms of androgen deficiency)

If your doc is prescribing both he may have a reason for it, but I can’t think of one, it just makes me think he may be confused, I’m not going to say uneducated because he is a doctor, and the very process of becoming a doctor is very difficult, especially when it comes to retaining all the info they have to learn, he is probably very smart as most doctors are, however the relatives in my family who are doctors, and one of my parents all said TRT and AAS are not taught in medical school.

I don’t know how effective HCG by itself is, I think honestly it’ll skyrocket your E2, also I personally dislike aromatase inhibitors. when I was in my early teens I was given 1mg of arimidex/day instead of growth hormone as I had short stature + precocious puberty therefore my growth plates (bone age) was ahead of what my age was. The crashed estrogen fucked up my joints and I never really got my joints back to what they were previously, I also sustained multiple lifting injuries and broke my ankle which had to have screws put in (the ankle still irritates me), I also have osteopenia in parts of my spine. It was due to tanked E2 but you get the point, lots of the time aromatase inhibitors are totally unnessecary and they can do a number on your good cholesterol. HCG will skyrocket your E2 tho if used as a primary treatment for hypogonadism. I don’t feel comfortable giving advice but I suggest you talk to another guy on this forum about this, if I was in your situation is probably look for a different doc, preferably one that’ll prescribe weekly shots and HCG, but im not telling you that’s what you should do, I’m telling you what I’d do.

Are you in the US? It shouldn’t be that hard to find a super up to date doc there, you said you were prescribed test cyp which makes me think US

Thank you for the response. So this was my first appointment with this doctor and it he had been the first urologist that I have seen willing to prescribe me Testosterone injections. Others didn’t even consider it. I seen an endo and her response was “there’s something else going on. Lose weight and do blood work then come back in 6 months. I know it’s tough but you’re in normal range.” I asked her about HCG and her reply was “you don’t want to do that because those side effects are so much worse than clomid. She then said you’re fine and you probably have a defiecny elsewhere.” So I was done with that doctor and a waste of a $70 copay. Yes my copays are crazy!!! So this doctor said he would like to try arimidex and Clomid for 3-4 weeks and if I don’t feel any better he will prescribe me TRT and HCG. I was just going to take clomid because that’s what I heard and he said “sure you can but you really only need HCG.” So it seems that this is repetive with the clomid and arimidex where it didn’t really work for me. It raised my TT but didn’t do much. Yeah that’d be awesome if you could explain it. I’m educating myself on this and have been for the past 6 months trying to read at least one article a day. Yes I am in the U.S. and have seen 1 endocrinologist and this is my 3rd urologist. It’s been a struggle. I did call defy as well and a few Low T clinics and it was really pricey. Much rather go through a doctor for insurance purposes.

Clomiphene is a SERM (selective estrogen receptor modulator). This means that it works by binding to estrogen receptors in the body therefore blocking the effects of estrogen. This stops estrogen from having a negative feedback effect on the HPTA (hypothalamic pituitary testicular axis), therefore levels of LH (luteinizing hormone) and FSH (follicle stimulating hormone) are increased. LH stimulates the testicles to produce testosterone and FSH I believe stimulates spermatogenesis production in sertoli cells in the testicles. (I can go into detail about the types of cells and stuff but I don’t think it would interest you, however if you want to know I can include it). While this sounds awesome there are a few things to be aware of with clomiphene. Many guys feel like shit on clomiphene

So clomiphene (this isn’t widely known) is actually a mixture of two medications, enclomiphene and zuclomiphene. Zuclomiphene is quite estrogenic in nature, and while I may be off base here, I believe that is due to the fact that clomiphene binds to estrogen receptors the body can detect the compound as estrogen therefore it can actually act as estrogen in itself and activate estrogen receptors in the brain (however I’m not a doctor, there’s a good chance my understanding is flawed, ask one of the doctors on this website if you want a full explanation on as to why clomiphene can be estrogenic). It’s other counterpart, enclomiphene I believe is currently in development for the treatment of male hypogonadism, whether this will work I doubt it. Clomiphene is not an aromatase inhibitor, it merely stops the effects of estrogen in many areas of the body sensitive to estrogen receptors (the breasts etc.)

Unlike testosterone and most androgens that bind to and decrease SHBG, an increase in estrogen causes an increase in SHBG (which may be a bad thing depending on your current SHBG level and in your case that’s not a good thing as your SHBG is super high), therefore libido can be negatively impacted via estrogenic side effects (mood swings, depression, low libido etc) and from low free testosterone due to an increase in SHBG.

Clomiphene may be cytotoxic to various cells and rare side effects of clomiphene include visual disturbances and even occasional ocular nerve damage and this can result in permanently damaged vision, seriously if you are having vision issues with clomid tell your doctor ASAP!

For some people clomid works and restores their HTPA, bodybuilders will use it (or tamoxifen, or toremifene, or both, or all three) after a steroid cycle as steroids cause secondary hypogonadism and is typically reversible, SERMS help restore LH and FSH back to normal quicker therefore testosterone production can be started up again and said bodybuilder can keep more of his gains as he isn’t in a hypogonadal state for as long. (and in said hypogonadal state cortisol, a catabolic hormone can become the dominant hormone… not good for preserving or gaining muscle mass).

Finally, you seem to have secondary hypogonadism from the information you have provided. If one has primary hypogonadism (low testosterone due to failure of testicular function), an increase in LH and FSH won’t do anything and taking clomid would be like injecting saline for TRT… as in it wouldn’t accomplish anything

If I have anything wrong (which I may, I’m no expert compared to like physiolojik or other doctors or specialists and whatnot) feel free to correct me anyone reading this.

Endocrinologist and urologist usually have poor knowledge in male hormones and don’t know how to design a proper TRT protocol as it isn’t taught in medical school, so naturally they are going to shy away from prescribing TRT, they are going to stick with what they know best.

The truth is doctors prescribing a (patented drug) Clomid is far more profitable than prescribing an unpatentable hormone is less appealing. Clomid is ridiculously expensive, testosterone cypionate is dirt cheap. The decision not to prescribe TRT is a financial decision, so there’s little reason to prescribe TRT. I’ve seen this pattern on countless threads on various forums, it’s sickening.

TRT cuts into the profit of other drugs when prescribed, never forget that doctors work for the pharmaceutical companies. You stand little chance locating a knowledge doctor within your insurance network do to the culture of how doctors are working for the pharmaceutical companies, pharma companies are the ones who put these doctors through medical school who largely ignore hormone therapies.

Seeking private care is the better option, someone that isn’t connected pharma.

Might want to do some math and figure out the difference if you were to go private.

Ok. can you at least give me how many years it was since you tanked, to now?

Don’t make me beg. Please.

You’re welcome, sorry about deleting all the comments, I’m very paranoid about someone figuring out who I am no matter how slim the chance. Anabolic steroids (even TRT) are vehermontly stigmatized here for no good reason. I wish you luck in your recovery

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I totally understand.

From what I have gathered from other forums and posts. It seems that guys start feeling better after about 1-2 years after they stop taking it.

One dude thought he completely blew out his hip and needed a replacement, but after a few years he was back to normal.

I don’t know if ill ever be normal again, which sucks, but i’m definitely not going to sit on my ass the rest of my life.

Luckily my knees are the only joints still affected. It seems like they have plateaued though, as far as recovering.

Now its just a constant, “burning” irritation. Seems like low level inflammation, constant. gets worse with activity. Hopefully one day I can bike or squat again.

Its the worst mindfuck in the world for me. All I want to do is mountain bike and be able to squat again.

The reading was 199 in 2014 and I didn’t feel right. What sucked is that I felt bad before that though. I think I’ve had this issue for some time. When I was younger and a lot dumber I messed with some steroids. It was 2 1/2 weeks running test E at 500 per week and equipoise at 400-500 per week (can’t remeber). Basically 5 injections because I injected 250 twice per week. (I know it was so dumb) I’ve told my docs that and they said it was too short to mess things up. So there’s that. Anyway I felt great during that time and finally was able to lose fat and put on muscle. It was like I felt like I did when I was yonger.

No worries man. Thanks for the insight.

Can you go into more detail about this? I have just started TRT without HCG (trying to get a Rx asap) however I do have primary hypogonadim, so is taking HCG not worth while? Are there any other options for preserving fertility for propel with primary?

HCG use in those who are primary will do nothing for sperm production or keeping the testicles producing small amounts testosterone and estrogen, but it may help with mood and libido in a select few men.

There are men on TRT only and have no complaints, actually adding HCG to a TRT protocol can complicate dialing in as some men have mood problems and just don’t feel good on HCG.

If you’re not completely devoid of sperm, freeze them now before it’s too late, injecting FSH is much more effective v.s HCG.