Enclomiphene or Straight to T?

Hi all, I’m having a consult with my doc shortly. Wanted your opinion on some labs and how to proceed.

I’m 43 years old. Just had some labs done and here’s the interesting ones. Cholesterol/CBC/CMP was unremarkable and all within range.

DHEA-S 260 range:102-416
LH 4.1 range:1.7-8.6
Estradiol, sensitive 10.7 range: 8-35
SHBG 21 range 16.5-56
*** DHT 26 LOW (range: 30-85)
Total Test 308 (i’ve been as low as 275 prev), range: 264-916
Free Test(direct) 8.7 range 6.8-21.5

I’ve never tested DHT before so that’s interesting. I’ve been losing hair for years so assumed it would be high.

My 2 questions.

  1. Should I jump straight to T shots, or since low DHT, ask for scrotal cream since I heard that can raise DHT?

  2. I saw they now have access to Enclomiphene (the good isomer of clomid). Should I try that first and see if it can jumpstart anything naturally? Is it even worth pursuing or just raises some test results but you still feel like crap? (also my E2 is towards the low end so not sure that’s a good idea)

Thanks so much for your opinions!

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No magic pill is going to turn back the clock, you are 43 years old and testosterone is on the decline, you don’t need drugs to increase testosterone. You need to put some effort into your diet and stay metabolically active.

Please fill in the missing details, detail your diet, any medications, exercise and how is your sleep because anyone these could be responsible for your low-T. Your pituitary gland is producing a fair amount of LH, but as we age the leydig cells in the testes become less efficient.

TRT can accelerate hair loss so if you are prone to hair loss so don’t be surprised if your hair starts thinning. You are a good candidate for TRT on the basis of your Total T, DHT and especially your estrogen labs, you just need to find someone well versed in TRT.

Thanks for the info. I’ve actually been fairly low on total T for some years. Just finally felt crappy enough to do it. I’ve been measuring Total T since at least 40 and it’s always been in the low 300s to high 270s.

My diet is actually good. I don’t eat red meat or pork, but eat lots of veggies, try to maintain good blood sugar levels but they have been creeping up. I’m 5’8" and 150lbs so very thin. Have never been good at putting on muscle.

I was going to the gym doing heavy workouts 3x a week but have stopped since Coronavirus going around. i do have weights in my house so I really need to hit those.

No medication, diagnosed with sleep apnea for ~2 years and sleep on CPAP with well controlled AHI (always less than 1).

I left out one important possible cause for low-T, sleep apnea can cause low-T. If you had sleep apnea for a long time, you just might have a reason for your low-T. It’s good you have the sleep apnea under control because TRT can worsen it if it’s not being treated.

I stopped going to the gym weeks ago because of the coronavirus, just got an email 24 Hour is closing as of yesterday.

Yeah, i actually started T therapy 2 years ago the same week I had my sleep study. I gave myself 2 shots before the sleep doctor called and said I had pretty severe apnea and said to just treat that first and stop the shots, optimistically thinking that would just raise my T normally.

That never happened, and I’ve seen studies that’s common not to have an impact on T levels. It’s definitely improved my life elsewhere, but the T level is still int he toilet.

Just had the convo with the doctor. I’m starting 12.5 Enclomiphine/day for 6 weeks and re-testing. If I still feel like garbage, backup plan is to start T at that point. I guess its worth a shot.

Enclomiphene if legit can be a good idea but in your case I see zero point to load yourself with a drug that can have so much more side effects than testosterone

Testosterone is the safer and more natural option especially for a guy at your age

Well… after discussing, she wants me to try 6 weeks of Enclomiphene, see how I do and then decide. We have a plan to move to T therapy if I see no benefits. It’ll be interesting at least. Hopefully I’m not just wasting another 6 weeks and lab costs. :frowning:

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She is doing it just to cover her ass and document that she has tried stimulating you before giving you testosterone

Serum DHT has been proven to be unrelated to AGA, but unfortunately the myth is hard to die. They have to sell castrating drugs to men after all.

What has been proven to be common in balding men is an impaired T:E2 ratio, especially in cases of estrogen dominance.

Estrogen dominance is a myth as well. There is no such thing as estrogen dominance, there is inflamation, insulin resistance, swing of hormones due to not frequent enough injections and the symptoms caused by that issues

I was talking about regular people not on TRT.

Everything except injection frequency applies to them as well

Are we stating fact or opinion?

Ive recently seen a lot of discussion and evidence about it and I have not seen a legit evidence supporting that. In all evidence it seems increased estradiol is another consequence of the same problems causing the other symptoms and even increased estrogen is a means of the body to protect itself, because like testosterone estradiol is proven to have anti-inflamatory action and to decrease body fat

You’re talking by absolutes as usual.
I’m waiting for the day you guys are going to inject bio-identical E2.

It makes sense for a body builder on a nandrolone solo cycle, where E2 has been shown to have neuroprotective properties against nandrolone, but only when administered to restore normal levels. Not the levels you are having for sure.

Once again we are talking about ratios and balance. A high T:E2 ratio is bad as a low T:E2 ratio.

Update how feeling on enclomiphene?

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Eat red meat. Eat meat with fats, eat more calories. Train heavy twice a week. Sleep better. Don’t be scared of coronavirus.