T Nation

Exploring TRT after Clomid Restarts (15-month Test Results Posted 4/2/19)

Hi all,

Just wondering if anyone’s ever run into this. Over the past four years I have done three clomid restarts, all with good success. My last one was at the middle of last year. A few weeks ago I got my testosterone levels checked because I was having symptoms again - my GP only did total t - and I’m in the low 300s again. I’m 28, no health issues otherwise, other bloodwork factors look good (TSH 1.04, don’t remember PSA but it looked good).

I will obviously be doing more blood work before starting any protocol and will be talking to my urologist before I get started on anything - my previous urologist, recommended to me on here, retired a few months ago, so i’ll be seeing his replacement. He and I previously disagreed on where my E2 levels should have been, i again don’t have the numbers in front of me but remember they were slightly elevated over what would be considered ideal for someone my age.

At this point I have no aversion to going on TRT. Frequently-cratering test levels have damn near ruined my twenties and I’m not going to keep feeling like shit into my thirties. I probably won’t want kids and if I do it will be years from now. If I’ve gotta jab myself with a needle twice a week to feel good, then that’s what i’m in for. I’d presumably be doing Test C, Anastrozole, and HCG.

I’m just wondering if it’s common for clomid to eventually not work and/or to only temporarily work. I think I saw one or two threads that suggested this would be the case but it’s not something i had previously researched.


Clomid rarely works, I’ve only heard of a few cases that were successful. Just note if your SHBG is lower than 25 injecting EOD has brought great results for most with 18-24 SHBG, don’t shortchanged yourself by not trying it. I recently did it and wow, just wow! You might even try insulin syringes injecting in the shoulders, it’s painless.

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Cool, I’ll definitely check in on the dosing protocol once i have more complete bloodwork. Should be about two weeks, might restart clomid and anastrozole in the meantime if the doc okays it. Which he may not, due to its effect on SHBG, but at this point he’s got four years worth of my old labs to look at, too.

Going in for bloods on Saturday, electing not to jump onto Clomid until after the bloods are done. Saw good stuff about a doc on here up in Seattle, but this new urologist has an MD plus a PhD in Molecular Biology, and has had articles about TRT published in multiple journals. In contrast, the guy up in Seattle is… uh, a Naturopath. Naturopaths are allowed to prescribe in Oregon and Washington, and he seems nice and very, VERY knowledgeable, but my biases lead me to wanting to stick with the “real” doctor first, I think. Should I not get adequate treatment from him, I’ll head to Seattle!

In looking at old tests, my E2 seems consistently too high, even on Clomid. I believe my last test was September 2016, when it was 39 (!!!), but I haven’t tested it in a while. We may start there. New doctor wants Total T, Free T, E2, PSA, SHBG, Liver, CBC, lipid, prolactin, and albumin. I’m going to ask for FSH and LH, too, if y’all think that’s wise. @KSMan is of course especially invited to chime in. If it would be helpful I can post all previous bloodwork that I have (minus the tons I had in September, since the full blood and metabolic panels may not be of interest to y’all).

This forum’s been here for most of my journey over the past few years, I appreciate y’all.

Do you mean a doctor with a Doctor of Osteopathic medicine? Its still an MD for the most part. A naturopath is completely different. https://www.doh.wa.gov/Portals/1/Documents/Pubs/690158.pdf

"MD’s practice allopathic medicine, the classical form of medicine, focused on the diagnosis and treatment of human diseases.

DO’s practice osteopathic medicine which is centered around a more holistic view of medicine in which the focus is on seeing the patient as a “whole person” to reach a diagnosis, rather than treating the symptoms alone."

No, I do indeed mean a Naturopath.

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Apologies…I found it odd so I did a quick search and that was where I found the pdf I attached.

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It’s pretty bizarre. Up here in the hippie-dippy Pacific Northwest, Naturopaths are allowed to call and advertise themselves as doctors and have the ability to prescribe all kinds of medication. It’s also mandatory that insurance cover them (should they choose to accept it). MOST of the “low t clinics” out here are run by naturopaths - some of whom come highly recommended by knowledgeable people! - but at the end of the day, they’re not real doctors.

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Doctor has agreed we’ll review other kinds of treatment since Clomid has dropped off. Going in to test Free/Total, SHBG, LH, FSH, Lipids, Prolactin, E2, Albumin, CBC. After these tests, I will start low doses of clomid and some UGL anastrozole that I have to see if that can bridge me into feeling a little better before my appointment on the 12th. The clomid is prescribed and as I may have mentioned, I’ve never had sides or negative experiences with clomid, it always brings my levels into the mid-600s without affecting too much else, it just stops working after I stop taking it. The anastrozole is my own solution to the fact that my E is consistently in the thirties in blood tests (I should note I’ve only had it tested two or three times) but I will defer to experts here as to whether or not I should add that in.

He also wanted PSA and Liver values but I had those done a few weeks ago so i’m just bringing 'em with me. I’ve never had lipids, cbc, or albumin tested - why would these be tested? I imagine that this with the liver is to see if I’ve been using any steroids/etc? Or just to get a general idea of my health? Or is this because albumin, etc bings to testosterone in the same way SHBG and can throw off free/bioavailable testosterone even when total test is in a healthy range?

EDIT: here are my two previous threads. Apologies for not keeping them concise.

And, finally, here are my test results from last weekend with ranges where applicable. I have metabolic profiles, lipid profiles and full blood panels (RBC, WBC, Hematocrit, etc) as well if those are helpful. If they aren’t, I won’t post them because there’s a ton of numbers and that’s a pain in the ass to type out.

Total T - 459ng/dL (300-1080)
Free T - 104pg/mL (47-244)
SHBG - 22nmol/L (11 - 80 nmol/L)
FSH - 10 mlU/ML (<=18 mIU/mL)
LH - 8 mIU/mL (<=10 mIU/mL)
E2 - 24pg/mL (<=47 pg/mL)
Prolactin - 10.4 ng/mL (3.7 - 16.0 ng/mL)
PSA - 1.24ng/mL (0.00-4.00 ng/mL)
TSH - 1.07uIU/mL (0.35-5.50 uIU/ML)

The 459 is higher than expected but still low. Prolactin seems slightly elevated, but other than that nothing jumps out at me as an “A HA!”

My Total T was 349ng/dL on 9/9/17 has been as low as 117ng/dL in the past year and a half. Last time I got on clomid my total T jumped to nearly 776ng/dL but my E2 spiked to 39pg/mL.

What do y’all think? Primary, secondary? What should I be exploring at this point? I have not had problems or sides when taking Clomid, but should I stay on it or should I explore injections? Switch to Nolvadex?

@KSMan you are showing as being online right now so I’m hoping I’ve managed to catch your attention, anyone else knowledgeable please feel free to chime in as my appointment is tomorrow. My thought is that I am secondary because my LH and FSH do not appear elevated and because I have had good results with Clomid in the past. I think I will ask to continue Clomid (unless someone can sell me on Nolvadex as being WAY better) and add Anastrozole.

Not on clomid:
T levels are not deeply low while LH/FSH are high. This is a degree of secondary. SHBG is low and then SHBG+T is lower, so TT is understating your T status to some degree.

Clomid and SERMs in general increase E2 levels as expected. If dose it too high, E2 can get out of control.

Secondary: With high LH/FSH, taking a SERM will simply lead to higher LH/FSH while you remain secondary. Have you had testes examine for a vascular abnormality. Otherwise secondary is not reversible.

Have you checked oral body temperatures to eval thyroid status? - see below.

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.

@KSMan - I have. My morning body temperatures are never abnormal, always in the high 97 to low 99 range and almost always right around 98.4-98.6. I do not have the exact numbers in front of me but I have no reason to suspect any thyroid abnormality. I have not had any vascular abnormalities checked for but will do so at my appointment tomorrow.

Assuming we find no vascular abnormalities, what would you (and others here) recommend as a course of treatment, if not a SERM? I have been dealing with this for a few years now off and on and am really pretty set on getting it figured out.

Thanks for the prompt response.

Like you I am on clomid and though you are not over the range you have high normal LH. As do I on clomid. It doubled my LH I got the up to 500 T. At 41 perhaps that’s all my testes could do. So am now thinking about injections. Tough decision for me as with you. Do I live with 500 and take Viagra to have sex. Rhetorical question. I am weening myself off clomid and retake labs. This to make sure I def need treatment.

@anon10230041 - I am not currently on Clomid, rather I have been on and off a few times over the last few years. A doctor who was recommended to me on here put me on it, but he has since retired. My appointment tomorrow is with a new doctor at the same office.

I have always seen my total T rise after Clomid, but then estrogen has spiked soon afterward, and when i have weaned myself off clomid (as a ‘restart’) my total t levels have slowly decreased again, which is the situation i find myself in now.

Ic. Are you thinking about clomid for life? That’s what I was thinking before I find out the best i did was 500 t. Am leaning more towards injections.

@anon10230041 - Barring testicular/vascular abnormalities as @ksman suggested, clomid for life with anastrozole would be my inclination but I am waiting to see what more knowledgeable people think. My impression has previously been that SERMs are effective treatment for secondary hypogonadism and that injections are effective for primary. As I have never had side effects on clomid (minus the elevated E2 that could be solved with anastrozole) and it has put me into the 6-700 range for total T, I am not personally opposed to staying on a low dose of clomid, but, again, i defer to more knowledgeable folks on the issue.

SERMs can help with secondary hypogonadism, with primary when LH/FSH are already high, SERMs have very little room to work and TRT is best option.

@KSMan - Sorry - to clarify, because I am secondary, you believe long-term use of SERMs could be effective in my case? However, if I were primary and also had high LH/FSH, TRT would be the best option? A vascular abnormality in the testes would indicate primary, yes?

Thank you!

When SERM induced high LH levels lead to high T–>E2 in the testes with high serum E2 levels, anastrozole has limited effects as it does not work inside the testes and it does nothing to reduce existing E2.

Got it, I think I understand. So if I took a SERM, there is a chance that E2 levels could spike too high and I’d feel like crap again, and there would not be a way to mitigate this, correct?