T Nation

From Clomid To TRT and Fatigued!


#1

29 years old

-height- 5'7

-waist- 36"

-weight- 165lbs

-Low body hair. Have to shave about every fourth day.

-Carrying weight in mid-section

-I was diagnosed with having secondary hypogonadism

-I currently take welbutrin 300mg. Test Cyp .25ml twice a week. When i was 17 i did take Acutane.

-As of lately my diet is absolutely shit. It seems ever since i started taking welbutrin i have not cared about what i ate. I used to track all my foods and make sure i got all of my macros and cals for the day

-I was training four days a week. all resistance training. As of now, I can barley get any motivation to train.

-Testes do ache once and a while. usually when i was on a SERM

-As of now i do not wake with morning wood nor nocturnal erections.

Here are my labs without being on anything:

09/27/2012:

TT-232 ( 260-1070 ng/dl)
LH-3.1 ( 1-10 nIU/ml)
Prolactin-9 ( 3-16 ng/dl)
CBC:
WBC-5.45 ( 4.00-10.00 th/ul)
RBC-4.54 ( 4.50-5.90 mil/ul)
Hemoglobin-15.9 (13.5-17.5 gm/dl)
Hematocrit-44.9 (42.0-54.0%)
MCV-98.9 (82.0-103.0 fl)
MCH-35.0 (26.0-34.0 pg)
MCHC-35.4 (30.0-37.0 gm/dl)
RDW-11.5 (11.5-14.5%)
Platelet Count-206 (150-399 th/ul)
Neutrophil#-3.05 (1.84-7.80 th/ul)
Lymphocyte#-1.29 (0.72-5.20 th/ul)
Monocyte#-0.45 (0.12-1.00 th/ul)
Eosinophil#-0.62 (0.00-0.60 th/ul)
Basophil#-0.03 (0.00-0.30 th/ul)
Immature Gran#-0.01 (0.00-0.15 th/ul)
Neutrophils%-55.8 (46.0-78.0%)
Lymphocyte%-23.7 (18.0-52.0%)
Monocyte%-8.3 (3.0-10.0%)
Eosinophil%-11.4 (0.0-6.0%)
Basophil%-0.6 (0.0-3.0%)
Immature Gran%-0.2 (0.0-1.5%)

After the doctor saw these tests, he referred me to a urologist. The urologist then put me on clomid 50mg EOD for 30 days and then we would retest. After two weeks on clomid i felt superhuman. Everything felt great! so the 30 days came and i still felt great.

Labs after 30 days on clomid:
12/5/2012:
TT-703 (260-1070 ng/dl)

The doc told me to continue with taking this dose. As the months went on, the effects started to diminish rapidly (energy,sexdrive and since of wellbeing).

Next labs:
05/15/2013:
TT-600 (260-1070 ng/dl)
FSH-2.7 ( N/A)
Estradiol-26 Pg/ml ( N/A)

The doc said everything looked great and he didnt understand why i was having these symptoms. he did offer viagra and said see you next visit.

Next Labs
10/30/2013
TT-542 Ng/dl
FT-83 Pg/ml
FT%-1.5%
Albumin-4.6 G/dl
SHBG-53 nmo/l

Again he said looked Great! But still having awful symptoms. So i thought this was how it was going to be, until i started to do some digging. i thought i should be going to an Endo for other hormone testing, so i thought. This guy thought adrenal fatigue was something the internet made up. Also when these were drawn i was still on clomid 50mg EOD and i was taking DHEA 50mg ED.

Endo Labs
05/13/2014:
TT-936 (250-1100 ng/dl)
FT-138.0 (35.0-155.0 pg/ml)
FSH-1.6 (1-10 miu/ml)
LH-5.0 (1-10 miu/ml)
TSH-1.769 (0.350-4.940 uiu/ml)
Free Thyroxine-1.2 (0.7-1.5 ng/dl)

There are more labs that he drew CMP and CBC. Let me know if i should post them. So, The Endo called me and said everything looked great and stay with waht i am doing. I still felt like shit!

Next Checkup with Uro and he drew more labs:
07/08/2014 Again they dont have ranges.
TT-428 ng/dl
FT-71 pg/ml
FT%-1.7
Albumin-4.5 g/dl
SHBG-45 nmol/l

I told him after this i wanted to do something different. Then he prescribed androgel 1.62 two pumps every morning. so i did this for a few months and there was a slight increase in energy, mood and my sex drive was kinda getting better, maybe 15% better. i was also growing a lot of facial hair ( I grew a Full Beard in 2 weeks). Needless to say i Thought i was getting a little better, Kinda.

Labs To see how the androgel was working
10/30/2014:
TT-244 ng/dl

I did not expect that it was going to be that low. The Doctor did not like this and said i wasnt absorbing it well. so he said i could go to four pumps in the morning or go back on clomid. Well, He talked me into going back on clomid. I was Not very happy about this. Thinking im screwed, i came across T-Nation and holy carp. I read an extreme amount of info (BTW sorry KSman if i forgot something). After two weeks of reading i called my doctor and talked him into injections (test cyp). He said 1ML 200mg cyp E2W. after reading this i could not believe this. F-that, i am now doing .25ml's twice a week. Also, He did not prescribe me an AI or HCG. My issue is that since i have been injecting this past week, I am feeling exteremly fatigued. I am wondering if it is because I was taking clomid two weeks prior and suddenly stoping and going straight to Injection.

Any help, Please!


#2

I have had the same issues while taking the same dose at the same interval…
Have since stopped with a slow Clomid PCT and am now taking nothing and feel better…
its been 6 weeks since my last clomid… I plan on going about 8 months and go from there on how I feel…

Some beleive that with TRT your Adrenals may not be able to keep up…

I can’t help other than that !


#3

You must know that I want to have you tell me about your intake of iodize salt [history] and oral body temperature when you first wake up and also mid-afternoon. Do you feel cold easily? If so, starting when.

Your symptoms are common to low T and thyroid issues.

Inability to absorb transdermal T is a symptom of hypothyroidism.

Great writeup!

Waist=31"? What is your waist side around your belly? Having trouble with where your 165 pounds is carried.

So you are now off clomid and feel worse? I wish that you were able to switch to nolvadex at one point to see if clomid sides were the problem.

TRT can make some feel worse who have metabolic rates that are low because of thyroid function issues.


#4

Currently i do not get any iodine intake. The ingredients on my multi-vitamin do not list iodine. I also tend to use sea salt(I’m not sure if there is any iodine in it). I do get cold easily and it takes awhile to get warm. Especially my feet.

Current temps starting from lastnight
10:15pm- 97.1
5:15am- 96.3
9:30am- 97.7
1:00pm- 98.1

Correction on waist-36". My stomach is where I’m having trouble with fat reduction.

New labs
11/23/2014
TSH-1.460 (0.350-4.940 uiu/ml)
Estradiol-32 (10-50 pg/ml)
Total 25-OH Vitamin D-96.0 (30-80 ng/ml)
B12-1020 (210-920 pg/mg)
Folate-14.7 (7.0-31.4 ng/ml)
Cholesterol-142 (0-199 mg/dl)
HDL- 48 (>=59)
LDL-82 (0-100 mg/dl)
Triglycerides-59 (30-149 mg/dl)

Still waiting for TT, FT and DHEA-S.


#5

There is iodine in sea water, but that is lost during production. So there is no iodine in sea salt, however one can find iodized sea salt.

Get a high potency B-complex multi-vit with trace elements including iodine AND SELENIUM.

See the thyroid basics sticky.

Cholesterol=180 is ideal, 160 and below are associated with increased all-cause mortality, including trashed hormones. Cholesterol is the root of all steroid hormone cascades, including cortisol and your own Vit-D3 production. You could be eating more cholesterol rich foods and healthy fats. Get EFA’s from fish oil, flax seed meal/oil, nuts.

Improved T and thyroid function will increase metabolic rate and allow for fat loss. Your E2 may be a problem. Need to see current T labs.

So you are now off clomid and feel worse? I wish that you were able to switch to nolvadex at one point to see if clomid sides were the problem.

So you are now off clomid and feel worse? I wish that you were able to switch to nolvadex at one point to see if clomid sides were the problem.

So you are now off clomid and feel worse? I wish that you were able to switch to nolvadex at one point to see if clomid sides were the problem.

Please try to address all issues/questions.


#6

Alright, so i just received my other lab results from last weeks draw.

11/23/2014
TT-1321 (250-1100 ng/dl)
FT-315.5 (35.0-155.0 pg/ml)
DHEA-S-342 (85-690 mcg/dl)

Well, I am assuming that my fatigue is coming from very high TT and FT. Would that be correct?


#7

You could be down some from E2=32, but should be quite functional with these levels.

You win a prize for not been able to read my posts. Why do I bother?


#8

[quote]JL85 wrote:
Alright, so i just received my other lab results from last weeks draw.

11/23/2014
TT-1321 (250-1100 ng/dl)
FT-315.5 (35.0-155.0 pg/ml)
DHEA-S-342 (85-690 mcg/dl)

Well, I am assuming that my fatigue is coming from very high TT and FT. Would that be correct?[/quote]

That either may or may not be causing fatigue, but you should reduce your dosage in any case, since such high levels can be harmful to your health if sustained.

As for your prior problem with Clomid, this drug has active metabolites that have a long half life (especially the zuclomifene metabolite). As a result, its levels in the blood continue to build up for perhaps a couple of months months before they stabilize. This could explain why you felt good on Clomid after two weeks to one month and then started feeling bad later on.

Since you felt great already at two weeks on Clomid, this could mean that your body responds well to low levels of the drug in your body, and responds badly to higher levels of the drug. So the first thing that you doctor should have done would have been to reduce your Clomid dose by a factor half or even less (to say, 25 mg EOD instead, or even E3D).


#9

Let me start off by saying, thank you, for taking time out of your lives to help me with mine.

Macmathews, the adrenals are definitely something that’s on my radar. Stress management is something I have to practice everyday. But, as far as testing them, not likely. My doctor does not believe in adrenal fatigue.

Seeknok, that completely makes about the active metabolites in clomid. I will be definitely discussing that with my uro next visit.

Ksman, I would like to apologize about that last post. After rereading it, it definitely sounded like I was dismissing everything you recommended. It was a bad choice of words on my part. I have been following your advice. I no longer use sea salt, only iodized salt on a daily basis. I can’t figure out how to raise my cholesterol though. I eat a ton of heathly fats( fish oil, coconutoil, grass fed butter, whole eggs, mixed nuts and olive oil). Its usually between 80-100grams per day for the past year. I am also in the process of getting a quality multivitamin. What are your thoughts on Swanson’s triple iodine complex?

Also an update on my fatigue symptoms. As of the past two days, I am noticing, I am only fatigued first thing in the morning. No more yawning mid-day,25% increase in libido and feeling motivated to train. Hoping to progress when I add in iodine and lower e2.


#10

There are many good iodine supplements. One bottle of that product will be a full IR, you will need maintenance after that.

Some guys here have low cholesterol that does not respond to consumptions of more fats etc.

Multi-vit: High potency B-complex with trace elements including 150 mcg iodine and selenium


#11

I now have been on trt for 90 days and I am still trying to figure this out. At the moment i am injecting sc .25mls e3d. This feels good to me but, not great. I have alot of brain fog and forgetfulness all the time however, my libido seems to be around 75%. Anyways, last week I had a checkup with my uro and had some labs drawn.

Total T- 719 (175-780 ng/dl)

E2- 90 (20-75 pg/ml)

WBC- 7.2 (4.10-10.20 k/ul)

RBC- 4.92 (4.69- 6.13 m/ul)

Hemoglobin-17.3 (14.10-18.10 g/dl)

Hematocrit- 51.9 (43.5- 53.7 %)

MCV- 105.4 (80.0- 97.0 fl)

MCH- 35.2 (27.0- 32.0 pg)

Platelets- 208 (142.00- 424.00 k/ul)

Lymphocytes, Abs#- 1.7 (0.6- 3.4 k/ul)

Neutrophils, Abs#- 4.7 (2.2- 6.9 k/ul)

RDW-12.7 (11.6- 14.8%)

Mid%- 11.3 (0.1- 24.0%)

Neutrophils%- 65.5 (37.0- 80.0%)

MCHC- 33.3 (31.8- 35.4 g/dl)

Lymphocytes%- 23.2 (10.0- 50.0%)

After my uro went over my results he prescribed me arimadex 1mg per week due to the high e2. I am taking .5mg e3d at the same time as my injection. I took my first dose on Tuesday and the next day i felt like a zombie. I felt just completely worn out. However on Thursday i was somewhat normal. So my question is should i lower my dose? Which would be really hard considering the pill is very tiny. Or could there be something else?


#12

E2 affects the brain. Typically it takes a few days for one to feel the effects of lower E2 from anastrozole. So there is a period of adjustment. You will be less emotional, perhaps “drier” emotions, more analytical perhaps. Brain adjustments might lead to some confusion for some, but that is not typical. If you feel depressed, probably simply to low E2.

You might be an anastrozole over-responder and would then be expected to need 1/4th of the expected dose. If you don’t feel right after a few days, stop anastrozole for 5 days then start at 1/4mg per week. You will need to dissolve pills in vodka, 1mg/ml. Count the drops per ml, dispense by the drop. Shake to pick up the fillers that do not dissolve. Anastrozole will be in solution because of the alcohol. There are anastrozole liquid products on the WWW, sold as research chemicals and that would be convenient, but not quite “legal”.

When TRT is introduced, some who have low thyroid function can fell worse as their systems cannot keep up with the increased/restored metabolic rates from TRT. So keep focused on thyroid, iodine body temps etc.

E2 can be high because liver is not clearing E2 from blood stream properly. AST/ALT [liver function] lab work might be informative. Some Rx or OTC meds can also reduce E2 clearance.


#13

[quote]KSman wrote:
E2 affects the brain. Typically it takes a few days for one to feel the effects of lower E2 from anastrozole. So there is a period of adjustment. You will be less emotional, perhaps “drier” emotions, more analytical perhaps. Brain adjustments might lead to some confusion for some, but that is not typical. If you feel depressed, probably simply to low E2.

You might be an anastrozole over-responder and would then be expected to need 1/4th of the expected dose. If you don’t feel right after a few days, stop anastrozole for 5 days then start at 1/4mg per week. You will need to dissolve pills in vodka, 1mg/ml. Count the drops per ml, dispense by the drop. Shake to pick up the fillers that do not dissolve. Anastrozole will be in solution because of the alcohol. There are anastrozole liquid products on the WWW, sold as research chemicals and that would be convenient, but not quite “legal”.

When TRT is introduced, some who have low thyroid function can fell worse as their systems cannot keep up with the increased/restored metabolic rates from TRT. So keep focused on thyroid, iodine body temps etc.

E2 can be high because liver is not clearing E2 from blood stream properly. AST/ALT [liver function] lab work might be informative. Some Rx or OTC meds can also reduce E2 clearance.

[/quote]

If one had more energy problems after adding TRT , and Thyroid suspect could it be expected that TSH would be more elevated after adding TRT than before ?


#14

I have been on trt for a couple of years. I take 70mg of testosterone cypionate once a week. No AI or hcg. I have been dealing with low libido for years now. I would love some suggestions on how to bring it back. These labs were taking on the morning of my injection. Any thoughts?
Estradiol- 31 pg/ml (10-50)
Ferritin- 68 ng/ml (12-410)
Iron- 130 ug/dl (35-170)
cholesterol- 171 mg/dl (0/199)
Triglyceride- 87 mg/dl (30-149)
HDL- 41
LDL- 113 mg/dl (0-100)
Morning cortisol 11.7 mcg/dl (3.7-19.4)
IGF-1- 343 ng/ml (53-331)
A1c%- 4.7
Avg glucose- 88
Vitamin d25-oh-78 ng/ml (30-80)
Antithyrperoxidas-<3.00 iu/ml (0.0-5.6)
Thyroglobulin-<3.00 iu/ml (0.0-4.1)
Total t3- 1.1 ng/ml (0.6-1.6)
Tsh- 1.358 uiu/ml (0.350-4.940)
Prolactin- 6 ng/ml (3-16)
Shbg- 23 nmol/l (10-50)
TT- 398 ng/dl (250-1100)
FT- 55.9 pg/ml (35.0- 155.0)


#15

Injecting once a week has levels peak and fall and then the labs are rather useless as the results are strongly artifacts of lab timing.

Please see these stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

TT and FT are very low. May be because you are an testosterone hypermetabolizer and some need 100mg/week to get where others are at 100mg/week.

For now, do this if you can:
50mg T twice a week
0.5mg anastrozole at time of injections

Always do labs halfway between injections.
Do labs in 5 weeks.

I did suggest anastrozole a long time ago. If you want progress, you need to take action.

Libido can also be low from low thyroid function. TSH is not the complete picture.

  • check oral body temperatures as per the thyroid basics sticky
  • have you always used iodized salt?