T Nation

Long Term Clomid/Anastrozole Use


What are your guys thoughts on long term use of Clomid/anastrozole. I have been on Clomid 12.5 mg eod and .125 Anastrozole for almost 5 months now and have been doing well. I originally was taking 25mg clomid eod and .25 Anastrozole EOD but dropped dosage. I have been diagnosed with secondary hypogonadism and have seemed to remain stable on this dosage for quite some time. Would there be any reason to change this and wean off completely. Are there any long term concerns I should have from using anastrozole?

Last blood work showed:

Total Testosterone: 765 348 - 1197 ng/dl
Estradiol 19.5 7.6 - 42.6 ng/dl
T4 1.4 0.82 - 1.77 ng/dl
T3 2.76 1.81 - 4.06 ng/dl
LH 3.6 1.5 - 9 ng/dl
FSH 3.0 2.0 - 9.2 ng/dl
Free T 15.9 9.3 - 26.5 ng/dl
SHGB 44.7 16.5 - 55.9 ng/dl
TSH 2.33 0.45 - 4.5 ng/dl

Please let me know your thoughts


I have no concerns on long-term anastrozole use (no evidence to support a concern) and some small concern about lifetime use of Clomid, due to some evidence supporting potential slight genotoxicity for which the jury is out. If wishing to continue a SERM permanently, toremifene could be a better choice on that account.

For ordinary PCT use, where the drug is being used only relatively few weeks per year, as personal opinion I think the benefit to risk ratio of the SERMS is excellent. For lifelong use of Clomid or Nolvadex, I’m not as confident. It’s certainly not a likely cause of problem, but is it enough to make it a questionable risk? Unknown, and of course also a matter of personal judgment.


Your result seems quite decent. Not sure about TSH=2.33

Please read the thyroid basics stick and check your oral body temperatures which are an overall measure of thyroid function.
Have you always used iodized salt?
Feel cold easy?
Dry skin?
Outer eyebrows sparse?

Also see advice for new guys sticky.

You might feel better with Nolvadex, same dosing. Some have estrogenic side effects from Clomid.

SHBG is rather high. Typically it goes up with higher E2 and down with more T. SHBG is reducing your FT.

Age, weight., waist, energy, mood, libido, socialization, initiative ?

If you were to wean off, that would be a HPTA restart. Age is a factor. The original cause may still be there.


I just read the Thyroid basics. I will take my temperature over the next couple mornings and get back to you later this week. rt3 elevation would seem very plausible. I have been know to over train in the past, work a lot, and had some money stress ( which thankfully has gone away). I have always suspected I have adrenal fatigue. I do intermittent fasting, which I may cut out if it will help fix the problem

I use iodized sea salt, but I just double checked and haven’t been using it lately

I don’t feel cold easily.

Skin isn’t too dry, and outer eyebrows seem to be intact.

I do have male pattern baldness and have been loosing hair more rapidly it seems.

I do experience brain fog, and low energy

Age: 29
weight: 210
Waist: 33"
energy: decent, ups and down, I do get tired very frequently and don’t have the energy I used too.
LIbido: not as prevelant as when I was 20
socialization: Good, I am a very social person, sometime too much. I have trouble saying no
Initiative: high

what would elevate SHBG? how can I reduce this number. It seems my estradiol is in range and total test is good, but I agree the free T is lacking.

I forgot to mention my Prolactin is 11.9 4.0 - 15.2 ng/dl

If temperature is low, would attempting a iodine load be the next best step?


Temperature Morning 1: 97.4


Forgot to mention I am 6’ tall


Need afternoon temperature too.

We do not have fT3, fT4 data. TSH is up and temperatures down. You have not been using iodized salt. You can try iodine replenishment. You will need multi-vit with trace elements iodine and selenium. Will not be final solution if fT3 is elevated.

You could do these to have a better idea of whats going on.


So update on temps:

7:00 Am: 97.1

2:30 Pm 98.6

I am having labs drawn next week, I will see if they can do TSH, fT3, fT4, rT3 with my labs


SERMs such as Cllomid or Nolvadex often cause elevated SHBG.



Just got some of my labs back, the ones they put up in my patient portal and this is what it looks like:

TSH: 4.441 0.45 - 4.50 <— this does not look good any suggestions?
FT4: 1.32 0.82 - 1.77

I was trying the iodine load, would this cause a response like this?

They did not take T3 or rT3 for reasons unknown, when I see the doctor on Thursday I will request those tests


By “iodine load” do you mean something sensible like 1 or at most 2 mg per day, or something extreme like 20 mg/day?

If the latter, then yes it could have caused your problem.


Yes… I was using 50 mg Iodine replenishment form the thyroid thread… would backing it off to a lower dose be appropriate? I imagine that TSH that high long term is not good


Not just lower dose, but totally stop such a thing.

There is no scientific evidence of the human body containing in total more than about 20 mg of iodine. It is complete whackery to take, day after day, these gigantic amounts. There is not a single published medical reference advising it or showing data supporting it. In contrast, there are multiple large studies showing high iodine intake over prolonged time, but far far less amounts than this, causing reduced thyroid activity.
Consequences of excess iodine. Nat Rev Endocrinol. 2014 Mar; 10(3): 136-142.

More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis. European Journal of Endocrinology (2011) 164 943-950

Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Endocrinol Metab. 2010 Feb;24(1):13-27

Iodine toxicity from soy milk and seaweed ingestion is associated with serious thyroid dysfunction. Med J Aust. 2010 Oct 4;193(7):413-5.

Iodine Excess as an Environmental Risk Factor for Autoimmune Thyroid Disease. Int J Mol Sci. 2014 Jul; 15(7): 12895-12912.[/i]

Extreme iodine intake is supported only in the sense that all kinds of various crazy health ideas are advocated somewhere on the Web by someone, with various individual claims of “I benefited” but with nothing at all showing they wouldn’t have benefited as much or more with far less amount or duration. They provide no evidence that they did not overshoot, no evidence that they did the best for themselves, nothing towards that being the best way or a harmless way to do it.

There’s all kinds of things out there. This is one of them, and nothing more, except worse than many.

1 mg/day is plenty for ongoing and there’s some evidence even that may be a little too much at least for some. This amount also will replenish within reasonable time: there are no giant stores that need replenishment, simply not true. If desired 2 mg/day for a short time such as a few weeks will replenish faster.