T Nation

Looking for a UK Based Urologist/Endo


#1

Hi Guys,

Long story short... I have low T and a low sperm count. Diagnosed back in 2008 as primary, but that was after 2 years of taking a tri-cyclic AD that caused me to gain 8 stone in weight. At the time, my T was 5 nmol/dl and my balls had shrunk.

I've been experimenting with Clomid with a urologist and at 50mg a day, that gets my T up to 25 nmol/dl which would probably indicate a different issue to primary hypogonaidism?

Anyway, we're trying to have a family. We successfully had our daughter in 2014 through the help of ICSI, and we're continuing that journey. However, going on TRT to feel better is off the cards at the moment as I need to hold onto whatever fertility I have left. Currently ~0.4 million per ml.

I'm looking for a recommendation for a urologist, preferably based in the southeast or London, or available online to consult. I'm keen to try HCG and potentially HMG to see if I can kick my balls back into life, would also be good to be able to get on TRT to just feel better!

Any recommendations appreciated!

Cheers


Tamoxifen, Clomid, Arimidex... What's Going On?
#2

Read this:
https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct

And these stickies:

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

Endo’s and urologists can be the worst. But in nanny state the GP’s are really bad.

50mg clomid may be too much and E2 can be high.
If you could get LH/FSH, TT, FT and E2 checked while on Clomid, that would be good.

How do you feel on Clomid? Some guys do not do well. Nolvadex does not have those side effects that some get.

Fertility: You can do TRT and be on low dose Nolvadex and adjust Nolvadex dose to manage good/safe LH/FSH levels.
hCG can be used with TRT as well, but with your fertility issues, you are probably better of with Nolvadex.

Post labs with lab ranges and not just T levels.

Which tri-cyclic AD?


#3

Hi Ksman!

Thanks for getting back to me. Here are some blood results:

17/06/2013 - 50mg Clomid ED - 3 Months

FSH = 55.9 IU/L Range (1.4 - 18.1)
LH = 29.0 IU/L Range (1.5 - 9.3)
Oestradiol = 213 pmol/L Range (<146)
Testosterone = 23.8 nmol/L Range (8.4 - 28.7)

05/04/2013 - Baseline

Testosterone = 10.0 nmol/L Range (8.4 - 28.7)
FSH = 22 IU/L Range (1.4 - 18.1)
LH = 5.5 IU/L Range (1.5 - 9.3)
Cortisol = 339 nmol/L Range (140 - 690)
SHBG = 33.7 nmol/L Range (17.3 - 65.8)
TSH = 2.2 mu/L Range (0.35 - 5.0)
Prolactin = 185 miu/L Range (45-375)
Vitamin D = 71 nmol/L Range (75-200)
Albumin = 48 g/L Range (35-50)
Calculated Free Testosterone = 0.183 nmol/L Range (0.167 - 0.588)

30/09/2013 - 12.5mg Clomid ED + 1mg Arimidex ED - 3 Months

FSH = 39.6 IU/L Range (1.4 - 18.1)
LH = 21.3 IU/L Range (1.5 - 9.3)
Oestradiol = 184 pmol/L Range ( < 146)
Testosterone = 20.0 nmol/L range (8.4 - 28.7)

On Clomid I feel ok at around 25mg 3 times a week, but I do get bloating and constipation. I tried taking arimidex at 1mg a day but that made me feel really stroppy and anxious.

Not really sure where to go from here. Semen analysis has been pretty constant at 0.4 million per ml since I first had it tested in 2008. My best result was 1m per ml in May 2013 which may indicate that the high does of Clomid was helping me. Problem is it killed my sex drive, was not interested at all, I couldn’t sleep at night and my balls ached!!


#4

Oh, and the truth-cyclic was clomipramine.

I’m currently on 150mg a day of Sertraline which in my opinion is a wonder drug. All the benefits of an anti depressant without any of the side effects (sex drive, anorgasmia, sweating)


#5

17/06/2013 - 50mg Clomid ED - 3 Months
FSH = 55.9 IU/L Range (1.4 - 18.1)
LH = 29.0 IU/L Range (1.5 - 9.3)
Oestradiol = 213 pmol/L Range (<146)
Testosterone = 23.8 nmol/L Range (8.4 - 28.7)
E2 too high from extreme LH causes by too much clomid. This can also desensitize LH receptors, a step backwards.
In this case, anastrozole cannot reduce the high T–>E2 production rate inside the testes.

05/04/2013 - Baseline
Testosterone = 10.0 nmol/L Range (8.4 - 28.7)
FSH = 22 IU/L Range (1.4 - 18.1)
LH = 5.5 IU/L Range (1.5 - 9.3)
Cortisol = 339 nmol/L Range (140 - 690)
SHBG = 33.7 nmol/L Range (17.3 - 65.8)
TSH = 2.2 mu/L Range (0.35 - 5.0)
Prolactin = 185 miu/L Range (45-375)
Vitamin D = 71 nmol/L Range (75-200)
Albumin = 48 g/L Range (35-50)
Calculated Free Testosterone = 0.183 nmol/L Range (0.167 - 0.588)
TSH too high, should be closer to 1.0
How are you getting iodine? Added to dairy there.
High FSH can be a symptom of a FSH producing testicular cancer [not rare] or pituitary adinoma [rare].
You might have some degree of primary hypogonadism

30/09/2013 - 12.5mg Clomid ED + 1mg Arimidex ED - 3 Months
FSH = 39.6 IU/L Range (1.4 - 18.1)
LH = 21.3 IU/L Range (1.5 - 9.3)
Oestradiol = 184 pmol/L Range ( < 146)
Testosterone = 20.0 nmol/L range (8.4 - 28.7)
Males on TRT often need 1mg anastrozole per week, once a day is wrong.
Yet, E2 was not low and FSH still high.

Your case is unusual.
Have your testes been examined?
Any aches or pains there when not on clomid.

If you were put on TRT [T only as a trial]. FSH and LS should go near zero in a week. If not, raises concerns for tumor/adinoma even higher.

Some have mood and libido problems with clomid, others not at all.

Read those stickies! :wink:


#6

Thanks for the response.

I’ve had my testes examined more times than I’d like to remember, no obvious abnormalities there. Also, about 5 years ago I had a dexamethasone suppression test to check my pituitary which came back fine.

Ball ache is only apparent on higher doses of Clomid, I.e closer to 50mg a day.

I’ve been checked for all the genetic abnormalities but they’re fine (kleinfelters and micro deletion). All blood test results come back clean, never had mumps etc.

Not sure about the iodine comment. What would I do there?

Any suggestions on what to do next or who to see? Generally, I find that the endo or the urologist wants to fill me up with testosterone injections or gel and go away. I’d love to see if I could get some fertility back.


#7

This is a classic example of what happens with high SERM dosing:
17/06/2013 - 50mg Clomid ED - 3 Months
FSH = 55.9 IU/L Range (1.4 - 18.1)
LH = 29.0 IU/L Range (1.5 - 9.3)
Oestradiol = 213 pmol/L Range (<146)
Testosterone = 23.8 nmol/L Range (8.4 - 28.7)

High LH is creating high T–>E2 aromatization inside the testes [and anastrozole can’t be used to correct that].
You should be looking to be close to E2=80 pmol/L, 213 will be creating bad side effects.
How did you feel doing this? [mood, mental and physical energy, libido] <<<<<<<<<<<<<<<<<<<<<<<<
Testosterone was not really that good. This indicates a lack of testicular response.

17/06/2013 - 50mg Clomid ED - 3 Months
FSH = 55.9 IU/L Range (1.4 - 18.1)
LH = 29.0 IU/L Range (1.5 - 9.3)
Oestradiol = 213 pmol/L Range (<146)
Testosterone = 23.8 nmol/L Range (8.4 - 28.7)
E2 too high from extreme LH causes by too much clomid. This can also desensitize LH receptors, a step backwards.
In this case, anastrozole cannot reduce the high T–>E2 production rate inside the testes.

05/04/2013 - Baseline
Testosterone = 10.0 nmol/L Range (8.4 - 28.7)
FSH = 22 IU/L Range (1.4 - 18.1)
LH = 5.5 IU/L Range (1.5 - 9.3)

T is low, LH is mid-range. Again some testicular response problems.
FSH is high. We have to be watchful for high FSH as that can be from:

  • a FSH secreting testicular cancer
  • a FSH pituitary adinoma [rare]
    When you start TRT, LH and FSH should be zero. If FSH is not, see the above.

30/09/2013 - 12.5mg Clomid ED + 1mg Arimidex ED - 3 Months
FSH = 39.6 IU/L Range (1.4 - 18.1)
LH = 21.3 IU/L Range (1.5 - 9.3)
Oestradiol = 184 pmol/L Range ( < 146)
Testosterone = 20.0 nmol/L range (8.4 - 28.7)
FSH again very high
LH high and E2 problems as explained earlier.
T about the same as higher SERM dose.
Perhaps some LH receptor fatigue on 50mg clomid.
Note how the very high anastrozole dose was not able to mange E2.

Blood work was clean? According to you lab ranges and doc. I might see things differently.

TSH = 2.2 mu/L Range (0.35 - 5.0)
TSH should be closer to 1.0
This may be part of your problem.
TSH can be elevated because you are iodine deficient.
Have you been using iodized salt for years?

How are you getting iodine? Added to dairy?bread there.

Evaluate overall thyroid function by checking oral body temperatures.

  • when you first wake up, should be 97.7-97.8F, higher is OK, 97.3 is a problem [convert to C degrees]
  • also mid-afternoon check for 98.6F/37C
  • THIS IS IMPORTANT

If you are doing TRT, hCG injections will preserve your testes. If not available, you can do low dose SERM.
If your mood was bad on clomid, you should try to get Nolvadex which does not create the mood problems caused by clomid in some males.

Where are you located?