New to TRT -> On Clomid

[antor]

Hi there,
I've got one question .. ive got low test levels, around 370 (550 a year ago) , LH of 4.8.
A doctor told me it is posible to suplement testosterone with a 200 ml of Nebido. He says such a low dose and long ester will suplement my endogeneous levels and enable me to obtain my previous levels without supressing endogeneous production.
I think this is ackward, since i never listen this anywhere...

What are your thoughts about it ?
Many thks,
Best

[KSman]

Bad advice.

Where are you? Affects diagnostic and treatment options.

Doc is suggesting a treatment where your levels peak and crash which predicts a poor quality of life. That also makes E2 management, which is often mission critical, impossible.

You cannot ever 'supplement' T as added T absolutely shuts down your own production, LH/FSH-->zero in a day or two. Doc suggests that your T levels will drop low enough that LH/FSH production will resume. But as your T levels drop that low, you are likely to be drowning in a sea of residual estrogens. Libido will suffer too.

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

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

[antor]

Hi, I am located at Europe.

My test is 370. It was 550/600 a year go. I took a mild oral during 6 weeks on last Januray and February.
after that i couldnt recover my test levels ( although LH was te same before and after something like 4.2).
Lost a lot of muscle mass ( 10 kgs) and gained fat and gyno on end of april
I took tamoxifen 20 mg for 3 months from june to august and the values of test went to 700. When i discontinue it felt great for 3 weeks and then i crushed again. My test levels resume to 370 again.
Doctors refused to help me and said 370 was good. Gyno kept progressing (still is). Finally i found a doctor that clasified me as a low test case.
His proposal was to take 125 mg of e-tes every month and try to put my tests alive again.
I am 14 days after my 2nd shot and my value is 380. I now this protocol works for delay puberty.. but i am allready 37 yold ..
He says if it doesnt work after the 4th shot he'll put me on low dose Nebido
No sex drive, gyno, complete body reconfig. and nobody seems to care.

Another doctor suggested me to do HCG 5000 ui every week and tamoxifen 10 mg a day for trying to recover my endogeneous values.

The odd thing is that my LH is the same as usual (4) but my test values are not good enough.

What do you think are my chances, and what do you think would be my best course of action?
Which would be the best plan of action for try to recover my endogeneous test values? (HCG monoterapy with arimidex ? TRT ?)

Really need some advice here, cause i am living a real nightmare for 9 months.
Many thks,

[KSman]

Your doc is guessing and does not know what he is doing.

Please read the HPTA restart sticky and let me know what you think.

hCG 5000/week is an absolute disaster!

[antor]

with my numbers do you recommend :
Nolvadex 20 mg for 6 weeks
Anastrazole 0.5 twice a week for 6 weeks
Tapper serm slowly

I am 37. Am I too old ?

I try tamoxifen for 3 months and didn't tapper off. Doctor saw liver transminases and almost obligate me to quit cold turkey
I crashed to my old values 7 weeks after descontínua it.

If this doesn't work what can do? Go to TRT or hcg mono therapy?
My test level is 370 lh 4.2 estradiol less than 20

I am desperate for seeking help with doctors with no help. Gyno growing is a living nightmare.

Many Thks

[KSman]

with my numbers do you recommend :Nolvadex 20 mg for 6 weeksAnastrazole 0.5 twice a week for 6 weeksTapper serm slowly

Yes, with mid-flight labs as suggested.
Anastrozole .25mg twice a week after PCT to cruise, if you get this far

37 may be pushing it.

If SERM increases T, then hCG would work, but yield is not predicable.

"liver transminases"
and now?
AST/ALT can easily be elevated from working out and sore muscles, shame on your doc if he did not know to ask you about that.

TRT always works.

LH=4.2
FSH=?
LH changes a lot and lab can catch whatever it is at that time. FSH has a longer half life can can often be the better indicator. Best to test both.

Testing FT is important. TT might be inflated by higher SHBG+T and TT can be thus inflated and status can be worse than TT indicates. Your E2 was 19 or reported as <20. If <20, you need a different lab test that resolves below 20.

[antor]

Transminases are fine now.
They got 10 point above max range into 40s.

Fsh is 7.8

I can get higher test values with higher LH, problem is that now I am stucked with an LH of 4 and with that LH I only have high 300.

I was an athlete and this gyno is ruining my life. I need to get my test levels ok before surgery.

Btw ... I got normal basal cortisol but high urinary cortisol. Cushing was discarded but doctors can't explain the urinary cortisol. They gave up and me too aswell. Can be depression from the situation or too much sport

[antor]

Estradiol usually is 25 , sometimes 30 when my test is on 500. Ratio test estradiol usually is 17.
I've got a panel of labs on the previous year.
Free t is 10 and shbg is 42

Do you think there is a chance of the protocol of 125 mg of test each month (4 inj) work? It's a protocol commonly used in delay puberty ...

With an lh of 4 do you think it's a Hpta recovery issue or I just got old sooner (andropause)

Many Thks

[KSman]

Typically LH and FSH numbers are roughly equal. As LH move a lot, released in pulses with a short half-life, any single lab can catch a high or a low. So FSH is often a better indicator of LH status than LS itself. There are exceptions.

So rather than thinking LH is low, one can consider that FSH is high which can be from a FSH producing testicular tumor. Then is TRT is started, you check FSH which should -->zero, if FSH does not fall, tumor is suspected more. Any soreness or lumps in your testes? Testicular cancer is not rare and is a young[er] man's disease. May not apply, but awareness is important.

125mg T per month or 125mg/week for a month
Neither will recover your HPTA.

protocol commonly used in delay puberty

That can stunt growth as T-->E2 increases E2 and ultimately it is E2 that stops bone growth and that is why women are typically shorter. Low estrogen women can be taller but with smaller breasts.

I am not yet fully convinced that you are secondary...

I took a mild oral: That could be anything and some guys have adverse effects to these zeno-testosterone chemicals. These get into cell nuclei to alter gene expression - good so far, but can make some nasty epi-genetic changes to gene expression in some guys. Hate what I see this does sometimes. May not be your issue.

[antor]

I've done exams to tests , lungs , adrenals , hipofisis.
Nothing was found.
Several doctors checked the tests and no one found anything .. neither do I.

These are the values of late November
Igf1 262
Hgh 0.8
Fsh 7
Lh 4.7
Estrogen 32
Testosterone total 374
Free 10.3
Shbg 40
ACTH 13,9
Basal cortisol 12.4
Urinary cortisol 288
Tsh 1.4

This history is very strange. All started after a mild oral (tbol) for 6 week.
Every other health parameter is ok. I did marathons and gym almost everyday. 1.88 , 94 kgs ( now 88 kgs) and 12 bf ( now 20)
Still go the gym almost everyday, strenght is same as last year , eat healthy don't drink ... but is useless .. can't stop body recomposition . I've got belly and chest fat for the first time in life.

160 points of difference on testosterone doall this mess ?
what is an healthy test to estrogen ratio ?

I think I will take the 3rd injection. If it doesn't work I'll go for this nolvadex protocol which I know Pits me in high test values ( at least with 20 mgs ed did).

The taper off period should be how long ? 3 week on 5 mg eod and then other 3 week with 5 e2d and then 5 e3d ?
Why didn't it work before? Cause i didn't tapper it off ? I thought it had a large half life ...

Many thks

[KSman]

I thought that you reading the HPTA restart sticky would address some things that you are asking about.

SERMs increase E2 and SHBG. Stop SERM and suddenly the HPTA sees E2 and can't get off the ground and SHBG lowers what FT you can get.

Low FT and E2=32 makes you very estrogen dominant. That can explain everything. If it were not for the mixed signals LH/FSH you would be a clear candidate for TRT. At 37 I do see a need to attempt fixing things, all the more because TRT in Europe is not promising. I can recommend TRT details but what can you obtain?

Any decent attempt at a taper should work. Remember that E2 needs to be managed during and after the PCT phase. And higher amounts of SERMs can be worse.

[antor]

O iVe read a few times.
8 august levels were testosterone 667 ; free T 20; estradiol 52; lh
I quit Tamoxifen 2nd september cold turkey (at 20 mg)
18 of september my values were testosterone 776 ; free T 15; estradiol 38, lh 5,1
30 october my values were testosterone 350; estradiol 24; LH 4,4

Do you think my estradiol values were that high to cause shutdown ? that's what i cant figure out...

Do you think i am primary or secundary ? I've got normal LH values but my tests just produce much less test. This is something I cant figure it out.
Why is that for the same LH am I producing now much less test?
If i am primary, then why did Tamoxifen worked on increasing testosterone values ?
I suppose this Tamoxifen + AI works for secundary.

Another posibility is try to restart with 2500 hcg a week and tamoxifen 20 mg for four days each week. I would be doing this for 4 months. That's another proposal from another endo ...

Here are the last year labs...
Tamoxifen between 6 june and 1 september (20 mg each day)
date / Total T/ Free T/ Estradiol/ LH
01-10-2015 /550 / */ 25 / 4,2
01-11-2015 /500 / * / 26 / 4,1
28-01-2016 /70 / */ * / *
21-03-2016 /330 / * / 25,8 / 4,2
05-04-2016 /356 / * / 21,7/ 4,2
11-05-2016 /471 / * / <20 / 2,9
30-05-2016 /371 / * / <20 / 4,8
08-06-2016 /390 / * /24,4 / 3,9
27-06-2016 /656 / * / 37,6 / 5,1
15-07-2016 /573 / * / 31,1 / 10,6
06-08-2016 /667/ 20,82 / 51,4 / 8,5
15-09-2016 /804 / 15 / 28 / 6,2
19-09-2016 /776 / * /38,3/ 5,1
30-10-2016 /357 / * /20,4/ 4,7
16-11-2016 /463 / */ 35,9/ *
21-11-2016 /454/ */ * / *
26-11-2016 /374 / 10,3 / 31,9 / 4,7
31-12-2016 /554 / * / 38/ / 5,8 (23 days after 1st 120 test shot)
16-01-2017 /384/ */<20/ 4,4 (14 days after 2nd 120 test shot)

I can get all meds.. Different doctors follow different protocols... One suggested Nebido, other Sustanon, Other Enanthat .. I can get HCG 5000 ui .. I've got tamoxifen and anastrazole ..
Just cant figure out what to do.. Cause each doctor says different things

[KSman]

Another posibility is try to restart with 2500 hcg a week and tamoxifen 20 mg for four days each week. I would be doing this for 4 months. That's another proposal from another endo ...

Horrible. That is way too much hCG and the serum adds LH to the fire. Just stick to the thinking and recommendations of the HPTA restart thread.

---

You seem to be secondary and your high E2 levels shut you down.

Things went wrong :27-06-2016 /656 / * / 37,6 / 5,1

---

You should attempt HPTA restart. For the record, my standard recommendation follows for you to compare to what others have suggested to you.

TRT:

• inject 50mg SC/SQ T eth 200mg/ml twice a week
• take 0.5mg anastrozole at time of injections
• inject 250iu hCG SC EOD
• use #29, 0.5ml 12mm insulin syringes for T
• hCG can be same or #31 7-8mm
• understand from stickies what anastrozole over-responder means, signs and response
• always to any labs halfway between injections
• adjust anastrozole to get near E2=22pg/ml - 80pmol/L

[antor]

I am not thinking on TRT yet.
After the 3rd 125 mg attempt I will try another restart using tamoxifen 10 mg and anastrazole 0,5 mg twice a week. I'll be there for 6 week. I ll discontinue gradually tamoxifen 2 weeks on 5 mg Ed, 2 week on 5 mg eod and then e2d Then I quit.
I'll stay on anastrazole another month after ending completely tamoxifen
I'll adjust doses so estradiol be on 20-25.
Do you think it's ok?

Usually this protocol works in guys over 35 ?

I know it can increase my values but can they stand by themselves ?

[KSman]

Usually this protocol works in guys over 35 ?

We do not see may guys in that age group needing to attempt this. Works best I think with a younger and more vital guy.

[antor]

Over 35 people just go to TRT ?
I am 37 but I feel young

One question. On this protocol what happens at the end? I suppose high test and controlled estradiol. But when one discontinue anastrazole on the final step what happens ? Probably estradiol will be higher and then by negative feedback the story will start again.
Is 1 mg of anastrazole a week very hard on liver ?

I think we all agree that what matters is free t right ? Is a value of 10 that bad ?
What is the value guys usually have .. I know that test should be something like 550-600. 2% percent of 550 is 11. Where is my judgment error ?

There is something peculiar in my numbers... My LH is normally between 4 and 5. The main difference is that before those values led me to a value > 550 and now i only get 370.
I think we can derive some hypotesis from this:

1- If for the same LH, testicles are producing less testosterone, can we infer that probably testicles are not functioning at their full-power? Somekind of minimal atrophy ? Would HCG help on this? I was only 6 weeks on AAS, but probably it was enough for a litle downgrade ...
2- Hypotalamus cant recognize that more LH should be produced to obtain a value larger than 500. Is just like my organism forgot what was its previous value..
From my labs, everytime i get a value over 5 i get test values over 50

[KSman]

One question. On this protocol what happens at the end?

Your get better or you don't. You need to try to fix this.

You have not been posting lab ranges for FT.

Are all labs done by same company?

1.0mg anastrozole per week would be good if T is high normal.
That is a very small drug load, guys have been on this for many years [10+ for me].
The published side effects for 1mg/day for women includes many problems from E2-->zero that does not apply to TRT context.

37 is not old, but young guys may bounce back better.

hCG helps with atrophy, but not in any way better than a SERM induced healthy LH+FSH.

[antor]

Sorry, i didnt make my self clear when i said, what happens next.

1 stage (6 weeks) > Tamoxifen (10 mg) and Anastrazole 1/2 + 1/2 mg a week (or less, depending labs)
2nd stage (2 Weeks) > Tamoxifen (10 mg EOD) and Anastrazole 1/2 + 1/2 mg a week (or less, depending labs)
3rd stage (2 Weeks) > Tamoxifen (10 mg E3D ) and Anastrazole 1/2 + 1/2 mg a week (or less, depending labs)
4rd stage (2 Weeks) > Tamoxifen (5 mg E3D ) and Anastrazole 1/2 + 1/2 mg a week (or less, depending labs)
last stage (4 Weeks) > Anastrazole 1/2 + 1/2 mg a week (or less, depending labs)

So, after 16 weeks, will my estradiol came up again when i quit anastrazole ? Should I tapper off Anastrazole aswell ?

My free T right now is around 10.5.

Here are the last year labs...
Tamoxifen between 6 june and 1 september (20 mg each day)
date / Total T/ Free T/ Estradiol/ LH
01-10-2015 /550 / 9 (3-22) / 25 / 4,2
01-11-2015 /500 / * / 26 / 4,1

28-01-2016 /70 / */ * / *

21-03-2016 /330 / * / 25,8 / 4,2
05-04-2016 /356 / * / 21,7/ 4,2
11-05-2016 /471 / * / <20 / 2,9
30-05-2016 /371 / * / <20 / 4,8
08-06-2016 /390 / 10,7 (8.8-max) /24,4 / 3,9

27-06-2016 /656 / * / 37,6 / 5,1
15-07-2016 /573 / * / 31,1 / 10,6
06-08-2016 /667/ 20,8 (8.8-max) / 51,4 / 8,5
15-09-2016 /804 / 15 (8.8-max) / 28 / 6,2
19-09-2016 /776 / * /38,3/ 5,1

30-10-2016 /357 / * /20,4/ 4,7
16-11-2016 /463 / 15 (8.8-max) / 35,9/ *
21-11-2016 /454/ */ * / *
26-11-2016 /374 / 10,3 (8.8-max) / 31,9 / 4,7
31-12-2016 /554 / * / 38 / 5,8 (23 days after 1st 120 test shot)
16-01-2017 /384/ */<20/ 4,4 (14 days after 2nd 120 test shot)

There are 4 companies involved on this numbers... But their methods and ranges are quite the same.

One odd thing about my number is my estradiol variability.. Sometimes is < 20 (like last labs) , other times over 35.

What is the interpretation you get from my LH values ? Cause all the LH numbers seem consistent with a 4-5 baseline, and only when LH values get > 5 i can get acceptable test values.
How can get the pit to modulate my LH over 5 in a consistent manner ?

The best time in last year was when i came out tamoxifen.. 2 weeks later between 15 sep and 15 oct I felt just great .. I did some labs there and of course test was 800 and estradiol 28 ( 38 a few days later) ... So, i dont quite understand what happened, why hpta didnt stand and i crashed, since estradiol was not that high?

[KSman]

FT lab ranges can vary greatly from one lab to another. Still have no feeling for your FT status.

LH levels change by the hours, FSH arguably better for time base tracking as you are doing.

Some changes to labs and libido are not going to be explainable or make sense.

You may be getting too analytical. All I can do is help you understand the basic factors so you can take a reasonable course of action.

As for you restart plan, I see large changes in tamoxifen and anastrozole not changing. You mention labs, but doing that many labs seems over the top. You will need to be making some reductions in anastrozole to be closer to 1/2mg per week at the end and cruise on that. That is my only concern.

[antor]

Many thks for your guidance, explanations and patience with all my questions. I trully apreciate it.
All this situation is very ackward and i am trying to get as knowledge as posible. Endos are very peculiar. Some atribute all my simptoms to psychological issues and dont see any problem in my numbers. I wouldnt see any problems aswell if i didnt had the symptoms. The first reason i went for the numbers was to try to explain symptoms.. and the only difference i have found between before and after labs is the testosterone value.
At first i belive doctors and thought i had somekind of anxiety or psychological issue or even cortisol problems (cushing) , but then i realize that there are guys in internet with storys similar to mine.
Even mantaining the same training routine and diet and suplementation, i lost a lot of muscle and i am constantly gaining fat. I ve got mild gyno that is still growing and sex drive is off... nocturnal erections are sparse... all of this is new to me... and there was a holly period on last september where everything was fine.
So.. My analytical mind is looking for answers to try to replicate and mantain the parameters that allow me to have a quality of life.
I dont get it.. There are so many futile things that doctor attend to and medicate , and why is it so complicate to help a man in trying to recover is life quality.
Sometimes i feel dumb for not be able to help myself... dumb for puting myself in this situation and dumb for not helping my self better... I dont have any knowledge on this issue.. what i know is what i read on foruns and some studies (and for god sake, the opinions are so diverse), talk to doctors, and with people like you that have some experience in this issues and dont react like i am talking chinese.. because ive heard a lot of times that this is a software issue... Ok, it can be.. but how can i fix this ???
And this situation goes against my believes... with effort and dedication all is posible... Damn lie! It's not!

One of the doctors says that he only treats estradiol if its larger than 70 !!!! Other says Free T is useless. Everyone has his opinion and protocol.. Its pure madness! This must be conducted by a model, by homeostasis and by parameters... It must be modulated !

Regarding my restart, and sorry if i didnt explain better... When you say cruise, youre saying cruise on 0,5 mg a week for how long ?
So i think the only way of doing this is liquifying anastrazole right ?

Is that bad to mantain for a very long period something like 5 mg tamoxifen a day and anastrazole 0.5 mg week ? If so, why secondary just don't keep this dosages and avoid TRT ?

Is it true that tamoxifen diminishes igf1even at a low dose like 5 or 10 mg a day?

I tryed tamoxifen for 3 months as I said and didnt solve my mild gyno. do you think it was a short period ?mand I should have went longer ?