T Nation

Prescribed Clomid Despite High SHBG + E2

Hi guys,

I’m a 30 year old male with a number of low-T symptoms:

  • Fatigue
  • Difficulty concentrating/brain fog
  • Susceptibility to depression
  • Difficulty gaining muscle
  • Lack of interest
  • Anxiety/easily overstimulated
  • Low body temperature (typically 96.9 - 97.34F when waking)

Some of these, however, could be due to my thyroid as well as POTS/dysautonomia, which I also suffer from.

Saw an endo that supposedly specializes in TRT due to my low T symptoms/low-ish free T. He caught me off-guard when he suggested 50mg clomid EOD, which is something I wasn’t at all familiar with. Having done some reading since my appointment, however, I’m a bit confused, as clomid, while increasing total T, also tends to increase SHBG and E2? This strikes me as an odd approach given my already high normal E2 and high SHBG levels?

He also prescribed me a trial dose of thyroxine to see if this could fix my subclinical hypothyroidism. I’m a bit confused by this as well, and by what appears to be the general consensus on this forum with regards to any TSH level > 3. I understand 1 - 1.5 would be optimal, however, a fairly recent metanalysis found thyroxine to be of no benefit for the treatment of SCH? https://jamanetwork.com/journals/jama/article-abstract/2705188

What’s interesting is that since upping my iodine intake after my high TSH results in July, within 3 weeks my TSH dropped from 6.1 to 3.9. In the same time, my total test also increased from 503.5 to 654, despite only a slight increase in SHBG, resulting in my free test rising from 8.2 to 10.3. While a lot of my symptoms have improved during this time, they’re still not completely cured.

At the moment I’m kind of leaning towards upping my iodine slightly as well as supplementing Vit D (levels were a bit low), and then retesting in a month in the hopes that things will continue to improve without the need for drugs. Just wondering if anyone would do things differently in my place, and what to make of the clomid prescription? Surely TRT would be a better option for raising total T and lowering SHBG?

You probably don’t have a low T problem. Clomid will boost test as well as E2 he’s probably trying to do a restart while fixing the thyroid.

Do you think there could be some merit to his approach then? Is it theoretically possible to ‘jump start’ a slightly off endocrine system with just a short bout of medication?

T4 only treatment with high Reverse T3 is a problem, it means you will convert more T4 -->Reverse T3. You need T3 only, maybe T3+T4 down the road if you can decrease Reverse T3 <15 ng/dL.

Thyroid treatment will see an increase in SHBG, so as thyroid medicine increases SHBG, so to does clomid.

You’ll never produce enough LH to overcome SHBG binding up all your Free T.

You’ll get nowhere fast with this TRT specialist and you are spinning your wheels.

Yea I did question his choice of thyroxine over natural dessicated and he replied with the usual no evidence of it being better than thyroxine and inconsistent dosage issues etc.

I feel that my excessive rt3 conversion is likely due to chronic stress, which is something I’m genetically predisposed to because of my ehlers danlos/hypermobility, and is not something I can do a great deal about.

Yea I haven’t collected the prescription as I don’t have much faith in either/him. So you think just t3 and somehow trying to get my rt3 under control is the way to go for now?

Exactly, maybe if you can get Reverse T3 down you could try adding some T4 separately. There are studies showing T4 only treatment to be less effective than T3+T4 or T3 only medicine, you doctor is old school and isn’t up to date on his knowledge.

The only patient that would do good on T4 only is one who has low normal Reverse T3, but most people who have thyroid problems are stressed and creating a lot of Reverse T3 because other systems are out of whack.

Yea that sounds about right. Okay thanks for the advice. I’ll give the iodine a bit longer, and if that fails l’ll try self medicating with t3.

Iodine is a waste of time. No one on here is actually qualified to say that the T4 would fail to get the job done. It certainly won’t do any worse than taking iodine. The doc is following the playbook ,T4 first, T3 (cytomel) if that doesn’t work. It does provide for more consistent dosing than dessicated thyroid, but is not well tolerated by eeryone.