T Nation

Restart


#1

Hey all,

My labs are really good and I feel great, but I want to attempt a restart for various other health reasons. My current numbers are:

Dihydrotestosterone 131 High ng/dL
Reference Range:
Adult Male: 30 - 85

testosterone,Free and Total
Testosterone, Serum 675 ng/dL
Reference Range: 348 - 1197

DHEA-Sulfate 336.4 ug/dL
Reference Range 71.6 - 375.4

DHEA, Serum
Dehydroepiandrosterone (DHEA) 54 ng/dL
Reference Range: 31 - 701

Estradiol, Sensitive 39 pg/mL
Reference Range: 3 - 70

Sex Horm Binding Glob, Serum 22.8 nmol/L
Reference Range: 16.5 - 55.9

I am not attempting a restart until my body fat is around 12%. Last time I tried it my BF was around 25%. I was also insulin resistant, which I no longer am. A1c went from 6.8 to 5.1 with diet and exercise. I tried Scally's protocol the first time I attempted a restart and my total T went to 575ng/dL before crashing back down when I stopped. Consensus is that my SHBGs were too low due to insulin resistance and it was probably the issue I had to begin with before TRT (IR and T conversion to estrogen due to adipose fat).

I tried low dose Clomid the next time and my LH and FSH pegged to the top after 1 month but the testicles were not producing. My first attempt (Scally) did show a response to HCG so I am not primary and I would be surprised if suddenly I was. I was like the 10+ years I have been on TRT had the boys so asleep that they would need some help waking up before trying the protocol defined here: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_protocol;jsessionid=9476B76205771E8D4763B8779988D1EA-mcd01.hydra

My question is: Do you agree that I probably (nobody can be sure) should be starting any attempt to kick in my own T production with a pre-SERM dosing period of HCG to wake the boys up? It did work before as I stated, but with the Clomid only and my LH and FSH being pegged I was still surprised my boys did not at least kick out something (I was still below 250ng/dL). This stuff is complex and other changes may have prevented the boys from responding well even to high levels of LH and FSH. I went on a two week vacation from TRT to get a baseline (173ng/dL) before staring the Clomid only. So it looks like the boys did respond a bit and kicked me up to 250ng/dL but were slow to get moving along. What do you think? Try again but with some HCG to start the party? Thanks man!


#2

Too much clomid. You never want LH/FSH extremely high. Never combine hCG and a SERM.

Try 10mg/day or EOD clomid while on TRT. Do labs to detect LH/FSH levels. You need your testes working on levels that are not significantly larger than your restart LH/FSH levels might be. The alternative is that you flog the testes with high LH, then when you taper out of the SERM the the testes then see a much weaker signal and don't know what to do. High LH can also be desensitizing the testes.

So you can find a SERM dose on TRT that gets a reasonable LH/FSH levels, then taper off of the T, then taper off of the SERM. You should be using anastrozole on TRT, less on the taper and cruise on 0.5mg/week* after taper to prevent estrogen rebound.

  • or 1/2 your on TRT dose that gets you near E2=22pg/ml

Do not test DHEA, only test DHEA-S

"Estradiol, Sensitive 39 pg/mL " is horrible, you need to get E2 management under control first.


#3

Thanks KSMan. When I did the Clomid only I was on just 25mg EOD and my LH and FSH shot up to the upper limit. This tells me that my pituitary was functioning and because it was not getting a response it was jumping LH and FSH up higher and higher. This would be typical of primary hypogonadism where the LH and FSH is screaming high but no T.

So your recommendation is 10mg Clomid EOD while on Testim until LH and FSH are near levels I would see prior to a restart. My concern about Arimidex is that my E2 levels are already fairly low. From my labs above they are at 39pg/mL. At .25mg every third day I found I was a hyper-responder. I have had E2 as high as 79 before and felt fine. I only don't feel good if it gets too high (over 90) or is bouncing around all over the place. The spot you seem to be aiming for is 22pg/mL and for me I could probably hit that after losing about 10 more pounds. Once I am there, is there a need for arimidex?

I was unaware that Clomid would do anything to LH and FSH while on TRT. It seems like you are suggesting that. If my hypothalamus and pituitary are shut down due to plenty of exogenous T in the system, how would taking Clomid increase LH and FSH (which are bottomed out at the moment)? Am I not understanding something fundamental here? Don't I have to be off T before starting Clomid for it to have any effect?

I'll ask follow ups later and thanks so much for the advice. I'm just a bit confused at the moment and want to understand what you are saying. If my goal is to hit LF and FSH that are near where my restart would be, why would I not stop the T, take about 500IU EOD of HCG for 20 days, then start 10mg Clomid ED or EOD?


#4

The HPTA is a slight change to the female HPOA. The key point is that it is estrogen that is the significant feedback signal. I think that a SERM will produce LH while on TRT as the SERM will mask the estrogens. The point was to find a suitable SERM dose before the PCT/restart. Never suggested that but you seem to have a history of high LH while on a SERM. Typically I never see that data.

The testes take time to recover form and function and perhaps your SERM was also shorter duration as well as the other aspects. So you will spend some time on SERM without TRT and then later do the taper, if subsequent lab work shows useful amounts of T.

If LH is good and T is low, you are staying with TRT. Makes sense?