T Nation

SERM Restart


I just finishing up a restart and not sure it really told me anything.

I have an old thread here somewhere. Summary:

36 years old. Verified low T for a few years now. Started with SSRI I believe. Recently tried SNRI and it tanked again. Been off that for awhile and just tried a restart. T levels over the last three years or so:
224 - on SSRI
327 - off SSRI. Fixed poor sleep. Cleaned up diet.
531 - AlphaMale
448 - Got DHEA up via transdermal Mag. Seemed to help. Fixed high E2 (edit: AI used to lower E2)
323 - on SNRI. Was sick so disregarded. Was trying to test the effects of DAA
298 - on SNRI. Still on DAA. Still on SNRI
All were Labcorp so ng/dl with range of 348-1197. Nothing but SNRI changed since 448 test.

I did 20mg of Tamoxifen for 4 weeks. Got tested week 3. Tapering and adding anti-E stuff now.

LH - 5.2 mIU/mL (1.7-8.6)
FSH - 4.2 mIU/ml (1.5-12.4)
Total Test - 429 ng/dl (348-1197)
Free Test - 9.2 pg/ml (8.7-25.1)
E2 - 48.6 pg/ml (7.6-42.6) expected this to be high. Wanted to test to verify SERM was good and see if I needed anti-E afterwards.

My E2 levels have been around 20 for a few years now, most recently even lower, so the SERM was good and did what it was supposed to. I am thinking LH should have been higher on the SERM. Any feedback on that? Am I correct in thinking I may have a bit of secondary?

I don't think primary can be ruled out given the lowish T with mid level LH. Could give HCG a run but am inclined to find out if/why I am secondary first. Guess I could have also run the SERM a bit longer to see if testes came back on line a bit more.

I don't feel terrible at 400, just not like virile man I was not too long ago. 400 feels a hell of a lot better than 200-300. Energy is ok and I'm not a complete sack of shit. Definitely not content to stay at 400 though.

Some crazy shit was happening at the end of my SNRI run. Really bad night sweats, even with the window open in the dead of winter. Blurred vision on and off. Really low T. I was expecting high prolactin, but that checked out fine when I got off the SNRI. Not tested during.

I have an appt with a new endo next month. Will probably get tested again before my visit. Hopefully this one knows his head from his ass. I'd like to get a comprehensive look at adrenals and thyroid. Not expecting much there, but would be nice to make sure. When my test was 323 last year I had the following:
TSH - 1.94 (seems to fluctuate between this and just below 1)
Free T4 - 1.29 ng/dl (.82-1.77)
Free T3 - 3.5 pg/ml can't recall what the range was but seems like 3.4-3.9 is pretty good.


Not much interest in this thread, but I thought I would put in an update. Just another piece to puzzle.

Saliva Results from ZRT labs

DHEAS - 5.7 ng/ml (2-23)

Cortisol - ng/ml
Morning - 1.5 (3.7 - 9.5)
Noon - .4 (1.2 - 3)
Evening - .2 (.6 - 1.9)
Night - .3 (.4 - 1)

I guess no point in looking T, E, or thyroid until I get this sorted. What's funny is that I was worried the test wouldn't reflect how I normally felt. I felt pretty good the day I did the test. A week or so afterward I swore I had mono. I felt half dead. If my temperature wouldn't have been hovering just below 98 deg like it always is, I would have went to the doctor.

It somewhat satisfying to find something as significant as this to work on, but very frustrating that 2 GPs and 2 endos have wanted nothing to do with me. I don't have the strength (literally and figuratively) to try another Endo. It sure would be nice to get some HC while I sorted this out though.

Plan of attack is DHEA x 25mg x 2, Pregnenolone cream x 45mg per day to start, Ortho-Adapt, and the Biotest Rhodiola.

I'm also going to try a gastroenterologist to rule out any issues with my gut. I've been taking probiotics and digestive enzymes for awhile. Gut seems fine, but might as well rule it out along with any food allergies.

If I can get my cortisol numbers a bit more inline, I'm going to try a sleep study to rule out sleep apnea. No point in going now, I'd never fall asleep.

I'll probably just test DHEA and serum morning cortisol in a month to verify any improvement, or lack thereof, I may be feeling.

A bit more info on my journey if anyone's interested.


It's been a pretty steady decline since then.


Thought I would provide an update here in case anyone else is having issues with low cortisol and fatigue.

The supplements listed above provided a modest but short lived improvement. After reading the following article I decided to take a different approach.


I did tyrosine, ginseng, licorice root, astragalus and Huperzine A. I also kept the DHEA. Took everything in the morning and ginseng/tyrosine again at noon. This provided a sizable improvement. I was feeling a little overstimulated at night, so I dropped the licorice root.


Cortisol ng/ml
Morning - 5.7 (3.7-9.5)
Noon - 1.3 (1.2-3)
Evening - 2.5 (.6-1.9)
Night - .5 (.4-1)

Probably still a bit low in the morning, but a pretty significant improvement in energy levels. So obviously a signalling issue, not an adrenal issue.

My T levels were still really low after this. I finally found a decent urologist in MN after being through a few bad endos. I've been on T for couple of weeks now. I'll start HCG when it comes in the mail and have some liquidex on hand. Don't go back to the doc for another month, but am going to test E on my own and see if I need the adex. Guessing I do.

Doc also thinks I have hashimotos, so we'll see if we can sort that when I go back.


Judging by your results with 4 weeks at 20mg of tamoxifen your results look a little poor.

It looks like you had better results with alphamale.

If you have hashi's you will be on thyroid meds.

So are you on t injections now? How are you feeling?

Glad you found someone willing to help you.


200mg T Cyp per week. Inject twice a week. About a month in now. Go back in a month. Probably end up cutting T in half and address any E issues and Thyroid when I go back.

I'm feeling much better. Energy is where it should be after years of feeling like shit. Mental clarity is better. Visual disturbances are gone. Anxiety is coming back a bit, but that will get sorted as I get dialed in. Strength is back to where is was a couple years ago when T levels were just kind of shitty.

Libido is great after being nonexistent for years, but performance has gone south a bit. Going to test E on my own next week. Still have really bad night sweats. Go to bed, sweat my ass off for a few hours, wake up cold.

I'll probably try a restart again at some point. I just need to feel normal for awhile and try and sort any underlying issues. I'm looking at this is a reset of sorts. Hopefully an extended period of time at healthy androgen levels will do a body good. I'll probably go the more traditional clomid route and run it longer before testing.


Visual disturbances what kind?


Progesterone is converted to cortisol in the adrenals and pregnenolone is upstream of that. Progesterone can be used to manage recovery from adrenal fatigue. You can get 2% progesterone cream OTC, get KAL brand, it has a good absorption rate that some other brands do not. You will use very little. Your wife might find that it is of benefit for her.


Blurred vision. Might be fine in the morning but would get progressively worse as the day goes on. It seemed like glare or issues with light. If I were reading white text on a black background, the white text would bleed into the black and be unreadable. I would also see a very bright glare with all the lights off and my eyes closed. Probably a combination of blood sugar issues, cortisol near zero, and a long time with low androgen levels.

vision is not perfect, but it's gotten much better. I don't notice it most of the time.


I've taken transdermal progesterone and pregnenolone on and off. Currently taking Progesterone at night. I need a lot of help to sleep. I take selenium, melatonin, Z-12, transdermal magnesium and progesterone. Figured it couldn't hurt for cortisol and E control as well. Using lifeflo right now. I'll try the KAL brand next. Was actually thinking about making my own.

Not sure if I'll go back to pregnenolone without testing first. I'm feeling a little overstimulated if anything now. Probably going to scrap the huperzine A next.


Not exactly sure why he thinks I have hashi's. Going to ask him for a bit more detail on this when I go back.

TSH - 1.88 uIU/ml
Free T3 - 3.0 pg/ml (1.5-4.1)
Free T4 - 1.2 ng/dl (.8-1.9)
Total T3 - 101 ng/dl (84-172)
Total T4 - 6.8 ug/dl (4.5-12.5)
TBG - 14.2 ug/ml (13-39)
Albumin - 5.1 g/dl (3.5-5)
Thyroidglobulin - 11.1 ng/ml (.8-39)
Anti-TPO - 24 Iu/ml (10-35)
Anti-thyroidglobulin - <20 IU/ml (20-40)
Triiodothyronine reverse - 253 pg/ml (90-350)

I know T4 and T3 are less than optimal, but not sure where the smoking gun is here.

Other results from the last round of testing. After 24hr cortisol test but before T injections.

E2 - 15.5 pg/ml (10-30)
FSH - 3.6 mIU/ml (.7-11)
LH - 2.5 mIU/ml (.8-7.6)
SHBG - 12.1 nmol/l (13-71)
Bio T - 64.9 pg/ml (250-300)
Total T - 243 ng/dl (300-1600)
Prolactin - 2.7 ng/ml (1.9-25)
DHEA-S - 470 ug/dl - taking DHEA
Cortisol - 8.9 ug/dl (5-25) around 1pm.
Insulin - 7.7 uIU/ml (6-30)
Glucose - 78 mg/dl (70-105)
CRP - 4.2 mg/l (1-3)
Homocysteine - 1.88 umol/l (5-12)
Iron - 102 ug/dl (65-175)
Ferritin - 111 ng/ml (28-365)


Interesting as I suffer with a similar issue, I always thought it could be because of my shitty T levels. Hope I can get sorted out too so far taking 5 years.

Bought some progesterone cream also brand name is NOW gonna give it a try. How much are you applying? I read some article to apply 100mg daily. Does it matter where you apply?


Doc said low t may cause issues with smooth muscle and eyes would be the first to see the effect. Going by memory here, I wasn't paying much attention this. I swear I read low aldosterone levels could effect vision. Thought maybe this would tie it to my adrenal (or signaling) issues. Who knows. I'm focusing on fixing the things that can easily identified and corrected. After my system has some time to run at healthy hormone levels, I'll re-assess.

I just take one pump of the lifeflo transdermal. Maybe 20mg? I'll test it at some point and adjust from there. I put it on my upper arm, inside and out. That way it's covered by my t-shirt and doesn't get on the sheets.


We know for some on female HRT that progesterone helps some sleep, for others, it increases cortisol and interferes with sleep.

Melatonin should be time release to avoid a 4-5 hour bounce wakening.

Trazodone is a very good sleep aid [Rx].

100mg per day would be for women, you want small amounts. If levels get up, that can be negative feedback on your HTPA.

Thyroid: see comments in sticky 'advice for new guys' re body temps, iodine, iodized and sea salt.


Seems to help for me.

Yep. I take the LEF time release. 300mcg. If I take too much, I'm a bit groggy. Might need to increase it now cortisol seems to be bouncing back, or something that stimulating me.

Thanks for the suggestion. I'll look into this. When I was feeling really bad, sleep seemed solid. Now that other things are bouncing back, I'm feeling a little anxious/over stimulated. Might have to look at sleep issues again. Hoping cutting back on T dose and keeping E in check will normalize things a bit.

I take an LEF multi that has 150mcg of iodine. I also use sea salt with iodine. Says 240% of daily recommended value. Body temps were low last time I was tracking it. Anywhere between 97.3 and 97.8. I was tracking multiple times per day for a month or so and it got into the 98s maybe once or twice.


reason I asked about application site is I read an article by some doctor who suggested 100mg daily and to apply on the scrotum.

So was wondering if that was really necessary. Going by what you and ksman say 100mg is probably too much so will go with 20mg.


Newest BW. I did this on my own just to see how E2 looked after 5 weeks of 100mg twice weekly inj. This was the morning before my Thursday night inj, so 72hrs since my previous inj. This panel was only $30 more than E2 test, so I figured what the hell.

I go back to the doc in a few weeks, but I was feeling like shit and wanted to verify why. I had some liquidex on hand anticipating results like this. I have HCG but don't really want to start that until E2 is under control. I'd also like to cut T dose in half.

Not sure what my cortisol levels looks like, but symptom are pretty much gone. A little too stimulated if anything. Cut out all cortisol related sups accept Progesterone before bed and the Ginseng. Just crazy high E2 symptoms now.

Edit. 72hrs since last inj, not 36


let's try this again....


having issues..


pg 2



Lower E2 and fT will increase and that will also make you feel better.

No need to ever test LH/FSH again, might be a cheaper panel.

Increase iodine and see if body temps improve, if they do, that can make a big change in how you feel.