T Nation

Severe Fatigue for the Last Two Months

Hello all. I have been on test cyp 140 mg/wk and arimidex .5mg 2x week for almost 5 months now. My current E2 level is 47, but was previously 68 when I was taking .25mg AI 2x/week. Also on daily DIM/Clomid to preserve fertility. Total test has remained around 1300. Since I am high converter my clinic wants to up my AI dosage but I am not sure this is a good idea.

For the past two months I have been experiencing severe daily fatigue. I simply cannot get rested. I was diagnosed with hypothyroidism several years ago but kicked out of it with diet and exercise.

My fear is that TRT has now brought back my hypothyroidism. Before starting TRT my bloods stated that my TSH was 4.7 which is high (borderline hypothyroid but bearable without meds). Most probably this will have increased since then.

I am not sure if the fatigue is coming from the AI, high E2, high TSH, or hypothyroidism. At this point I am about ready to do a PCT and hopefully the fatigue will go away. I was feeling better during the first month or so, but the fatigue at this point is just not making the whole process worth it. Just trying to get some advice. Thank you.

I would be willing to bet that, if you did LH/FSH labs you would discover the same thing as other guys on here. The Clomid is not preserving anything at all while you’re on injections. HCG would, but that’s not what you’re taking. Find a different practitioner, preferrably one that knows what he’s doing. The Clomid and/or the AI are the probable root cause of your problem.

The clomid and lower dosage AI never really made me feel fatigue like this. It wasn’t until I upped the AI the fatigue really started to kick in. The clinic I am going to wants my E2 to be around 20-30 and will probably try to up my AI. Not sure I want to go that route so considering just stopping TRT and see if the problems subside. Thanks!

I suggest dropping the Clomid and the AI, and looking for a different provider. This one is a little out to lunch. There is no reason to tryt and maintain that range on TRT, unless a specific medical condition pops up requiring it. The Clomid is not meant to be a long term drug for anyone, and neither is the AI. You ideally use the fewest number of things possible to achieve your result, and there is no medical reason to be concerned with getting E2 under 30. Seriously, they are screwing you up. Fertility can be achieved through HCG or other drugs when you actually want to be fertile, and you are not necessarily infertile on TRT anyway.

I totally agree with you. After researching Clomid everyone says it should not be used in combination with test. I am losing faith in this clinic the more I research. Less is better, I agree with you again. My main concern is that without AI my E2 will probably be over 100+ which could possibly lead to gyno, etc.

Since my E2 has lowered and fatigue has increased it is most probably not the E2 levels at all causing the issues, unfortunately I don’t think the clinic is too flexible on their E2 protocols.

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Ditch the AI and find a new doc. The whole 20-30 range is bro-science that is dying a slow death and has no justification in the medical literature. You’re even demonstrating it yourself as the lower it gets the worse you feel. There might be one man in ten thousand that might need an AI… Maybe. You’re not that guy.

Thanks! Yeah this clinic is probably not the best after researching.

If I get rid of the AI how long will it take to feel an improvement? As far as I know Arimidex is out of the system fairly quickly.

The arimidex is out quickly but it can take several weeks for your estradiol to get back up to a healthy level. Where are you located?

Located in Ohio.

Best doc I know in Ohio is Dr Eric Serrano. Brilliant physician and good friends with John Meadows. He’s helped many family members and close friends. He’s in Pickerington.

That’s a couple hours drive for me. What do you think about online clinics like Defy?
Do they try to get AI in range?

I’d much prefer a place like Elevate Men’s Clinic versus defy for telemedicine. If they are using an AI by default, it’s an indicator they have zero understanding of hormones.

elevatemensclinic dot com

I have no affiliation. They are excellent at what they do so I send people there, particularly guys seeking telemed.

Appreciate the info! Yeah I have a meeting with the clinic in a few weeks and will be looking to find something new or may just discontinue for the time being. Thanks again.

I have a ton of content on the TRT and Hormone Optimization YouTube channel. Great place to learn about this stuff. It’s difficult to only rely on doctors in this area as the vast majority are somewhat clueless on the subject.

The whole lying to you about what Clomid does thing should have been the giveaway. FYI, if my TT and e2 were at you levels I’d feel lousy too. Not everyone is going to be range-bound, and some of us feel great with higher e2.

BIL is in Ohio and he’s using Evolve (every one of these goddamn t-mills uses the same kind of dumbass name), they didn’t even discuss AI, and they gave him HCG because fertility is a top concern of his. So you’ve got some options. Reality is that you have a credit card which is the only preexisting condition necessary for 9/10 of these places. Choose the one that’ll work with you the best and go from there.


Depends a lot on who you get there… they’ve never pushed AI’s on me but ask every time if I’m having ‘high e2’ symptoms, but leave it alone after that. I’m sure some of their docs/NP’s are more in the “control e2” route than Saya is

That being said… Serrano is probably as good as it gets. If he were closer to me, that’s where I’d be going.

dbossa - have same issue as testman2. Do you have a Dr in Houston you can recommend?

Closet good doc I know would be Dr. Jordan Grant but he’s up in Paris, TX which is quite a ways from you. He ‘has’ done some telemed on occasion.

Well, not in the closet anymore, lol.


Hahahahaha!! It’s amazing what one little typo can do LMAO!

CLOSEST… thank you for that, my friend :wink:

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