Taking Low Dose Clomid while on TRT?

I have a separate personal thread – but I hope for this thread to be more a general discussion of the merits/pros/cons of taking low dose clomid while on long-term trt ((probably injections)).

I understand that while on trt, clomid won’t be super effective, but I am trying to understand whether say one 50mg pill weekly could be enough to keep your lh/fsh ticking over and at least maintain a bit of fertility and testicle size.

This article suggests, that trt and clomid can be taken together with good results. See the case study on the 47 year old man.

“”“Clinical practice guidance for the use of clomiphene citrate in Male Hormone Replacement Therapy (HRT)”“”

“”" Our case study reflects a five-year study of a 47-year old man seeking treatment for andropause. Baseline levels for total testosterone (TT), free testosterone (FT), estradiol, DHT, LH, and prostate specific antigen (PSA) were measured and recorded at the outset of the HRT. The patient commenced HRT using compounded testosterone cream (CTC) 100 mg applied topically each day. The topically applied CTC was fully absorbed within two hours. Target levels for TT and FT were achieved. After one year on HRT, the patient observed evidence of HPTX down-regulation confirmed by low-normal serum LH levels. The patient was then taken off CTC and given CC 50 mg/day to test the efficacy of CC as monotherapy. The target level range for TT was 750-900 ng/dL and FT was 20-25 pg/mL. As shown in [Figure 2], the optimal ranges were based on the testosterone level that a typical male 20-year old would produce.

150x95 Figure 2: Normal total testosterone production with aging

Click here to view

On CC monotherapy, the patient achieved only 66% of target for TT and less than 66% for FT. Taking 50 mg/day of CC together with 100 mg/day of CTC proved to be too high a dose of T, as serum TT and FT generally exceeded the targeted levels.

After trying various combinations and allowing the body time to adjust to adjuvant therapy, the patient was stabilized to reach target levels for TT and FT on a dose of 25 mg/day CC together with 100 mg/day of CTC. Average post-treatment TT levels were 538 ng/dL in the CC monotherapy portion of the study, and 982 ng/dL when CC was used as adjuvant therapy to HRT. Average post-treatment FT levels were 14.7 pg/mL in the CC monotherapy portion of the study and 22.0 pg/mL in the adjuvant CC portion. CC consumption raised serum luteinizing hormone levels from the lowest quartile with HRT to the mid-point and third quartile of the reference range [1.7, 8.6] mIU/mL.“”"



Could this be the best of both worlds? Keep your nuts, the pituitary ticking over, and get the major advantages of straight testosterone supplementation?

@andyreed what is your goal here? Why are you trying to complicate a simple TRT protocol?
I would never take clomid and T injections at the same time. HCG to keep your LH active is the best you can hope for. If you want to experiment fine I’ll be glad to review your mini blood tests to see if your theory is worthwhile. But I would not get my hopes up.

Studies have shown that clomiphene is safe in low dose up to 3 years. Anyways it’s a dirty drug and case studies have shown liver toxicity. I would agree, if you want to preserve fertility and/or testicular size go with 100 - 200 IU 2-3x per week on top of TRT.

Will 200 ui 3 times per week preserve much of the fertility? The studies show like you need 3 x 500 at least what I’ve seen

So I definitely want to keep my testicles and current fertility. I hear you on HCG being the best option – but I have travel internationally a ton and HCG is mega pain in the ass to travel with, with all the cold storage requirements, the vial can’t get shaken up, etc. When I was on pure HCG for years it was exhausting to have to bring a cooler everywhere and fight with airport security about getting ice/gel-packs, etc. on the plane. Nearly every flight I got personal screening and had to get swabbed for explosives etc. It sucked.

That’s what brings me to the minimal dosing of clomid. Minimal clomid with trt would be a much easier combination to get fertility/nuts and hopefully feel better as obviously testosterone doesn’t not to be refrigerated and it can be handled more roughly. I have seen some examples of people successfully mixing both ((like the above)) but there aren’t a ton out there.

I have an appointment with an Andrologist in a few hours… so we will see.

Hi Vonko1988 as an FYI. I was on 250 ui HCG 3x a week monotherapy and that got my total testosterone to about a thousand and I had a decent sperm count. I think a lot of medical literature really overstates how much hcg some guys need.


Why did you stop HCG mono? How did you feel reagarding low-t symptoms?

I plan to try it soon. I have injected two injections on HCG to test for adverse reactions, 500 UI and 100 UI.

I experienced feeling shitty and low energy on the next days, with the higher dose stronger.

Coviello et al 2005
hCG eod
Posttreatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group.
Roth MY, et al 2010 confirmed this and McBride 2016 did a nice review.

If you have 25% less inter testicular testosterone you would still be fertile, that’s like dropping eg from 600 ng/dL to 450 ng/dL in total T. But if you want to be at the save side - I agree - go with 250 to 500 IU.

After a few years on HCG, I switched to a combo of HCG and testosterone. My urologist at the time thought it would be a more “stable” combination and he claimed to sometimes see more benefits for those with at least some traditional testosterone in their treatment plans. ((Like others state on this forum)). If you live in Southern Cal by chance he is now the Director of the UCLA mens clinic. Jesse N. Mills, MD - Urology | Los Angeles, CA

One of the few doctors that I’ve seen my life who really seemed to both give a shit and have the knowledge. I’m on the east coast now sadly.

For what it is worth ---- My body definitely had the tendency to convert testosterone to estrogen on HCG. 500iu 3x a week even with Anastrozle gave me major fluid retention in the ankles and a total T over 1400. I’d really recommend starting lower.

The study stated that they stopped his HRT to give him clomiphene. First, they did it because he was shut down - which tells you the intelligence level of the room. I wonder how long it takes them to change a light bulb? Anyway, clomiphene while ON TRT accomplishes nothing, except extra drugs in your system that cannot override the test in your system keeping you shut down.
The HCG mimics LH, so it fires up the testes, but either way you’re not making LH while on.