T Nation

Test Very Low After SERM-only Regimen. WTF?


Should I have responded better to this SERM/AI only regimen?

So I had a tests done a week ago. I've been on TRT about 2 years. I was considering a "HPTA restart". The blood was taken 14 days after last T shot (100mg) and had been taking clomid, nolva and adex 7 days when I took the test. Here are results (thyroid stuff tested periodically too so threw that in there)

TT = 192 (249-846ng/dl)
FT = 4.0 (8.7-25.1pg/ml)

Here is the thyroid panel with TSH

TSH - 5.730 (.450 - 4.500 uiu/ml)
Thyroxine (T4) - 7.7 (4.5 - 12.0 ug/dl)
T3 uptake 29 (24-39%)
Free throxine index 2.2 (1.2 - 4.9)

Dosing for the 7 days leading up to the test (format is clomid/nolva)

Day 1: 75/20
Days 2-5 50/20
Days 6-7 50/10

AND I don't have my records on me but I believe the adex dosage was 1mg divided in halves.

I've heard of people taking (25?)mg of clomid daily and achieving a very high T level after 1 week (if I remember correctly)...WTF? One of the reasons I want to "restart" is in the hope I can have kids one day. I spoke to a Urologist a few months ago; he said something like "I think you might be able to (restart)" based on a blood panel where I cleared my system for ~3 weeks and took a TT test, (estrogen) among others. He also checked my sac. He referred me to an endo for this, but I haven't gone to this point partly because I don't have a lot of faith in them in this area.

I came off TRT for ~3 weeks about 8 months ago; trying adex only and my total T came back at 350 ng/dl from the same lab. This was dosing at least 3 mg weekly.

(I have all the blood panels I've ever taken over the years, some of which include estrogen.)


What are you doing about your thyroid problem?
Get cold easily?
Do you use iodized salt?
Iodine in your vitamins?
Thyroid gland looks large?
Symmetrical and smooth? [no lumps]
Really need fT3 data.
Check waking body temp when you first wake up. Write that down for a few days, then post here.

Your lab is stupid. Should be checking LH/FSH. If those are up and T is not, your testes are not working. If LH/FSH are low, the top end of your HPTA is defective. A hCG challenge would also determine if your teste are capable.

LH/FSH should be tested while on the SERM(s). If no action there, PCT is doomed.

Shutdown testes take time to physically recover. 7 days is not enough. You should have been on hCG for two months to get the testes ready for a PCT attempt. You should have been on hCG for all of your TRT. Without hCG, the testes can be expected to have some degree of permanent impairment.

What are your E2 lab numbers?
Not using Arimidex?

Tell us about your age, build, other conditions etc. If that was done in a prior post, this post should have been in that thread so we would have context.


Thanks for the response.

Blood Panel: When I start the "restart" again I'm going to include a TT, FT and LH/FSH.

Testes: I noticed after a week on the SERMs I definitely had some size increase, although my left testicle is significantly larger than the right, which feels funny/uncomfortable.

I'm 38, have an average build.

Medical conditions: hypogon, anxiety disorder.

TRT: I stated before I've been on for 2 years; not accurate, for the better part of 2 years before that I was "self-medicating" my low level T w/OTC Novedex - this put me at ~ 900ng/dl total. I've been injecting about 1.75 years. The earliest "lab" I have indicates TT of 305. I think though that I had been on Androgel (which I used about 3-4 months I think) for a month at that time. I think I was ~240 ng/dl when first tested; upper 200's at most. Prolactin tested normal. The endo never tested estrogen of any "flavor". TRAB tested at 9 (0-9%) in 9/09. The first time estrogen has been tested is when I used adex only for several weeks and Estradiol was 13.6 (7.6-42.6 pm/ml), TT was 351..academic - IGF-1 was 154 (109-284). These are some of the tests I've had. Several other components have been tested over the years.

When I've run a standard 50mg 2x weekly injection regimen I've tested at TT and FT 674 and 20.2 respectively. FWIW, I abstained from everything for 3 weeks and had these results on 9/10/10:

FSH .3 (1.5-14.0)
LH .1 (1-9)
prolactin 12.7 (3.0-30.0)
TT 131ng/dl (241-827)
estradiol 13.0 (10-42pg/ml)
estrone 8.8 (9-36pg/ml)
total estrogens 21.8 (19-69pg/ml)

HCG: it's expensive but I'm willing to get it in an attempt to correct things. Is it significantly better than SERMs for testicular restoration?

Footnote: I've never had that much sex drive; which, suffice to say, is not good. I've been very attracted to girls (my preference has never been in question) since I was in the 2nd grade. My quality of life would be enhanced if I could find a way to address this issue. I've been told by doctor(s) - physically everything is fine. I'm thinking there's not really anything to "uncover" and this really may be out of my control. Anyway, if anyone's got any feedback on this, great. If any questions on specifics I can elaborate.


I do.

Go to a urologist/andrologist that deals with fertility issues.

My doc said that when I want to have a family one day, it might take up to six months of clomid or HCG use to get up to speed.

I happen to be one the good responders when I took 25 mg of clomid, which brought me from 240 to 790 ng/dl for total T in one month.

Why are you on both arimidex and clomid at the same time. Why is he checking you after only seven days?


I just saw you also take Nolvadex in addition to Arimidex and clomid at the same time. Why?

I took clomid ONLY at 25 mg and I had a great response.


adex w/SERM? I researched it and didn't come up w/anything consistent on this. I figured I would get the benefits of the SERM and the reduction of estro provided by an AI. Seemed to make sense as far as LH goes.

andrologist? I remember finding one in San Antonio, but none in Austin. I just emailed a fertility clinic regarding my issue asking whether they think they can help me. I'm thinking I could address weaning off of TRT and fertility issues w/them and have insurance cover the cost of meds.

EDITED to remove link of clinic - they are not in my network/not using them. There are plenty in my network.


You said you "figured". You're not a doctor, and neither is anyone in this thread. Nor is anyone on this board in a position to give medical advice even if they have medical qualifications. I'm very surprised that people self medicate based off of just reading, when in fact specialists in this area had to go through years and years and years of training to even be in a position to deal with such a matter.

Who's to say that if you take an SERM you'll have problems with estradiol? Did your blood test show this? I had no problems with estradiol, and never did in NINE years of TRT. After all, if one doesn't have supraphysiological levels of testosterone, why would they have supraphysiological levels of estradiol?

Anyway... there are quite a few doctors listed on www.impotencespecialists.com that specialize in andrology and fertility (my doc being one of them), and several are listed for Texas. When I bought clomid it was dirt cheap, with and without insurance.


SERMs typically increase E2, managing E2 with an AI can avoid or improve mental and libido problems.

Use hCG for a longer term to get testes recovered as much as possible, then switch to a SERM and have it take over the load by producing LH & FSH. If those do not respond, end of road. If LH & FSH look good taper off of the SERM and hopefully the top end of the HPTA starts to work. At that point you do not want an estrogen rebound shutting down the HPTA, that is why you would continue E2 management.

That is the basic program concept , uncluttered by the implementation details.


Thanks for replies.

"mental and libido problems"

Yes, this is another reason I included the AI that I forgot about - I didn't know how I would respond to Clomid. I've heard of guys having some significant side effects. I was hoping some/all of those sides could be alleviated if I reduced estrogen.