T Nation

Thinking of Switching from Clomid to TRT

I’m a 42 y/o male, and my marriage is in jeopardy due to my long-term lack of sex drive. Having browsed this forum, I think it may partly (if not all) due to taking finasteride for about two years. I’ve stopped taking it for 4.5 years now, but I know the damage can be permanent for some people…

I am 181cm tall, 76 kg. I’m generally lean, don’t smoke and occasionally drink 1 - 3 cans of beer a week.

Having consulted a urologist, I was put on Clomid 25mg ED.

Six months in, my test results came out as follows:

  • Testosterone: 19.40 nmol/L (ref range 8.64 - 29) - this is about a 50% increase from pre-Clomid results
  • Estradiol: 156 pmol/L (ref range 41.4 - 159)
  • SHBG: 27.4nmol/L (ref range 16.5 - 55.9)
  • LH: 8.5 IU/L (ref range 1.7 - 8.6)
  • FSH: 4.7 IU/L (ref range 1.5 - 12.4)
  • Prolactin: 224.7mIU/L (ref range 85.7 - 322.2)
  • Albumin: 44g/L (ref range 35 - 50)

In hindsight, it would’ve been good to get other test results as well i.e., DHT etc., but this is what I have for now.

My doctor said that my test results were “fab”, but I told him that my symptoms haven’t gone away at all; my libido remains very low and I struggle to maintain an erection. I assume this is probably due to the high estradiol level, but my doctor repeatedly claimed that this is “in normal range” and dismissed my request to consider putting me on TRT even though my wife and I are not thinking about having another child.

Having browsed this very helpful forum, I know that ‘good’ numbers don’t mean anything unless your symptoms go away or lessens. So I’m consulting another doctor tomorrow to ask for a TRT treatment, but I am wondering if I need to wait a few weeks/months for the effects of Clomid to taper off before I start my TRT session. I am also very worried that I may have a PFS that is irreversible. Any helpful insight would be greatly appreciated.

Thanks

The story of clomid getting levels into the normal range while not resolving symptoms is a common one. I don’t know why, I assume it’s something to do with how it messes with estrogen receptors.

Do you have bloodwork from before you started on clomid just to make sure TRT makes sense? It sounds like it could, just want to make sure the numbers make sense

A couple of things TRT wise

  1. Don’t use gel. It’s too weak and absorption varies too much individual to individual and over time.

  2. Don’t accept one shot every other week. A lot of docs start people at 200mg every other week which turns into a rollercoaster of being back to your baseline every 8 days or so then having another 6 where you feel bad. At least make it 100mg every week to keep levels more stable if that’s where he wants to start you.

  3. Don’t start with any estrogen control meds or HCG. Just T. Get that dialed in, then worry about HCG if needed. Arimidex should very very rarely ever be needed. If he tries to prescribe this, just don’t take it.

  4. A lot of people don’t just instantly feel better 24 hours after their first shot. Give whatever dose, etc a good 6-8 weeks to let things stabilize and see if it works for you or not.

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I also tried Clomid for a year and had lab numbers within range but didn’t feel much better at varying doses so switched to TRT, as perhaps many others have done. Most docs should be giving you the option of trying Clomid (if you want) OR going on TRT, as my understanding (from my doc’s explanation) is that Clomid monotherapy is NOT an official approved treatment for low testosterone AND has long-term risks (vision, etc.). The “Clomid test” is in part to determine whether you are primary hypogonadal (balls don’t work to produce testosterone) or secondary hypogonadal (balls work but brain signal to balls doesn’t work), and is likely a nice-to-know rather than a need-to-know given low testosterone is still the end result of both hypogonadal situations. If your symptoms aren’t resolved with Clomid then TRT is the right request, even if it means changing docs.

I waited 8 weeks after Clomid monotherapy before starting TRT but I don’t believe that any waiting period is necessary. You could probably start right away BUT you should wait at least 2 months once you are on TRT before drawing any conclusions as to effectiveness as you will need the Clomid fully clear your system and TRT to take over.

@ncsugrad2002 points above are all bang-on in my view. I tried gel and it wasn’t strong enough. I do my injections every other day (EOD). Ideally you want to be doing your own injections as most on this forum do, rather than going into a doctor’s office.

I tried clomid for 2 days. By day 2 I made an appt with my TRT doc. Clomid is a horrible hormone therapy method. It simply doesnt work for the majority of guys, and when it does work, its temporary.

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Thanks much for your helpful response. I unfortunately do not have the bloodwork from before I started on Clomid, and I only recall my testosterone level being much lower than what it is now.

Your points are duly noted - thank you. I did briefly talked to the doctor over the phone and he was trying to get me on ‘one shot every two months’ protocol. I’m already thinking this guy might also be a joke…

As an aside, do you think it’s worth doing a test for Progesterone and DHT? If I get low levels for them I imagine it would mean that my system’s damaged from my finasteride intake.

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Thanks hercules987. Very helpful to know someone who’s already been there and done that. How has your switch to TRT been so far?

In my experience, I was horny as ever for the first week of taking Clomid, but everything went downhill thereafter.

Clomid was mostly downhill for me as well. Interestingly my lab ranges didn’t vary a lot with changes in Clomid dosage (ED, EOD, etc.) over a year of trying different protocols, which I’m mentioning in case your doc suggests you try less or more Clomid. I too had issues with libido on Clomid and lots of estrogen-like side effects yet my Estradiol was well within the range for 3 lab tests over the year. My initial month on Clomid was the only time I had increased acne and higher aggression/anger (I get none of that on TRT), but I had been untreated for low testosterone for 3-4 years prior, so maybe it was just a rebound effect and my body was like wtf. I was given the choice to try Clomid (not a requirement), and was mostly because I didn’t want to inject testosterone, which was stupid as TRT is a better protocol than Clomid, and injecting is no more work than brushing my teeth.

TRT has been mostly great. Energy/muscle gain/etc. are fantastic, but libido takes a bit to dial-in so you have to be patient (for some this is not the case and libido is immediate). Libido is better on TRT than on Clomid for me though. Note that some have a “honeymoon” period in the beginning of TRT where they feel fantastic because they are on injections plus their body is making their own testosterone for the first while, but this can disappear, so patience is key. I did not have a honeymoon period. I did not do any anabolic steriods or hormone-altering drugs when I was younger. My testosterone shutdown was random and happened at 36-37.

As mentioned above, I would start with Testosterone-only and not touch any other treatments (HCG, anti-estrogen) until you get your TRT dose dialed in, unless you have some very specific health issues that require those drugs. This can be a point of debate, but common sense is that it is often difficult to dial-in 3 different hormone-altering drugs at the same time, hence why many scientific studies focus on changing one thing (independent variable) to observe a demonstrable cause/effect relationship on other things (dependent variables). Some on this forum also point out risks of Anti-Estrogens (AI’s). I would also make sure to stick to whatever TRT dosage you pick for ~3 months before changing, as it takes a while for the body to adjust. I have been on TRT for almost 2 years now and am under the care of an Endo.

You have plenty of sound replies above. I think you are wasting your time with clomid. TRT time and you may need to run it higher than the range to get your desired results. If I’m you, I would go with 160mg a week and see what happens.

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Thanks highpull. My T levels are okay in terms of numbers (mid-range I think), but would be grateful if you could kindly let me know the rationale for recommending a much higher dose compared to 100mg which seems to be the starting point for first timers (also taking into account that I already have a high level of estradiol). Thanks in advance.

Thanks for the detailed account of your experience hercules - much appreciated. I will start with T only and dial in and see how things go. I am really hoping that if my numbers improve, but symptoms will improve… but let’s see.

No prob, on your dial-in, there are generally 2 options: (1) start at the standard 100mg/week, get your labs within range, then assess your symptoms to see if any correlation between labs and symptom resolution (for some of us on there we still felt like crap at 100mg/week), or (2) do the opposite and go balls-out with a much higher dose (what @highpull noted above), soak your body in testosterone/estrogen and wait 2-3 months for things to normalize, then stay there or titrate your dose back down (or higher?) if you are still having symptom issues. Many of us have found that having labs “within range” on TRT still doesn’t offer full symptom resolution so we are trying Option #2. We aren’t all looking to get jacked with muscle at these higher doses, we are just trying to get our normal lives and health back (sleep, libido, bone density, cardiovascular health, bodyfat reduction, energy, etc.).

Your doc is likely opting for Option #1 as they can’t really put a patient at supraphysiological tesosterone/estradiol levels as part of a normal long-term injection treatment plan. If you can get a higher weekly dose prescribed, you can at least run Option #2 on your own after satisfying your doc with Option #1 labs (and assuming you don’t have any other health risks), if you end up still searching for more symptom resolution.

I take everyone’s personal situation seriously, but you’re not a 45y/o, recently divorced overweight guy who wants to get back to the dating scene… with 26y/o women.

You need to be higher. It is not unheard of for guys to start TRT with this level.

Because you are on clomid. Top of the range E2, mid range testosterone.

No.

Ignore the numbers above then. Hold on, not totally, but you’ve made my point.

If this is the case, you’re likely going to need to run testosterone above the range, maybe significantly above. I’m basing that on what I’ve seen in these cases.

It might seem that way if you go off what you read on the internet. In the real world, it is closer to 200mg. Guys I see that have been on pellets are usually running sky high levels, just didn’t know it. Guys I see coming over from other TRT practices are almost always on 200mg, plus other stuff they don’t need. Of course, guys coming over from a GP, endo or urologist are at 200mg every two weeks, so yes, 100mg if they were splitting the dose. But, here they are, so that wasn’t working. Guys using an underground source switching over to me are almost always taking 200mg a week.

I usually start at 150-200mg and 95%+ of them stay there. There are a few at 100-120mg. If I’m you, I’m taking 160mg once a week and if not getting results in six weeks, going to 200mg. I would not be opposed to just going there now.

Whatever you do, good luck. This sucks. When I see couples in the office, I always ask the wife, “are you on board with this?” Often, they’re the one encouraging their husband to get help. Funny part is it’s not uncommon for the wife to be in five months later as a patient because she can’t keep up.

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Update: Doc prescribed 100mg a week to be injected on a weekly basis. I’ll see how this goes and may request a higher dose down the line as suggested here. The doc also suggested that I continue taking Clomid to minimise testicle atrophy, but not sure if I should. Any thoughts?

I thought I had seen some studies saying Clomid doesn’t work while on TRT.

Regarldess, I would NOT continue taking it. You want to get away from all the negatives of Clomid, not continue it indefinitely. HCG is your better option for that purpose if needed.

I tried Clomid for 6 months a couple years ago. Labs showed a definite improvement but I felt zero subjective benefits and in fact actually felt pretty moody often. I joked with my wife that I knew then what PMS was like. I recently started Test Cyp IM injections and it’s night/day difference to Clomid FOR ME.

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