T Nation

Will Clomid Help Current TRT?


#1

My trt protocol has been 150mg of test-cyp per week. I tried to get my doc to follow the stickies protocol with hcg and anastrozole. He would not go for it. Two years later now, after complaining of testicular atrophy, decreased ejaculate volume, and long recovery time for sex. They mentioned adding clomid to the 150mg test-cyp proctocol. Will this help with these issues? Thanks


#2

yes. clomid will work, it is a SERM and a better choice would be Nolvadex/tamoiphen as it avoids the nasty estrogenic side effects that come have with clomid. In any case, you do not want a high dose of either. 10-12 mg might work well.

SERM’s are drugs and foreign chemicals. hCG is a human hormone, so that should be a first choice as it avoids the unknowns of long term use of a drug.


#3

[quote]KSman wrote:
yes. clomid will work, it is a SERM and a better choice would be Nolvadex/tamoiphen as it avoids the nasty estrogenic side effects that come have with clomid. In any case, you do not want a high dose of either. 10-12 mg might work well.[/quote]

Is that 10-12mg for clomid or nolvadex, and is it every day, EOD, weekly? Do you know the approximate half-life of clomid and nolvadex? When adding SERM to testosterone and AI, would you generally expect to lower AI dose, raise it, or leave AI dose alone? Apologies if this is already in the stickies, I searched and did not find it.

Thanks!


#4

Is the estrogenic effect of Clomid higher E2 levels. I had a bout with high E2 from DHEA multi supplement. I quit the supplement. But because of it I have Anastrozole on hand.


#5

The estrogenic sides are due to the molecule of Clomiphene mimicking Estradiol at receptors. It may or may not cause some triggering of the pathway or block estrogen where it is actually beneficial. In this case I think bro science has more information than real science. Everyone is different. I experienced a slight decline in libido for a couple of weeks but with consistent use of Clomid it eventually returned to normal. I am on 100mg/wk TRT and so far I don’t feel like it’s doing anything but need to confirm via bloodwork shortly.


#6

DFW: Your LH/FSH response to a SERM is unknown and your testicular response to a given level of LH/FSH is also unknown. You will have to do labs and also note how you feel. Dose should be lower if possible, whatever it takes to restore size to testes and having your scrotum hanging normally. Sperm tests driven by any need to be fertile.

emmac: If SERM dose is too high, LH will be too high and T–>E2 inside the testes can be too much and anastrozole cannot reduce that production. That is a testicular process. Your DHEA–>E2 probably was an adrenal activity.


#7

I am scheduled to see the Urologist in less than 2 weeks. I told the doctor about the possible atrophy and lack of ejaculate. I also get occasional discomfort on the left groin and testicle. This is also the side I had inguinal hernia surgery by a different hospital system about 4-5 years ago and I believe started the low T. The doc recommended going to Urologist and having all checked out. Does having a Urologist involved typically help getting on the Test, hcg, and anastrozole protocol? My sex drive is great. But the small scrotum, lack of ejaculate, testes not feeling full, and long sexual recovery time this kind of stinks.


#8

Urologists and endocrinologists can be difficult to work with. They typically do not understand TRT issues, have stupid and wrong ideas and are unwilling to learn/listen. There is a finding a TRT doc sticky.

Deeper advice would take up back to one of your other threads were we have context of your case.


#9

Doc office called. They are sending script over to Costco for Clomid. He wants me to stack 150mg test-cyp per week and 25mg Clomid per day for first month or two. Have bloods done. Then drop Clomid to 25mg EOD. I will post bloods here. These are most recent 12/20/14.

Testosterone 594 220 - 1000 ng/dL
Testosterone Free % 3.5 0.5 - 3.2 % H
Testosterone Free 209.5 40 - 240 pg/mL
Protein, Total 6.7 6.0 - 8.4 g/dL
Albumin 4.3 3.5 - 5.0 g/dL
Calcium 9.9 8.5 - 10.5 mg/dL
Bilirubin, Total 0.6 0.0 - 1.5 mg/dL
Alkaline Phosphatase 56 40 - 150 U/L
AST 35 7 - 40 U/L
Glucose 114 65 - 100 mg/dL H
BUN 9 10 - 25 mg/dL L
Creatinine 1.21 0.70 - 1.40 mg/dL
Sodium 140 135 - 146 mmol/L
Potassium 4.7 3.5 - 5.0 mmol/L
Chloride 101 98 - 110 mmol/L
CO2 27 23 - 32 mmol/L
Anion Gap 12 0 - 15 mmol/L
ALT 21 5 - 50 U/L
TSH 1.600 0.400 - 5.500
Free T4 1.4 0.7 - 1.8 ng/dL


#10

Glucose is high were you fasting properly?

Get HGA1C

Creatine could be better, drink more water.

Because of how long you’ve been shut down, two months of SERM should probably be done. Check FSH and LH levels.

Once nuts return to normal size start HCG and stop the SERM.


#11

Thanks Tunapancake. They never mentioned fasting. So I did not. I drank coffee and sugar.
The nurse that called said the doc wanted me on the SERM for 2 months. Labs done after first month. I will try to push for the hcg but it is hard to get these people to go with stuff. It is like they are two years behind. When I first got on trt I was informing the doc of my concerns and how I wanted to follow the tnation protocol. He listened and stuck to test-cyp only.

Now two years later, I voiced the same concerns which were becoming a reality to his medical assistant. She said he recently started adding Clomid. Hopefully I can push him and the Urologist to get on board. KSman mentioned finding a trt doc. The thing that sucks is I am insured through my wife. She works for the “Clinic-call today for an apt today”. The benefits were great as are the doctors. But my test-cyp was $26 per 3 months and now it is $176. The Clomid is not covered for men so the nurse said Costco was cheap. We shall see. One step at a time. Would love to see the “boys” back.


#12

[quote]emmac13 wrote:
Thanks Tunapancake. They never mentioned fasting. So I did not. I drank coffee and sugar.
The nurse that called said the doc wanted me on the SERM for 2 months. Labs done after first month. I will try to push for the hcg but it is hard to get these people to go with stuff. It is like they are two years behind. When I first got on trt I was informing the doc of my concerns and how I wanted to follow the tnation protocol. He listened and stuck to test-cyp only.

Now two years later, I voiced the same concerns which were becoming a reality to his medical assistant. She said he recently started adding Clomid. Hopefully I can push him and the Urologist to get on board. KSman mentioned finding a trt doc. The thing that sucks is I am insured through my wife. She works for the “Clinic-call today for an apt today”. The benefits were great as are the doctors. But my test-cyp was $26 per 3 months and now it is $176. The Clomid is not covered for men so the nurse said Costco was cheap. We shall see. One step at a time. Would love to see the “boys” back.[/quote]

Very interested in how this works out for you.

A month of generic clomid for me was 26 bucks at 25mg ED. Cheap stuff.


#13

Picked up my Clomid from Costco. $54 for 45pcs 50mg. Also got quote on Test-Cyp 200mg 10ml $65. I was talking to the pharmacist about the prices going up and how my sons Imuran is on back order. She said it is happening with lots of meds. And drug companies a stopping production of meds. She believes it is the Obamacare not paying much out so the companies are not making enough money so they just quit production. This sucks because my sons meds were working great and now he has to find an alternative. Anyways I took my second dose of Clomid. Will respond in a week.


#14

Its been over a week. More like three weeks. The Clomid has increased testicle size a bit. Not huge close to what they were before trt. Volume and ejaculate pressure have increased. Here are my most recent labs. Is low LH normal? Testosterone test results still waiting.

Estradiol 17B 15 10 - 60 pg/mL
Vitamin D 25 Hydroxy 38.6 31.0 - 80.0 ng/mL
Vitamin B12 742 221 - 700 pg/mL H
Vitamin B1, WB 178 Reference range: 70 to 180
Vitamin D 25 Hydroxy 46.4 31.0 - 80.0 ng/mL
LH <0.1 1.0 - 7.0 mU/mL L
Glucose 101 65 - 100 mg/dL H
BUN 15 10 - 25 mg/dL
Creatinine 1.29 0.70 - 1.40 mg/dL
Sodium 140 135 - 146 mmol/L
Potassium 4.5 3.5 - 5.0 mmol/L
Chloride 101 98 - 110 mmol/L
CO2 31 23 - 32 mmol/L
Anion Gap 8 0 - 15 mmol/L
Calcium 10.1 8.5 - 10.5 mg/dL

I take 150mg/week of Test-Cyp., 25mg/day Clomid, (Vitamin D, Vitamin B12, daily vitamin, L-Arginine)/daily, fish oil eod.
Should the low LH be concerning? Did not fast so Glucose is high.


#15

I read the stickies. Never mind the low LH question. I am on trt. So low or no LH is to be expected.


#16

[quote]emmac13 wrote:
I read the stickies. Never mind the low LH question. I am on trt. So low or no LH is to be expected.[/quote]

To be expected without clomid. you are taking the clomid to try and raise LH. That’s the purpose of the Clomid is it not?


#17

If Clomid were working, LH shouldn’t be undetectable. It is LH (and FSH) that stimulate the testicles. FSH is usually a better test of whether Clomid works because it doesn’t oscillate as much as LH does. But still, it seems a contradiction that LH is undetectable and yet you detect an increase in testicle size. The only way to be sure really is if you did actual measurements, though, since it is easy to kid oneself with these self-observations.


#18

Well isn’t this a kick in the balls. HeHe. I am going to message my doc.


#19

Should I worry about a tumor near the Pituitary? My maternal uncle had one.


#20

Here were test results when I got started on trt 3/30/2012

FSH 10.7 1 - 10 mU/mL H
LH 7.2 1.0 - 7.0 mU/mL H

I am thinking almost 3 years of test-cyp only made my LH nonexistent.