T Nation

Would Appreciate a Second Opinion (Updated: Post-Clomid Results from Dec.)


#1

Age: 34
Height: 5’ 9"
Waist: 32"
Weight: 157

Body/Facial Hair: Can grow a beard, probably on the higher end of body hair growth

Fat: I carry fat mostly in my lower abdomen, butt, and thighs. Even cutting my weight down to 145 did nothing to reduce the fat.

Symptoms: anxiety/depression, low libido, soft erections, fatigue, hard to lose fat and gain muscle, lack of concentration, frequent urination, poor sleep, gynocomastia

OTC Drugs: Wellbrutrin (150mg 3 times a day) for depression, recently prescribed Clomid (15mg ED) and Anastrozole (0.125mg ED) for TRT

Diet: I generally try to eat healthy and stay away from processed food. Up until a couple months ago I was bulking, but I’ve moved more towards maintenance since starting TRT.

Training: Weight lift 3-5 times a week depending on fatigue level

Testes Ache: On rare occasion, but I wouldn’t think frequently enough to be of note, probably only like once or twice a year.

Labs (9/28)

For some reason they weren’t able to test Free T, but I do have two earlier tests with those numbers:

Labs (5/17)
Total Testosterone: 4.41 (3.48-11.9 ng/mL)
Free Testosterone: 11.3 (8.7-25.1 ng/mL)
Estradiol, Sensitive: 45 (8-35 pg/mL)

Labs (8/18)
Total Testosterone: 592 (264-916 ng/dL)
Free Tesosterone: 14.1 (8.7-25.1 ng/mL)

(Oddly 5/17 test was within two hours of waking after a full night of sleep, 8/18 was after a night where I barely slept.)

History:

Just to be brief: I’ve been dealing with constant fatigue and generally feeling crappy for the past few years. I’ve been treated for depression/anxiety for it, but started looking into other causes a couple years ago while changing my lifestyle to be healthier by adjusting my diet and working out. Thyroid issues, dietary problems, and sleep apnea have all been ruled out.

Earlier this year, my doctor checked my testosterone and determined it was the low end (5/17 labs), but within range. I then went and had my E2 levels checked on my own and it was found to be high. Based on this and the fact that I have a lot of symptoms consistent with low T, my doctor suggested I look into TRT. A specialist has started me on Clomid (15mg daily) and Anastrazole (0.125mg daily) in an attempt to balance out my levels. I started taking them Monday, so it’s probably too early to tell if it’s helping (though I have noticed my testicles have increased in size, and I feel more anxious).

Concerns:

Outside of E2, my hormone levels all look pretty normal. My T was a little on the lower end in May, but the other tests suggest that it’s normally mid-range. This has me wondering if TRT is addressing the right issue. Obviously my E2 is way too high and causing problems, but this doesn’t appear to be a result of hypogonadism otherwise my T would be much lower, right? Is it possible something else has caused my E2 to be high in a way that isn’t impacting my other levels? Or am I just way overthinking things? I know Anastrazole will work to bring my E2 to a better level, but I just want to make sure I’m not wasting my time by treating the symptom of something else.

I’m also wondering why my DHEA-S is so high. My doctor said it wasn’t anything to be worried about since stress can raise it, but I’ve also read it can be indicative of other issues.

The past couple years have taught me that doctors don’t know everything and don’t often investigate beyond the surface unless pushed, so I’d really appreciate if anyone has any thoughts on this.


#2

Your issue is your TT is low and E2 is high, it’s supposed to be the other way around. Having a TT of 800 and E2 in the 20-30’s is ideal, once you spend many months within these ranges you will start feeling better. Clomid rarely works and most fall back down to starting levels after a few months, you need to be struck by lightening for it to actually work. Most guys feel terrible on clomid, TRT always provides a better wellbeing feeling. It’s women who are supposed to have higher E2 than testosterone (T->E2 ratio out of balance), when this happens to a guy he becomes a moody bitch.


#3

Need more information. Your Thyroid may be playing a big part. If it’s off, it can have a big effect. It could be as simple as correcting a Thyroid problem that will reduce body fat that will reduce Testosterone from converting to estrogen leaving you with higher T levels, and lower Estrogen levels. I believe I read somewhere that in some cases they were able to double a patients Testosterone levels by correcting their Thyroid issue


#4

@systemlord
I know there’s an imbalance in my hormone levels and my levels aren’t optimal, but wouldn’t TT in the 500s be considered average? If this were a hypogonadal problem, wouldn’t my TT be a lot lower and there be other indications in LH, FSH, and SHBG, which all appear to be normal in my bloodwork?

And yeah, I’m starting to see what you mean about clomid. First day it seemed like I had a little more energy and libido (probably psychosomatic), but then I had a panic attack that lasted hours a couple days ago and my anxiety and depression have been getting increasingly worse since. (Though, I also wonder if they overshot correcting my E2.) I’m supposed to stay on this for a month but if things continue the way they are, I’m definitely going to try to get them to switch me to TRT. I would’ve rather have started with that straight away since I’ve read a lot of negative things about clomid and I’ve already wasted a lot of time trying to fix this, but it seems like this is the first course of action for most doctors unfortunately.

@monkey_punch1
My thyroid was checked out pretty thoroughly a couple years ago (long after these problems started). It was one of the first things they suspected and led them to thinking I had thyroid cancer (which turned out to be an x-ray error…). I saw an endo and had an ultrasound done. Even then, there weren’t any irregularities in my bloodwork, and I know they went beyond just checking TSH, T3, and T4.

(And I apologize if some of this sounds familiar. I forgot I posted here before on a different account. I’ll keep everything in this thread from now on.)


#5

I took Welbutrin for many years and my TT went from low 300s to over 500 a few months after stopping it. 150 mg 3x per day is the highest dose I have ever heard of. I took 50 to 100 mg 1x per day. I was never convinced that it did anything and my depression may have been related to
low T instead.

Taking that much Welbutrin may be making it harder for you to sort out what is causing your symptoms.


#6

150mg x 3 is the highest dose a psychiatrist can prescribe. Wellbutrin gives me slightly more energy and it’s the only antidepressant I’ve taken which doesn’t make me feel like utter shit, but I am starting coming to the conclusion my depression/anxiety is related to my hormones (particularly with as bad as I’ve felt this week). Makes me think all those SSRIs that made me worse were because my serotonin levels are actually fine and so they were giving me Serotonin Syndrome instead. Frustrating if that is the case since I’ve been complaining to doctors for over a decade about how I feel and just kept getting told it was because I was depressed, yet no one bothered questioning why nothing was making me better…

I haven’t read anything about Wellbutrin affecting T levels and I had these issues prior to starting it, so I don’t think it’s the culprit. I wouldn’t mind getting off of it if it’s really not doing much to fix my problem, but my doctor said I should stay on it for now so I wasn’t changing too many things at once which makes sense.

It does look like there is a possibility Wellbutrin could explain my elevated DHEA-S levels though.


#7

Being in the 500’s would probably provide symptom relief, but to feel your best most would need to be a bit higher, in the 600-800 range. Some actually feel better in the middle range which isn’t surprising given how people aren’t cookie cutter clones like doctors tend to groupe everyone do to laziness.

Your response to clomid seems typical. Doctors have an ethical responsibility to persevere the endocrine system in young men and to prevent infertility, can you imagine if in 30 years we started seeing a big drop in babies being born and it was do to HPTA suppression. I’m not saying it can happen I’m just providing prospective from a doctor’s point of view as our endocrine system is still developing well into our mid 20’s .

I agree you should probably see if you can wean yourself off the Wellbutrin, medications aren’t natural to the body and there are always unintended consequences when one introduces chemicals to the body.


#8

Yeah, I have to say for as much as I’ve had to push my GP to look into my issues (I would never have discovered a problem if I didn’t do research and went and got E2 tested on my own; she initially dismissed hormone issues) and with as horrible as her office is at ever communicating with me, one thing I really appreciate is she was willing to admit her knowledge in this area is limited and only would’ve treated me if I was 55+ or uninterested in having any children.

After seeing it can affect my DHEA-S, I think I’m at least going to try to get off of it before my next bloodwork. I’ve read high DHEA-S can by a sign of adrenal problems, so it’d be good to make sure it’s just the medication. With as much as clomid/anastrazole is affecting my mood, I’m not sure getting off of it right now is smart.


#9

Ok, this clomid definitely isn’t going to cut it. It’s been a little over two weeks. I feel like I’ve given it my best, but the panic attacks aren’t going away and feel like they’re getting worse (woke up panicky today and have yet to have it go away). I’ve tried to persist, hoping my body will adjust, but it doesn’t seem like that’s going to happen. I’ve had some positives with it (slightly more energy, morning wood, firmer erections), but the negatives are outweighing it by a large margin.

I have a call into my doctor and I’m supposed to hear back tomorrow, but if I don’t: Is it okay to just stop taking the clomid? I really can’t go through another day feeling like this (though I know it will take at least a couple days to be completely out of my system). If so, should I also stop the anastrazole to avoid the risk of crashing my E2?


#10

I just wanted to say that according to my old doc, who was VERY good for the most part, a very rare side effect of Wellbutrin is that it can totally demolish your T levels. I was on Wellbutrin for a month and it put me into the sub-100 range for Total T. This is going to probably be a balancing act.


#11

Only got to talk to a medical assistant today. He says they might switch the clomid to every other day. He said it’s an unusual side effect and might be due to my testosterone being pushed too high. Though, I would think if that’s the case, I would notice some more positive benefits, particularly with libido. At least I’m only supposed to be on this for another week or two before they decide if we need to try something else.

Well, if there’s someone who is a candidate for rare side effects, it’s me. Like I said, so many antidepressants I’ve taken just made me worse, even to the point where one made me clench my teeth so hard I couldn’t eat solid food. I think I’ll try to either cut down or wean myself off it completely before my next bloodwork to see if that makes a difference.

I’m hoping it’s not the case though, because part of the reason I started taking Wellbutrin was because of all the symptoms I’ve been experiencing. If Wellbutrin has been screwing with my hormones and that’s what I’m seeing in my bloodwork, then I’m back to square one of having no idea what’s wrong with me.


#12

You are supposed to wean yourself gradually off of the Welbutrin according to my Dr. If you stop suddenly you risk severe mood swings. Welbutrin is known to affect libido negatively BTW.

Hopefully you can start clean and prescription free after that and start to gain the benefits of a properly administered TRT program. It will take some time.


#13

Yeah, I’m definitely aware about weaning myself off it. You should never stop any antidepressant cold turkey.

As far as libido goes, I’ve mostly read the opposite about Wellbutrin and that it can improve libido. It’s one of few antidepressants to not have common sexual side effects (something I can definitely attest to). But, honestly, I didn’t experience either an improvement or decrease in my libido once starting, unlike some other medications.

I’ve already started weaning myself off ahead of the bloodwork I should be getting in a couple weeks, though I doubt it will be completely out of my system by that point. If my doctor switches me to test injections, I’d definitely like to be off of it ahead of time so I can get a clearer picture of how it’s doing.


#14

Well, I think my bloodwork shows a really clear picture of why clomid/anastrozole was making me feel like utter shit:

LH - 19.2 H (1.5-9.3 mIU/mL)
Total Test. - 1421 H (250-827 ng/dL)
SHBG - 51 H (10-50 nmol/L)
(And they neglected to test free-t yet again.)

Here’s the kicker:

Estradiol (Sensitive) - 130 H (<= 29 pg/mL)

I’m guessing that would explain why I was having horrible panic attacks, performance suffered in the gym, and I just felt generally unwell. It’s crazy. My doctor told me she was putting me on a higher dose of anastrozole than normal (0.125mg daily) since I already started with elevated estradiol levels (45 on one test, 39 on another), but taking clomid and anastrozole together tripled my levels.

Not sure what this means overall. Obviously clomid had too strong of an impact on my other hormone levels as well, but I thought the anastrozole would’ve kept my estradiol levels around the same at worst since I’ve read about how strong it can be. I’ve never heard of this, but is it possible anastrozole just doesn’t work for me?

Of another note, my DHEA-S levels also came back elevated:

604 (106-464 mcg/dL)

I had cut down my Wellbutrin and had stopped taking it for about a week and a half before the blood was drawn. Considering the levels are almost identical to my initial test (603), it’s pretty clear the Wellbutrin isn’t what’s driving that up. I’m guessing my doctor will suggest the elevation is due to being stressed because of the panic attacks I was getting, but I’d think if that was the case, the numbers would’ve shifted some since I wasn’t having those panic attacks prior to the first test. I’m thinking it might be time to have my adrenals checked out.