26 Year Old - HCG or Clomid?

Pharma / TRT Testosterone Replacement
1

Hi all,

I hope this thread may develop into something of value for the members of this forum.

I will soon have a follow up meeting with a Private Andrologist to decide whether I will move forward with Clomid or HCG Treatment.

I would greatly appreciate any member feedback to help make my decision, particularly as my first Consultation raised a couple of concerns, so I feel that I could need additional advice from those who have already walked the path.

Background info
Age - 26
Weight - 67kg
Height - 5 foot 10
Bodyfat - approx 15%

Body & Facial Hair:

  • Modest amount on arms, legs & chest
  • No back hair
  • Thick head of hair
  • Ability to grow a (somewhat whispy) beard

Health Conditions

  • Dyspesia // Gastritis on and off since 2010. Most severe symptoms abated since cutting alcohol and improving diet & supplementation

Diet:

  • No alcohol since 2012
  • No smoking since adolescence
  • No recreational drugs
  • No junk or processed foods consumed for a number of years
  • No Gluten, Dairy and Soy since 2016
  • Consume a balanced diet of wholefoods, organic where possible. A typical meal would be: Fish / Meat, Green vegetables, Starchy vegetables and Fruit
  • Experimented with Intermittent Fasting since 2016

Nutritional Deficiencies:
Vitamin B12 (minor)
Iron (minor)

Supplementation:
1 tsp Collagen
1-2 caps Turmeric
12mg Iron
Vitamin B12
1-2x Probiotics capsules
2x Enzymes capsules
Vitamin D3 & K2
1 cap Fish Oil

STATS

  • Testosterone - 11.5 nmol/L [7.6 - 31.4]
    LOW-NORMAL
  • Free Testosterone - *0.184 nmol/L [0.3 - 1.0]
    ABNORMALLY LOW
  • SHBG - 46 nmol/L [16 - 55]
    HIGH-NORMAL
  • Oestradiol - 50 pmol/L [0 - 191]
    MID-RANGE

FSH - 4.2 IU/L [1.5 - 12.4]
LH - 5.5 IU/L [1.7 - 8.6]
Prolactin - 151 mIU/L [86 - 324]

DHEA-S - 6.9 umol/L [0.44 - 13.4]

TSH 0.838 mIU/L [0.27 - 4.20]
FREE THYROXINE 14.3 pmol/L [12.00 - 22.00]
TOTAL THYROXINE(T4) 82.5nmol/ [59.00 - 154.00]
FREE T3 3.54 pmol/L [3.10 - 6.80]
THYROGLOBULIN ANTIBODY 14.100 IU/mL [0.00 - 115.00]
THYROID PEROXIDASE ANTIBODIES 9.65 IU/mL [0.00 - 34.00]

HAEMATOLOGY

HAEMOGLOBIN (g/L) 141 g/L 130 - 170
HCT 0.419 0.37 - 0.50
RED CELL COUNT 4.68 x10^12/L 4.40 - 5.80
MCV 89.5 fL 80 - 99
MCH 30.1 pg 26.0 - 33.5
MCHC (g/L) 337 g/L 300 - 350
RDW 12.6 11.5 - 15.0
PLATELET COUNT 272 x10^9/L 150 - 400
MPV 9.9 fL 7 - 13
WHITE CELL COUNT 5.94 x10^9/L 3.0 - 10.0
Neutrophils 63.8% 3.79 x10^9/L 2.0 - 7.5
Lymphocytes 25.3% 1.50 x10^9/L 1.2 - 3.65
Monocytes 8.9% 0.53 x10^9/L 0.2 - 1.0
Eosinophils 1.7% 0.10 x10^9/L 0.0 - 0.4
Basophils 0.3% 0.02 x10^9/L 0.0 - 0.1
ESR 10 mm/hr 1 - 10

BIOCHEMISTRY
URIC ACID 399 umol/L 266 - 474
C Reactive protein 0.6 mg/L <5.0
Rheumatoid Factor Turbidimetry <10.0 IU/mL <14.0

AM body temperature: 36.1 Celsius (96.98 Fahrenheit)
(NB. I have noticed a marked decrease in my ability to handle my morning cold shower, which I have practised since 2011. I now get a chill afterwards)

Symptoms

  • ED and lack of libido (both sex and masturbation). Since 2013 with increasing severity
  • No Morning Wood. Flatline since 2015
  • Episodes of Depression. Since 2012, with increasing frequency & severity
  • Low Normal T-Levels and low energy. Since mid 2017

Private UK Andrologist Consultation & Suggestions:

  1. Urologist Scan
  2. Therapeutic trial prescription of my choice of one of the following:
  • HCG
  • Clomid
  • Testosterone Spray
  1. Separate psychiatric treatment in conjunction with T treatment

Concerns

  • He did not ask for my Thyroid stats. My understanding was that Thyroid levels should be a first port of call, at least to check, before prescribing a T treatment?

  • He claimed I would have no need for an Aromatase Inhibitor with Clomid / HCG - “because you are not overweight”. Surely either treatment could have a potent Estrogen boosting effect nonetheless?

  • He was only interested in follow up checks of Blood Count & Total Testosterone levels. He did not believe that there was any need for tracking Estrogen or SHBG, for example.

I had imagined that there would be, particularly as I have higher levels of SHBG already, and therefore abnormally low Free T levels?

Questions:

  1. Does anyone have any thoughts as to whether Clomid or HCG would be an appropriate treatment, considering my age and stats provided?

  2. Are there any other diagnostic tests I should run in order to find a potential causal factor?

Thank you in advance!

2

Regarding Colmid vs HCG and appropriate treatment check out this sticky: https://t-nation.com/t/hpta-restart-for-trt-w-application-to-gear-pct/211723?u=ksman&source_topic_id=38

…actually…read all the stickies. They directly answer your questions.

For what it’s worth, I’m trying Clomid right now with mixed results. I started taking it to see if I could jumpstart my HPTA systems and begin producing my own T at sufficient levels. It’s working, just not as well as I hoped for.

Being young I think starting with Clomid or HCG is a reasonable first step. Once you introduce exogenous T your body shuts off it’s natural production, which may impact fertility if you’re interested in kids.

I believe a good process would be to first identify, if possible, what’s causing your low T. Is low T a symptom of a larger issue, if so, it may be beneficial to fix the large issue first.

Enjoy the journey…It’s a long and winding road.

3

–groan–

While TSH is good, fT4 is below midrange.
fT3, the active hormone, is way below mid-range --problem–
Guessing that years of inadequate iodine may have led to some thyroid nodules that are producing some hormones and lowering TSH when other labs suggest that TSH should be high.

Please discuss history of using iodized salt?
Sea salts and natural salts do not have any useful amounts of iodine to support thyroid hormone production, not healthy. And you may not be getting enough selenium.

Males hoard iron and needing supplemental iron is often a sign of a GI bleed and an occult blood test to detect blood in your poop is good screening.

Heart burn meds reduce absorption of minerals and B-12.

Your have primary hypogonadism. Stimulation of LH receptors with hCG or via LH induced by a SERM [clomid] it probably going to be totally inadequate. If you use high doses of those, you may get high E2.

Your high SHBG is not explained by E2 but could be from very low FT.

Low T lowers HCT. But yours is a bit extreme. High T levels from TRT would fix this.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

4

@azwildcats @KSman

Thank you both for your replies.

KSman - I have only ever used regular table or “Himalayan” salt. I have never regularly consumed seaweed or Iodized salt.

I ran a Micronutrient Test (Spectracell) last month, it did not flag my Selenium levels to be deficient. I have previously tried supplementing Selenium, but I found it gave me Gastric pain.

I agree with your point regarding potential GI issues. I will look into FOB tests.
I also understand that both B12 and Iron are symptoms of Atrophic Gastritis.

I imagine that correcting any GI issues could well improve my T levels. That said, if there is indeed an issue with my Testes production of T, then I appreciate that ameliorating my Gut will only do so much.

I was willing to give HCG or Clomid a try, but moving onto TRT requires more careful consideration, given my age. Additionally, the Doctor has only offered a Testosterone spray (Tostran) at this stage, which I have not been able to find much research for

My Plan of Action:

  1. Start supplementing Iodine, provided you think that would be appropriate? I had in mind to use a Kelp supplement (Organic Kelp), as well as consume Iodized salt with meals.
  2. Investigate my GI issues further with a FOB test.

If you believe there are any other avenues I should pursue, do let me know

I will update progress shortly. I have my next Consultation with the Andrologist soon and will voice my concerns. Perhaps trialing either Clomid or HCG might still be prudent, if only just to prove that the issue is primary, rather than secondary hypogonadism?

Thanks again for your feedback!

5

To give an update, yesterday I started a low-dose clomid protocol (12.5mg twice weekly // EOD). I was prescribed 25mg EOD by the Doc, but I am overly-cautious by nature…

Baseline blood are below

Blood Draw 26th July (Control Test)

TESTOSTERONE --------------------------------10.2 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) ---------*0.16 nmol/L 0.30 - 1.00
17-BETA OESTRADIOL --------------------------50.7 pmol/L 0.00 - 191.99
SEX HORMONE BINDING GLOB -----------------47.68 nmol/L 16.00 - 55.00

Blood Draw 11th September (6 weeks Plant Based Diet)

TESTOSTERONE ---------------------------------14.7 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) -----------*0.2 nmol/L 0.30 - 1.00
SEX HORMONE BINDING GLOB ------------------*61.2 nmol/L 16.00 - 55.00
FREE ANDROGEN INDEX --------------------------24.02 Ratio 24.00 - 104.00
17-BETA OESTRADIOL ----------------------------34.4 pmol/L 0.00 - 191.99
D.H.E.A. SULPHATE -------------------------------5.700 umol/L 0.44 - 13.40
FOLLICLE STIM. HORMONE -----------------------4.03 IU/L 1.50 - 12.40
LUTEINISING HORMONE --------------------------4.79 IU/L 1.70 - 8.60

I appreciate it may seem counter-intuitive to start a Clomid treatment based on my already high SHBG. These are my reasons:

  1. My FT levels have always been abnormally low, with the exception of a Vegan experiment I ran last year. Although my SHBG rose high, my Total Testosterone shot up to compensate, creating a higher FT than I have ever had while Omnivore

  2. I have seen significant benefits on my mood since switching Plant Based, which is equally important to me as other symptoms

  3. I have not yet seen a successful protocol which has reliably decreased SHBG to the level I would need it to decrease to in order to get decent FT. I figure I might as well see it as ally rather than enemy and not worry about boosting it, with the hope that my TT and FT rise in order to compensate

  4. I’m 26, so I figure to go with the least invasive option first and take it from there

Will update with changes in symptoms and post new results as and when.

Any thoughts or questions, just let me know!

Penguin

6

Wise beyond your years!

Take things at the pace you’re comfortable with and honor the process. Most importantly, it sounds like you’re feeling better which is the most important thing. Your symptoms will provide a clear path, and if needed, TRT will always be available at an appropriate time that you and your Doc agree to.