Clomid and ED

Looking for some help. Here is my story, the short version.

Went to the doctor back in March of 2014 when i started having ED issues with the wife and lack of energy, brain fog. Physical came back normal but asked my old man doctor to check my T levels(will post labs further down). Of course that was the only thing he checked. I had him order panels below to hopefully cover everything.

age - 40
-height - 6’1
-waist - 40"
-weight - 240

-lab results with ranges -
Cholesterol: 250, range (110-200mg/dl) flagged as high
TRIG: 133, range (40 -149mg/dl)
HDL: 52, range (40-59mg/dl)
LDL: 171, range (50-99mg/dl) flagged as high
VLDL: 27, range (8-30mg/dl)
Glucose: 103, range (65-99mg/dl) flagged as high
BUN: 27, range (6-22mg/dl) flagged as high
MPV: 11.2, range (6.0-10.8) flagged as high

Vitamin D, 25 OH: 36.0, range (32.0-100ng/ml)

-My Testosterone was checked twice, once in PM and AM (had doctor
recheck b/c initially blood was done in the afternoon)
PM Overall Testosterone: 260, range(348-1197ng/dl) flagged as Low
PM testosterone free: 6.40, range(5.00-21.00ng/dl)
PM % free Testosterone: 2.46, range (1.50-4.20%)
AM Overall Testosterone: 326, range(348-1197ng/dl) flagged as Low
AM testosterone free: 6.59, range(5.00-21.00ng/dl)
AM % free Testosterone: 2.02, range (1.50-4.20%)

Estradiol: 11, range (8-43ng/l)
TSH: 2.15, range (0.27-4.20 MCU/ML)
T4: 5.7, range (4.5-10.9mcg/dl)
T3 Free, 2.3, range (2.3-4.2pg/ml)
SHBG: 27.3, range (16.5-55.9nmol/L)
Cortisol: 18.4, range (6.2-19.4mcg/dl)
FSH: 2.8, range (1.5-12.4 MIU/ML)
LH: 3.5, range (1.7-8.6 MIU/ML)
Prolactin: 10.4, range (4.0-15.2 NG/ML)

PSA: .48, range (< 1.400NG/ML)

So i went to a urologist who put me on 25mg of Clomid daily with 1 tablet of AI (anastrozole) weekly. I definitely started feeling a lot better and ED issues improved immensely. After about 3 months on the above protocol my labs were rechecked with the following positive results

FSH - 3.7 (0.9-15.0 mIU/mL)
LH - 3.1 (1.5- 9.3 mIU/mL)
E2 - 15 (11 - 44 pg/mL)
Testosterone - 668 (250 - 1000 ng/dl)
Sex Hormone Binding - 34 (11 - 78nmol/L)
Free Androgen Index - 68.1 (19.2 - 123.2)
Testosterone Free - 145.0 (47.0 - 244.0 pg/ml)
So after the results above the doc had me stay on the same protocol, no changes
25mg daily dosage of clomid and 1 tablet per week of anastrozole

Fast forward 3 months after that visit and the ED issues have started to reappear which deeply concerns me. I still feel good but def have been having trouble getting an erection for the wife. This is of course a big blow to my man hood. Also, im scheduled to see my doctor again in the next few weeks so any help would be appreciated.

Thanks
Mike

Your experience is not uncommon for clomiphene. You might do better on hCG with the same AI however sperm production could drop, possibly to zero.

thanks for the response. So I should ask my doctor about a HCG/AI protocol instead of Clomid/AI? But a side effect could be lower sperm count?

Yeah Clomiphene is an estrogen receptor blocker to increase release of LH and FSH from the pituitary. LH promotes testosterone production in the testes and FSH with the testosterone both promote sperm production. hCG is an analogue of LH and produces testosterone in functioning testes, which yours are based on your trial with Clomiphene. However the production of FSH may or may not be suppressed by a protocol of hCH+AI and spermatogenesis can be greatly diminished. There seems to be a misunderstanding here that hCG alone can do both promote testosterone and spermatogenesis.

E2 - 15 (11 - 44 pg/mL)

E2=22pg/ml is a good target.

You did not need anastrozole and with anastrozole, I think that E2 is too low, causing libido and other mood/energy effects. Suggest that you stop anastrozole and note changes.

Thank you for the reply. I just started removing the anastrozole from the protocol that my doc set me up on. So, it will just be the 25mg of clomid daily. I’m curious what my labs show in a few weeks. I’ve heard that guys on clomid cant trust e2 lab results. Has anyone else heard of that? You have to go on how you feel and right now my penis isn’t getting hard. Frustrating b/c everything seemed to be approving. Also heard that anastrozole is not effective with testosterone produced in the testes, don’t know if that’s true. Very frustrating. Maybe I should switch to novaledex(sp)

“Also heard that anastrozole is not effective with testosterone produced in the testes”
Anastrozole is a competitive drug [with T] at aromatase reaction sites. If needs to balance your serum FT/Bio_T levels and then it can control T–>E2 in your peripheral tissues. Inside the testes, T levels can be up to 80 times higher than serum in “normal” virile males. However, with too much SERM induced LH or hCG, T–>E2 inside the testes can be high and anastrozole then is 80 times too weak and is thus ineffective inside the testes.

I don’t know where "very hard to get an accurate reading of E2 while taking clomid " comes from. This might be mythical or bro-science. Might from experiences of guys taking a lot of SERM [common problem] and getting high E2, even with anastrozole or letro, then concluding that from the AI, E2 must be low and high E2 lab results are a cross effect on E2 labs when its the problem discussed in the above paragraph. I wish that you had not dropped that comment in this sticky.

[quote]

I don’t know where "very hard to get an accurate reading of E2 while taking clomid " comes from. This might be mythical or bro-science. Might from experiences of guys taking a lot of SERM [common problem] and getting high E2, even with anastrozole or letro, then concluding that from the AI, E2 must be low and high E2 lab results are a cross effect on E2 labs when its the problem discussed in the above paragraph. I wish that you had not dropped that comment in this sticky.[/quote]

I think what he means is that the estrogenic effects and estrogen blocking action of Clomiphene make the side-effects mismatched with lab results.

It’s difficult to say which tissues Clomiphene is acting on from client to client. It does seem that libido and erectile tissue are estrogen sensitive and a lab result may not completely explain the experience.

Clomid may make the numbers look better but its also known for causing mood issues and did absolutely nothing for my libido, if anything killed it completely. Nolvadex is the better option here if going that route. I am curious at 40 tho why TRT is not the option here? ED sounds in this instance to be estrogen related (low), performance anxiety given a bad episode, or clomid is making you depressed and killing your libido. You can have the best working dick in the universe but if you don’t feel like using it, your gonna have ED problems… If you can get an erection while masturbating and keep it until finishing, these problems are mostly mind related with a mix of low estrogen and low libido.

" estrogenic effects and estrogen blocking action of Clomiphene make the side-effects mismatched with lab results. " This is exactly what I heard from Dr. Crisler forum. Not trying to poison the discussion. Trying to separate the facts.

TRT protocol (Test/HCG/AI) was an option my doctor gave me. Unfortunately my wife was with me during the visit and started talking about wanting to have kids. He said clomid was the better option if wanting kids. I argued that you could still have children on TRT but it wasn’t worth it. Might ask about Norvaldex (sp) Also, I have been feeling better since removing the Anstazole(sp). Actually got it up last night…

If your balls are still producing, it seems silly to go on TRT. Your thyroid numbers are less than desirable. You should recheck now that T has been solid for awhile. Vit D was also low and should be addressed.

First get BW after stopping the Anastrozole. If that looks good, you could also try reducing your dose of Clomid. 25mg every MWF might produce the same effect with less drug. As mentioned above, if Clomid has you feeling off try a different SERM. If that fails to produce the desired effect, HCG would be the next logical step.

You could also check for DHEA-s and get to the top of the range if low.