Some do not do well with Clomid and feel better with Nolvadex.
Try ~.5mg anastrozole per week in divided doses.
Dose depends on your serum available T, FT is not as strong as TT.
SHBG will be increased by high E2, creating more T+SHBG that is not bio-available, lowering FT and inflating TT. Do E2 labs in 3 weeks. If you feel crashed, you are an anastrozole over-responder and will need to reduce dose by a factor of four. Small doses need to be managed by making a solution of anastrozole in vodka, 1mg/ml and dispensing by the drop or volume.
Have you had any blows to the head that might injure pituitary?
When did your T levels seem to slip? Sudden or creeping over years?
Thyroid issues can also affect energy, mood and libido.
Your E2 was high relative to FT before Clomid. Suspect liver is not clearing E2 properly. Some meds, Rx or OTC can do this by competing for same enzyme pathways that clear E2.
Please post other lab work.
CBC
hematocrit
AST/ALT
fasting glucose
fasting cholesterol
Higher Clomid/Nolvadex doses are discouraged as high LH/FSH can lead to a lot of T–>E2 inside the testes, but this does not seem to apply to you as a problem. So your liver remains a possible factor with high E2.
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.