I have similar test results to you at 30 and what seems like white collar adrenal fatigue. Thanks for sharing the clomid experience. Good luck.
So I had my annual physical, and I asked them to check my T level along with the standard bloodwork. Here’s where I am after more than 3.5 months on Clomid:
Test 418
Free Test 278
Estradiol 28.6
After one month on Clomid, my T level went from 270 to almost 700, so essentially I’m regressing back to where I was before I started. It’s also worth pointing out that I had no change in symptoms when the T level was higher. It’s been like taking nothing the whole time. Apparently this is a common result.
At least it looks like I’m secondary rather than primary. I was considering trying to reduce the E2, but after seeing these results I’m going to start HCG monotherapy.
Don’t you have to taper off the Clomid to see the full benefit of the restart? You’re still on right?
What does the TRT doc say about using an AI? You may want it even with the HCG.
So…figured I would update this thread with events of the last several months.
(Quick recap of previous posts: Test level of 215 at age 27, probably due to stress/adrenal fatigue, poor lifestyle, etc. Raised to 265 after a few months of healthy living. Went on Clomid, which raised me to 679 TT but with no symptomatic improvements at all. Stayed on Clomid for approx. 4 months)
I started HCG monotherapy (1500 units MWF) close to two months ago. Initially felt like crap, but gradually started to notice some improvements. After about 1.5 months, I started to feel pretty good. Energy improved. Was getting major morning wood and random erections, which hadn’t happened in years.
I felt some hints of E2- tender nipples, some itchiness. Nothing major though, until middle of last week. After a shot I started getting puffy, inflamed nipples, hot flashes, itchiness and drowsiness. Significant puffiness around breast area kind of freaked me out about getting gyno. Previous good effects mostly left.
Got bloodwork the next day. TT had gone up to 880, and E2 was at 92. Obviously that is the problem. I have a doc appt in 1.5 weeks, where I will try to persuade him to give me Arimidex. We’ll see if he’s cooperative. In the meantime I’m going down to 500 units MWF and taking 50 mg/day of zinc. Feel okay, but not amazing.
Were you dividing 1500 units between the three days or taking that much every day? With HCG (or SERM), you want to take as little as possible and still get the desired effect. Taking too much HCG in particular can make controlling E2 very hard. Before chasing E2 with an AI, I would lower the dose and retest.
I was taking 1500 each time. It is a fairly large amount, but thought I might be able to taper that down after a while.
Why would you avoid the AI? I guess that fewer medications is better, but I’d rather take arimidex than settle for a lower T number. Does HCG often have the same effect at a lower dose?
I wouldn’t avoid the AI, but high doses of HCG could make dialing in an AI very difficult. There’s lots of talk about intertesticular aromatase that seems to make some sense. The assertion is that this aromatase cannot be controlled well with an AI. You’re 92 E2 with an 880 T number seems to support this. Even if this is just broscience, taking no more than you need to get the desired effect seems to make sense with hormone manipulation.
If you can get 80% of the total T with half the HCG, my guess is E2 will be drastically lower. You should test after doing 500 for a week or two. If T is still good, I would cut it down to 250 for a couple weeks and retest again.
You could add an AI, which should increase T more than running without it. I personally would go with a standard AI dose and not try and dial in E2 until you’ve settled on an HCG dose.
I’m just some random guy on the internet, so take this for what it’s worth. I’ve never treated anyone but myself.
Thanks for the response. I’ll have to research the intratesticular aromatase issue some more.
[quote]KSman wrote:
Do not ever do a dead stop on a SERM, always taper off!
Clomid has nasty sides for some, nolvadex is a better choice.
Best thing to do is read the stickies.[/quote]
Why? The half life is so long that it takes at least 2 months to leve your system even if you don’t tper. It tapers itself.
[quote]KSman wrote:
Fixrun: Hot flashes might be because you get estrogen side effects from Clomid. You can try Nolvadex and see if that provided relief.
Bone loss from AI: AI’s do not cause bone loss. Low estrogen’s cause bone loss. As we are modulating E2 levels within normal range, there is no issue. .[/quote]
Not if all the estrogen you see in the blood test is from your fat tissue, say, while E2 is low in your bones.
Thought I would post a little more information. I went to the doctor this morning, and got the bloodwork results from last week. After close to two months on HCG monotherapy (MWF shots, 1500 units per shot):
LH: less than .2 (1.5-9.3)
FSH: less than .7 (1.6-8.0)
SHBG: 24 (10-50)
TT: 883 (241-827)
FT: 3.39 (.95-4.30)
E2: 92 (less than 39)
The doctor won’t give me Arimidex, because I had slightly low bone density when I was scanned after being diagnosed with low T. In terms of bone density, I can’t see any logical difference between a natural E2 level of 25 and a drug-induced E2 level of 25, but I can’t get the prescription.
He’s just having me lower the dose to 1000 from 1500. Will re-test in a month and see what happens. In the meantime, I’m trying to do what I can to reduce the aromatase activity naturally.
The logical difference is that we don’t know if the drug might, for example, suppress aromatase in your bone tissue too much. The level of 25 is an average of aromatase activity over all tissues in your body, and does not tell us what is happening in individual tissues like your bones. Until a study has been done on men on TRT and AIs, it would be imprudent for him to prescribe the AI.
It is better anyway, if possible, to lower your E2 by lowering your TRT doses as opposed to adding another drug, so that should always be tried first.
My understanding is that the bone density loss is a result of the low E2 resulting from the AI, rather than any direct effect of the drug itself. That’s what the doctor told me as well, which makes me scratch my head about why he’s opposed to using an AI to bring E2 to within normal range.
I’m not saying that I know that for sure, but I haven’t seen any info to the contrary- my impression (maybe wrong) is that they are extrapolating from data that comes from women using much higher doses of AIs to combat tumor growth during breast cancer, which results in pathologically low level of estrogen (although necessary given the circumstances). I wonder how applicable that is to male TRT.
Obviously many men do use AIs prescribed by their doctors. I’d be interested to see the results of a study on men.
1500 iu of HCG is very high.
You probably will desensitize the leydig cells if you do this long term.
[quote]TheRedneck wrote:
My understanding is that the bone density loss is a result of the low E2 resulting from the AI, rather than any direct effect of the drug itself. That’s what the doctor told me as well, which makes me scratch my head about why he’s opposed to using an AI to bring E2 to within normal range.
I’m not saying that I know that for sure, but I haven’t seen any info to the contrary- my impression (maybe wrong) is that they are extrapolating from data that comes from women using much higher doses of AIs to combat tumor growth during breast cancer, which results in pathologically low level of estrogen (although necessary given the circumstances). I wonder how applicable that is to male TRT.
Obviously many men do use AIs prescribed by their doctors. I’d be interested to see the results of a study on men.[/quote]
It isn’t the E2 in your blood that builds bones. It is mostly the E2 that is being produced by aromatase locally in the bone cells themselves that builds bones, and an AI would be suppressing that - perhaps too much - we wouldn’t know how much from a blood test.
[quote]seekonk wrote:
It isn’t the E2 in your blood that builds bones. It is mostly the E2 that is being produced by aromatase locally in the bone cells themselves that builds bones, and an AI would be suppressing that - perhaps too much - we wouldn’t know how much from a blood test.
[/quote]
Is this a widely shared view? Obviously it would apply to everyone who uses an AI…I haven’t read anything about people getting regular bone density scans to check for bone loss while taking an AI.
[quote]Tunapancake wrote:
1500 iu of HCG is very high.
You probably will desensitize the leydig cells if you do this long term.
[/quote]
As I read more on these forums, I’m definitely getting the impression that most people who do hcg monotherapy use a lot less than 1500 iu per shot/3 shots per week. Is there any definitive protocol for hcg monotherapy?
As far as the leydig cell desensitization goes, my impression is that evidence for this comes from experiments done on rats that were given very high doses of hcg to mimic longer-term, lower doses in humans. Is there any direct clinical experience of this happening to TRT patients? And is this definitely a permanent, primary hypogonadism-inducing effect, rather than just a “downregulation” that is reversable?
I want to emphasize that I don’t know for sure that this is true…I’m trying to gather info here.
[quote]TheRedneck wrote:
Recapping earlier posts: 1500 iu hcg per shot, 3 shots per week produced 883 T, 92 E, and significant estradiol side effects.
5 weeks later…
I reduced the hcg dose to 500 iu per shot, 3 shots per week. After 5 weeks on that, I recently got two blood tests a few days apart:
TOTAL TEST: (1) 507 (2) 527 (Range 241-827)
FREE TEST: (1) 1.84 (2) 1.50 (Range .95-4.30)
SHBG: (1) 22 (2) 21 (Range 10-50)
ESTRADIOL: (1) 56 (2) 40 (Range <39)
Low t symptoms have not really improved much…low energy, etc. After some prodding, I convinced the doctor to prescribe Arimidex. He told me to take 1 mg per day, which, based on my reading, seems like a huge dose. (No wonder he was worried about bone loss from low estrogen…) I’m going to go with .3 mg MWF to start with and see what happens.
I’m curious about how well people are able to cut those tiny pills apart. Seems like a real pain to get an accurate dose.[/quote]
I dissolve mine in vodka and dose with a measured dropper. I do .5mg per ml. I fill it to the 6 mark on my dropper, which would be .6 ml or .3mg.
Nice case thread. Very interesting…
I was surprised by people taking Armidex every other day, it has a half life of 2 days which means a 30% drop per day(.7*.7=.49). Makes the level of the AI bounce around quite a bit.
[quote]sameul11 wrote:
I was surprised by people taking Armidex every other day, it has a half life of 2 days which means a 30% drop per day(.7*.7=.49). Makes the level of the AI bounce around quite a bit.[/quote]
Not really. Make a spreadsheet and see what happens after a week or so.