HPTA Restart Attempt after 6 years of TRT

Pharma / TRT Testosterone Replacement
1

So, I’m attempting an HPTA restart after being diagnosed with Hypogonadism 6 years ago and being on TRT ever since. The reason I’m doing this is because I changed doctors. For the past 6 years, I’ve been going to an anti-aging clinic because it was my only viable option if I wanted, what was considered at the time, the best treatment (ample amounts of injectable Testosterone Cypionate, aromatase inhibitors, and HCG). Gradually, over the course of 6 years, with lots of trial and error and over a dozen blood tests, I dialed into a protocol that alleviated all symptoms of hypogonadism while minimizing side effects. That protocol was 77 mg test cyp/wk divided into EOD sub q injections. That’s all. No AI. No HCG. FYI - I’m 40 yrs old, 5’9", 177 lbs, 12% BF.

Why did I change doctors? The anti-aging clinic is a rip off when you can get a good endo to prescribe injectable testosterone if you truly are testosterone deficient in the clinical sense. So I found an endo who specializes in TRT and is only 5 mile from home. He spent over an hour with me on my first visit which I appreciated. He looked over my medical records meticulously. His final decision was to attempt a clomid restart over the course of 6 weeks since I am secondary. He said if it fails, at least he will know how much testosterone to prescribe based on my current protocol and lab results. I’m really curious to see if the restart works, but honestly, I’m not that hopeful.

My restart protocol has been 500 IU HCG every day for 1 week combined with 25 mg of clomid every day. After week 1, just 25 mg clomid every day for the remaining 5 weeks. So far, I feel just okay. I think the clomid is keeping my testosterone in a healthy range, but my libido tanked. The clomid has a calming effect for me almost like it’s killed all anxiety. I’m wondering if it’s messing with my serotonin/dopamine balance. Anyway, strength is still good, sleep is fine, energy levels are okay. For two weeks in, I can’t complain. Luckily my wife is understanding of the libido issue and supports the restart attempt.

I posted my labs below from my very first blood test in 2013 and my baseline after initial visit with new endo (while on trt).

Pre-TRT Lab Results 1 from Aug 2013
Total Testosterone, Serum: 238 ng/dL Low (348 – 1197)
Free Testosterone (Direct): 5.8 Low (8.7 – 25.1)
FSH: 1.3 Low (1.5 – 12.4)
LH: 3.1 (1.7 - 8.6)

Lab Results from Sep 2019 (Protocol consisted of subcutaneous injections of 11 ml (22 mg) of Test Cyp EOD, or 77 mg per week)
Total Testosterone, Equilib: 701 ng/dL (264 - 916)
Testosterone, Free: 21.52 ng/dL High (5.00 - 21.00)
*Estrogens, Total: 159 ng/dL High (40 - 115)
Cortisol AM: 9.0 ug/dL (6.2 - 19.4)
FSH: 0.1 mIU/L Low (1.5 -12.4)
LH: 0.1 mIU/L Low (1.7 - 8.6)
*Note: Based on my math, my E2 would be approximately 54 ng/dL (lab range, <39), assuming proportionality.

Lab Results from Oct 3rd 2019 (25 mg clomid ED)

Coming soon!

Total Testosterone
Estradiol
FSH
LH

2

Clomid and HCG is a waste of time and product. One cancels out the other, they aren’t both going to work at the same time.

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3

Doesnt make any sense. Agree with @hardartery .

You might want to go with hCG only for some time for an extra stimulation of your testis in case you experienced a lot of atrophy. But a restart of the HTPA will not work under hCG.

To restart use clomiphene or tamoxifene only.

Unfortunately your chances are very low that you will have higher T levels after restart than you did before in 2013.

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4

Read through previous threads about restarts. Agree with these guys, HCG and Clomid together makes no sense. I attempted a restart from TRT myself. Have a post tracking it along the way here:

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5

Thanks for the feedback. I kind of expected some negative responses on the PCT protocol. In my opinion it’s not a half bad protocol coming from an endo - HCG then clomid. I know my balls grew back in a week from the HCG. According to my endo, my FSH and LH should also be firing after the first week due to the coadministration of clomid. No labs to prove this though. Although I don’t feel like dogshit, so that’s a good sign. Worst case scenario, I wasted 7 days worth of clomid.

Don’t get me wrong, I’m not trying to claim that I’m doing it right. Just posting one man’s endo-supervised HPTA restart. I think the important thing here is that I’m trying a restart after 6 years! Will it work? Will it fail? Stay tuned to find out.

6

roscop12,

I have read your thread before actually. Very interesting. It sucks that your restart was unsuccessful, but I’m glad you’re feeling better now that you’re back on TRT. Has anyone ever posted a successful restart after long term TRT? I’ve never come across one. My story could just be one more failed restart thread. We shall see.

7

A restart at age 40 is pointless, levels have been declining since age 30 and levels are expected to decline further as you age. Your endo is just following protocol, if you want insurance to pay for TRT then you must prove you are eligible for treatment and that’s why you endo is doing a restart.

I can see your endo testing your levels twice, one below 300 and one above and he will tell you your levels are normal, seen this occur over and over again. Your levels sucked 6 years ago and even though you have been on TRT, the decline is still ongoing.

Usually when men do steroid cycles for long periods of time without doing restarts every 8 weeks have induced secondary hypogonadism, you’ve been on TRT for 6 years with no restart attempts.

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8

I’ve read about some successful restarts, but mainly from people who had normal, functional HPTAs to begin with and just got shut down from running a cycle or jumping on TRT unnecessarily. If your system didn’t work efficiently before, not a great chance 6 years later you could simply kick start it.

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9

Okay. So my lab results are in from yesterday’s blood test. They look really bad. This is after two weeks of PCT in accordance with my endo’s prescription.

Testosterone, Serum: 69 ng/dL Low (264 - 916)
Estradiol, Roche ECLIA: <5.0 pg/mL Low (7.6 - 42.6)
FSH: 1.4 Low (1.5 - 12.4)
LH: 1.6 Low (1.7- 8.6)

I felt fine until I saw the numbers… ugghhh. I would’ve guessed my testosterone was around 300 ng/dL by the way I’ve been feeling. Although this explains the low libido. It’s funny. I’ve been crushing it at the gym this week too. I almost wish I didn’t see these numbers now.

10

I find that promising that your LH is almost normal.
I’d stick it through to see what happens.

My experience, your TT may hit 300 and then when off clomid, prob drop to 175-200 and back on trt.

IMO, I’ve never seen a successful restart in someone who didn’t have normal to above normal levels beforehand…

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11

Right you are, at 400-450 things are not beyond saving at this point if SHBG levels are on the lower end, but if you wait until thing are worse, it’s more than likely too late to do anything about.

Things are broken at 300 and is past the point of no return.