I was on 200 mgs cyp… 500 ius of hcg every 5 days and 1 I u growth for years. My wife had some issues and we went to fertility. My sperm came out 55 million. After was I had 20 million 100 precent forward moving. She’s now 3 months pregnant.
Thanks lancerevo, KSman and i2ripped for your comments!
I’ve been doing well on Clomid, no problems so far. I’ve been feeling a little tired today and yesterday, but it was after 3-4 days of poor sleep (5-6 hours/day, with lots of work). We’ll see how it develops.
I understand that the BW might not be helpful to determine T or Clomid’s effect. But I just want to check how I’m doing, especially regarding E2 to rule out if I’m gonna need to take an AI.
i2ripped, great to hear your story. I never had sperm issues, but my wife does have some issues which will be treated by the end of the year. I wouldn’t want to add another issue with taking T without HCG or IA. Hence, I will see how Clomid works, and will have the appointment with doc in a couple of weeks to see what protocol he recommends.
UPDATE 09-24-2014
- 12 days on 25mg Clomid ED so far. I’ve been feeling good. Good mood and libido. I’ve been failing to have quality sleep (6 hours max) plus strength training, so yesterday I felt kind of tired. Today much better throughout the day, but now I’m tired again. Due to the lack of sleep together with continued training, I don’t know if this is caused by that or by Clomid and potentially high E2. Any suggestions? I will have my BW tomorrow to assess levels in general.
Questions:
-
My doc prescribed 50mg Clomid ED, a dose I halved due to suggestions in the forum. What should I take into account to increase or reduce the dose?
-
My doc didn’t prescribe Arimidex or another IA. Considering that several of you, including KSman, suggested me taking an IA if necessary while on Clomid, what is a reliable place to buy it online?
Search for it. It is not a good idea to be discussing sources on this forum. Creates legal risks.
Lets wait for lab results.
Thanks KSman for your reply. Wasn’t aware of legal risks.
UPDATE 09-26-2014:
I just got my BW results (blood taken yesterday 09-25-2014):
TT: 239
E2: 23.0
LH: 1.2
FSH: 1.5
Recap of prior events:
- TT 198 on 08-18-2014 (noon; no fasting).
- 300 mg T shots on 08-23, 08-30 and 09-06.
- Since 09-13, 25mg Clomid ED (14 days so far).
- Yesterday’s BW was taken at noon with a 13 hour fast, without having taken 25mg Clomid yet (which I usually take in the morning).
- I’ve been feeling really good. Good libido and strength (yesterday I hit a new squat PR).
Questions:
- I understand that TT 239 is really low for my age (27 y.o.), but that the SERM (clomid) might not have become effective in 2 weeks?
- I understand that E2 at 23 is ok. Right?
- LH and FSH are in the lowest range. I understand that this might have to do with TRT shutting me down. Although I do not have a baseline before TRT. Correct?
- Should I double or halve my Clomid dose? Or keep it just as it is for now?
That amount of LH FSH may OK for maintenance of your testes. LH is low, so more clomid should not do any harm. You will need more LH/FSH, suggest that you double the clomid. It will take around one week for clomid levels to reach final levels.
Your T levels are really low. Testes might not be fully responded yet.
When your T levels are low, your E2=23 makes you very estrogen dominant. Will need to watch E2 levels.
Thanks KSman for your reply.
I will double the clomid and will check again in a couple of weeks. Will keep you posted. By then I will also have the appointment with an urologist from Dr. Lipshultz’s team in Houston, TX, so I can be in better hands that my previous docs.
Noted the E2 issue. I assume that if doubling my clomid dose increases T it will also increase E2, correct?
So E2 being now =23 is a sign that I will probably need an IA later, correct?
UPDATE 10/06/2014
I had an appointment with Dr. Mohit Khera from the Baylor College of Medicine Urology Center in Houston (he works with Dr. Lipshultz):
- He recommended to first try hCG alone (while keeping with clomid for first 2 weeks of hCG treatment), and eventually add T shots (and reduce hCG dose) if hCG alone is not sufficient.
- I’m not sure the exact hCG dose yet. He said something of 2 injections per week of 2,000 IU (not clear if total for both injections or for each one). Injected in belly fat.
- Had blood drawn to perform new lab tests.
- I’ve been feeling very good with 50mg clomid ED so far.
Any comments? I feel like (what I think is) the prescribed hCG dose might be a little too high from what I read in other comments. Should I be concerned about " leydig cell desensitization"?
UPDATE 10/09/2014
I got the results from Monday’s labs:
T = 423 [292-1052]
E2 = 37
FSH = 5.9
LH = 8.7
My previous labs (09-25; this is, 2 weeks ago):
TT: 239
E2: 23.0
LH: 1.2
FSH: 1.5
This has been on 50mg Clomid ED. Been almost 4 weeks now.
Should I be concerned with E2 = 37? I have felt really good while on Clomid. Doc suggested to switch to hCG mono.
As per the stickies, that is would be too much hCG.
Please read this and supply to you doctor(s)
http://press.endocrine.org/doi/full/10.1210/jc.2004-0802
Your TT is middle of the road, not where you need to be.
How long on clomid?
FSH and LH indicate that it is working very well and your clomid dose is too high, leading to high T–>E2 inside the testes.
If you lower the dose, TT will be less.
You testes are not ready yet or you have a degree of secondary hypogonadism.
And your E2-37 makes you very estrogen dominant. You can try anastrozole, but I suspect that it will have limited effect.
Your doc is using sledge hammers and I really don’t see what his goals are.
Thanks KSman for your reply.
- I had 25 mg Clomid ED from 09/13 through 09/29 (approximately 2 weeks).
- Then I doubled dose up to 50 mg ED, from 09/29 to date (approximately 2 weeks).
So when my blood was drawn I had been 2 weeks on 25 mg and then almost other 2 weeks on 50 mg.
Doc recommended hCG mono to preserve fertility and see where I can go just with it. Doc said that he would prescribe T hCG if hCG mono is not sufficient.
The dose he recommended is huge as per the stickies (6,000 IU per week). Since I already purchased the hCG, I am thinking in using hCG mono per the stickies (250 IU 3 times a week) or a little more, to see where I can get.
What do you think?
An alternative would be to continue another round of Clomid, or even try Nolvadex, but I understand that my response to Clomid regarding TT has not been the best (although it doubled TT from baseline, it still is middle of the road, while LH/FSH are quite high).
Two weeks may not be enough for the testes to fully respond to the increased LH/FSH
6000iu could have negative effects on the testes. Most docs do not have the time to become knowledgeable.
Give things more time. I expect that 50mg clomid will create excessive E2, you can’t stay on that in any case.
FSH = 5.9
LH = 8.7
- this was adequate, there is not point in pushing these higher. And if you can’t make enough T with these levels, then hCG mono therapy is probably not going to be any better.
- anastrozole might work OK with these levels, but probably not with 50mg clomid.
Please add FT to your labs.
Print that paper!
UPDATE 11/04/2014
I followed KSman’s advice and kept going on Clomid for one more month, although at half the dose (25mg ED).
New lab tests are not very different from the previous one (although it’s a different lab):
Blood drawn on 11/03/2014:
T = 467 [348-1197]
E2 = 27.3 [7.6-42.6]
FSH = 6.1 [1.5-12.4]
LH = 8.6 [1.7-8.6]
SUMMARY SO FAR:
1
Blood drawn on 08/23/2014:
TT = 196
First idiot doc puts me on 300/mg T per week. Had three shots: 08/23, 08/30, and 09/06. Felt great but it was insane. This site saved me on time.
2
Second doc suggests Clomid monotherapy, which I do:
- 25 mg ED from 09/13 through 09/29 (approximately 2 weeks).
3
I get new resuts of blood drawn on 09/25/2014:
TT: 239 [348-1197]
E2: 23.0 [7.6-42.6]
LH: 1.2 [1.5-12.4]
FSH: 1.5 [1.7-8.6]
- Maybe it was too soon to have my testes recover.
- I decide to double dose up to 50 mg ED, from 09/29 to 10/13 (2 weeks).
4
I get blood drawn on 10/06/2014:
T = 423 [292-1052]
E2 = 37 [<=63]
FSH = 5.9
LH = 8.7
PSA = 1.1 [<4.0]
- I decide to lower dose to 25 mg ED because E2 was too high.
5
After being for 3 more weeks on 25 mg ED, I get blood drawn on 11/03/2014:
T = 467 [348-1197]
E2 = 27.3 [7.6-42.6]
FSH = 6.1 [1.5-12.4]
LH = 8.6 [1.7-8.6]
- It is still in lower range, and I should be in upper range (27 y.o., male, fit, active lifestyle).
QUESTION: Should I give up on Clomid helping me get to high levels of T?
Doctor has recommended hCG monotherapy, and if it doesn’t work then go to T hCG (and eventually AI). But after reading about hCG mono I think I should I go straight to T hCG AI. Any ideas?
With those strong FSH/LH numbers, I don’t expect that hCG would take T much higher. But only one way to find out.
Were your testes examined for vascular abnormalities?
I assume that DHEA is not low and that is not limiting DHEA–>T
You may need T hCG to get to higher levels. With that, E2 can easily be an issue.
Thanks KSman for your reply. I think I will give low-dose hCG mono a try for a month, and if it doesn’t work I’ll have my doctor prescribe T-hCG-AI.
A couple of things:
-
I did not have my testes examined for vascular abnormalities. I had them examined by ultrasound a couple of years ago when my varicocele was detected and treated. Was that the appropriate test?
-
On 10/06/2014, my DHEA-S was 349 [240-549]. It is mid-to-low range. Is that low for DHEA-S → T?
-
I thought my symptoms were indicating secondary hypogonadism instead of primary. Do you think it might be primary instead?
varicocele: if fixed, that is all that can be done
DHEA: your level is fine. Levels could be higher at your age, but that would be average and not everyone can be above average 
Many guys have a blend of primary and secondary when older. Typically, younger men don’t have the issues with age related decline in testicular function.
Your game plan looks good, one step at a time.
UPDATE 12/2/14
So I started trying hCG mono on 11/06/2014 (250/300 IU EOD).
Blood drawn on 11/26/2014 (3 weeks after starting treatment):
T = 275 [348-1197]
E2 = 27.6 [7.6-42.6]
FSH = 1.8 [1.5-12.4]
LH = 1.9 [1.7-8.6]
QUESTION: These values are lower than me on Clomid mono, but maybe 3 weeks was too soon for levels under hCG to stabilize? Should I continue with this dose for some more weeks, increase the dose, or talk to my doc of going into T-hCG-AI?
Your time on clomid that produced LH and FSH was also contributing to conditioning of your testes. So you can add something to the 3 week duration of hCG.
Your T is lower and E2 is the same. That suggests that with hCG, your T–>E2 is higher, but the picture is incomplete without FT.
You have exhausted your alterntive options. I think that you need to do TRT: T hCG AI
UPDATE: Doc says he wants to try first hCG plus Clomid 50 mg. Quite reluctant to go into T-hCG-AI.
I think hCG-Clomid may skyrocket my E2, correct?
hCG and clomid or nolvadex both stimulate the LH receptor. So hCG clomid can always be expected to have these negative effects:
- high T–>E2 in the testes with high serum E2 levels that cannot be managed with anastrozole
- risks if desensitization of the testes - really hard as you then have secondary hypogonadism