Urologist Yelled at Me for Not Wanting to Take Clomid

Pharma / TRT Testosterone Replacement
1

I’ve been on TRT for two years with an older endocrinologist. He’s old school and wanted to do 200mg every 14 days but now lets me basically do 120-140mg/week, or whatever I want. He doesn’t believe in testing E2 or things like that, but he’s a nice guy, and easy going.

I booked an appointment with a Urologist that I know runs a TRT clinic on the side.

The guy comes into the office and just starts talking, rambling, ranting, how my endocrinologist is just trying to money grab me and he knows the best guy.

He said (without asking me why I was even there), we’re going to take you off insurance, and get you 50% Cypionate, 30% enanthate, and 20% propionate blend, 800mg, for $30 a month. We’re going to throw in Clomid at $75 a month.

I said I really just came to see if you’d help me with subcutaneous injections because I’m having a hard time with weekly IM, and wanted to know your take on TRT.

He says get used to it (injecting for life). I asked, aren’t Clomid and TRT pointless to take together as you’re gonadotropins are going to be suppressed regardless?

He looks visibly mad at this point and rants that I’m trying to be the doctor and he’s going to teach me a lesson. Draws out the HPTA on a piece of paper and then says, yes, to a degree, you’re right there will be some inhibition regardless.

Wasted $100 to be told by a Urologist to leave insurance and pay his “guy” in Florida for whatever I want. He said if I don’t take Clomid and stay on TRT my balls will never come back or make sperm again.

But the final question is…there really isn’t a point in taking Clomid on TRT, right? I’ve never seen someones bloodwork on TRT showing elevated LH/FSH while on exogenous testosterone.

2

So if you are worried about testicular atrophy with testosterone only why not consider hCG?

This is a complex topic. How much info do you need or want?

If you wanted to maintain some endogenous LH/FSH production you could consider testosterone nasal gel or a selective SERM for example enclomiphene.

Good review here and thread is good read to stimulate thought:

3

I’m not concerned with testicular atrophy enough to take hCG or Clomid while on TRT. If I want kids, I’ll ask my endo for hCG down the line. I just don’t want to take Clomid indefinitely while on TRT with no interested in fertility right now because this whacko urologist demands it.

I’ve simply not seen any lab work showing LH/FSH is actually NOT suppressed if Clomid is taken with TRT.

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4

Gotcha and agreed. With testosterone ester protocol where testosterone is elevated all day every day for major portions of the week with little pulsatility it is very unclear that clomid along with TRT would significantly raise LH/FSH levels. But if he has clinical experience with patients that have relatively weak feedback of androgens at the hypothalamus then maybe he has some examples? Never hurts to ask but it sounds like he would not be down for that type of detailed discussion?

Relevant discussion for those interested:

See diagrams in this thread.

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5

Well said and I think you’re right. He’s not interested in a medical discussion. If test from his compounding pharmacy is $30 a month and Clomid is $75 a month, he wants you on everything. He had a shopping list of hCG and other things I didn’t look at. But, I understand why he does it, because some people line up for that. I just want normal levels and a therapy that works, guess I’ll stick with my endo.

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BTW, what issues are you having that started the 2nd opinion consult?

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This urologist sounds like a nervous salesman, and probably rehearsed what he was going to say before he came in to the appointment.

It’s 100% money grab.

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8

This was my opinion as well. Didn’t know enough to comment on Clomid, but the antics used by this person sound like someone whose more interested in OP’s wallet than his health.

9

Issues have arisen I don’t feel I can bring up to my endo because he has no idea. Things like insomnia, tinnitus, water retention sometimes, extreme tension headaches.

Doctors feel like I’m crazy, or I’m bothering them, to test my estradiol etc.

I was hoping to get from this guy #1 - better labwork done every 6 month checkup besides CBC and total test, and #2 - a doctors OK on injecting 2x a week with smaller needles SC.

Everything fell apart after 1 year on TRT for me, but perhaps for other reasons.

I just can’t do 22g 1 inch injections in my glute myself anymore. So, right now I’m doing 0.25-0.30mL 2x a week with 27g 1/2 inch, but I still get freaked out to stab myself in my delts or even glute sometimes. I feel like I’m doing something “wrong” and just want a doctor to show me.

I fully virialized after testosterone (grew a beard from 0 facial hair) at 33, and finally got a gf and now have normal sex (never had sex prior until 33). It gave me a sense of well-being in my body I’d never had through teens or twenties. I felt like a boy, and testosterone did help change me mentally and physically, but I know I need to exercise and diet better.

I just get freaked out about some of the side effects sometimes. Never had tinnitus until TRT (hormone related?), never had tension headaches until TRT (hypertension? high-hematocrit?), never had pigmentation changes until TRT (adrenal hormones cause pigmentation changes, something else going on?).

10

This is a scare tactic!

11

Here down for DG technique (I used same 27g gauge setup as you):

Shoulder:

Going back through your history you really could benefit from finding a local PCP/men’s clinic who cares about you and isn’t trying to sell you a bunch of stuff. Your dosing may be too high and perhaps 70-80 mg/week test ester or less (once weekly injection may be something to consider) after discussion with provider. Or discuss pulsing exogenous T with nasal gel or other methods. If you have other endocrine issues going on of course exogenous T isn’t going to address all of that…thyroid/GH/IGF-1/etc.

I also have experienced similar issues to what you describe (insomnia, headaches, tinnitus) while using testosterone and the sleep was a big deal.

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12

Thanks for the links. I guess I’m not doing DG that wrong, but I also guess with a half inch it’s really just going into the fat, which limits the volume I want to inject. I think I would do better on a lower dose at the moment.

I 100% had sleep apnea on higher doses. I was waking up gasping for air, not breathing, felt like someone put my head under water. I think that was a big issue for the blood pressure and headaches. Since I’ve lowered my dose over the past 6 months (because sometimes I just flat out skip days) my headaches are gone, BP is 130/78 an hour after waking if I don’t drink coffee or use nicotine, but tinnitus is still around.

So, maybe moving forward I’ll go down to 100mg a week but not sure I want to inject that with an insulin pin.

13

You could try injecting 0.3 ml with 25 g setup, build confidence and then work your way up to 27g insulin pin. Would also kill two birds with trialing a lower dose potentially.

14

I used heavy gear for 10+ years with no clomid and I have 2 children, anecdotal I know.

Also, if a doctor ever yelled at me as a grown ass man, somebody is going to the ER and it isn’t going to be me.

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15

You should consider lowering your dose since the liability you take on with assault probably isnt warranted given he was just yelling at you :grinning:.

But then you are skilled in the legal arts so perhaps you have all the tricks. “Your honor, the provider tried to inject me with an 18 g needle.” Cruel and unusual punishment.

16

I might have calmed down some, but the raging aggressive asshole is still in there, gear or not. There are certain things in certain settings you just don’t do to another grown man. I may not have physically assaulted him, but I would have made it known he was crossing a line :smiley:

My back surgeon found that out real quick after making light of my suffering when I was sent home after an 8 hour back surgery for a double level fusion in the lower back with Percocet and muscle relaxers. This was due to covid and procedures at the time as this was March of 2020. I should have been on a pain pump with morphine for 2-3 days. I have a high pain tolerance and I literally rolled around in sweat and pain for 5 days after surgery at home because of junkies.

Funny shit my first foray into gear was Test and Deca and I was using an 18 gauge needle from the local tractor and supply…

I would prefer the, “Your honor he tried to sexually molest me and force drugs on me.” Word versus word is a double-edged sword.

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17

Hey I understand. Just looking out for your estate and making sure you got that umbrella policy active and in full force.

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18

A man must know his limits and faults.

I have a huge life insurance policy and all of my estate / businesses are tied up in a trust in my childrens’ and wife’s name. I urge anyone with sizable assets to protect them legally similar to how corporations protect themselves albeit in different ways from people looking for some “easy” money.

On paper, legally, my worth would be hard pressed to buy you a used clapped out Civic.

I have been more than blessed. My wife and children will never have to worry about money.

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19

Great advice for people to read. Thanks.

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20

I’ve been asking on reddit for a long time for someone to post labwork showing an increase in LH/FSH while taking a SERM along with TRT (or any AAS) and so far, no luck. My assumption (from my AAS days) was that there was no point since the stimulation from the SERM would not overcome the shutdown from the test.