Want To Change From Clomid. Need Advice

Pharma / TRT Testosterone Replacement
1

Hi, I’m new here and in need of advice.

Currently I am on Clomid treatment (I think the doc meant it to be a Clomid trial to see if he can restart my T production).

I am 37, currently 84 kg, 176 cm. For the past ten years I’ve been experiencing varying levels of fatigue, generally increasing. No morning wood, or very rare (sth like 1 in 2 weeks) with very short periods of it happening more often (difficult to say what influenced it – tried tracking it).

My libido has also decreased significantly and became very low. Since starting Clomid it’s become non existent.

A few years ago hair on my hands and legs decreased. (I never had coarse bodyhair I see other guys have but I definitely had more hair.) Around that time my testicles also kind of shrunk. And my semen volume decreased and it got more see-thru. Since then my testicles got a bit bigger but that’s about it. Semen colour got whiter on Clomid but not more volume.

I feel tired and sleepy a lot of the time and have much less energy than other men I know my age. I just try to survive each day.

The first labs I had taken a few years ago showed

total testosterone of about 420 ng/dl (range 249 – 836)

free testosterone was 8,3 pg/ml (range 8,8 – 38,8) – below range

I felt bad then but doc said I was fine.

Also got my thyroid tested and tried dialing that in in hopes of getting more energy. But nope.

(I have a slightly underactive thyroid and diagnosis of Hashimoto’s. Doctor started treating me with T4 only medication (it’s called Letrox) almost 2 years ago. I read of conversion issues and guys restoring their T levels and energy when on thyroid medication. Nothing like this happened and doc tried raising the dosage and even got me on a T4+T3 medication a few months back. Upping doses and changing to T4+T3 made me only get some hyper symptoms and almost undetectable TSH with fT3 above range but didn’t make me feel better. Since then I am back to T4 only medication as it seems my body converts well and I don’t need the extra T3. The only change I noticed after starting thyroid treatment is that my memory got a bit better.)

Since then I tried dieting under dietician’s and personal trainer’s supervision, generally eat a cleaner diet, practically don’t eat gluten and dairy (am lactose-intolerant), work out with a personal trainer a couple times a week, supplement vit D and zinc and selenium. Plus varying supplements depending on trainer’s advice. Those changes made my TT rise a bit but it varies within 480 – 590 ng/dl after these changes. It didn’t make me feel much difference in my energy levels or libido. There were a few bursts of energy I got shortly after training sometimes and that made me think it could still be sth to do with free T maybe.

Finally when the thyroid doc said nothing more can be done about thyroid I tried another doc who suggested taking Clomid cause my body might need more testosterone than I was then producing. Doctor suggested that my SHBG is high for my age but that not much can be done about that and that it influences my free T.

My labs before taking Clomid were (May 18th 2018):

FSH 2.34 mIU/ml (1.5 -12.4) N

LH 2.28 mIU/ml (1.7 – 8.6) N

TT 596.8 ng/dl (249 – 836) N

FT 17.21 pg/ml (1 – 28.28) N

Estradiol 15.2 pg/ml (11.3 – 43.2) N

Prolactin 10.1 ng/ml (4.04 -15.2) N

SHBG 44 nmol/l (18.3 – 54.1) N

PSA 0.971 ng/ml (0 – 4) N

Total cholesterol 224 mg/dl (115 – 190) H

Cholesterol HDL 44 mg/dl (>40) N

Cholesterol non-HDL 180 mg/dl

Cholesterol LDL 140.2 mg/dl (0 – 130)H

Triglicerides 199 mg/d ( 0 – 150)H

Cortisol 18.9 µg/dl (7:00 - 10:00am – 6.2 – 19.4 µg/dl)

Vit D25 37 90 ng/ml (30 – 50 optimal)

I also tested insulin and glucose levels (July 5th 2018):

Glucose tolerance test (75 g) Fasting glucose 85 mg/dl (70 – 99)

Glucose after 1 h 185 mg/dl

Glucose after 2 h 141 mg/dl

Insulin after giving glucose (75 g glucose 0,1,2)

Insulin before glucose 11.9 µIU/ml (2,6 - 24,9)

Insulin after glucose (pkt 1) 125 µIU/ml

Insulin after glucose (pkt 2) 101 µIU/ml

I was suggested this indicates insulin resistance and I’ve cut out sweets since then. I do have cravings for sweets.

I waited a bit since May and started taking Clomid in early July cause the doc told me to switch from T4+T3 (Novothyral) medication and I felt horribly tired switching and didn’t want to change two things at the same time so waited until things somehow normalised and then started off with Clomid.

After 3 weeks on Clomid (1 week of Clomid 25 once a day + 2 weeks on Clomid 50 once a day) my results were:

(July 27th 2018)

FSH 6.21 mIU/ml (1.5 - 12,4) N

LH 7.82 mIU/ml (1.7 - 8.6) N

(July 25th 2018)

Estradiol 65.7 pg/ml (11.3 – 43.2) H

TT 13.1 ng/ml (2.49 – 8.36) H

SHBG 42.9 nmol/l (18.3 – 54.1) N

DHT 775 ng/l (219 – 1080) N

I experienced some Clomid side effects – visual and heat waves and excessive sweating and decreased it to 25 once a day. After 2 more weeks the results were (August 10th 2018):

Estradiol 72 pg/ml (11.3 – 43.2) H

TT 9.98 ng/ml (2.49 – 8.36) H

FT41.98 pg/ml (1 – 28.28) H

I still didn’t feel too well. Non-existent libido, low energy, but got some morning wood for about a week. Cut down on Clomid 25 every second day. Morning wood much rarer. Still very low libido, but maybe a little bit better.

Tomorrow I’m going to see a new doctor (had to travel far to see the Clomid doc) and want to ask him to switch me from Clomid to Nolvadex and Proviron as I had this suggested by a personal trainer that it might help with my issues and lower SHBG. I did some reading and it seems that I might be not be experiencing the benefits or raised testosterone on Clomid due to estradiol going above range and my SHBG being too high for my age.

Is it a good idea to switch to Nolvadex + Proviron? And if so what dosage should I think about? The suggestion I got from that guy was of 20 Nolvadex once a day and 12.5 or 25 Proviron every 12h.

I really want to finally experience some energy and libido increase.

We’re planning to start trying for a baby with my wife soon so I am still looking at the medication before classic TRT option cause I want to be fertile.

English is my second language but I tried my best.

Any advice would be greatly appreciated.

2

To cut it short as the above post is very long.

I am currently on Clomid.
My pre-Clomid labs:

FSH 2.34 mIU/ml (1.5 -12.4) N
LH 2.28 mIU/ml (1.7 – 8.6) N
TT 596.8 ng/dl (249 – 836) N
FT 17.21 pg/ml (1 – 28.28) N
Estradiol 15.2 pg/ml (11.3 – 43.2) N
Prolactin 10.1 ng/ml (4.04 -15.2) N
SHBG 44 nmol/l (18.3 – 54.1) N
PSA 0.971 ng/ml (0 – 4) N

After 3 weeks on Clomid (1 week 25, 2 weeks 50):
FSH 6.21 mIU/ml (1.5 - 12,4) N
LH 7.82 mIU/ml (1.7 - 8.6) N
Estradiol 65.7 pg/ml (11.3 – 43.2) H
TT 13.1 ng/ml (2.49 – 8.36) H
SHBG 42.9 nmol/l (18.3 – 54.1) N
DHT 775 ng/l (219 – 1080) N

After 2 more weeks on Clomid (lower dose again 25):
Estradiol 72 pg/ml (11.3 – 43.2) H
TT 9.98 ng/ml (2.49 – 8.36) H
FT41.98 pg/ml (1 – 28.28) H

I feel like crap even though my TT is above range on Clomid. I think of switching to Nolvadex + Proviron and would welcome any advice as to dosage and whether asking doc for this switch is a good idea?

3

So common to have excellent numbers on Clomid and still feel like garbage, half the pill is pure estrogen. Some have seen good results on 12.5 - 25mg EOD or even every 4 days.

4

Thanks for the answer @systemlord. So I feel like crap because the estrogen is out of range high? I thought that might be the case. Before Clomid it was 15 pg/ml and on Clomid it went to 72 pg/ml. I wonder whether it wasn’t too low before Clomid? But seems too high on it.

EOD means every day? Right now I am on 25 of Clomid every 2nd day and still don’t feel any benefits. I feel weird and weak, even worse than usual. Have headaches from time to time and got a bit irritable - that’s probably the estrogen, right?

Do you think it’s worth trying to lower the dose even more? I read somewhere a doc mention that Clomid usually brings success in young guys with low SHBG. As this isn’t my case I started thinking of switching. Tbh I would just try actual TRT now if we weren’t planning children soon.

Have you heard of any successful switches to Nolvadex?

5

EOD is every other day, I think don’t think you’re ever going to feel amazing on clomid, very few men do. You can freeze sperm and go on TRT, adding FSH to your TRT protocol has been shown to work well.

There are lots of men on TRT having babies.

6

@systemlord Wife wants to start trying for children in the next couple of months so I think I will want to wait with going on TRT at least until she gets pregnant.

Thanks for the info on Clomid effects on wellbeing. Definitely makes sense compared with my own experience so far.

So the normal route is to try Clomid and if it fails then go on TRT? Does switching between SERMs make sense in a case like mine? Maybe I want too much but I’d like to impregnate wife and actually have a libido while doing this :wink: and kind of jumped on the idea of Nolvadex and Proviron to get T to stay on levels similar to achieved on Clomid but without Clomid sides and use Proviron to lower SHBG/free up some more T/lower estradiol and give libido a kick. Or am I barking at the wrong tree?

I got most of my knowledge from forums like this one and online articles, unfortunately there are very few doctors working with male endocrine systems in my country. Even the one that put me on Clomid and was supposed to be one of the best laughed at the detailed labs I had and said he will only need TT and LH numbers at check up. It’s a frustrating process. Happy that there are forums like this one where information is shared.

7

Have you considered hCG concurrently with testosterone? Using hCG will maintain fertility.

8

@highpull I have read about this option and as far as I know it’s not a common practice in my country unfortunately. I guess it could be done if I got lucky enough and convinced the doc.

I also read that in some cases hCG doesn’t prevent shutdown and I’d like to father at least one child before taking that risk.

When thinking about going on TRT I am thinking of trying the hCG option along with it, just dunno if docs will make it possible. I may want to father more than one child but if this means postponing whatever treatment proves effective much longer - then I feel unwilling to wait. I want to finally start functioning cause right now it’s zombie mode most of the time.

Also wondering if there is any success in longterm Nolvadex + Proviron use? I read that Clomid works for some lucky men just like mentioned above, def I’m not one of them though.

Essentially hoping to switch meds and feel better and if it works thinking of continuing for a while. If it doesn’t work then first 1 baby and then TRT.

Or does this Nolvadex+ Proviron switch sound unlikely to work and TRT is just the natural next step and I’m grasping at straws trying to postpone it?

9

Have you talked to your doc about an aromatase inhibitor like arimidex? That high estradiol might be hurting you.

10

Arimidex very strong. Your free t and total t are high. Drop dose further before doing ai. That’s the best way to avoid ai

11

I was prescribed only .125 anastrozole EOD, it took my E2 down to 12 in a week. Now taking 1/4th of that dose.

12

I haven’t talked to my doc about aromatase inhibitor @apexbreed. I’ll see what he says today in general.

@anon10230041 the above labs were done when I was on Clomid 25 every day. I dropped to 25 every other day in the last two weeks, but still see no improvement in wellbeing. Not sure if dropping to even less will make a difference?

@systemlord Did it influence your wellbeing? How did you feel before anastrozole and now?

13

I felt jittery and hands shaking a little and anxiety when estrogen was high, low estrogen is very similar. I’m teetering on my sweat spot for estrogen levels, dipping between low and in that sweat spot every 2 days since lowering my AI dosage.

I started the reduce AI dosage on Sunday, Tuesday I felt like I was in heaven, amazing feeling I’ve never felt before. I’m feeling it right now again. I feel this way a day after my injection and AI.

Finding that sweat spot takes time to find, you have to play around with the AI dosage a little, it helps that the AI is compounding into powder, I can dose it precisely. My advice is start out on a very, very low dosage and slowly work your way upwards.

14

@systemlord Thanks for the info, sounds great once it is dialed in. I saw the doctor today and he didn’t go the AI direction my case though… (will post below).

15

OK, so I am after my consult with the new doc. It was interesting and he seemed quite open-minded and willing to find a way to help. I guess time will tell.

He said that in my case he sees three options to look at, trying them out one at a time.

  1. He said that my prolactin levels are a bit high, not clinically high but might be too high for me. He told me to stop taking Clomid altogether for now and in a few days start taking Dostinex. He told me to take half a pill once a week 3 times and then add Clomid.
    So starting Monday I am supposed to take half a pill of Dostinex, then 2 more times week after week and after that last one start taking Clomid 50, take one more dose of Dostinex and come for a check up in the next couple of days.

So I will have taken Dostinex half a pill four times over the course of 3-3.5 weeks and within this time Clomid for the last 1-1.5 weeks.
He said he is the most interested in whether I start feeling better, but I may bring prolactin results from before and after this trial as a bonus. But he is more interested in my subjective impression than whether this works biochemically.

  1. If the above doesn’t help then he will want to put me on beta hCG shots but don’t know the details of this plan yet other than that he said that in my case adding Proviron to this sounds ok and that this wouldn’t be his usual protocol but in my particular case it makes sense to him.

  2. And if that doesn’t help he wants to try how I react to melatonin but I don’t know the dosage he has in mind yet. It’s supposedly one of the recent approaches that can help in reduced energy if I don’t enter REM sleep phaze for some reson.

What do you guys think? I’m starting the 1st option after the weekend.

16

I got my prolactin tested on Monday before taking Dostinex and after seeing my results decided to call the doc and consult whether I should take this med or not. Here are my labs from this Monday (September 3rd 2018):

Estradiol 82.2 pg/ml (11.30 - 43.20) H
Prolactin 8.6 ng/ml (4.04 - 15.20) N
Total Testosterone 12.50 ng/ml (2.49 - 8.36) H

I took the last dose of Clomid last week on Wednesday evening (25 taken every second day for circa 2.5 weeks before this last dose).
Doc said that I don’t have to take Dostinex, I mentioned my previous prolactin labs and he muttered that probably he decided to give me Dostinex due to the labs from December (it was 13.8 then).

Here are all the prolactin labs I’ve had done so far:
prolactin ng/ml (4.04 - 15.20)
2018-09-03 10:41 8.6
2018-05-18 08:00 10.1
2017-12-11 08:14 13.8
2017-02-02 08:03 11.3

So my newest result is the lowest it’s been. When I mentioned how high my total testosterone and estrogen are he said that we have to meet for a consult because he won’t decide on the course of action over the phone.

Last time we met he said his next step would be HCG with Proviron so I am guessing he might suggest this when we meet this Friday.

Can you guys suggest any questions I should ask him and/or whether this sounds like a good combo and/or should I ask for an AI if taking HCG? Thanks!

17

Any advice? Please and thanks!

18

I’d go with testosterone over Proviron. Ask why he wants to go with that though I think I know. Do you have any E2 sides?

19

@highpull He said he doesn’t want to do anything that would supress my fertility and didn’t really discuss TRT as such with me.

I do have E2 sides, they are milder now than when on Clomid - especially when on 50 I felt pretty bad - excessive sweating, heat waves, some headaches and had double vision a few times, and complete zero libido.

20

i am in a same problem just like you were before using clomid…low TT,FT,lh,fsh etc and also low estradiol…lets see if clomid works in my case…have you seen any positive effects like strength or muscle gain?
and one more thing…you had FT 8.3…how did you get to 17 without even using clomid?