Misread that. I stand corrected. Proceed.
So the treatment is basically to take the clomiphene citrate, which will decrease E2 and raise T levels? Is this a typical treatment for high e2 but low T?
Any red flags that my Uro hasn’t mentioned PSA or a physical prostate exam to establish a baseline?
Do I need HCG? AI? I’ve read some guys dont do well with Clomid, what should I look out for?
SERMs. [clomid, nolvadex] increase E2 levels. You must insist that they provide anastrozole, get Rx for 1mg/week and start at 0.5mg/week in divided doses.
Your doctor is an idiot.
Do not take 50mg clomid in one day, take 25mg EOD. Still could be too much.
Some guys feel horrible on clomid, is so, push to get nolvadex which does not do that. Do not expect doctor to know this.
SERMs increase LH/FSH. You never combine with hCG as it also stimulates the LH receptor.
If LH receptor stimulation is to high, there will be high T–>E2 inside the testes and anastrozole cannot manage T–>E2 there. Docs understand that? -No, I uncovered that problem.
Your doctor sees low T and very high E2. And lets this slide? Your T–>E2 rate should below so we have to suspect that your liver is not clearing E2 properly. But AST/ALT do not point to a liver problem, which is not conclusive. But medications may be causing this E2 clearance problem. You cannot expect an urologist to think out side of his little box.
Sometimes adverse gut flora can recycle estrogen metabolites in the liver bile back into active estrogens. Try a good probiotic. Google ‘ultimate flora’. You already have gut problems.
Did you follow this suggestion?
“shits - try pepto bismal, three doses in one day, one dose next day, will make your shit black”
What was the result?
You now have your case spread across ?4? threads and I can’t get the picture any more. Did I provided suggested stickies for you to read and did you? You really seem to be uninformed and with that reading you would be dealing with this differently. You clearly need to know more than your doctor and that is clearly achievable.
A lot of great info…
“Sometimes adverse gut flora can recycle estrogen metabolites in the liver bile back into active estrogens. Try a good probiotic. Google ‘ultimate flora’. You already have gut problems.”
I was taking a grocery store probiotic but recently ran out. I will look into this.
“Did you follow this suggestion? “shits - try pepto bismal, three doses in one day, one dose next day, will make your shit black” What was the result?”
I did not try this (yet). Per gastro, I’ve been taking psyllium fiber supplements in the morning, which has bulked me up to where its easier passing. I didn’t have diarrhea before, just soft BMs that were hard to pass. But I will try if you still think I should.
“You now have your case spread across ?4? threads and I can’t get the picture any more. Did I provided suggested stickies for you to read and did you? You really seem to be uninformed and with that reading you would be dealing with this differently. You clearly need to know more than your doctor and that is clearly achievable.”
I have only two threads, this one and one just to find if anyone else had digestion issues as a symptom. However, my “case” is in this thread. You were helping me with idonine/thyroid in this thread and now that I have updated T/E numbers, I will be reading more specific regarding the T/E. I didnt make the connection from clomiphene citrate to SERMS / Clomid, which I remember reading and in the stickies.
I had a follow-up with a gastro this morning, who I met with a few weeks ago. Told him the fiber he recommended had helped but thought I might be struggling with hemorrhoids. He mentioned doing a colonoscopy. I asked about the occult blood test, which he said would only tell us to do a colonoscopy and we’re leaning towards that anyway. I informed him of my T/E2 levels and how I switched multivitimans and back to a iodine salt and if my hormones could be contributing to my intestinal issues. He responded “yes it could”. So we left it as a lets get the hormone issues fixed then reevaluate on the colonoscopy. However, driving into work, I was leaning toward just doing it.
I’m sorry you sound frustrated but I appreciate your advise. As I mentioned before, I got this last information from the providers PT portal, so I have not had any discussions around treatment yet and I’m unaware if the Uro has seen the full test results. I wanted to get it posted on here before I met with the gastro this morning and a follow up with the Uro.
I am learning master.
A colonoscopy will not visualize any source of bleeding in the upper intestine or via liver bile or common bile duct. You doc is not thinking this through. Occult is a cheap test, colonoscopy is expensive and not conclusive re blood loss. But if you have blood loss and scoping lower GI does not disclose a source, you still need to look further.
Do the pepto bismal and if helps, you know that adverse bacteria are the problem or are a complication to something else. If no effect, you know its not a simple gut bacterial problem; however, there are more complex bacterial problems that are possible. Why do you ask if I think that this is a good idea after I suggest it twice? It is cheap and something that you can control. Take 3 time one day and once next morning. Take a good gulp for a dose.
With your gut problems, you can easily have multiple vitamin and mineral deficiencies. Are you taking supplements?
I will get the Occult done and do the pepto test.
Is there a mail order option for the Occult?
I had a mineral test done in 2013 at the time, Vit D was the only one noted.
I currently take 5000iu of D 5/7 days and switched from a generic multi V 2-3 times per week to “Nature’s way Alive Men’s Energy” every day because it includes iodine and Selenium. I’m on day three of the new MV.
Occult is typically a card that you take home and smear some poop on it then take back to doctor’s office and they apply drops of liquid and read a negative/positive. Have also seen the cards mailed out for processing. You should be able to phone in a request and pickup the kit and not get hit with an office visit charge.
Update: I’m going to cease taking the new MV (Nature’s Way Alive Men’s Energy) due to sudden diarrhea. I’ve read in reviews that others have experienced this. My plan is going to switch back to my original MV and find a specific iodine/selenium (or “thyroid health”) compliment vitamin or a new MV that my gut can handle. Are their recommendations from the forum? MV or Thyroid Health blend?
I purchased Pepto and will wait until my BMs normalize and run the full test.
Temps today (same as before):
Woke up (6am) 97.9
Afternoon (2pm) 98.2
However, I feel “warmer” almost like a mild hot flash or mild sunburn.
In the three days taking the new MV, I believe I feel better and my vision/brain fog is also better. Maybe a 20% improvement?
I haven’t had to wear my glasses today.
I purchased Ultimate Flora Probiotics, I started today.
I also purchase one of those home colon health tests, yet to test.
The nurse from the URO called me yesterday. Told me about the Clomid script. I told her that according to the lab results I already have high e2. Taking that would/could raise it more. Is there something we can do about it? She said she would check… She called back this morning, said the Uro stated that it could raise E2 and that he would prescribe Arimidex 1/wk at 1mg but doesn’t prescribe unless I was symptomatic? I told her I never discussed with him all of my symptoms (maybe 3) because he was referred by my PCP and he wanted to rerun labs. She said she would add it to my chart.
I re-read the stickies now I have some direction…
So if I proceed with this Dr/treatment, I will want to:
-Anything outstanding above (Blood Occult, Newer Thyroid Panel (after IR), Cortisol, Pepto, new MV w iodine+selenium)
-Try to get the Clomid swapped to Nolvadex
-Get a PSA+DRE done before starting anything
-If I stay on Clomid, dose 25mg EOD, retest and evaluate
-Divide AI dosage instead of the once per week script
Other:
-Test results confirm (Low LH, Low T, Clean MRI) = Secondary Hypogonadism
-I’m not a likely canidate for HPTA restart?
-Issue with aromatase (Could an AI by itself, lower E2 + increase T?)
-Basically is treatment SERM+AI for life?
-Best way to divide Clomid/AI dosage, Pill cutter?
AI will not be able to reduce T–>E2 inside the testes and the usual caution re such effects from SERMs.
You seem to have a good handle on your approach to these issues.
When testing for fecal occult blood, do not eat red meat for a while prior.
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So you’re saying, my E2 could go higher if its converting in my testies regardless of AI?
Anyway to test that in a lab? If that happens, whats plan B? Ditch SERMS and inject?
Do you think its odd the Uro didnt want to do a PSA/DRE before prescribing?
Could high E2 be from something other than testie conversion? Weight loss (I lost 30), weight gain (gained 10 back), cortisol or something else?
At 40, perhaps not. But doctors lawyers should be worried about the liabilities if something is there.
Arimidex/anastrozole is a competitive drug with T at aromatase reaction sites. T levels inside the testes is way higher inside the testes and the AI is outnumbered and ineffective there. There is always some T–>E2 inside the testes, but sometimes as I describe, it can be out of control.
T–>E2 in peripheral tissues is driven by your T levels and AI can manage that.
@KSman
@gonadthebarbarian
@equalo212
@ others
Update:
-I completed an home blood occult test, which was neg. I did have my wife put a test strip in the toilet with a used feminine product and surprisingly, it did not indicate blood for that. However, it did for the test packet that comes in the kit.
-I just filled the script for Arimidex @ 1mg/pill. I plan to take .5mg/week until my next labs. I’ve used a pill cutter and will be taking .25 E3.5D
-I also have the Clomid script @ 50mg/pill. I plan to take 12.5mg E3.5D for 25mg/week total
Questions:
-How’s my protocol sound?
-Should I take them together? Should I take one before the other? I suspect my symptoms are due to the high e2 but I’m not currently on TRT and I already have a high E2! This worries me.
-I plan on trying a “restart” after I loose some weight. Hoping my issue is being heavy is what’s producing estrogen and aromatase. Thoughts on this? I feel like I was doing well last year trying to loose weight (I lost 30lbs, gained 10 back) and that’s where I felt like I ran into a brick wall. I got a fit bit for fathers day and have been walking my ass off only to gain 2 pounds!
-It might be the E2 talking but I’m scared as hell to step off the edge and take my first pill. I’m 40 and never had to take anything and I’m worried that it will make me feel worse.
-Should I get FSH tested? I don’t care about fertility. Getting a vasectomy soon.
-Should I get Cortisol tested?
I still have the same symptoms as I stated above. I have also been struggling with an increase of lipomas, which I’ve read can be an estrogen exacerbated issue. Dermatologist said they were hereditary. My dad had them too. Might be because of the 10lb weight gain. I have felt a little better over the last 3 weeks. Not sure if that’s getting my mid life crisis under control back in March or walking with my fit bit or a combination.
I welcome any input and thank you for the expertise in this forum. I’ve been reading and trying to participate / give back to the group.
Don’t worry about your past weight issues. They are in the past once you get this fixed.
Your clomid dose sounds low, but I think just getting your E2 under control will give you a decent T boost. I dissolve the arimidex in water and dose daily to add up to around 7/10mg a week. You will likely need more than me as my E2 was only 32. My first dose of arimidex was 1mg and I felt like shit. It’s more powerful than people think, that’s why I ended up dosing daily, I don’t think I could go with a twice a week regimen.
If you aren’t in your 20s, you should give up hope of a restart. You can try, but be mentally prepared that you are going to be on this stuff for life.
Good luck, you are getting there.
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In addition to my questions in my last post…
I also had my insurance reject the Clomid saying they don’t cover fertility drugs. I’ve left messages with the Uro but didn’t know if anyone else has any advise?
Yeah, pay the 60$. It’s worth every penny. Shop it around, walgreens wanted 150, my wife found an online coupon, got it down to 70$. Costco pharmacy charged me around 60$. They were very apologetic about it too. I laughed and said I’d pay a hell of a lot more for the stuff.
Arimidex was like 20$ for 30 pills, and that will last me around 6 months.
Keep in mind, 60$ worth will probably last you a few months.
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@KSman, What do you think of my protocol since it differs so much from my Dr’s?
See what the labs say about it and note differences in how you feel. That will cut through the complexities of what is going on.
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OK, started dosing… I’m praying this helps. So am I to understand that it takes 4-6 weeks on Clomid and Arimidex before I start to feel an improvement?
Also, I’m looking over my old labs from 2013 and I notice these values:
C-Reactive Protein 4.21mg/l Range: 0.00-3.00 HIGH
Relative risk for future cardiovascular event Low <1.00, Avg 1.00-3.0, High >3.00
HDL 44 Range >39
LDL 138 mg/dl Range 0-99 HIGH
Cholesterol, Total 201 Range 100-199 HIGH
This was before I started working out and I lost 20 pounds and I made some diet changes. The CRP is concerning me. My plan is to take the Clomid/AI out to my next bloodwork and test these as well. Any thing I should know about these especially on my current TRT protocol?
It’s pretty “normal” for someone with low T to have high risk of a “future cardiovascular event”. Also same with cholesterol.
I felt better within 3 hours of taking my first clomid dose. You shouldn’t expect that. You should be prepared to wait up to 4-6 weeks before seeing the effects.
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OK, 1 week into TRT…
Feels like I’m going backwards a bit with muscle / joint soreness. Feeling jittery, brain fog issues, thinking my eyes are more puffy too, still moody (just ask the wife), now I’m more itchy. At least it’s stopped my lipomas from being sore by 90%.
Another issue that I’ve had before TRT was a sore neck, mainly the larynx and trachea area. In the last year, I had a CT scan and MRI on my neck and was told it was normal (including thyroid) because of a swollen lymph node. I was reading more about hashimoto’s? Was going to get a full thyroid panel again in 3 weeks, found out it includes the two hashimoto antibodies. Thinking about getting this done now? Thoughts @KSman ? Any benefits on waiting?
Arimidex -Taking .5mg/week until my next labs @ .25 E3.5D
Clomid - Taking 12.5mg E3.5D for 25mg/week total