Are guys that do well on low dose clomid unicorns...or do they really exist?

[Julio75]

Is it possible that some other group had an interest in Androxal never becoming legal, like, say the manufacturers of testosterone cypionate?

Is it possible any of those companies could influence the FDA?

 

[FrankUnderwood]

Dr Saya - fascinating info.

Any thoughts on how obesity in males determines the success/failure of clomiphene therapy, e.g. the higher the BF (i.e. morbidly obese) the more prone your guys are to feel like garbage with clomiphene due to high levels of existing aromatase in the body?

You caught me just before going offline ;-) I'll take a quick stab at your question. I love educating if you haven't suspected already!

So...there really isn't a better way to manage the estrogenic effects of the zuclomiphene other than simply LIMITING the burden of zuclomiphene (via dosage adjustment of Clomid) based on the patient's sensitivity. This is superior to DIM, CDG, or AI. Now some patients tolerate the zuclomiphene fine even at higher Clomid dosages, some need much lower due to sensitivity...this is where working with an experienced practitioner is IMPERATIVE!

Also keep in mind that with the increase in testosterone with SUCCESSFUL Clomid treatment -> there will be a concurrent increase in E2. Now this is cumulative to the estrogenic zuclomiphene effect (thus an E2 level of 30pg/mL in a TRT guy isn't apples to apples comparable to an E2 level of 30pg/mL in a Clomid guy).. Hope that makes sense as that is a difficult concept for even most physicians that treat with Clomid (and not coincidentally a common reason for the failure of their Clomid treatment for their patients). Now that increase in endogenous E2 (again concurrent with the estrogenic zuclomiphene), IF CAUSING ISSUES - will respond to DIM, CDG, and if needed LOW dose anastrozole (with AI > DIM/CDG).

Hope this makes sense, even many physicians I try to educate on this cannot grasp it!

 

[Dr Justin Saya MD]

Dr Saya - fascinating info.

Any thoughts on how obesity in males determines the success/failure of clomiphene therapy, e.g. the higher the BF (i.e. morbidly obese) the more prone your guys are to feel like garbage with clomiphene due to high levels of existing aromatase in the body?

E issues in general, including aromatization with Clomid therapy or frank TRT, are more consequential for higher BF% guys. They simply require a better appreciation of the "finer details" of both E management and enclomiphene/zuclomiphene management.

 

[Dr Justin Saya MD]

Is it possible that some other group had an interest in Androxal never becoming legal, like, say the manufacturers of testosterone cypionate?

Is it possible any of those companies could influence the FDA?

Possible? I suppose... there are always many "interests" at play on both sides of the fence throughout the FDA approval process.

More likely, in my opinion, is that they had very poorly designed studies/data that didn't reflect a distinct advantage over the already existant clomiphene. I say poorly designed studies/data as, based on our knowledge of the isomers, I would expect well designed studies WOULD show a distinct benefit. Time will tell.

 

[HarryCat]

More likely, in my opinion, is that they had very poorly designed studies/data that didn't reflect a distinct advantage over the already existant clomiphene. I say poorly designed studies/data as, based on our knowledge of the isomers, I would expect well designed studies WOULD show a distinct benefit. Time will tell.

^^^^This.

From my reading, this is the most plausible explanation.

 

[Nick108]

Dr Saya, first of all - many thanks for you sharing this essential knowledge with us.
We all know Clomid causes increase in LH, which then stimulates testes to produce more testosterone. Should we monitor how much it raises LH? Is there some maximum limit of LH beyond which overstimulation, desensitization of Leydig cells may occur?

My second question is - is there any method known to medicine that would increase the amount of Leydig cells in testes?

 

[Vince]

Trying Defy Restart; Hoping to Be a Unicorn https://www.excelmale.com/forum/showthread.php?6255-Trying-Defy-Restart-Hoping-to-Be-a-Unicorn

 

[Dr Justin Saya MD]

Dr Saya, first of all - many thanks for you sharing this essential knowledge with us.
We all know Clomid causes increase in LH, which then stimulates testes to produce more testosterone. Should we monitor how much it raises LH? Is there some maximum limit of LH beyond which overstimulation, desensitization of Leydig cells may occur?

My second question is - is there any method known to medicine that would increase the amount of Leydig cells in testes?

You should ABSOLUTELY monitor LH levels when on a Clomid regimen, as without LH levels one cannot ascertain the degree of primary vs secondary hypogonadism by correlating the LH response with the resultant testosterone response. One should generally aim for mid to upper-normal LH levels typically 6-10mIU/mL. It is fine if there is a robust response and LH levels shoot above this range initially, but appropriate adjustments should be made thereafter to attain LH levels in this approximate range if continuing Clomid therapy for a significant duration (>30 days).

To your second question, it isn't really a matter of increasing number of leydig cells per se, but more so increasing the ACTIVITY of the leydig cells. Without adequate stimulation, the leydig cells atrophy (can down-regulate receptors as well) and significantly decrease their hormone production. Anyone with a significant decrease in the NUMBER of leydig cells likely has a strong PRIMARY hypogonadism and wouldn't benefit much from Clomid therapy in the first place. Whereas someone with a SECONDARY hypogonadism, where the leydig cells weren't being stimulated enough and may have atrophied/down-regulated receptors, thus decreasing testosterone production, may benefit from Clomid through increasing LH stimulation of the leydig cells and regaining ACTIVITY (not necessarily number) of the leydigs.

 

[Speed]

Trying Defy Restart; Hoping to Be a Unicorn https://www.excelmale.com/forum/showthread.php?6255-Trying-Defy-Restart-Hoping-to-Be-a-Unicorn

Why ? What is the reason for that? Mood, libido, something else ?

 

[Dr Justin Saya MD]

Why ? What is the reason for that? Mood, libido, something else ?

The patient in that thread is 35yo, was prematurely placed on TRT about 7 months ago by a doctor who didn't counsel him or offer alternative options/testing despite the fact that he appeared strongly SECONDARY on initial labs with suppressed LH/FSH. Both he and his wife aren't thrilled about the idea of lifelong TRT at 35yo unless it's the ONLY option, and unfortunately his initial work-up by the other doctor didn't answer that question sufficiently. He would like to give his body one last fighting chance before he commits wholeheartedly to TRT (this really should have been done initially anyways given his age and initial labs indicating secondary hypogonadism). If a Clomid stimulation fails, then both he and I (and his wife) will feel more comfortable committing to lifelong TRT as we'll be confident it is 100% necessary at that point.

 

[Speed]

Tnx, Doc, I have misunderstood that Vince is trying to be the Unicorn

 

[Dr Justin Saya MD]

Tnx, Doc, I have misunderstood that Vince is trying to be the Unicorn

Ah yes, lol...I would have been confused in that case as well.

 

[Braindev]

Dr. Justin, I have 400 ng/dl of testosterone at 22 y/o. If restart protocols fail, should I go on TRT?

 

[Dr Justin Saya MD]

Dr. Justin, I have 400 ng/dl of testosterone at 22 y/o. If restart protocols fail, should I go on TRT?

That should be a discussion and a mutual decision between you and your physician taking MANY different factors of your specific case into consideration!

 

[thatoneguy]

I am in the process of getting a consultation with defymedical, I've had my labs done just waiting on the physical from my pcp.

I am a little anxious waiting since it seems like I've been dealing with these symptoms forever with no end in sight. I was trying to wait until my consultation but I'm not patient.

With that being said I am 29yo 175lbs, my total T levels have been 390, 410, and 452 being the most recent. I know these levels are not terrible, but i dont feel great. Free T ranging from 8 to 12. My LH is 4.3 which appears to be middle range. Would Clomid be the best option for us to discuss during my consultation, or would another treatment be better?

Thank you if you are able to answer. If not then i will talk with you during my consultation.

 

[Dr Justin Saya MD]

Would Clomid be the best option for us to discuss during my consultation, or would another treatment be better.

Hi thatoneguy!

I understand your impatience, especially when you are not feeling well. We will have up to an hour to discuss all of your symptoms, labs, and options during our initial consult which will be MUCH more productive than a Q&A corrspondence through the forum. In short, yes, Clomid will likely be an important part of our initial discussion due to your age (many other factors will also be considered during our consult), and may offer both diagnostic AND therapeutic value. The DIAGNOSTIC value of a Clomid stimulation, especially for younger guys, is often overlooked. I look forward to our consult.

 

[thatoneguy]

Thank you for the quick reply, you have calmed my nerves at least for now. I look foward to our consultation, I know I will be in good hands.

 

[duffman7050]

Hey Dr. Saya,
I'm a 27 year old male whose been struggling with my testosterone levels. My readings have been anywhere from 262 to 301 without intervention. I tried a clomid restart and it raised it to 626. I then tapered off over the course of 2 months and my testosterone plummeted. I have a history of antidepressants, adhd medications (high dose), and benzodiazepines for sleep (my sleep cycle is broken). I've since then come off all these medications in the past year but I feel as if these meds has had a lasting effect on my HPTA axis. My question to you is, is there hope for a successful HPTA restart using clomid again for someone like me? Does it typically take more than one clomid restart to stick?

 

[trthcg05]

Hi Doctor,

My testicles are shrinking fast on pellet TRT. If it matters, I am concerned about fertility, so that's legal in Louisiana! I am willing to drive to Houston to get the HCG, if I must. I also want to do a restart as soon as my pellets wear off. It's been 3 1/2 months.

I know I am secondary (low FSH and LH before TRT)! I have 2 and 4 year old kids, so they were working. Wish I would have researched all this before i agreed to TRT that I can't remove because it's implanted in me. But, I know now. Will restart in due time and make major changes. I have also lost lots of hair and gained a lot of weight. No fun. Estradiol never went above the 20s on TRT, and I peaked at 1400 Test, but I am having horrible side effects. Strange...

Can you help?

 

[trthcg05]

How did things turn out for you? I am a lot like you in my old Test levels and how I felt before TRT.

I am in the process of getting a consultation with defymedical, I've had my labs done just waiting on the physical from my pcp.

I am a little anxious waiting since it seems like I've been dealing with these symptoms forever with no end in sight. I was trying to wait until my consultation but I'm not patient.

With that being said I am 29yo 175lbs, my total T levels have been 390, 410, and 452 being the most recent. I know these levels are not terrible, but i dont feel great. Free T ranging from 8 to 12. My LH is 4.3 which appears to be middle range. Would Clomid be the best option for us to discuss during my consultation, or would another treatment be better?

Thank you if you are able to answer. If not then i will talk with you during my consultation.