Clomid (and maybe more) with Defy

[Esq]

I am on day 3 of a clomid protocol with Defy Medical and wanted to document things in a thread here. While I've been a lurker only so far, this forum has been extremely helpful as I have considered my options over the last few months.
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So, my story. I'm 35, a lawyer, and married with two young daughters. I train regularly (5/3/1 and similar programs), have my diet pretty dialed in (track calories and macros), and generally live a relatively healthy lifestyle (no drugs, alcohol in moderation, etc.).
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About two years ago, I started having a lot of symptoms, both psychological and physical, that I couldn't explain. The most noticeable were the dreaded brain fog, a general lack of motivation both at work and at home, difficulty motivating myself to do even routine chores around the house, feeling fatigued frequently, a significant decrease in libido, cessation of morning and nighttime erections, terrible recovery after workouts, difficulty increasing lean mass and a general decline in body composition despite being dialed in with diet and training, and not feeling rested and difficulty getting out of bed even after a full night's sleep. I generally sleep well and have not had any real erectile dysfunction issues, though I have noticed that erections are not as "robust" as they once were. I have a 2 year old and an 8 week old, so fertility isn’t an issue.
`
At first I chalked all of the symptoms up to a demanding career and just getting older. Eventually I began to wonder whether I had low testosterone since my symptoms matched the usual complaints of low testosterone sufferers. In late 2015, I had labs done, which came back showing total testosterone of 783 (range 348-1197) and free testosterone of 20.6 (range 8.7-25.1). I was pretty uninformed at the time so that's all I had tested, and I quickly dismissed low testosterone as an issue based on the numbers.

 

[Esq]

Over the next year, all symptoms either remained the same or seemed to get worse. Frustrated with my body composition and training performance, I even began to consider an AAS cycle, though I changed my mind on that pretty quickly. Ultimately, in the fall of 2016, I decided to do an 8 week cycle of LGD-4033 to see if it improved performance, followed by a mild 3 week run of toremifene (60/40/20) to counter any suppression. All of that took me into the first week of January 2017. The LGD seemed to increase strength and improve recovery modestly, but did nothing for the underlying symptoms.
`
During that time I was periodically reading this forum, the Peak Testosterone forum, and the Testosterone subreddit, and decided to contact Defy to see if I could get to the bottom of my symptoms. My initial labs with Defy were done on January 16 (33 days after my last dose of LGD and 8 days after my last dose of torem). The CBC, metabolic panel, and lipid panel came back with optimal numbers, including extremely good lipid numbers. Relative to this discussion were the following numbers:
`
Total testosterone: 1000 (range 348-1197)
Free test: 25 (8.7-25.1)
Albumin: 4.4 (3.5-5.5)
DHEA-Sulfate: 642.7 (102.6-416.3)
TSH: 1.8 (0.45-4.5)
LH: 6.5 (1.7-8.6)
PSA: 1.0 (0.0-4.0)
Estradiol, sensitive: 34.2 (8.0-35.0)
SHBG: 52.4 (16.5-55.9)
`
After seeing the testosterone numbers, it struck me that the torem may have left those elevated since it had only been 8 days. On February 9, I had testosterone, estradiol and SHBG re-run, showing:
`
Total test: 702 (348-1197)
Free test 17.5: (8.7-25.1)
Estradiol, sensitive: (30.2 (8.0-35.0)
SHBG: 52.5 (16.5-55.9)

 

[Esq]

I had my consult with Dr. Saya last week. The consult was extremely informative and Dr. Saya was patient and understanding. I was concerned that with the relatively high test numbers my symptoms would be dismissed as “all in my head,” but Dr. Saya had much more compassion than that.
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The first number that caught his attention was the high DHEA. Because of that, he wants to run some additional labs (IGF-1, DHT, prolactin, progesterone, and cortisol) to see if there may be some adrenal issues going on. I wondered about my SHBG numbers, which stayed in the low 50s even after the torem was out of my system, but Dr. Saya did not think there was much to be concerned about there. He recommended taking Vitamin D3 at 5000 iu/day and stinging nettle root to keep SHBG in check and potentially lower it a bit, which I am doing.
`
In addition to the testing for adrenal function, he offered that we could try running clomid at 12.5mg/day for 6 weeks to see if it helps some with symptoms. Based on my response to toremifene (increasing total test by 300 ng/dL and free test 7.5 pg/mL with almost no noticeable effect on e2 and SHBG), he didn’t really see any downside. He made clear that he didn’t see it as absolutely necessary, but if I wanted we could try it while the other testing was being done.
`
I opted in, and took my first 12.5mg dose of clomid on Monday. I’ll run that every day for 5 weeks, and on the sixth week will retest total and free testosterone, e2, and SHBG along with IGF-1, DHT, prolactin, progesterone, and cortisol. I’ll track my reaction to clomid here and post updated lab numbers in 6 weeks.
`
Wish me luck!

 

[Esq]

As noted, I'm on day 3. I've noticed some anxiety since I started taking it, almost feeling wired with my head racing like I've had too much caffeine or something. I also slept rather poorly the last two nights. Anxiety and trouble sleeping are not common problems for me, so I'm hoping it's just my body reacting and adjusting to the clomid and that those reactions will go away soon. So far, no real alleviation of underlying symptoms, but I wouldn't expect any results that quickly.

 

[Sean Mosher]

Please keep us posted.
Your numbers don't look that bad at all, but would like to see if your labs come back with adrenal issues or some other unknown.
Thanks for posting!

 

[Esq]

Thanks. Yes, the numbers seem fine (solidly mid-range for free and total test), and I'm probably not a good candidate for TRT at this time. One could argue that SHBG is a bit high at 52.5 nmol/L , but I don't think that would cause all the symptoms and Dr. Saya wasn't concerned with it.

I had some concern with the fact that free (20.6 to 17.5) and total (783 to 702) testosterone both declined from September 2015 to February 2017, but Dr. Saya said those differences are within the normal fluctuations and probably don't indicate declining levels.

In any event, I'm interested in seeing if the clomid alleviates symptoms at all while waiting for the adrenals to be evaluated. My anxiety is down some today, so I'm hoping that was a temporary side effect.

 

[CoastWatcher]

We're glad you joined Excelmale and hope you'll be an active member. Please keep us updated - Clomid journeys are not as familiar as the standard TRT journey for most of us. All the best.

 

[Esq]

I'm into the second week of my Clomid protocol. As I mentioned above, I had some anxiety and sleep issues the first few days, but those have dissipated entirely. Beginning roughly Thursday of last week through the weekend, my energy and motivation were through the roof. I felt really great. Unfortunately, yesterday and today have seen that boost mostly disappear. Basically, I feel like I've returned to baseline.
So far, I haven't noticed any changes in libido or sexual function, either positive or negative, other than possibly some minor reduced penile sensitivity. It's not major, but it is something I noticed when taking toremifene as well.
I haven't noticed any vision issues or side effects, so that's a positive. In any event, I haven't noticed anything negative yet, so I'm content to stay the course until my follow-up labs and next consult with Dr. Saya. I'm hoping I get back to feeling like I did Thursday-Sunday, and also am hoping for some libido improvement.
I'll update again in a few days.

 

[Esq]

Just wanted to keep this updated. I'm approaching the end of my third week on Clomid, and things are pretty much unchanged from my last post, which is to say no real side effects, but also no real improvement in symptoms. I had a really great four days or so at the end of my first week, but since then I feel back at baseline. Low energy and motivation, brain fog, low libido, difficulty recovering from workouts, etc. I'm not optimistic about Clomid being the solution, but since I'm not having any negative side effects I'll stay the course until my next labs and consult.
I was supposed to have labs done during my sixth week, but will be traveling that week. I called Defy earlier this week to ask whether I should have them done early or late, and was advised to have the labs done post-travels so that I will have been on Clomid a full six weeks before test, free test, estradiol, and SHBG are checked again. So, still a few more weeks before evaluating both my Clomid response and adrenal and growth hormone status (IGF-1, DHT, prolactin, progesterone, and cortisol).

 

[CoastWatcher]

It seems like a long road to travel when results are not forthcoming. We have members who are very pleased with their results of a Clomid protocol, and many who aren't. Six weeks will arrive.

All the best.

 

[Esq]

Thanks for words of encouragement. If there is one thing I have learned from reading this forum, it's that patience is a virtue and a requirement for treating these kinds of symptoms. I'm at peace with things right now and content to wait this out, but it is frustrating that for four days, I felt better than I have in at least two years, and then it was gone.

I gather this is a somewhat common occurrence when starting Clomid? I have read several comments here and elsewhere of people experiencing a short period early on of significant symptom improvement followed by a fast return to baseline. In other words, a very cruel tease.

 

[CoastWatcher]

Thanks for words of encouragement. If there is one thing I have learned from reading this forum, it's that patience is a virtue and a requirement for treating these kinds of symptoms. I'm at peace with things right now and content to wait this out, but it is frustrating that for four days, I felt better than I have in at least two years, and then it was gone.

I gather this is a somewhat common occurrence when starting Clomid? I have read several comments here and elsewhere of people experiencing a short period early on of significant symptom improvement followed by a fast return to baseline. In other words, a very cruel tease.

My impression, and that is all it is, would confirm your thesis. Yes Clomid can work; does it work in all men who try it? No. Dr. Saya is very skilled and doesn't prescribe it if in his professional opinion it doesn't have a good chance of success. Testosterone replacement has a far, far higher record of success but comes with its own challenges. You have lost nothing but time (easy for me to say, it's not my time) going down this route. Remember, your options have not been foreclosed if this fails.

 

[Disco41]

Esq, how old are you? And would you happen to have any sort of PTSD? Sorry if i missed any of that info provided.

 

[Disco41]

Thanks for words of encouragement. If there is one thing I have learned from reading this forum, it's that patience is a virtue and a requirement for treating these kinds of symptoms. I'm at peace with things right now and content to wait this out, but it is frustrating that for four days, I felt better than I have in at least two years, and then it was gone.

I gather this is a somewhat common occurrence when starting Clomid? I have read several comments here and elsewhere of people experiencing a short period early on of significant symptom improvement followed by a fast return to baseline. In other words, a very cruel tease.

Not always. What threads did you read of a "short period of significant symptom improvement followed by a fast return to basline." on here or elsewhre? I have not seen those and would like to read them. Thanks

 

[Disco41]

coast watcher and ESQ have owned this thread. Until he tells me where he has seen how clomid shows a "short period of significant symptom improvement followed by a fast return to basline." this is NOT passing a sniff test.

 

[Disco41]

Over the next year, all symptoms either remained the same or seemed to get worse. Frustrated with my body composition and training performance, I even began to consider an AAS cycle, though I changed my mind on that pretty quickly. Ultimately, in the fall of 2016, I decided to do an 8 week cycle of LGD-4033 to see if it improved performance, followed by a mild 3 week run of toremifene (60/40/20) to counter any suppression. All of that took me into the first week of January 2017. The LGD seemed to increase strength and improve recovery modestly, but did nothing for the underlying symptoms.
`
During that time I was periodically reading this forum, the Peak Testosterone forum, and the Testosterone subreddit, and decided to contact Defy to see if I could get to the bottom of my symptoms. My initial labs with Defy were done on January 16 (33 days after my last dose of LGD and 8 days after my last dose of torem). The CBC, metabolic panel, and lipid panel came back with optimal numbers, including extremely good lipid numbers. Relative to this discussion were the following numbers:
`
Total testosterone: 1000 (range 348-1197)
Free test: 25 (8.7-25.1)
Albumin: 4.4 (3.5-5.5)
DHEA-Sulfate: 642.7 (102.6-416.3)
TSH: 1.8 (0.45-4.5)
LH: 6.5 (1.7-8.6)
PSA: 1.0 (0.0-4.0)
Estradiol, sensitive: 34.2 (8.0-35.0)
SHBG: 52.4 (16.5-55.9)
`
After seeing the testosterone numbers, it struck me that the torem may have left those elevated since it had only been 8 days. On February 9, I had testosterone, estradiol and SHBG re-run, showing:
`
Total test: 702 (348-1197)
Free test 17.5: (8.7-25.1)
Estradiol, sensitive: (30.2 (8.0-35.0)
SHBG: 52.5 (16.5-55.9)

Your DHEA sulfate is pretty crazy man. Not worried about that? But questioning the clomid?

 

[Esq]

Esq, how old are you? And would you happen to have any sort of PTSD? Sorry if i missed any of that info provided.

35, no PTSD.

 

[Esq]

Not always. What threads did you read of a "short period of significant symptom improvement followed by a fast return to basline." on here or elsewhre? I have not seen those and would like to read them. Thanks

I didn't say always. I said "somewhat common." I've read several theads here and elsewhere (Peak Testosterone forum and the r/Testosterone subreddit in particular) of guys feeling much better after a week or two of clomid, only to see symptoms return and sometimes even worsen. The theory seems to be that for some, the enclomiphene part of clomid provides the initial boost and abatement of symptoms, which over time is overpowered by accumulation of zuclomiphene. I don't have time at this moment to link those, but just read several of the threads in this very sub-forum to see what I'm talking about. Hell, read the "Are guys that do well on low dose clomid unicorns...or do they really exist?" and " Enclomiphene Now Available As A Research Chemical" threads for some discussion of this.

 

[Esq]

coast watcher and ESQ have owned this thread. Until he tells me where he has seen how clomid shows a "short period of significant symptom improvement followed by a fast return to basline." this is NOT passing a sniff test.

I have no idea what this means. You seem to have some issue with me or my posts. I don't know what's not passing a "sniff test" for you, but I'm on this protocol under the supervision of Dr. Saya and Defy Medical and I'm just sharing my experience. I don't know what your issue is.

 

[Esq]

Your DHEA sulfate is pretty crazy man. Not worried about that? But questioning the clomid?

It was discussed with Dr. Saya. He was not overly concerned, but it is the reason that follow-up labs in a few weeks will address adrenal function in more detail. I'm not "questioning the clomid," I'm just reporting on how it has made me feel so far. That's all I can do.
I can't tell if you're upset that I'm on clomid in the first place, or that it hasn't been life-changing for me so far.