Clomid (and maybe more) with Defy

[CoastWatcher]

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.

Adrenal function is something that gets glossed over, or totally overlooked, by too many doctors and their patients (the patient isn't at fault). I have Addison's Disease and successfully brought it in line with hydrocortisone. Keep us posted, if you will, on that as you learn more.

 

[Esq]

Just wanted to update this thread as its been several weeks. I'm roughly seven weeks into 12.5mg/day clomid (along with vitamin D3 and stinging nettle supplementation). So far, no bounceback from the huge boost I felt during the first 5-8 days. I've actually felt a bit worse over the past 3 or 4 days, but I was traveling for almost 2 weeks so diet, exercise, and routine were all thrown off so that could be the cause. I've had very little energy, some trouble sleeping (not a common problem for me), and signifcant issues recovering from my last few workouts, but perhaps things will at least return to baseline now that I'm back on a normal routine.
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Bloods were drawn yesterday to re-check total test, free test, sensitive e2, DHEA, and SHGB, and then testing for the first time FSH, LH, prolactin, IGF-1, dihydrotestosterone, ACTH, and salivary cortisol (doing the four times/day thing today). I should have results in a week or so, and then my next follow-up with Dr. Saya is on May 1. I'm interested to see if all of this is an adrenal or GH issue.

 

[CoastWatcher]

It will be interesting to see where your numbers have settled at this point.

Would you say you've gone from "pleased" to "not so pleased," with the Clomid journey? Or is that a misunderstanding on my part?

 

[Esq]

It will be interesting to see where your numbers have settled at this point.

Would you say you've gone from "pleased" to "not so pleased," with the Clomid journey? Or is that a misunderstanding on my part?

I'd say that's right. I haven't really had any negative effects as far as I can tell, but it also hasn't done much for me. If my response to clomid is anything like my response to toremifene, I expect to see total test numbers above 1000, but I have not noticed any changes in symptoms other than about five days early on of feeling amazing.
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I suspect that's either because (1) my symptoms are not testosterone-related (though I continue to question whether my free test is an issue - see my post from today in this thread: https://www.excelmale.com/forum/sho...erone-Calculation-are-there-different-methods) or (2) if the symptoms are testosterone-related, then I simply don't respond physically or psychologically to it, notwithstanding (possibly) higher numbers.

 

[CoastWatcher]

I'd say that's right. I haven't really had any negative effects as far as I can tell, but it also hasn't done much for me. If my response to clomid is anything like my response to toremifene, I expect to see total test numbers above 1000, but I have not noticed any changes in symptoms other than about five days early on of feeling amazing.
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I suspect that's either because (1) my symptoms are not testosterone-related (though I continue to question whether my free test is an issue - see my post from today in this thread: https://www.excelmale.com/forum/sho...erone-Calculation-are-there-different-methods) or (2) if the symptoms are testosterone-related, then I simply don't respond physically or psychologically to it, notwithstanding (possibly) higher numbers.

Without jumping to a conclusion I'm not qualified to draw, please keep in mind that response to Clomid is never a sure thing. Under Dr. Saya's direction, it makes perfectly good sense to see if you are one of those men who respond well to such a protocol. However, we have seen men here post excellent results on Clomid with no subjective improvement.

As I noted, I reach no conclusion; I only point out that many of these men transition to testosterone replacement and do quite well. A lot to discuss with Dr. Saya.

 

[buggies100]

Today is my 14th day in a row on 50 mg of clomid daily. That is what TRT dr prescribed as his typical starting dosage. I can tell no difference in how I feel, still low sex drive and general lack of drive. I will do labs after another week, but like you said, some men have no results with it. I went into it with a 50/50 chance of it working.

Without jumping to a conclusion I'm not qualified to draw, please keep in mind that response to Clomid is never a sure thing. Under Dr. Saya's direction, it makes perfectly good sense to see if you are one of those men who respond well to such a protocol. However, we have seen men here post excellent results on Clomid with no subjective improvement.

As I noted, I reach no conclusion; I only point out that many of these men transition to testosterone replacement and do quite well. A lot to discuss with Dr. Saya.

 

[Esq]

Today is my 14th day in a row on 50 mg of clomid daily. That is what TRT dr prescribed as his typical starting dosage. I can tell no difference in how I feel, still low sex drive and general lack of drive. I will do labs after another week, but like you said, some men have no results with it. I went into it with a 50/50 chance of it working.

14 days is a relatively short period, but you're also on a much higher dose than me. I take your post to mean that you have not felt any changes, even temporary? I only ask because when I started, the first 3 to 4 days I felt extremely anxious and irritable, followed by 4 to 5 days of feeling better than I have in years, followed by a return to pre-clomid baseline. Some 50 days in, nothing more, good or bad. I should have lab numbers back in a day or two.

Also, are you on an AI? 50mg daily seems like a very high dose, so I'm curious what that will do to your estrogen levels.

In any event, Defy likes to wait at least 6 weeks to check labs after starting clomid, so at only 14 days in, you still might start to feel some changes (hopefully positive!) after some time passes. These things move slowly.

 

[Esq]

Without jumping to a conclusion I'm not qualified to draw, please keep in mind that response to Clomid is never a sure thing. Under Dr. Saya's direction, it makes perfectly good sense to see if you are one of those men who respond well to such a protocol. However, we have seen men here post excellent results on Clomid with no subjective improvement.

As I noted, I reach no conclusion; I only point out that many of these men transition to testosterone replacement and do quite well. A lot to discuss with Dr. Saya.

Absolutely. He noted in our first consult that I was a rather interesting case, so I'm very interested to see whats labs show regarding my response to clomid, adrenals, and GH levels.

As an aside, I appreciate your helpful comments and kind words in this thread.

 

[CoastWatcher]

Today is my 14th day in a row on 50 mg of clomid daily. That is what TRT dr prescribed as his typical starting dosage. I can tell no difference in how I feel, still low sex drive and general lack of drive. I will do labs after another week, but like you said, some men have no results with it. I went into it with a 50/50 chance of it working.

Is your doctor keeping a close eye on your estradiol? I know that it can be a challenge when Clomid is used and you are a high dose.

 

[buggies100]

Yes, we will test it along with t, free t, hct after 3 weeks and see if we have had any movement. We have good pre clomid levels to measure against.

Also the 3 weeks is short i am aware, we are just beginning. I have been following this thread and started a thread of my own to document as we get blood values. Seems we hear alot of failures of clomid but not so many success stories.

Is your doctor keeping a close eye on your estradiol? I know that it can be a challenge when Clomid is used and you are a high dose.

 

[Esq]

All my labs (except the cortisol x4 test) came back today. Some interesting results.

Testosterone: 1104 ng/dL (348-1197)
Free test (direct): 30.5 pg/mL (8.7-25.1)
Estradiol, sensitive: 68.3 pg/mL (8.0-35.0)
SHGB, serum: 67.5 nmol/L (16.5-55.9)
LH: 7.6 mIU/mL (1.7-8.6)
FSH: 11.3 mIU/mL (1.5-12.4)
DHT: 105 ng/dL (no reference range given, but flagged as HIGH)
DHEA-Sulfate: 669.1 ug/dL (102.6-416.3)
ACTH, plasma: 25.1 pg/mL (7.2-63.3)
Prolactin: 6.1 ng/mL (4.0-15.2)
IGF-1: 189 ng/mL: (88-246)
Progesterone: 0.4 ng/mL (0.0-0.5)

My observations - the first things that jumped out at me (other than total test going from 702 to 1104 and free test from 17.5 to 30.5), is that my sensitive estradiol shot up from 30.2 to 68.3 and SHBG went from 52.5 to 67.5. I immediately called Defy to see if I need to get on an AI stat (next consult with Dr. Saya isn't until May 1), and am waiting to hear back.
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DHT is high, but without a reference range I don't know how high and frankly I don't know what high DHT means. Is that something I should be concerned about, at least until I have my next consult?
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DHEA sulfate remains high, but was at 642 on my last labs. It has gone up some. I'm sure we'll cover this in the next consult.
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FSH, LH, ACTH, prolactin, IGF-1, and progesterone are all within range, but I have no idea if those values are optimal or not.
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Clearly I have responded to the low-dose clomid in a big way, at least based on the numbers. I wonder if the reason I'm not feeling any better is my estradiol shooting up? Is SHBG too high, even with relatively high free test numbers?

I welcome any input.

 

[Dr Justin Saya MD]

All my labs (except the cortisol x4 test) came back today. Some interesting results.

Testosterone: 1104 ng/dL (348-1197)
Free test (direct): 30.5 pg/mL (8.7-25.1)
Estradiol, sensitive: 68.3 pg/mL (8.0-35.0)
SHGB, serum: 67.5 nmol/L (16.5-55.9)
LH: 7.6 mIU/mL (1.7-8.6)
FSH: 11.3 mIU/mL (1.5-12.4)
DHT: 105 ng/dL (no reference range given, but flagged as HIGH)
DHEA-Sulfate: 669.1 ug/dL (102.6-416.3)
ACTH, plasma: 25.1 pg/mL (7.2-63.3)
Prolactin: 6.1 ng/mL (4.0-15.2)
IGF-1: 189 ng/mL: (88-246)
Progesterone: 0.4 ng/mL (0.0-0.5)

My observations - the first things that jumped out at me (other than total test going from 702 to 1104 and free test from 17.5 to 30.5), is that my sensitive estradiol shot up from 30.2 to 68.3 and SHBG went from 52.5 to 67.5. I immediately called Defy to see if I need to get on an AI stat (next consult with Dr. Saya isn't until May 1), and am waiting to hear back.
-
DHT is high, but without a reference range I don't know how high and frankly I don't know what high DHT means. Is that something I should be concerned about, at least until I have my next consult?
-
DHEA sulfate remains high, but was at 642 on my last labs. It has gone up some. I'm sure we'll cover this in the next consult.
-
FSH, LH, ACTH, prolactin, IGF-1, and progesterone are all within range, but I have no idea if those values are optimal or not.
-
Clearly I have responded to the low-dose clomid in a big way, at least based on the numbers. I wonder if the reason I'm not feeling any better is my estradiol shooting up? Is SHBG too high, even with relatively high free test numbers?

I welcome any input.

Hi Esq,

Indeed it's quite difficult to gauge any subjective response to Clomid with the current E2 levels. Forward this thread to the office (info@defymedical.com with attn: medical team) over the weekend and on Monday have them arrange anastrozole 0.25mg EOD until your consult in May so we can see if it offers any subjective changes. We'll want to recheck E2 levels about 5-6 weeks after starting the AI.

 

[Vince]

My understanding is high DHT, has many benefits. One of them I believe is covering up the bad effects of estradiol.

 

[Esq]

Hi Esq,

Indeed it's quite difficult to gauge any subjective response to Clomid with the current E2 levels. Forward this thread to the office (info@defymedical.com with attn: medical team) over the weekend and on Monday have them arrange anastrozole 0.25mg EOD until your consult in May so we can see if it offers any subjective changes. We'll want to recheck E2 levels about 5-6 weeks after starting the AI.

Thanks, Dr. Saya. Appreciate you checking in. I have forwarded this thread to your office as requested. Have a good weekend.

 

[ryox82]

New here and read the whole thread. I saw this comment and wanted to weigh in. I am on a 25 mg eod and I too did experience the same about 2 week high and then a return to baseline that Esq noted. I have seen others make this comment on message boards as well.

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

 

[Esq]

My salivary cortisol test came back yesterday.
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8am: 0.458 (0.025-0.600)
Noon: 0.097 (<0.010-0.330)
4pm: 0.023 (0.010-0.200)
Midnight: <0.010 (<0.010-0.090)
.
At first glance, all looks within range.
.
I'm still waiting on Defy to prescribe the AI (anastrazole 0.25mg EOD as recommended by Dr. Saya last week). I called on Friday and was told the medical team would review and get back to me. On Saturday, I forwarded Dr. Saya's post here to [email protected], and then called again yesterday afternoon. I was told Defy would locate the email and call me right back, and as of noon today, still no response. I realize this stuff can move slowly, but I'm a little worrried about my estradiol levels and wasn't expecting to wait this long for the AI to be prescribed. I'm moderately annoyed at the moment. I'm not sure how to get in touch with Defy on this because calls and emails don't seem to be working. Hopefully someone will contact me today, but now I'm going to have to pay $$$ for the fastest shipping because of the long wait. Otherwise it will be next week at best before the anastrazole gets here.

 

[CoastWatcher]

My salivary cortisol test came back yesterday.
.
8am: 0.458 (0.025-0.600)
Noon: 0.097 (<0.010-0.330)
4pm: 0.023 (0.010-0.200)
Midnight: <0.010 (<0.010-0.090)
.
At first glance, all looks within range.
.
I'm still waiting on Defy to prescribe the AI (anastrazole 0.25mg EOD as recommended by Dr. Saya last week). I called on Friday and was told the medical team would review and get back to me. On Saturday, I forwarded Dr. Saya's post here to [email protected], and then called again yesterday afternoon. I was told Defy would locate the email and call me right back, and as of noon today, still no response. I realize this stuff can move slowly, but I'm a little worrried about my estradiol levels and wasn't expecting to wait this long for the AI to be prescribed. I'm moderately annoyed at the moment. I'm not sure how to get in touch with Defy on this because calls and emails don't seem to be working. Hopefully someone will contact me today, but now I'm going to have to pay $$$ for the fastest shipping because of the long wait. Otherwise it will be next week at best before the anastrazole gets here.

Call again. You are right to be frustrated. You can request (for an additional fee) overnight delivery of the AI.

 

[Esq]

Call again. You are right to be frustrated. You can request (for an additional fee) overnight delivery of the AI.

I was trying to do just that when you posted. After sitting on hold for their maximum wait time of 7 minutes, I was forced to leave a message, which I did, and also sent another email. I can't believe it is this difficult, especially after the doctor said I needed it.

 

[Esq]

I was trying to do just that when you posted. After sitting on hold for their maximum wait time of 7 minutes, I was forced to leave a message, which I did, and also sent another email. I can't believe it is this difficult, especially after the doctor said I needed it.

Jesse at Defy just called and had everything cleared with the medical staff, so the AI is on its way. The delay was a bit too long in my opinion, but Jesse was apologetic and understanding, so I'll simmer down now.

 

[CoastWatcher]

Jesse at Defy just called and had everything cleared with the medical staff, so the AI is on its way. The delay was a bit too long in my opinion, but Jesse was apologetic and understanding, so I'll simmer down now.

I'm as short-tempered as can be, so I get it. You expedited the delivery?