Clomid Restart w/Defy

[johndoesmith]

Spoke with an RN on Defy's staff, as Melissa was off today. She said that 0.22 AI ED was a very low dose and that they would not change my protocol based on that blood work, but that I should wait for the 30 day test. The decision to use AI was based on my non-sensitive readings, so I am a bit worried, but will submit to their expertise.

It is difficult to gauge how much an AI could lower my E2 in 30 days, but the tone on forums makes it seem as though it works rapidly. Nonetheless, I will stay the course.

I didn't know your 10 E2 was while ON the AI, that changes things.

They know their shit, go with them man, I'm just a dude on the forums haha.

 

[JakeH]

I didn't know your 10 E2 was while ON the AI, that changes things.

They know their shit, go with them man, I'm just a dude on the forums haha.

It is not. It was my blood work from the day before I started the daily AI of 0.22. I will amend my post above to be more clear.

 

[Dr Justin Saya MD]

It is not. It was my blood work from the day before I started the daily AI of 0.22. I will amend my post above to be more clear.

As anticipated, modest response to HCG, but testes should be ready to respond to LH/FSH (via Clomid) at this stage.

Melissa was somewhat more aggressive with the anastrozole in your case. It is important to have relatively tight E2 control while taking Clomid, but I'm not aware of all of the E2 details you two discussed during your consult. I recall one patient she discussed with me where she had more concern regarding E2 due to the discussion during consult and decided to be more aggressive. It may very well have been your case.

 

[Cyp250]

i am interested to see the out come of this. Dr. Saya, would doing a Clomid restart be better than him being on a consistent does of Test for his symptoms?

Do you think E2 is the cause for his lack of interest and low libido?

 

[Dr Justin Saya MD]

i am interested to see the out come of this. Dr. Saya, would doing a Clomid restart be better than him being on a consistent does of Test for his symptoms?

Do you think E2 is the cause for his lack of interest and low libido?

Time will tell whether a Clomid restart will turn out better for him, and his specific case, than a consistent TRT regimen (which is what he may very well end up on if the Clomid regimen is deemed inadequate).

Lack of interest and low libido are primarily related to the various hormone changes occurring in his body as he progresses through attempting to restart his endogenous testosterone production.

 

[GeauxBears]

I would like to start by saying that my statements are from a relatively ingnorant view point. And I could be entirely wrong. So then IMIO

I agree. I should have qualified my statement. It seems that there a lot individuals (online) that struggle to find the balance. Most likely the ones who do well have no need to seek help via boards like this.

My contention is, if someone is feeling terrible, as this man is, after only 4 days, why would he continue to administer the same drug that appears to be causing the issue? Or at least at the same dose? I ask because it seems to be the practice, or theory to "ride it out" and wait for the next blood test. I am through with that, and cannot understand anyone suggesting it to anyone else.

We are not cancer patience, being given radiation.

Sorry if that offends, but I have been told over and over (on this forum) to change doctors for a more qualified one such as yourself. And I am not disputing that you are. But this man is experiencing very simular symptoms as myself. Perhaps for different reasons.

The point is, Doctors are "practicing" medicine. They are humans like us. If a man is suffering from a treatment why would he "ride it out?"

Me personally, I am not going to continue to put a substance in my body, that is making me sick. No matter what anyone thinks is the proper protocol.


Again this is just my ignorant infantile opinion, based on, what I have read and my personal experience of the benefits that I have felt sense the subtraction of the prescribed HCG dose.

I plan on writing a post about my perspective on how to have a successful TRT journey soon, but in reading this post I thought I would comment. It took me 2 years to get to a steady state...2 YEARS. This journey included multiple approaches from several physicians until I landed with Defy...from plain TRT to HCG mono to Clomid to now successfully with TRT/HCG/AI.

When I finally landed on TRT/HCG/AI, we had to tweak the TRT dosage, injection schedule and AI dosage over the course of 6-8 months to zero in perfectly on a protocol that worked for me. The right approach takes TIME and expertise, and lots of it.

I think in the world we live in, we are used to instant gratification...tapping on a song we like and having it load to our phones in seconds, etc. As Dr. Saya and others have mentioned, the human body doesn't work that way. It takes time to achieve homeostasis, and every time something is changed in the process, the body has to completely re-adjust.

I'd be lying if I told you I didn't try to be my own doctor at times throughout this journey. The most vivid example I can think of was when starting anastrozole. For some reason, even at very small doses, I had very uncomfortable side effects with this med: headaches, irritability, the whole nine yards. I constantly decided to not take it...or take it less often...or mess with the dose...something to convince myself that if I only made this one next adjustment, everything would be "perfect". I finally decided to just take it as prescribed...EOD...and let it ride. Since then, magic has happened. My body has adjusted and I don't have those side effects I first experienced. We have made some changes since, but they have been focused on dialing in for specific things.

I say all of this to say: it takes time, focus and discipline to find a regimen that works for each of us specifically. Sometimes it takes longer than we'd like, but the important thing is to find the right physician, trust them with our care, and do our individual parts by staying true to the plan. I see guys on this forum and others constantly changing stuff, chasing perfection and treating their bodies as if they were some kind of science experiment. Success tends to happen more methodically than that.

Good luck.

 

[JakeH]

As anticipated, modest response to HCG, but testes should be ready to respond to LH/FSH (via Clomid) at this stage.

Melissa was somewhat more aggressive with the anastrozole in your case. It is important to have relatively tight E2 control while taking Clomid, but I'm not aware of all of the E2 details you two discussed during your consult. I recall one patient she discussed with me where she had more concern regarding E2 due to the discussion during consult and decided to be more aggressive. It may very well have been your case.

Thanks for the reply, Dr. Saya. I am glad my testes are primed to respond.

Melissa said it was a tight line to walk with regard to E2 on Clomid, with ED as an issue when both too high and low. Since she was basing my protocol on symptoms that pointed to E2 spikes during my TRT protocol and high E2 compared to test pre-trt (according to ECLIA assay) and high SHBG she had quite the needle to thread. I wanted her to have the latest snapshot, as she can only work with what she is given.

Melissa returned my call first thing this morning (great service!). She explained the art of trying to manage raising Test via Clomid, while not allowing E2 and SHBG to ruin the effect, hence the dosage of AI. We will run a set of labs at 14 days just to see how I am responding, and then we will proceed from there to the 30-day challenge results. Thanks again for your patience, reassurance and expertise, Melissa.


I will soldier on.

 

[JakeH]

I plan on writing a post about my perspective on how to have a successful TRT journey soon, but in reading this post I thought I would comment. It took me 2 years to get to a steady state...2 YEARS. This journey included multiple approaches from several physicians until I landed with Defy...from plain TRT to HCG mono to Clomid to now successfully with TRT/HCG/AI.

When I finally landed on TRT/HCG/AI, we had to tweak the TRT dosage, injection schedule and AI dosage over the course of 6-8 months to zero in perfectly on a protocol that worked for me. The right approach takes TIME and expertise, and lots of it.

I think in the world we live in, we are used to instant gratification...tapping on a song we like and having it load to our phones in seconds, etc. As Dr. Saya and others have mentioned, the human body doesn't work that way. It takes time to achieve homeostasis, and every time something is changed in the process, the body has to completely re-adjust.

I'd be lying if I told you I didn't try to be my own doctor at times throughout this journey. The most vivid example I can think of was when starting anastrozole. For some reason, even at very small doses, I had very uncomfortable side effects with this med: headaches, irritability, the whole nine yards. I constantly decided to not take it...or take it less often...or mess with the dose...something to convince myself that if I only made this one next adjustment, everything would be "perfect". I finally decided to just take it as prescribed...EOD...and let it ride. Since then, magic has happened. My body has adjusted and I don't have those side effects I first experienced. We have made some changes since, but they have been focused on dialing in for specific things.

I say all of this to say: it takes time, focus and discipline to find a regimen that works for each of us specifically. Sometimes it takes longer than we'd like, but the important thing is to find the right physician, trust them with our care, and do our individual parts by staying true to the plan. I see guys on this forum and others constantly changing stuff, chasing perfection and treating their bodies as if they were some kind of science experiment. Success tends to happen more methodically than that.

Good luck.

Thanks for the testimonial. It is reassuring knowing that no matter the direction we (Defy and I) decide to go, it will workout if given a fair shot.

 

[JakeH]

Day 5 Clomid (33 days post Test Cyp)
Ruff out of the gate, due to only sleeping in one hour stints the night prior. But, mid-afternoon things began to shift in a positive way.

Day 6 Clomid (34 days post Test Cyp)
8 hours of sleep and a workout this morning. Feeling good finally. Mentally my outlook is improved, and the feeling of physical and mental numbness has lessened considerably. It is noticeable to my significant other, but she was afraid to mention lest she jinx it.

Physically:
1) I am having night and morning erections, but I have not attempted sex since Sunday, so no updates there.
2) Weight continues to drop (10 pounds). I am now back to my pre-trt weight, but I am a bit leaner and strength remains the same.
3) Testicles seem to be full as when on straight HCG, so perhaps they are still awake and trying to work.

Other good news in my quest to rule out contributing factors to my ED: my CAD score is 0, so combined with my good lipid profile and low inflammation markers, I feel better about the source being a psyco/hormonal combo. I am working on both concurrently.

 

[JakeH]

Day 7 Clomid (35 days post Test Cyp)
Still feeling pretty good mentally and physically. Sleep has been broken still, with 2 sleep cycles running from 10:00pm to 3am and then 4am to either 6 or 7:30am, depending on the day's events, so I have not felt 100%. I have noticed a right eyelid twitch around the last three days, but that is most likely stress or increased caffeine consumption due to work and lack of sleep. My libido is there, but it is very on/off, meaning if approached I am ready, but otherwise not on my mind. Again, stress is likely the culprit and still-adjusting hormones.

Day 8 Clomid (36 days post Test Cyp)

The morning has been good so far, though my sleep was interrupted again. Erection worked last night, but I had to throw the max dose of Cialis at it to have any confidence. I plan to slowly start to titrate down again back to my 5mg a day TRT dose when I get stabilized after 30 or 45 days. But at this point, I am tired of the added anxiety of will it or won't it, so I am going to stay with a dose that I know works until then.

 

[JakeH]

Day 9-11 Clomid (37-39 days post Test Cyp)

Day 8 finished well, though I felt run down and mentally gray, which I attributed it to poor sleep the night before or T dip. I woke up with a full-on cold day 9, which was the first time I was happy to have caught a cold, because it relieved me of thinking the low was attributed to hormones. Despite being sick, days 9-11 have been really good from a mental and physical POV. Erections were strong (on 12mg Cialis, split 6am/6pm) and I lacked anxiety prior to and during sex for the first time in a while, which allowed me to actually enjoy things. I hope I have turned one of the many corners in the restart, but I will not know for sure until I can kick this cold.

 

[JakeH]

Day 12-14 Clomid
Still down with a cold, so no workouts and I have felt bad physically and dull mentally, which I assume is the illness and its effects on my sleep and physiology. I lost an erection twice during sex this morning and was not able to recover it the second time. I have been less sensitive the last week, almost numb feeling. Every time I think I am past ED worries, I find myself back in the spin. I suppose I can chalk it up to being sick.

I am drawing blood in the morning to see where my T/FT/E2/LH are sitting at two weeks. I have no expectations either way regarding levels.

 

[TheyCallMeTrinity]

Jake, thanks for all this information - I hope you keep it coming.

I soon plan on starting a similar thread myself as I am looking at going off HRT that I've been on for over TWO YEARS. I'm also a bit worried whether I can stabilize in 2-3 (or more!) months of protocol (I'll out line this in my thread).

I'm 44 now ... my total T was over ~430 when I started, so not super low. I had a varicocelectomy just 2 months ago and that alone I'm told should bump my total T 100-150 points (on average). Also, I've seen my Total T jump around from 700-1100 over the past 1+ years with no changes in dosages of T or hCG, so I'm fairly confident a majority of it is related to some of the changes I tried to diet/exercise/sleep/etc during this period, which I can tell from my detailed daily log I keep. That is one of the reasons I HOPE I can get my natural T back up around a good 800+ with a lot of hard work.

Anyway, thanks again for your updates and GOOD LUCK!

 

[JakeH]

Jake, thanks for all this information - I hope you keep it coming.

I soon plan on starting a similar thread myself as I am looking at going off HRT that I've been on for over TWO YEARS. I'm also a bit worried whether I can stabilize in 2-3 (or more!) months of protocol (I'll out line this in my thread).

I'm 44 now ... my total T was over ~430 when I started, so not super low. I had a varicocelectomy just 2 months ago and that alone I'm told should bump my total T 100-150 points (on average). Also, I've seen my Total T jump around from 700-1100 over the past 1+ years with no changes in dosages of T or hCG, so I'm fairly confident a majority of it is related to some of the changes I tried to diet/exercise/sleep/etc during this period, which I can tell from my detailed daily log I keep. That is one of the reasons I HOPE I can get my natural T back up around a good 800+ with a lot of hard work.

Anyway, thanks again for your updates and GOOD LUCK!

I look forward to your thread and progress.

 

[JakeH]

Day 15-18 Clomid
I finally kicked the cold, and I am feeling mentally and physically even. A tinge of anxiety has returned, especially with regard to erections, as my penile sensitivity has noticeably lessened over the last week, making it difficult to stay erect and orgasm. This led to my losing an erection again during sex today, but I was able to keep it up when we tried again an hour later. However, I lost another erection in the middle of the night when we tried.

The sensitivity issue had improved while on TRT shots, to the point of being youthfully sensitive. Not sure what is going on, as I have never been on Clomid to have a point of reference.

Maybe my blood work from day 14 will provide a few answers.

 

[TheyCallMeTrinity]

I look forward to your thread and progress.

Well, Jake, I'm REALLY on the fence now. My main age management Dr. just got back to me and said in his entire practice has has NEVER had anyone >30 age successfully get off HRT, while many have tried (I'm 44) going out 6-12 months (I will NOT go that long in my attempt). But he does know I track EVERYTHING closely (diet/exercise/sleep/libido/etc) and have tweaked myself as well as anyone in his clinic (he sees a couple thousand I think), so he gave me go ahead to try.


Just FYI - I've been on 35ml test every 3.5 days and 250iu hCG 3 times a week for over a year. I've lowered body fat% and all my lifts have been slowly & steadily progressing in the gym the whole past 2+ years. During this time I have been able to bounce my free Testosterone around between 700-1100 and found my "secret formula" for great libido, sleep and workouts after analyzing all my lifestyle factors.


I have gone through a ED issues you mention at various times as over the past 2 years at some point in my experiments with lifestyle ... below is what I found I did when twice I had my T at at the highest (1,100):


* RESISTANCE WORKOUTS: "Muscle for Life" workout plan (high weight, low reps https://www.muscleforlife.com/how-to-build-a-workout-routine/) This definitely bumped me up more than say P90X which I did first (10-12+ reps, lower weight - this was OK for keeping me in 800+ total T range). I do the 3 day split and only do each muscle group (chest/tris or back/bis or legs) once every 8-10 days. Seems like you should do more, but ALL MY workout numbers have increased over the past year this way and best/consistent libido, gains, etc with no injuries.


* CARDIO WORKOUTS: Hiit (https://www.muscleforlife.com/cardio-workouts/) on eliptical or running or Insanity Max:30 2 x week or in between resistance workouts. <30 minutes, no fuss and it works.


* I almost never workout (weights OR cardio) 2 days in a row, just every other day. That is best for recovery and all my lifestyle metrics.


* I'm most consistent and 100% satisfied with orgasms/sex (feel like 25 again) if (prioritized): (1) get quality 8 hours sleep (using Headspace app with sleep routine on iPhone helped me more than ANTYING ELSE I tried including meds!) (2) have sex on non-workout days or BEFORE my workouts, as they are pretty intense (3) no orgasm (porn/masturbation) 24 hours before being with a partner (4) diet (see below).


* DIET: I tried many macro and calories mixes. I'm ~165# (17% body fat but lowering), work at a desk. I eat ~2,000 calories a day on both workout and non-workout days. PROTEIN: 1g/lb body weight, FAT: ~90g, CARBS: the rest. This is usually ~125g/day (explained well here: http://www.marksdailyapple.com/how-to-succeed-with-the-primal-blueprint/)


* SUPPLEMENTS: DHEA 25mg/day, my fav pre-workout (will get you going even if tired): https://www.amazon.com/Pre-Rut-Advanced-Pre-Workout-Endurance-Certified/dp/B01AKS32LU/ - take less if you get jittery due to the 2 x cups of caffein in it.


Just posting in case some of this could help you recover function faster. Again, I can look at my log and this lifestyle gave me a several hundred point bump in T both times I tried it.

 

[Worried]

I thought I was a rambler. That was really confusing.

 

[TheyCallMeTrinity]

I thought I was a rambler. That was really confusing.

Happy to delete it if the thread poster agrees with you it was not helpful. My apologies.

If anyone else here has bumped their T 400 points via lifestyle changes while on HRT and can explain it more concisely, please do so. Reading other threads, I hear complaints about not providing enough background info.

 

[JakeH]

Happy to delete it if the thread poster agrees with you it was not helpful. My apologies.

If anyone else here has bumped their T 400 points via lifestyle changes while on HRT and can explain it more concisely, please do so. Reading other threads, I hear complaints about not providing enough background info.

I could be misinformed, but I did not think one could manipulate total testosterone that much via lifestyle when ON testosterone shots, due to the levels be more influenced by amount injected.

 

[JakeH]

Day 19 Clomid

The unicorns have returned to the barn for now. That is to say, I am not feeling good mentally, as my anxiety level is increasing still, though that could be function of not enough sleep, overtraining, etc., etc. I have to say that I am looking forward to getting to day 30, so I can see how I am responding objectively, because the subjective assessments are not bright so far.