Clomiphene and Anxiety / Negative Thoughts

[Kirk001]

So I'm 10 days into my first experience with hormone therapy. The protocol given to me was 15mg clomiphene ED, 25mg DHEA ED, and 0.125mg anastrozole as needed.

So far I have only taken the clomiphene. While waiting for the meds to arrive I did some research and asked in the forums. DHEA seems to have a wildly varied effect on different people, so I decided to wait on that to see how clomiphene affected me first. And the advice I got on anastrozole was to not take any until/unless I had high E2 symptoms and lab work to back it up.

Until today, I have felt no effects at all except that my testicles feel kinda like inflating balloons. So this has been a mild discomfort. But today I am feeling strong anxiety, worry, negative thoughts and emotions, pessimistic feelings... It sorta came out of the blue because I wasn't feeling this way yesterday, and it feels out of the ordinary for me.

So what to do now? I am supposed to do follow-up labs and consultation after 30 days and I wanted to try to do clomiphene alone with no anastrozole for the whole time period to see what my numbers would be. But there is no way I'm going to feel like this for 20 more days.

Should I just stick it out for a bit and see if these feelings are temporary? Or add in some anastrozole? Or try to get a rush consultation with my provider sooner than the 30 days? (I don't know if this is possible but I could try.) And if I do get an earlier consult, what changes if any to make in the mean time?

Pre-treatment numbers: Total Testosterone 297 ng/dL (264-916), Free Testosterone 8.3 pg/mL (8.7-25.1), Estradiol Sensitive 14.5 pg/mL (8.0-35.0).

 

[Systemlord]

Usually a typical response to Clomid is feeling good at first with a gradual decline and feeling unwell months later, it's not expected to get better and is the reason why some quit Clomid as I predict you will if things are this bad early on.

Most men feel horrible on Clomid, you may try 15mg EOD.

 

[Vince Carter]

I was going to suggest the EOD dosing. I would def not take the DHEA nor the AI. An all too common thing with Clomid is Estrogen, though you're not on an overly heavy dose of Clomid to begin with, but I'd do it EOD and see where things go.

 

[BryanW]

I'd cut the DHEA.

 

[Nelson Vergel]

So, you have been on low dose Clomid for 10 days? Is the reason you are on it the need for remaining fertile? Or are you not a friend of injections? Was your DHEA low?

Note to all members: Please, guys, ask further questions before you give your answers. I see this problem daily. Have you guys ever been to a doctor? They ask a lot of questions before coming up with a diagnosis and treatment plan. Most posts from new members lack key information.

 

[Kirk001]

Thanks guys and thanks for weighing in, Nelson. My pre-treatment lab for DHEA-S was 228.0 ug/dL (102.6-416.3). I don't really know what the optimal range for DHEA is but my provider thought I was a bit low. As I said though I have not started taking any supplemental DHEA yet because I wanted to wait to see how clomiphene affected me first.

To answer your questions Nelson, I was leaning more towards the combo of testosterone + HCG but my provider wanted me to try clomiphene first and I said ok. I'm leaning even more heavily toward my original inclination now. Maintaining fertility is a concern but my pre-treatment sperm count was high enough that I think HCG (+ FSH if needed) should be sufficient.

 

[Kirk001]

I also posted my current situation over at PeakT forums and Dr. Saya responded, stressing the extra demand for estrogen control on clomid due to the E agonist impact of the zuclomiphene isomer. So I'm taking his advice, I bit the bullet and took 0.125mg anastrozole this evening. Will see if that changes how I feel over the next day or two.

Meanwhile I think I should keep the clomiphene dosing as it is. Maybe I'm wrong in my understanding but I feel like if I were going to reduce the daily dose, I might as well just come off it altogether. I have not had any "honeymoon period" or any good feelings thus far so I'm thinking it must not have boosted my testosterone levels enough to feel anything positive. So I think if I were to lower the dose there'd be little hope of getting my T to a good range, so little point in even continuing it.

 

[Dr Justin Saya MD]

I also posted my current situation over at PeakT forums and Dr. Saya responded, stressing the extra demand for estrogen control on clomid due to the E agonist impact of the zuclomiphene isomer. So I'm taking his advice, I bit the bullet and took 0.125mg anastrozole this evening. Will see if that changes how I feel over the next day or two.

Meanwhile I think I should keep the clomiphene dosing as it is. Maybe I'm wrong in my understanding but I feel like if I were going to reduce the daily dose, I might as well just come off it altogether. I have not had any "honeymoon period" or any good feelings thus far so I'm thinking it must not have boosted my testosterone levels enough to feel anything positive. So I think if I were to lower the dose there'd be little hope of getting my T to a good range, so little point in even continuing it.

Lol. I was just was over on PeakT and posted an additional response to your thread...then hopped over to EM and ran across this one. I’ll paste response below for the sake of continuity. Good work making use of both resources. Both forums present thoughtful, educated, and sometimes differing opinions.

Pasted response:

“You’re still early being only about 10 or so days in...with that said, most guys that will end up having a positive clinical response to clomiphene will have some subjective benefit within the first 30 day interval. If no benefit is realized towards that time then it is likely on to TRT for you.”

 

[Kirk001]

16 days in now. Took 0.125mg anastrozole on days 11 and 14. I feel a little better since adding in the AI, but still nothing good to report and still feeling worse off than before I started.

Spoke with a nurse on the phone and I told her that because of the negative effects of the clomiphene so far, I'm not sure how much longer I can continue on this medication, or how much longer I want to. I think I'm ready for plan B which is testosterone and HCG.

She said I need to get follow-up labs and then consult with a provider. The best option I could get was to move the follow-up labs to around 3 weeks into treatment instead of 4 weeks into treatment. So I'll stick it out until at least the 3-week mark and then get blood drawn. May need to up the frequency of the AI to EOD to try to stave off these negative moods.

I'm not really sure what purpose the labs will serve though, considering I do not see myself staying on this medication. I guess it will provide some data for diagnostic purposes? Seeing how much my LH, T and E2 are elevated will indicate degree of primary vs. secondary hypogonadism?

It will probably take a whole month to get a consult appointment after the blood draw. If I stop the clomiphene after the blood draw, I will have been off of it for a month by the time of the consult. My levels will have probably returned to baseline by then -- they'll be nothing like what the numbers on those labs will say.

I really do not relish the idea of sitting on the sidelines twiddling my thumbs for a month doing nothing to address these low-T symptoms. So maybe in that sense it would be better to stay on the clomiphene so at least I'm "doing something." But it is not pleasant. And it feels like it's moving me in the wrong direction.

 

[AntCon]

I used to take clomid myself along with dhea and Anastrozole.. The first week in taking it my anxiety was really high and I felt way more off then normal. Over the weeks nothing really changed , a lot of ups and downs like before clomid and some days being worse than before. The only improvement I saw during my clomid attempt was when I discontinued the DHEA , I noticed a decrease in the higher anxiety and “more off feeling. I finally realized clomid wasn't going to be the answer for me so I began to taper off and stop completely. After stopping , I noticed even more improvement in the off feeling and anxiety.

Im not trying to steer you to stop, and if I were you I would stick it out like others have suggested. But, I feel like in my case, clomid made me feel a little worse than before.

 

[Kirk001]

Same boat as me huh... well did you switch to test and feel better?

 

[Kirk001]

Well, I did 30 days on clomiphene and then stopped to transition to TRT. I got labs done a little early, on day 21, because by then I was almost certain I wanted to discontinue taking it.

Total Testosterone went from 297 pre-treatment to 959 at day 21. Assuming this rate of increase continued to day 30, it would have been around 1243 (estimated) by steady state at day 30.

Estradiol, Sensitive went from 14.5 pre-treatment to 23.6 at day 21. Assuming this rate of increase continued to day 30, it would have been around 27.5 (estimated) by steady state at day 30.

Despite the improvement of the numbers, I felt no positive effects from this medication, only negatives. It increased anxiety and put me in a pessimistic mood. My appetite increased and I found it harder to stay under my daily calorie goal, so I ate too much and my body fat % increased.

And as a nice little parting gift, on my last day of taking it, I awoke to symptoms that I assume were the beginning stages of gynecomastia. (I posted another thread about this... burning nipples, pecs feeling sore/swollen, pea-sized lump by my right nipple, etc.)

So I am glad to be done with this and I'm hoping that TRT will be different. Moving forward it would seem that I may be particularly sensitive to estrogen and will need to keep it relatively low. Either that or I was particularly sensitive to the estrogen agonist part of the medication.

 

[Jiu Jitsu Dude]

Well, I did 30 days on clomiphene and then stopped to transition to TRT. I got labs done a little early, on day 21, because by then I was almost certain I wanted to discontinue taking it.

Total Testosterone went from 297 pre-treatment to 959 at day 21. Assuming this rate of increase continued to day 30, it would have been around 1243 (estimated) by steady state at day 30.

Estradiol, Sensitive went from 14.5 pre-treatment to 23.6 at day 21. Assuming this rate of increase continued to day 30, it would have been around 27.5 (estimated) by steady state at day 30.

Despite the improvement of the numbers, I felt no positive effects from this medication, only negatives. It increased anxiety and put me in a pessimistic mood. My appetite increased and I found it harder to stay under my daily calorie goal, so I ate too much and my body fat % increased.

And as a nice little parting gift, on my last day of taking it, I awoke to symptoms that I assume were the beginning stages of gynecomastia. (I posted another thread about this... burning nipples, pecs feeling sore/swollen, pea-sized lump by my right nipple, etc.)

So I am glad to be done with this and I'm hoping that TRT will be different. Moving forward it would seem that I may be particularly sensitive to estrogen and will need to keep it relatively low. Either that or I was particularly sensitive to the estrogen agonist part of the medication.

Kirk,
I had the same exact situation! T score of 727 and felt horrible the entire month! I wish it worked. The only thing I would have tried would be to micro dose like 12.5mg per week. But I could not take the side affects. Total PMS x 10 symtoms and I'm a chilled dude normally. LOL