do you use clomid with TRT?

[gerardo]

Good morning everybody. After reading several posts I would like to take this discussion. To keep the HPG axis less suppressed with TRT does anyone have experience or use low doses of clomid or tamoxifen during TRT? Would it be an alternative to using HCG with TRT?
Thanks

 

[robdonaldson]

Following.

 

[Cataceous]

For most this will not work. Negative feedback from testosterone still disables the hypothalamus, keeping the axis inactive. Until there's a SARM that blocks androgens only at the hypothalamus the best one can do is bypass it by injecting GnRH or maybe kisspeptin. In this case a SERM is sufficient to keep the pituitary active and producing gonadotropins.

 

[gerardo]

For most this will not work. Negative feedback from testosterone still disables the hypothalamus, keeping the axis inactive. Until there's a SARM that blocks androgens only at the hypothalamus the best one can do is bypass it by injecting GnRH or maybe kisspeptin. In this case a SERM is sufficient to keep the pituitary active and producing gonadotropins.

In the case of the hypothalamus and if you make single and daily applications of gnrh, can you not also suppress it since the release is pulsatile throughout the day?
In this case, would the serm maintain the pituitary gland and logically sperm production and prevent testicular atrophy, for example? What dose of clomid or tamoxifen would be needed for this? I don’t put enclomiphene because in my country it doesn’t have it.

 

[Jon H]

I use low-dose tamoxifen (10mg every 2-3 days) with TRT, but not to keep the axis less suppressed. I'm very sensitive to any sort of elevated estrogen, so the primary reason is to suppress gynecomastia.

 

[gerardo]

I use low-dose tamoxifen (10mg every 2-3 days) with TRT, but not to keep the axis less suppressed. I'm very sensitive to any sort of elevated estrogen, so the primary reason is to suppress gynecomastia.

Thanks Jon H. How long have you used tamoxifen in this way? Did you have side effects like loss of libido or increased serum estradiol? With that dose of tamoxifen, your testicle was less stunted? Thank you for your participation.

 

[Jon H]

Gerardo - I'm not sure my use of tamoxifen would be relevant to your situation. I'm extremely primary hypogonadal, so I have to use a pretty high dose of HCG to keep my POS testicles from shrinking. If I use it, they stay average size. If I don't use it, they will literally shrink to the size of small raisins, to the point of feeling non-existent. Tamoxifen use has had no positive impact in that area, and I doubt it would for most men.

I've been using tamoxifen tablets for about two months. I was using topical tamoxifen thru Defy Medical, but found that oral tamoxifen (thru Defy as well) worked better for gynecomastia suppression. It's also allowed me to use a much smaller dose of anastrozole. My libido is always great on TRT, but I will say that tamoxifen has helped alleviate ED to some degree. Any elevation of estrogen always causes problems in that area.

Regarding elevated serum estradiol level: I'm scheduled for labs in June, so won't know until then what my estradiol levels are. If you search the forum I believe the use of Clomid and/or Tamoxifen with TRT, to minimize suppression of HPTA, has been discussed a few times. If I remember correctly there were some comments from at least one doctor that said it simply didn't work well to stop suppression of LH and FSH in the patients that tried it.

 

[gerardo]

Gerardo - I'm not sure my use of tamoxifen would be relevant to your situation. I'm extremely primary hypogonadal, so I have to use a pretty high dose of HCG to keep my POS testicles from shrinking. If I use it, they stay average size. If I don't use it, they will literally shrink to the size of small raisins, to the point of feeling non-existent. Tamoxifen use has had no positive impact in that area, and I doubt it would for most men.

I've been using tamoxifen tablets for about two months. I was using topical tamoxifen thru Defy Medical, but found that oral tamoxifen (thru Defy as well) worked better for gynecomastia suppression. It's also allowed me to use a much smaller dose of anastrozole. My libido is always great on TRT, but I will say that tamoxifen has helped alleviate ED to some degree. Any elevation of estrogen always causes problems in that area.

Regarding elevated serum estradiol level: I'm scheduled for labs in June, so won't know until then what my estradiol levels are. If you search the forum I believe the use of Clomid and/or Tamoxifen with TRT, to minimize suppression of HPTA, has been discussed a few times. If I remember correctly there were some comments from at least one doctor that said it simply didn't work well to stop suppression of LH and FSH in the patients that tried it.

Got it, Jonh. Thanks. I read that serum estradiol increases with tamoxifen and libido decreases (more with clomid) but in low doses I couldn't find many studies. Let's wait for more people to experience it. I think this is a very important subject.

 

[gerardo]

For most this will not work. Negative feedback from testosterone still disables the hypothalamus, keeping the axis inactive. Until there's a SARM that blocks androgens only at the hypothalamus the best one can do is bypass it by injecting GnRH or maybe kisspeptin. In this case a SERM is sufficient to keep the pituitary active and producing gonadotropins.

What would be the best solution to maintain testis size without using Hcg? Hcg definitely gives me a horrible headache.

 

[gerardo]

Does anyone use clomid together with TRT?

 

[gerardo]

Effectiveness of combined tamoxifen citrate and testosterone undecanoate treatment in men with idiopathic oligozoospermia - PubMed

Treatment with tamoxifen citrate and testosterone undecanoate improved sperm variables and led to a higher incidence of pregnancy in couples with subfertility related to idiopathic oligozoospermia.

pubmed.ncbi.nlm.nih.gov

The combination of testosterone undecanoate with tamoxifen citrate enhances the effects of each agent given independently on seminal parameters in men with idiopathic oligozoospermia - PubMed

These results indicate that the combination of tamoxifen citrate with T undecanoate not only improves significantly important seminal parameters but also compares favorably with the single treatments used. Therefore, this combination deserves a place as a first line of treatment in idiopathic...

pubmed.ncbi.nlm.nih.gov

Endocrine effects of testosterone undecanoate as a supplementary treatment to menopausal gonadotropins or tamoxifen citrate in idiopathic oligozoospermia - PubMed

These results indicate that T undecanoate in combination with TAM or hMG not only had no adverse effects on pituitary and Leydig cell activity but also seemed to improve important seminal parameters and signify that androgens may be tried as a supplementary treatment to conventional regimes in...

pubmed.ncbi.nlm.nih.gov

Effectiveness of Combined Testosterone Undecanoate with Tamoxifen Citrate Treatment in Men with Idiopathic Azoospermia or Serious Oligozoospermia

To assess the effect of treatment with a combination of the tamoxifen citrate and testosterone undecanoate on sperm variables in men with idiopathic a…

www.sciencedirect.com

DEFINE_ME

 

[Cataceous]

What would be the best solution to maintain testis size without using Hcg? Hcg definitely gives me a horrible headache.

Natesto instead of conventional TRT. But if you're on regular TRT then the alternatives to hCG are less practical. They include hMG or GnRH therapy.

Does anyone use clomid together with TRT?

In general it will not work. In those studies you cite, tamoxifen plus oral testosterone undecanoate works because oral testosterone undecanoate alone is not very suppressive:

By and large, administration of T undecanoate as a single treatment had no inhibitory effect on pituitary activity, and its combination with TAM did not change FSH secretion.[R]​

In contrast, our conventional TRT methods are highly suppressive, be they injections, transdermal products or pellets.

 

[gerardo]

More attention should be paid to the treatment of male infertility with drugs—testosterone: to use it or not?

Testosterone replacement is strictly contraindicated for the treatment of male infertility’ was the advanced view from the ‘2013 European Association of Urology (EAU) guidelines on male infertility’, and this view brings extensive ...

www.ncbi.nlm.nih.gov

Natesto instead of conventional TRT. But if you're on regular TRT then the alternatives to hCG are less practical. They include hMG or GnRH therapy.


In general it will not work. In those studies you cite, tamoxifen plus oral testosterone undecanoate works because oral testosterone undecanoate alone is not very suppressive:

By and large, administration of T undecanoate as a single treatment had no inhibitory effect on pituitary activity, and its combination with TAM did not change FSH secretion.[R]​

In contrast, our conventional TRT methods are highly suppressive, be they injections, transdermal products or pellets.

Do you think that using Clomid or tamoxifen in small doses during TRT would not keep LH and FSH at normal levels and consequently the amount of sperm?

 

[Cataceous]

More attention should be paid to the treatment of male infertility with drugs—testosterone: to use it or not?

Testosterone replacement is strictly contraindicated for the treatment of male infertility’ was the advanced view from the ‘2013 European Association of Urology (EAU) guidelines on male infertility’, and this view brings extensive ...

www.ncbi.nlm.nih.gov

...

He keeps citing the same study. Clearly oral testosterone undecanoate is a different animal. But it seems to have resisted widespread adoption, perhaps in part because it is not very effective. The limited anecdotal reports on the forums are generally negative.

...
Do you think that using Clomid or tamoxifen in small doses during TRT would not keep LH and FSH at normal levels and consequently the amount of sperm?

Repeating, for most men SERM's are ineffective at HPTA stimulation when used with conventional TRT. The androgenic suppression of the hypothalamus is unrelenting.

 

[gerardo]

Natesto instead of conventional TRT. But if you're on regular TRT then the alternatives to hCG are less practical. They include hMG or GnRH therapy.

How does natesto not have the HMG protocol here? Isn't the cost too high? Would Gnrh be gonaderoline?

 

[Cataceous]

How does natesto not have the HMG protocol here? Isn't the cost too high? Would Gnrh be gonaderoline?

Rephrase the first question; it's unclear. The cost of hMG is relatively high, which is why I said it's less practical. Also, frequent injections would give more natural results, which is also the case with GnRH/gonadorelin. This is another point against practicality for either treatment.

 

[Trip McNeely]

Natesto instead of conventional TRT. But if you're on regular TRT then the alternatives to hCG are less practical. They include hMG or GnRH therapy.


In general it will not work. In those studies you cite, tamoxifen plus oral testosterone undecanoate works because oral testosterone undecanoate alone is not very suppressive:

By and large, administration of T undecanoate as a single treatment had no inhibitory effect on pituitary activity, and its combination with TAM did not change FSH secretion.[R]​

In contrast, our conventional TRT methods are highly suppressive, be they injections, transdermal products or pellets.

Why would Natesto not cause testicular shutdown? It's just another form of exogenous testosterone, like injections or creams.

 

[Cataceous]

Why would Natesto not cause testicular shutdown? It's just another form of exogenous testosterone, like injections or creams.

If you do a forum search for it you'll see that @madman has posted a lot of the research on it. What differentiates it from other forms of exogenous testosterone is its short half-life. It's dosed three times a day, each resulting in a fast rise in serum testosterone, which then drops to baseline within hours. The relatively short duration of the pulses and the time spent at baseline levels lead to reduced suppressive effects and continued functioning of the HPTA.
https://www.excelmale.com/forum/threads/acerus-pharmaceuticals-natesto®.23251/

The Effects of Natesto For Treatment Of Hypogonadism

https://clinicaltrials.gov/ct2/show/NCT04717362 Sponsor: Baylor College of Medicine Information provided by (Responsible Party): Larry I. Lipshultz, Baylor College of Medicine Detailed Description: Testosterone replacement therapy (TTh) is becoming increasingly common among men of...

www.excelmale.com

Short-acting T therapy to maintain homeostasis that more closely reflects normal physiology

Short-Acting Testosterone: Physiologic? Gerwin Westfield, Ursula B Kaiser, Dolores J Lamb, Ranjith Ramasamy INTRODUCTION Pulsatile secretion of a hormone refers to the intermittent secretion of the hormone in a burst like or episodic manner rather than constantly, with the frequency...

www.excelmale.com

 

[gerardo]

Rephrase the first question; it's unclear. The cost of hMG is relatively high, which is why I said it's less practical. Also, frequent injections would give more natural results, which is also the case with GnRH/gonadorelin. This is another point against practicality for either treatment.

Here in Brazil we don't have Natesto. Would a solution be Hmg?

 

[Cataceous]

Here in Brazil we don't have Natesto. Would a solution be Hmg?

If you have a lot of money and don't mind frequent injections then hMG could be used with TRT to maintain testicular activity.