Early Clomid Results - Thoughts?

[Anne Marie]

So my son (19 yrs) is working with Dr Saya and Defy. He's on 12.5mg clomid & 0.3 anastrozole EOD.

Our local endocrinologist ordered blood work after three weeks of treatment to keep close tabs. These are the changes after three weeks:

testosterone:
144 before
666 after
(range 348-1197)

LH:
4.8 before
17.4 after - HIGH
(range 1.7-8.6)

Estadiol:
32 before
41 after
(range 8-43)

I'm wondering about the LH. Should it be going up so high? Is this indicating primary hypogonadism? He has a diagnosis of secondary hypogonadism because he has other pituitary hormone issues, specifically severe growth hormone deficiency tested with a stim test.

Could he have both primary and secondary hypogonadism, or is the high LH expected when someone is on clomid?

He's not feeling much different that he did before starting clomid by the way. I know it's only been three weeks (well four now). We also started treating his primary hypothyroidism At the same time the clomid was started. This week he started HGH injections as well, not yet sure how that will effect testosterone.

Also is the estradiol a concern yet?

Thanks for any input!

 

[AbsoluteZ3R0]

I'm not a medical professional, so this is just my conjecture. To me, it looks like somewhat of a hybrid issue. As you know, primary hypogonadism is failure of the Leydig cells in the testes, and secondary hypogonadism is failure of the pituitary gland. Looking strictly at your son's blood work, I would have guessed that it was purely primary hypogonadism. An LH of 4.5 is healthy and would typically result in normal testosterone levels. However, if he has had pituitary issues his whole life, then lifelong under-stimulation of the testes might have result in weak/under-developed Leydig cells that don't respond as well to LH. It's also possible that his FSH (which wasn't tested) is low, which would also contribute to reduced testicular function. Was his testicular volume measured before starting clomid? That might have given some clues as to what the issue is. Regardless, the clomid seems to be working quite well, quadrupling his testosterone levels. If my conjecture is correct, his testicles will eventually adapt and start responding better to the clomid, unless for whatever reason the Leydig cells stay permanently underdeveloped. Assuming his testicles "restart," his LH will remain elevated due to the clomid, but probably not as much, because it will take less of it to create more testosterone/estrogen.

Estrogen reference range looks like it was measured via the standard estradiol test, rather than the sensitive. The standard test will show an inflated estradiol measurement. A lot of guys on clomid report not feeling any better or different than when they were purely hypogonadal. I personally felt better hypogonadal than even on a low dose of clomid, although I never took it with an AI. That said, hormonal responses take some time and even if he responds well to the clomid, it may take longer than 3 weeks before he experiences subjective improvement. I wish you and him the best of luck.

 

[Vince]

Personally to me his numbers look good, I wouldn't be concerned with the estradiol levels or high LH while on Clomid.

 

[CoastWatcher]

The estradiol isn't a concern because it would appear, from the associated range, that your local doctor ordered the incorrect estradiol test. Check your lab results and see if the words "Sensitive" or "Ultra-Sensitive" appear with the result. You should also see the phrase, "LC, MS/MS, the testing methodology detailed there. If one of these terms is missing, the lab result can't be trusted - it is the test for women.

Please don't draw too many, actually, any, conclusions from early labs (impatient as you understandably are in this situation).

 

[Anne Marie]

Thanks. My son did have the sensitive version of the test done before starting treatment but that version was not rerun. We will need to do that. We saw his endocrinologist yesterday and he was pleased with the numbers and will rerun them again in four weeks. Hopefully by then my son will notice some changes. We are also treating his thyroid and his growth hormone deficiency so there are several significant hormones that need fixing and we are anxious to have him feeling better after many years of dysfunction.