Enclomiphene restart - how long?

[GeauxBears]

38M who has been on TRT + HCG for ~5 years or so. I wanted to see if I could restart production with the help of enclomiphene, as prior to TRT I had a great response to clomid but could not handle the estrogen related sides.

I started 12.5mg ED about a month ago, and just got back labs from a week ago and am clearly still shutdown:

T - 25 (264-916)
LH - 1.3 (1.7-8.6)
E2, Sens - 3.4 (8.0-35)

If this restart was to be successful, how long should it take from the perspective of waiting for that last drop of synthetic T to go out of my system? Is it too early, or does this mean it won't work?

On the bright side, I've lost 10 lbs since starting (not muscle - my app says primarily fat and water) and am less moody and not as hot and sweaty all the time. Bad part is my libido is completely gone (and what makes that worse how little I care about it being gone).

 

[madman]

38M who has been on TRT + HCG for ~5 years or so. I wanted to see if I could restart production with the help of enclomiphene, as prior to TRT I had a great response to clomid but could not handle the estrogen related sides.

I started 12.5mg ED about a month ago, and just got back labs from a week ago and am clearly still shutdown:

T - 25 (264-916)
LH - 1.3 (1.7-8.6)
E2, Sens - 3.4 (8.0-35)

If this restart was to be successful, how long should it take from the perspective of waiting for that last drop of synthetic T to go out of my system? Is it too early, or does this mean it won't work?

On the bright side, I've lost 10 lbs since starting (not muscle - my app says primarily fat and water) and am less moody and not as hot and sweaty all the time. Bad part is my libido is completely gone (and what makes that worse how little I care about it being gone).

The exogenous T (TC/TE) is already out of your system.

Need to give it more time (3-6 months).




Conclusions

CC is a compelling option to treat male hypogonadism, although a chronic treatment is needed in most patients. About one in every four patients respond to a CC short trial to "reboot" the HPT axis physiology. Further understanding of TT kinetics in these patients in the long term is warranted.




Conclusions

In men prescribed CC for fertility optimization, we observed a maximal improvement in TT at 6 months, followed by a plateau. Sperm concentrations showed a statistically significant improvement at 9 months. Our results suggest that a longer duration of CC therapy may be needed to fully appreciate the benefit of CC treatment. Our study is limited by retrospective analysis, absence of controls, and small sample size. Work is underway to examine long-term follow-up data of CC in men seeking treatment for hypogonadism rather than optimization of fertility.




CONCLUSIONS

Overall, our study raises the question of what a suitable endpoint may be when studying CC monotherapy in the context of male subfertility and hypogonadism. We pose that 6 months of CC may be needed to achieve maximal benefit in TT while 9 months may be necessary to observe statistical benefit in sperm concentration. The findings from this work may serve as additional data for reproductive urologists to use to counsel men regarding the potential benefits of CC monotherapy for subfertility.

Would I be making a mistake?

You have been a member of the forum since Dec.2022. A fair amount of knowledge kicking around on the forum. You are missing many other blood markers which should be looked at because having healthy testosterone (TT, FT, and BAT) levels is only one piece of the puzzle. Dysfunction...

www.excelmale.com

Clomiphene citrate: A potential alternative for TTh in hypogonadal males

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males (2023) M. Huijben | M. T. W. T. Lock | V. F. de Kemp | J. J. H. Beck | L. M. O. De Kort | H. M. K. van Breda Abstract Background Hypogonadism is a worldwide problem among men causing sexual, physical...

www.excelmale.com

 

[GeauxBears]

Thanks! Would HCG help (I know it's still HPTA suppressive)? Will be chatting with doc soon on this but appointment is a few weeks out.

 

[Vince]

Thanks! Would HCG help (I know it's still HPTA suppressive)? Will be chatting with doc soon on this but appointment is a few weeks out.

Don't use HCG with a restart.

 

[GeauxBears]

Ok, I will hang in there.

 

[GeauxBears]

This has been a brutal couple of months. In early February with doctor's support I doubled the dose of enclomiphene (12.5 mg to 25 mg) and tested last week. Results came back essentially the same, although I guess LH roughly doubled in that time period:

T - 30 (264-916)
FT - Too low to result
LH - 2.5 (1.7-8.6)
E2, Sens - Too low to result (8.0-35)

My biggest issues are being cold 95% of the time, until I have a hot flash which lasts 2-3 minutes and zero libido. Can't even measure ED because erections don't occur. I am also start to notice some depression (not about this but generally) taking hold. My insulin resistance has exploded (I wear a CGM, so I can tell a statistical difference between before & after on how fast my body responds to insulin secretion following a heavy meal).

Ironically my testicles are larger than they were on TRT+HCG. I've also lost a lot of water weight.

How long do I give this? Is there anything I can do to stimulate my pituitary to create more LH? Or is there anything that could be inhibiting LH creation? Strangely prior to TRT, I was a hyper-responder to clomid, with T, E2 and LH sky-high. I am low SHBG and did not do well on clomid, so we switched to TRT+HCG.

 

[Systemlord]

How long do I give this? Is there anything I can do to stimulate my pituitary to create more LH?

Your insulin resistance is preventing your pituitary from creating more LH and is affecting your testicles production of testosterone.

Having abysmally low testosterone increases your chances of type 2 diabetes.

I was freezing cold when I was diagnosed with low testosterone, and type 2 diabetes. I had no glycemic control at all.

This is a battle you cannot win without TRT and or the carnivore diet.

With your baseline pre-TRT labs, I can’t fathom why you even bothered to stop TRT given how insanely low your levels were.

You just don’t have much at all to work with and you were already beyond the point of no return.

I recommend the carnivore diet if you want to reverse your type 2 diabetes.

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[GeauxBears]

Thanks for the response. I think we are largely saying the same thing. All of this aside, I do not have T2D and my blood sugars are very much under control. My diet is as good as it can get based on my lifestyle: I employ intermittent fasting (feeding hours 12pm-7pm), high healthy fat, high protein, high fiber, low carb.

The reason I made the comment about insulin resistance is because, since coming off TRT and starting enclomiphene (and the subsequent shut down), I’ve noticed my blood glucose is more brittle: it is easier to get it to 160 (my highest), and it stays there far too long. Again all of this relative to prior to the restart attempt. It was just a data point to inform how much longer I should wait for T to increase.

 

[sammmy]

Being cold most of the time suggests suppressed thyroid - this may be related to your low carb diet and intermittent fasting. Start eating normal amount of carbs and see if that improves your symptoms and the T restart.

Do you count the calories per day? They may be too low. People on carnivore diet get tired and depressed if they don't get sufficient calories.

 

[TLR]

This has been a brutal couple of months. In early February with doctor's support I doubled the dose of enclomiphene (12.5 mg to 25 mg) and tested last week. Results came back essentially the same, although I guess LH roughly doubled in that time period:

T - 30 (264-916)
FT - Too low to result
LH - 2.5 (1.7-8.6)
E2, Sens - Too low to result (8.0-35)

My biggest issues are being cold 95% of the time, until I have a hot flash which lasts 2-3 minutes and zero libido. Can't even measure ED because erections don't occur. I am also start to notice some depression (not about this but generally) taking hold. My insulin resistance has exploded (I wear a CGM, so I can tell a statistical difference between before & after on how fast my body responds to insulin secretion following a heavy meal).

Ironically my testicles are larger than they were on TRT+HCG. I've also lost a lot of water weight.

How long do I give this? Is there anything I can do to stimulate my pituitary to create more LH? Or is there anything that could be inhibiting LH creation? Strangely prior to TRT, I was a hyper-responder to clomid, with T, E2 and LH sky-high. I am low SHBG and did not do well on clomid, so we switched to TRT+HCG.

I tried a doctor supervised restart with Clomid and went 4 months on it before I threw in the towel….unlike you, I had great LH and FSH response, but apparently my balls are dead because they swole up to the size of lemons but my TT never got above 330….Im not trying to be a Debbie Downer here, because “restarts” can work….but anecdotally from my experience they don’t “work” more than they do…..

 

[GeauxBears]

Update here. Seems my body is finally starting to reset natural production:

T - 242 (264-916)
FT - 4.4 (8.7-25.1)
LH - they forgot to test, going back Monday
E2, Sens - 7.8 (8.0-35)

This has been a difficult few months. Primary complaint has been near-constant swings in body temperature, from being very cold to suddenly getting very hot, multiple times each hour. This has been most disruptive at night, where it wakens me throughout. I have noticed these begin to be less frequent recently, which is good.

Libido has been zero although I am seeing some subjective improvement now. I've had some unexplainable low mood scenarios as well, which are likely tied in.

I have a ways to go, but am glad to see this positive trend as I was thinking about throwing in the towel and going back to TRT after the first two results.

 

[GeauxBears]

Starting to come back!

T - 415 (264-916)
FT - 8.5 (8.7-25.1)
LH - 7.3 (1.7-8.6)
E2, Sens - Pending

Glad to see the LH accelerate and hoping the T will continue to do the same.

Libido has slowly began coming back in waves. Responded well to Vardenafil a few nights ago which was a great sign. Hot flashes are much less prevalent.

 

[FlamingDragon]

Are you still taking the enclomiphene? What is your dosing schedule now? What has it been. Are you going to taper it off or go every other day? Maybe even stick with it long term at a lower dose? Happy for you. Looking good so far.

 

[TLR]

Starting to come back!

T - 415 (264-916)
FT - 8.5 (8.7-25.1)
LH - 7.3 (1.7-8.6)
E2, Sens - Pending

Glad to see the LH accelerate and hoping the T will continue to do the same.

Libido has slowly began coming back in waves. Responded well to Vardenafil a few nights ago which was a great sign. Hot flashes are much less prevalent.

Good to see….as I stated above, it didn’t take for me even though my balls blew up to the size of lemons….on another note, a friend of mine who is FIFTY FIVE and been on over ten years quit COLD TURKEY a year ago (I just found this out yesterday)….he felt like shit for about 6 months but pushed through and now his total T is 590 and he feels fine, having sex a couple times a week….he started doing carnivore and IF and slowly tapered off all his other meds (SSRI, BP, PPI, Lunesta)…lost 30 lbs and his T level now is higher than it was when he got on….if only…!

 

[GeauxBears]

Are you still taking the enclomiphene? What is your dosing schedule now? What has it been. Are you going to taper it off or go every other day? Maybe even stick with it long term at a lower dose? Happy for you. Looking good so far.

Yes, 25mg daily but hopefully I can start to dial back over time.

 

[Cataceous]

Starting to come back!

T - 415 (264-916)
FT - 8.5 (8.7-25.1)
LH - 7.3 (1.7-8.6)
E2, Sens - Pending

Glad to see the LH accelerate and hoping the T will continue to do the same.
...

Keep in mind that LH is pulsatile, so don't worry too much if you have lower values in the future. Seeing a reading of 7.3 mIU/mL, even at a peak, is good news.

For others looking for a less painful restart, there may be alternatives to stopping cold turkey like this. The idea is to switch to a faster-acting form of testosterone that is less suppressive of HPTA function. The restart may take longer, but you don't have to endure a period of very low testosterone. Thanks to Maximus we know that using oral testosterone with enclomiphene should work. Testosterone nasal gel, e.g. Natesto, is another option. It can be used with or without enclomiphene. I have speculated that the combination of enclomiphene and cistanche extract may be able to restart the HPTA even with conventional TRT. However, this idea is untested as far as I know.

 

[Kenp]

Starting to come back!

T - 415 (264-916)
FT - 8.5 (8.7-25.1)
LH - 7.3 (1.7-8.6)
E2, Sens - Pending

Glad to see the LH accelerate and hoping the T will continue to do the same.

Libido has slowly began coming back in waves. Responded well to Vardenafil a few nights ago which was a great sign. Hot flashes are much less prevalent.

Very interesting thread, thanks for the updates

 

[DixieWrecked]

Keep in mind that LH is pulsatile, so don't worry too much if you have lower values in the future. Seeing a reading of 7.3 mIU/mL, even at a peak, is good news.

For others looking for a less painful restart, there may be alternatives to stopping cold turkey like this. The idea is to switch to a faster-acting form of testosterone that is less suppressive of HPTA function. The restart may take longer, but you don't have to endure a period of very low testosterone. Thanks to Maximus we know that using oral testosterone with enclomiphene should work. Testosterone nasal gel, e.g. Natesto, is another option. It can be used with or without enclomiphene. I have speculated that the combination of enclomiphene and cistanche extract may be able to restart the HPTA even with conventional TRT. However, this idea is untested as far as I know.

Wow that's a great idea. Man I'm really starting to think this is the way to go. That'd be a way easier transition to natural production

 

[GeauxBears]

Wanted to update this thread with my latest progress. As of 5/7, labs on 25mg enclomiphene ED:

Total T: 700 (264-916)
Free T: 10.5 (8.7-25.1)
E2, Sens: Pending
SHBG: Pending

Pending final results, my sense is my SHBG is high. What’s weird is while on TRT, my SHBG was low, ~10ish.

Why is my SHBG low on TRT but high(er) on enclomiphene? I noticed the same when on clomid several years ago.

 

[Cataceous]

...

Why is my SHBG low on TRT but high(er) on enclomiphene? I noticed the same when on clomid several years ago.

Androgens tend to lower SHBG while estrogens tend to raise it. TRT, particularly with injections, can result in unnaturally high levels of testosterone. This is what lowers SHBG. Clinical trials suggest that enclomiphene alone does not have much effect on SHBG. So basically your SHBG is bouncing back to a less suppressed state. Clomid contains zuclomiphene in addition to enclomiphene. Zuclomiphene is estrogenic, and consequently helps to raise SHBG.