On Clomid and Not Sure What to Do

[seppuku]

Hi everyone. Long time member, first time really stuck as to what to do. Currently 46 years old, nearly 47. Got my testosterone levels checked around 6 years ago - they were low "normal" (lol!). Two tests were around the low 300's if we're talking ng/dl. This is in the U.K, on the nhs. I self medicated with low dose clomid, as around this time it was really picking up as an alternative therapy to trt. After only a few 12.5mg doses, i got called back for another test - it came back at around 21 nmol/l (low 600's in ng/dl). I didn't tell my doctor what i'd taken, and i continued to take clomid at 12.5mg eod up till now, no other blood tests during that time.
Recently, i decided i wanted to get my levels checked as for about 6 - 9 months my libido's been low, energy low, gym work suffering, and i've just not been myself so to speak. I used a private medical company instead of begging my nhs doc (i used Medichecks). Just the total testosterone as it was on offer. My level was 11.7 nmol/l, (range being 7.6 - 31). In ng/dl, that's 337. Obviously, without LH etc, this tells very little, so this Monday i had a more comprehensive test done. I had assumed that the clomid had stopped working - it hadn't. My second test had my testosterone the same at 11.7nmol/l (337ng/dl). My LH though, was 8.1 iu/l (range 1.7 - 8.6), so near the top end of range. I really wasn't expecting that, it's pointing towards primary.
Guys, what would you do now? I can tell you now that the nhs will not treat this, i don't even see any point in going to see my doc, they're clueless. I have some underground test enanthate i bought a few years back when i thought i might diy trt (but instead discovered clomid) I know that's not ideal though, self treating, but i'm at a loss as to whatelse i can do. My SHBG was 32.9nmol/l (range 16 - 55), calculated free test was 0.232nmol/l (flagged as low). So my LH is top of range, total testosterone is near the bottom of range, as is free testosterone. Guys, what should my next move be? Is there anything i could be missing here? Thanks in advance for any advice you might have.

 

[CoastWatcher]

Where in the UK do you live? Depending on your location, we may be able to provide a referral to a (private) clinic.

 

[seppuku]

Where in the UK do you live? Depending on your location, we may be able to provide a referral to a (private) clinic.

I'm in Birmingham, West Midlands CoastWatcher.
Is there anything i could take that would improve the response of my testes? They obviously work 'a bit', i'm wondering if anything like certain vitamins, or even viagra which i read increases testosterone through a means not related to LH (and my LH is already over 8). I already take vit d3, magnesium, zinc, cod liver oil, vit k2mk4, dhea, pregnenolone, taurine, ginseng.

 

[CoastWatcher]

If your LH is at the top of the range it suggests primary hypogonadism...a problem with the testes. There is nothing you can take, vitamins/supplements, that will correct a case of primary hypogonadism.

 

[ratbag]

Any TRT specialist would say you are a candidate for TRT but you don't have that there... as Coastwatcher said there are a few TRT specialists there and one very good MD in Belgium. There is one in Dorset as I recall. I don't think there is anything you can add to your protocol that will increase T except for T.

 

[CoastWatcher]

Dr. Robert Stevens in Dorset, it's, I think, four hours from you, is a member of the Forum, has posted here (search his name), and is doing excellent work in this field in the UK. Call his clinic. It may only require the occasional trip.

http://themenshealthclinic.co.uk/contact/

 

[seppuku]

Guys, thanks for your help. I'll definitely look into the Dr you mentioned, it's a shame my holiday in two weeks isn't in Dorset else i could have just popped in while i was there!!
One question though - at a reading of 337ng/dl, although low, is that still considered primary hypogonadism? That's why i was asking about supplements for the testes, they're doing 'something' so they can't be completely gone. Or should i just bite the bullet and accept i need trt?

 

[CoastWatcher]

Guys, thanks for your help. I'll definitely look into the Dr you mentioned, it's a shame my holiday in two weeks isn't in Dorset else i could have just popped in while i was there!!
One question though - at a reading of 337ng/dl, although low, is that still considered primary hypogonadism? That's why i was asking about supplements for the testes, they're doing 'something' so they can't be completely gone. Or should i just bite the bullet and accept i need trt?

LH is released by the pituitary gland. It's sending a signal to the testes to produce adequate testosterone, a cry that is not being met. Your testicles are responding in a sad, half-hearted way and the pituitary pumps out more LH to try and evoke a testicular response. Your LH is elevated because your testicles aren't working (that is a primative explanation but gives you a basic overview of the problem). More testing is certainly called for - a lot more testing - but you're a TRT candidate.

 

[Will Brink]

Guys, thanks for your help. I'll definitely look into the Dr you mentioned, it's a shame my holiday in two weeks isn't in Dorset else i could have just popped in while i was there!!
One question though - at a reading of 337ng/dl, although low, is that still considered primary hypogonadism? That's why i was asking about supplements for the testes, they're doing 'something' so they can't be completely gone. Or should i just bite the bullet and accept i need trt?

Your T number is not what indicated primary, but your LH. I'd find a competent doc, get more tests done, decided what to do then. Much of it simply depends on how you feel, and what you want.

 

[Nelson Vergel]

I would go see Dr. Stevens and get switched to injections. Are you planning to have kids?

 

[seppuku]

Ok, thanks CoastWatcher

 

[seppuku]

Thanks Will - the competent doc part could be tricky!

 

[seppuku]

Thanks Nelson - as to kids, i've done all my breeding now, no more for me. I was really hoping something treatable might have been causing this though, like low thyroid, or varicoles etc. I've no fear of needles, i guess i was just hoping i could be cured.

 

[Guided_by_Voices]

While I agree with the advice from everyone else here, I’ll add three more items to consider. I was on Clomid too for a while before I got on TRT and I think its long-term effects are not as well-understood as many believe. For example, due to the different half-lives of its sub-components you are never really at “steady state”. I would read Patrick Arnold’s article on it that I posted here some time back. So, something to consider is to stop the Clomid for a while and then restart it, or try an HCG run. I am just speculating wildly here, but it might be that the pro-estrogenic aspects of Clomid cause some sort of shut-down affect independent of LH after a while, or some sort of other libido issue.

Also, as I’ve commented elsewhere, I’m a believer is starting with T-prop when you are doing a proof-of concept with TRT so you lessen the roller-coaster affect when you are trying to get dialed in, but I understand that may not be an option.

I also remember that you lifted fairly intensely, and that may be something to dial back a bit until this is sorted out. I subscribe to the (Chilln) theory that a lot of guys out-work their hormones and that leads to a vicious negative cycle (one of the main advantages of TRT IMO).

Good luck to you.

 

[seppuku]

Guided by voices - thank you very much for your insight on my situation. I've gotta say, i was playing in my mind with that exact idea about the hcg and cycling clomid. I'd read a study the other day (which i now can't find) that suggested something along the lines of the testes not being dead, but not being able to respond to endogenous LH. They'd taken someone (or a group, i can't remember), who'd got low T but raised LH, and given them hcg, and they responded to that with increased testosterone output. I'm tempted to try some hcg for a trial, use Medichecks for a blood test, just to see if this makes my nuts produce what they had done when i first took clomid (around 21 nmol/l, 600 odd ng/dl). If that works, maybe cycle on and off low dose clomid / back to hcg etc etc. Like you said, long term effects on clomid just aren't known. Maybe my problem is something weird that the zuclomephine part is causing, i don't know. I've read up so much about secondary hypogonadism over the last few years, getting this latest blood test has really made me feel out of my depth. I'm not really in a financial position to keep doing endless private blood tests, and that's why i originally liked the idea of taking clomid (although now it would seem i would have done well to have gotten tested regularly all along).
I'm suprised you remember anything about me mentioning my gym work - i'll be honest, i don't remember writting about it on here!! This is the worst part for me lately. I used to without fail put in three full body workouts a week, alternating squats with sumo deadlifts, overhead press with reverse grip bench etc etc. Since around last xmas though, various injuries have set me back, and just a lack of being able to add weight to the bar has had me doing one maybe two sessions a week, with 50% of those workouts being.....disapointing. I've a lot to think about here, i think the hcg trial wouldn't be a bad start

 

[Guided_by_Voices]

Well, as long as we’re speculating, injuries is a clue and I’ve had my share as well. That could mean raised cortisol or some other systemic stress. You may have been at a lower T level for a long time and it never mattered until something else triggered a problem. I’m in the Carl Lanore camp that says the body shuts down libido when it thinks it’s not healthy, and T may or may not fix that. I think we on forums like this often tend to focus on a few hormones a bit more than is appropriate. That said, don’t take anything I’m saying to be negative on TRT. It’s just that lots of people go on TRT and don’t see their libido return so it seem wise to eliminate other possible causes first.

If you haven’t already, I would investigate a lifting protocol that doesn’t take your sets to failure. It has been nothing but good for me and I’m stronger now that when I used to go to failure, but with much better recovery ability.

I’m not a big believe in over-testing. When I started on both Clomid and TRT I adjusted up and down until I got to a good place and then tested so that I knew what blood work looked like for me when I felt my best. I actually think it can create implanted negative placebo effects in some cases and distract you from focusing on symptoms. It can certainly offer good guidance as well so there is a balance to be struck.

And before you think you’re losing your memory, I remember your gym comments from the PeakT site.

And a question for you? Did you keep using the PT-141? Did it retain its effectiveness? Just curious as there seems to be a lack of long-term reports on it.

Ok, hang in there.

 

[seppuku]

Lol, of course, the Peak T forum! I'd forgotten how much i'd written about when i first joined up. About the pt-141, to be honest i didn't notice much from it other than a facial flushing effect. My libido at that time was already through the roof though, due to the sordid situation i was in (i ended up losing my job over it, management weren't keen on me having sex twice a day outside my breaktime, lol!). I think the most potent substance i've used that increases libido to pornographic levels would have to be ghb (although at the moment, it just makes me hungry and fall asleep).
As to my workouts, i agree with what you said about not pushing to failure. I'm more of a low rep guy anyhow, so i tend to try and finish with a tough last rep, not to failure though.
I'm wondering now whether cycling clomid with alternating nolvadex might be worth a shot......

 

[seppuku]

Interesting - now i have a name for my type of hypogonadism. Not primary, not secondary, but "compensated hypogonadism"

"Criteria from the European Male Ageing study were used to determine gonadal status. Men were categorized as having compensated hypogonadism if their testosterone levels were greater than or equal to 10.5 nmol/liter and their LH levels were less than 9.4 U/liter."

http://www.issm.info/news/sex-health-headlines/compensated-hypogonadism

 

[Will Brink]

Thanks Will - the competent doc part could be tricky!

Sadly, tricky for most.

 

[Guided_by_Voices]

When I was on Clomid, I found that if I needed to reduce the dose, I had to do a washout for a month or so, I couldn’t just drop the dose. Just my experience. It’s sounding increasingly like TRT may be the thing to try. Most people don’t have your success with clomid so at least you got several years out of it.