Would I be making a mistake?

[canadianeh]

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 thyroid/adrenals can easily mimic low T symptoms let alone even if one had healthy T levels dysfunction thyroid/adrenals can wreak havoc on the overall effectiveness of TRT.

Looking over the results for the labs you posted (TT/FT) your TT 350-375 ng/dL is not so stellar and more importantly your FT level is on the lower end which is well below where a healthy young male would sit.

In Canada, FT is calculated using the cFTV.

With the FT level you posted then you would have normal SHBG not high or low.

Keep in mind in order to know where your TT/FT level truly sits your blood work needs to be done in the early AM in a fasted state as we want to test at peak when T levels are highest due to the natural endogenous 24 hr circadian rhythm of a healthy young male.

Top it off the most accurate assays for TT/estradiol/DHT (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration) should be used.

If you do not have access to such then you will need to use/rely upon TT/estradiol (standard immunoassay) and FT (cFTV).

If you train with weights it would be wise to take a week off as overtraining can drive down natty T levels.

You stated that you have been lifting very heavy.

How is your recovery?

Do you periodize your training program?

Also need to understand that your FT was calculated using the linear law-of-mass action cFTV which as of now tends to overestimate when compared against what is considered the most accurate assays for testing free testosterone the gold standard Equilibrium Dialysis.

Your FT level may very well be somewhat lower.

Now for the tricky part which is symptoms.

Although low libido and lack of spontaneous/nocturnal erections are common symptoms for some this will not happen until FT levels are absurdly low.

One can still have a decent libido/erectile function with lower-end/subpar FT levels but still experience other symptoms related to low-T.

Again testosterone is only one piece of the puzzle as dysfunctional thyroid/adrenals can cause numerous issues when it comes to energy, mood, libido/erections, recovery, and so on.

Always best to have a more thorough set of labs before jumping on TRT.

Blood work should be done for TT, FT, estradiol, SHBG, DHT, prolactin, Vit D DHEA-S, LH/FSH, PSA, full thyroid panel (TSH, Free T3, Free T4, Reverse T3, antibodies), salivary cortisol (Four Specimens), lipids, CMP, CBC, and CRP.

Now for the tricky part which is that you stated you lack many of the low T symptoms.

More importantly, you have a strong libido and hopefully erectile function.

Hard to say how you would fair on TRT as it is not so cut and dry.

For some men it can do wonders as in life-changing in many ways, for others they will be better off than before but have nothing to brag about, many may end up struggling with ups/downs for years to come and some will be far worse off.

No point in getting caught up on this as you need to decide what is best for you.

The best piece of advice to increasing your chance of reaping the benefits of TRT is to always start low and go slow.

T only protocol, no AI (aromatase inhibitor) or hCG.

You can always add in hCG eventually if need be, increase your dose, or tinker with an AI (would try to avoid such).

Patience is key.

Do not get caught up in that more T is better mentality.

Do not go in with unrealistic expectations.

I understand you are on the fence here when it comes to libido let alone testicular atrophy.

Again no one can say where your libido will end up on TRT as it could stay the same, be better or lousy, and worst-case scenario non-existent.

Too many factors are involved especially when it comes to libido/erectile function as they are multi-factorial.

As for testicular shrinkage, this can easily be prevented/minimized with the use of hCG.

To be honest in your situation if you want to kill 2 birds with one stone while at the same time getting a taste of having higher T levels then your best would be trialing the nasal T gel (Natesto) which many of the endos/uros in Canada love to prescribe due to it being the least suppressive when it comes to the hpta let alone would allow one to maintain fertility, prevent/minimize testicular shrinkage and top it off will have the least impact on experiencing side-effects especially when it comes to elevated hematocrit.

Another option would be clomid/enclomiphene which some may fair well on although eventually many end up jumping on TRT.

Again take in as much as you can from everyone and decide what is best for you!

Appreciate this response.

Thank you. I do take regular recovery, and I believe the training protocol I follow is sound.

I have been thinking about clomid (I've read about 8 weeks to try and increase?) but comes with some side issues. Dr. Peter Attia suggested he used to do an 8-week stint to try and kickstart things.

I've considered HCG Monotherapy which sounds like it doesnt surpress natural as much and isn't necessarily a lifelong commitment.

I've never heard about natesto but I will ask about it!

Thank you again.

 

[Systemlord]

I've considered HCG Monotherapy which sounds like it doesnt surpress natural as much and isn't necessarily a lifelong commitment.

TRT isn’t a life long commitment either, you can stop any time, a regain HPTA functionality, however suboptimal it will be.

 

[canadianeh]

TRT isn’t a life long commitment either, you can stop any time, a regain HPTA functionality, however suboptimal it will be.

Yeah, but it doesnt sound that great, and doesnt always work...again, at least from experts I've listened to, etc.

Peter Attia says it doesnt always come back here:

 

[Systemlord]

Yeah, but it doesnt sound that great, and doesnt always work...again, at least from experts I've listened to, etc.

Peter Attia says it doesnt always come back here:

The one thing I noticed about the experts, the experts don’t always agree with the other experts. I could find a video of Dr. Abraham Morgantaller, saying the opposite.

Saying that the HPTA doesn’t always come back is pretty vague!

What are the percentages of those men that don’t get their HPTA back?

YouTube is not a good place for accurate, correct information!

 

[canadianeh]

The one thing I noticed about the experts, the experts don’t always agree with the other experts. I could find a video of Dr. Abraham Morgantaller, saying the opposite.

YouTube is not a good place for accurate, correct information!

Again, it's an opinion of one doctor, who seems to run a pretty successful practice in this area. At the end of the day we need to hear various points of view and decide for ourselves. You can pretty much find studies suggesting completely different results/hypothesis as well.

For example, he used to use clomid. He stopped. He treats the symptoms, not the number. He suggests you want about 2% FREE available from Total T.

It's good stuff and good to get different viewpoints. Yes, there's another doctor who says you can absolutely stop trt, but you shouldnt....

 

[BadassBlues]

The one thing I noticed about the experts, the experts don’t always agree with the other experts. I could find a video of Dr. Abraham Morgantaller, saying the opposite.

YouTube is not a good place for accurate, correct information!

I completely agree, but Peter Attia is an exception. I don't think he is the final word by any means, but he does come from a very logical and well thought out point of view. His positions are from a health span extension paradigm, which don't always jibe with the mainstream HRT crowd.

 

[canadianeh]

I completely agree, but Peter Attia is an exception. I don't think he is the final word by any means, but he does come from a very logical and well thought out point of view. His positions are from a health span extension paradigm, which don't always jibe with the mainstream HRT crowd.

He is a proponent of TRT. So I can appreciate his opinion based on his practice and what he's seen. His Longevity book is good btw. For example, in a recent postcasts he says he's not on TRT now but does believe and say for himself that it's an inevitable and trying to hold off as long as possible (per my comment above, is this inevitable?)

 

[FunkOdyssey]

He is a proponent of TRT. So I can appreciate his opinion based on his practice and what he's seen. His Longevity book is good btw. For example, in a recent postcasts he says he's not on TRT now but does believe and say for himself that it's an inevitable and trying to hold off as long as possible (per my comment above, is this inevitable?)

I'd like to see where he discusses inevitability of TRT and his personal plans around TRT if you are able to point me to it. Was it the recent interview with Derek from More Plates More Dates?

 

[canadianeh]

I'd like to see where he discusses inevitability of TRT and his personal plans around TRT if you are able to point me to it. Was it the recent interview with Derek from More Plates More Dates?

See what he says here:

Starting during the TRT discussion.

He says:

"yeah that's that's been my lazy excuse which is I'm 50. I'm a firm believer in the benefits of testosterone I wouldn't be prescribing it to patients if I didn't feel that way I've spent not as much time as you but more time than most people in the literature and completely buy the efficacy and safety of it but I'm like I don't need it yet yeah and I know that once I started I'm going to be on it indefinitely so I'm going to hold out as long as possible until I need it"

 

[madman]

Yeah, but it doesnt sound that great, and doesnt always work...again, at least from experts I've listened to, etc.

Peter Attia says it doesnt always come back here:

For the majority of men you will just return back to baseline levels.

Some may be worse off but it is far from common.

Men who have abused testosterone/AAS for years can end up with lower levels of SHBG.

Would not fret over a short stint of TRT 3-6 months.

Advantage to tapering down my test before starting my pct?

Hello. I need to get off trt in the next few weeks and looking for the best course of action. Please don't try to talk me out of it, I didn't come to my decision lightly but my mind is made up. I started trt in January of this year. I'm currently taking a total of 120mg per week via injection...

www.excelmale.com

 

[madman]

Appreciate this response.

Thank you. I do take regular recovery, and I believe the training protocol I follow is sound.

I have been thinking about clomid (I've read about 8 weeks to try and increase?) but comes with some side issues. Dr. Peter Attia suggested he used to do an 8-week stint to try and kickstart things.

I've considered HCG Monotherapy which sounds like it doesnt surpress natural as much and isn't necessarily a lifelong commitment.

I've never heard about natesto but I will ask about it!

Thank you again.

As I stated previously if you do not want to jump into TRT off the hop and suppress your hpta let alone maintain fertility than your best bet would be Natesto or clomid/enclomiphene.

Although hCG mono would be a good option when it comes maintaining fertility and keeping the testes plump you need to keep in mind that although it mimics LH your hpta will still be shut down.

Top it oiff that insurance will not cover it and you will be paying out of pocket.

You are looking at $100 for big pharma Pregnyl 10,000 units/vial.

Depending on your weekly dose it can be expensive in the long run.

PREGNYL hCG by MERCK CANADA

PREGNYL® (chorionic gonadotropin for injection, USP) 10,000 units/vial Human Gonadotropin Merck Canada Inc. 16750 route Transcanadienne Kirkland QC Canada H9H 4M7 The action of human chorionic gonadotropin (hCG) is virtually identical to that of pituitary LH, although hCG appears to have a...

www.excelmale.com

 

[canadianeh]

As I stated previously if you do not want to jump into TRT off the hop and suppress your hpta let alone maintain fertility than your best bet would be Natesto or clomid/enclomiphene.

Although hCG mono would be a good option when it comes maintaining fertility and keeping the testes plump you need to keep in mind that although it mimics LH your hpta will still be shut down.

Top it oiff that insurance will not cover it and you will be paying out of pocket.

You are looking at $100 for big pharma Pregnyl 10,000 units/vial.

Depending on your weekly dose it can be expensive in the long run.

PREGNYL hCG by MERCK CANADA

PREGNYL® (chorionic gonadotropin for injection, USP) 10,000 units/vial Human Gonadotropin Merck Canada Inc. 16750 route Transcanadienne Kirkland QC Canada H9H 4M7 The action of human chorionic gonadotropin (hCG) is virtually identical to that of pituitary LH, although hCG appears to have a...

www.excelmale.com

I've asked about clomid/Natesto...

Again, I've heard from doctors who say they do a 3month run of clomid to try and kickstart the system to producing more T - is clomid a one and one type of thing?

Same with Natesto? Are you basically on this for good if it drives T up?

 

[sammmy]

"Concerns and Goals: I’m interested in more energy and zest for life. I’d appreciate leaning out a bit and possibly reducing body fat, dont really want to look way more muscular….."

A change of diet (more meat, less other stuff) and a mild herbal stimulant in the morning will achieve that. TRT will not make you magically leaner on a bad diet. Even bodybuilders on anabolic steroids have to follow strict diet to reduce body fat before competition.

 

[canadianeh]

I eat 80/20 for sure. Pretty clean. Don't really have a bad diet. I do think I have some insulin resistance.

 

[Systemlord]

I do think I have some insulin resistance.

Nelson Vergel collected data across multiple studies and found metabolic syndrome below 450 ng/dL. Having suboptimal testosterone is a risk factor for developing type 2 diabetes.

Testosterone Level: How Low is Too Low? Health Consequences of Low Testosterone

I was able to summarize all available studies on testosterone blood levels and how they are linked to several health issues. I will add references soon. Low Blood Levels of Testosterone and Associated Risks: < 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome Reference: Dhindsa, S...

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[t_spacemonkey]

i can only speak from own exp, but it looks to me you are a T candidate. I did not had insane low T symptoms, or so at least I thought. my T was 230ng/dl total, 8ng/dl free.
worked out regularly, hard to gain mass etc. libido average, 1-2x week sex max.
this massively changed with TRT. 2 years in, my libido is 5-6x drive/week, 4x gym a week. visible muscle gains + excellent gym recovery. Now I am on the high side T, 210mg/week, but worked myself up slowly here with my clinic, due to the way I feel and metabolize T.
I also stopped completely getting any colds since started TRT, as I got sick 3x each year.
not sure if I see what your age is, but I did not expect my TRT benefits be so good TBH.
mentally I got much more resilient with more drive and less anxiety overall.

 

[Systemlord]

Again, I've heard from doctors who say they do a 3month run of clomid to try and kickstart the system to producing more T - is clomid a one and one type of thing?

I don’t agree with this idea that you can end up with better, higher testosterone naturally and a short run on clomid. The whole idea behind “kickstart” implies something is shutdown or not running, needing a “kickstart”.

This is a flawed analogy, flawed analogy -> flawed idea.

In the seven years I’ve been on these forums I’ve never seen a single case where this has occurred.

It sounds a lot like wishful thinking.

 

[GTSILVER]

Posted this to Reddit, and got some interested responses, but wanted to post here as I've been reading here all day.

Over the past 18 months, I’ve been on a journey to naturally increase my testosterone (T) levels. While I’ve tried various methods, including sleep improvement, diet improvement, supplements like tongkat and others, I’ve actually experienced a slight decline in levels with each test.

Background:

• Symptoms: I don’t have many typical low T symptoms. Good / strong libido, regular workouts (heavy lifting compound movement strength workouts with some HIIT twice per week in there 4-5 times a week for the past 7+ years), strong deadlift/squat/bench, full head of hair. Sleep is okay but often disrupted by a bathroom trip. I do have some mental fog and feeling a bit unmotivated.

Dr. Attia says most common symptoms he sees "erectile disfunction, low libido, low mood, difficulty putting on muscle mass, insulin resistance

Over the past 18 months, I’ve been on a journey to naturally increase my testosterone (T) levels. While I’ve tried various methods, including sleep improvement, diet improvement, supplements like tongkat and others, I’ve actually experienced a slight decline in levels with each test.

Background:

• Symptoms: I don’t have many typical low T symptoms. Good / strong libido, regular workouts (heavy lifting compound movement strength workouts with some HIIT twice per week in there 4-5 times a week), strong deadlift/squat/bench, full head of hair. Sleep is okay but often disrupted by bathroom trips.
• Body: Carrying some extra body fat, likely between 18-22% BF.
• Energy: It’s been lower lately. My job isn’t stressful, but I’m feeling a lack of energy and creativity.

Test Results (Over 18 months):

1st Test (6 months)

• Total T: 371 ng/dL
• Free T: 73 pg/mL (7.3 ng/dL)

2nd Test (12 months)

• Total T: 358 ng/dL
• Free T: 75 pg/mL (7.5 ng/dL)

3rd Test (18 months)

• Total T: 351 ng/dL
• Free T: 70.5 pg/mL (7.0 ng/dL)

Despite my efforts, there’s been a slight decline. I did see a drop in estradiol during this time which seems to be a positive. These numbers do suggest 2% of total T is free which is the number Peter Attia suggests.

Concerns and Goals: I’m interested in more energy and zest for life. I’d appreciate leaning out a bit and possibly reducing body fat, dont really want to look way more muscular…..

However, I’m concerned about potential side effects, particularly regarding libido, hair loss, and testicular atrophy.

I haven’t discussed this with my spouse yet.

A Canadian TRT clinic recommended starting with 100mg cypionate split 50mg twice a week. I admit I’m wary about potential side effects.

Question: Given my situation, should I consider starting TRT? Would the benefits outweigh the risks for someone in my situation?e

• Body: Carrying some extra body fat, likely between 18-22% BF.

• Energy: It’s been lower lately. My job isn’t stressful, but I’m feeling a lack of energy and creativity.

Test Results (Over 18 months):

1st Test (6 months)

• Total T: 371 ng/dL
• Free T: 73 pg/mL (7.3 ng/dL)

2nd Test (12 months)

• Total T: 358 ng/dL
• Free T: 75 pg/mL (7.5 ng/dL)

3rd Test (18 months)

• Total T: 351 ng/dL
• Free T: 70.5 pg/mL (7.0 ng/dL)

Despite my efforts, there’s been a slight decline. I did see a drop in estradiol during this time which seems to be a positive. These numbers do suggest 2% of total T is free which is the number Peter Attia suggests.

Concerns and Goals: I’m interested in more energy, feeling more motivated at work, improving sleep, body composition.... I’d appreciate leaning out a bit and possibly reducing body fat, dont really want to look way more muscular…..

However, I’m concerned about potential side effects, particularly regarding libido, hair loss, and testicular atrophy.

I haven’t discussed this with my spouse yet.

A Canadian TRT clinic recommended starting with 100mg cypionate split 50mg twice a week. I admit I’m wary about potential side effects.

Question: Given my situation, should I consider starting TRT? Would the benefits outweigh the risks for someone in my situation? Is this an "inevitable" someday anyways?

I’ve been on “TRT” for the past 12 years due to HYPOGONADISM, my “T” is too low. When not on “TRT,” my Total “T” goes down between 20-90. That’s extremely low and well below the minimum side of normal which is about 250-300.
Everybody has their best range of “TRT” to be on. You seem to be in the mid 300’s which is neither good or bad in itself. However, that may still be too low for you to feel at your best.
I would ask your physician to see if you could titrate up to 400-450 and see how you feel. You will certainly be able to tell if you feel better or not. Perhaps you might need to be up around 500 or so etc.
However, regardless of what you do, always have your blood markers checked regularly along with your PSA etc. You want to make sure that your Hematocrit levels don’t get to high or exceed 52!
Your Libido, overall muscle mass and psychological wellbeing are all easy to assess as you try different dosages of “T”
Best wishes and good luck

 

[jc2c]

I had good experience on Clomid until it stopped working. It worked very fast for me. Dr. Mohit Khera (in that podcast with Dr. Attia) talks about patients becoming non-responders if dosed daily. I dosed daily so that may be why my Clomid stopped working. I'd use enclomiphene + EOD dosing and try it if I were you.

 

[madman]

I've asked about clomid/Natesto...

Again, I've heard from doctors who say they do a 3month run of clomid to try and kickstart the system to producing more T - is clomid a one and one type of thing?

Same with Natesto? Are you basically on this for good if it drives T up?

Chances are slim, especially at your age.

Both would be used for the long-term as T levels will go back to baseline when you stop.

There is a small percentage of men who may respond to a short trial of clomiphene citrate to reboot the HPTA.

Younger men tended to do better.

Even then long-term high-quality RCTs on clomid/rebooting the HPTA are lacking.

Most giving clomid/hCG mono a go ends up jumping on TRT in the long run.




Key points here:

*We hypothesize that MH is a chronic irreversible condition in most cases, but in a selected group of patients, which Devoto and Aravena call mild hypothalamic dysfunction, a trial with CC could reboot the HPT axis

*Our study has some limitations worth discussing. About 40% of the subjects initially screened did not finish the follow-up and were excluded, of whom 40% kept symptomatic and 60% elected to change to testosterone therapy; however, this represents the real-life challenges that must be accounted for

*Based on current results, one in every four hypogonadal men with normal testicles may respond to a short trial of CC to "reboot" the HPT axis, with the potential for physiology maintenance, avoiding chronic treatment. Responders tend to be younger patients

*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

Clomid monotherapy to treat male hypogonadism- chronic treatment is needed in most patients

Testosterone kinetics on hypogonadal men under clomiphene (2022) Élcio Dias Silva · Maurício Moreira da Silva Jr · Tomas B. C. Moretti · Danilo L. Andrade · Natália Dalsenter Avilez · Leonardo O. Reis Abstract Objective To evaluate total testosterone (TT) kinetics and its predictors 6 months...

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*The main objective of our study was to elucidate which percentage of MH reversed by a 40-day CC treatment can sustain physiological TT levels in the midterm since scarce studies analyzed the kinetics of TT after stopping CC treatment.

Kaminetsky et al. reported that in patients with secondary hypogonadism who responded to enclomiphene citrate therapy, once the treatment was stopped, TT levels decreased and returned to the pre-treatment values [11]. The same happened in the Marconi et al. study, which reported decreased TT levels 3 months after discontinuation of CC treatment, 78% under the normal range. The six cases in which TT was in the normal range 3 months after CC discontinuation also dropped TT levels (to pre-treatment levels) 6 months after ending treatment [4].

Devoto and Aravena reported contrasting results in a subgroup of patients with functional hypogonadotropic hypogonadism who respond to CC therapy by maintaining normal TT levels 6 months after ending treatment [12]. Our study partially agreed with their data; 18 patients (24%) maintained asymptomatic and with TT levels over 300 ng/dl after 6 months of stopping the treatment, against the 12/16 (75%) of Devoto. This conflict could be due to the study draw since they just analyzed the patients who responded to a 10-day trial with CC and used a 6-month CC therapy. We hypothesize that MH is a chronic irreversible condition in most cases, but in a selected group of patients, which Devoto and Aravena call mild hypothalamic dysfunction, a trial with CC could reboot the HPT axis.

On behalf of drug safety and side effects, a long-term follow-up cohort demonstrates that CC is an oral therapy with durable efficacy and a favorable side effect profile in the long term up to 7 years. Only 36 men (9%) reported side effects in that cohort, the most common side effects were consistent with those reported in prescribing information. However, patients and providers should also be aware of the progressive need to monitor for symptoms of hyperestrogenemia while on sustained CC therapy [10].

Molecular studies show that CC is composed of two very different isomers, enclomiphene (EC), the trans-isomer (62%), and zuclomiphene, the cis-isomer (38%)—with potentially opposing effects. The first isomer has an estrogen antagonist effect, by preventing estrogen receptor-mediated negative feedback at the level of the pituitary and hypothalamus, while zuclomiphene acts as an estrogen agonist [13]. The trans-isomer is a very promising drug for MH, appearing to be responsible for the desired anti-estrogen effect of CC, offering significant elevations in T levels [11, 14].

This could result in the correction of testosterone levels and hypogonadal symptoms without suppressing spermatogenesis. In addition to the benefits mentioned above, enclomiphene lacks the estrogen receptor agonist activity seen with clomiphene citrate caused by the cisisomer zuclomiphene, which accumulates in the body and can take more than 6 months to be eliminated after discontinuation of treatment. This may mitigate some of the estrogenic side effects that some men can present and increase the potential beneficial effects [14, 15]. Unfortunately, due to the difficulty inherent in getting a new molecular entity approved by the FDA, the future of enclomiphene looks bleak at best [16].


*Our study has some limitations worth discussing. About 40% of the subjects initially screened did not finish the follow-up and were excluded, of whom 40% kept symptomatic and 60% elected to change to testosterone therapy; however, this represents the real-life challenges that must be accounted for.


Based on current results, one in every four hypogonadal men with normal testicles may respond to a short trial of CC to "reboot" the HPT axis, with the potential for physiology maintenance, avoiding chronic treatment. Responders tend to be younger patients. Baseline gonadotropins were not strong predictors of CC treatment response in hypogonadal men [2], thus not evaluated in our study.

A recent meta-analysis comprising 17 studies (four randomized controlled trials), with a total of 1279 patients has shown significant hormones, semen, and symptoms improvement in hypogonadal men during CC treatment, with<10% adverse events reported (none serious) [17]; however, more extensive prospective trials are needed to understand further the durability of the hormonal response to CC with time.

While little is known about CC’s effect on the intercellular signaling and testicular microenvironment, it modulates the inhibitory retro-control of steroids by interfering with ER in diverse targets, mainly the pituitary gland (LH, FSH production), preoptic area (libido), and the Leydig cell (testosterone production), recreating a balance between LH, FSH, T, and estrogen [18].




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.




Look over the CC/EC threads in post #7

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...

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Pulled a few out for you!

A paradoxical decline in semen parameters in men treated with clomiphene citrate (Clomid)

A paradoxical decline in semen parameters in men treated with clomiphene citrate Tejas Gundewar | Manish Kuchakulla | Ranjith Ramasamy Abstract Clomiphene, a selective estrogen receptor modulator, has been utilized in managing male sub-fertility since 1967. Numerous controlled and...

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5 | CONCLUSION

Treatment with clomiphene citrate can be associated with a decrease in semen count, concentration, motility, morphology, and total motile sperm count in up to 20% of patients. Among men who had a decline in semen parameters, 17% of them may not recover following discontinuation of therapy. The benefits of therapy should be weighed against potential negative impacts on fertility, and close follow-up should be maintained. More studies should report on the decline in semen parameters so the magnitude of this effect can be more easily measured by reproductive specialists in the future.

Clomid (Clomiphene Citrate) Treatment May Take Up to 9 Months to Show Max Sperm Response

Temporal Effects of Clomiphene Citrate on Testosterone and Semen Parameters (2022) TJiang, JSigalos, ASantamaria, NModiri, MZheng, VOsadchiy, RJayadevan, MIslam, JMills, SEleswarapu Introduction In men with secondary hypogonadism or impaired sperm concentrations, clomiphene citrate (CC) is...

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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.

Clomiphene May Take 9 Months to Fully Restore Sperm Count

Temporal Changes of Clomiphene on Testosterone Levels and Semen Parameters in Subfertile Men (2022) Tommy Jiang, John T. Sigalos, Vadim Osadchiy, Alvaro Santamaria, Michael H. Zheng, Neilufar Modiri, Keith V. Regets, Jesse N. Mills, Sriram V. Eleswarapu Purpose: Clomiphene citrate (CC) is...

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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.








Look over post #22

Hypogonadism 101

https://www.excelmale.com/forum/threads/testopel-%C2%AE-vs-generic-testosterone-pellets.22108/ https://www.excelmale.com/forum/threads/clinical-experiments-with-androgens-1939.22482/...

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Everything you ever wanted to know about Natesto!

Comparing Rates of Polycythemia in Hypogonadal Men Using Nasal T Gel Versus IM TC

Comparing Rates of Polycythemia in Hypogonadal Men Using Nasal Testosterone Gel Versus Intramuscular Testosterone: Update of a Randomized Clinical Trial (2022) Jesse Ory, Parris Diaz, Marco-Jose Rivero, Raul I. Clavijo, Nannan Thirumavalavan, Ruben Blachman-Braun, Justin Loloi, Ari Bernstein...

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Natesto lost effects quickly? nasal test

eh guys, tried Natesto I didn't squeeze the 10 doses out as they say to do as appeared to come out just fine first squeeze.. now, I only do 1 dose a day which was 100% all good as I felt energy confidence sex was better and lasted into the evening and even got better sleep... in fact even 1...

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Some more insight CC/Natesto!

Clomiphene to Natesto results

Converting men from Clomiphene Citrate to Natesto for hypogonadism improves libido, maintains semen parameters, and reduces estradiol Parviz K. Kavoussi M.D., G. Luke Machen M.D., Melissa S. Gilkey M.S., Shu-Hung Chen M.S., Keikhosrow M. Kavoussi M.D., Amy Esqueda R.N.C., M.S.N., A.P.R.N., J...

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Men converting from CC to Natesto with a desire to maintain spermatogenesis should be followed closely

Abstract Objective To report a case of a testosterone deficient man desiring maintenance of spermatogenesis converting from clomiphene citrate (CC) to Natesto, who had a decrease in gonadotropins and semen parameter values after making this medication change. The data on men maintaining...

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