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04-30-2012, 10:31 PM #1New Member
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Considering trying a Clomid restart prior to TRT
Hi. First post and I've been reading the forums for a bit.
I'm 46 and had my test levels tested in conjunction with my regular blood work.
My total T is low, free is in range but lower. Test results:
Testosterone , Serum 318 ng/dL [Low] range 348-1197
Free Testosterone(Direct) 8.3 pg/mL range 6.8-21.5
DHEA-Sulfate 112.6 ug/dL range 44.3-331.0
Estradiol 10.0 pg/mL range 7.6-42.6
TSH 2.980 uIU/mL range 0.450-4.500
Did not test LH and FSH.
I have BPH and a high PSA. Take Flomax daily for BPH. Just had a biopsy a month ago and it came back fine.
My symptoms are real, but not severe:
* Some brain fog,
* Some decreased libido, but not terrible.
* Some limited ED, but occasional only. Gets up fine, but doesn't stay occasionally.
* Some tiredness.
* I've retained my strength and body comp.
* Testes look full and don't hurt.
Saw my urologist today. BTW - I really like him and he is a top rated urologist. Of course that doesn't mean he's a top notch TRT guy.
He stated that he has prescribed TRT to many hundreds of patients. He, himself, is on Androgel . He was not concerned about my BPH while on Test. He told me that he's only taken one patient off of TRT because of increased BPH.
He is a fan of Androgel and does not prefer injections because of the hassle for patients. He does not prescribe HcG and only prescribes an AI when indicated.
He prescribed Androgel 1.62% at 3 pumps per day for me. I have a follow up scheduled in 3 months.
I'm considering trying a Clomid restart to see if I can avoid the long term commitment of TRT. Any thoughts appreciated.
I also would appreciate the protocol for a Clomid restart. I have found the protocol for PCT and wondering if it's any different for my purposes. Thanks.Last edited by DVC; 05-01-2012 at 06:59 AM.
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04-30-2012, 11:01 PM #2Banned
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Thanks for the informative, well written first post!
To help you, we really need the LH / FSH panels taken. This will help confirm if you are primary or secondary hypogonadal. Here's the deal, if you get on a Clomid protocol, then essentially what you're trying to accomplish is getting the HPTA functioning with LH & FSH production. In turn, that would trigger endogenous production with your testes. However, let's say your condition is primary, meaning failure at the testes level, then that would mean that your LH/FSH is more than likely elevated. It all works on a negative feedback loop. So, if your testes are not receptive to the LH signal at this time, adding a compound to produce more LH will just be redundant, and not healthy on a pituitary gland that might potentially already be overproducing these hormones.
At your age it's more than likely secondary, but I wouldn't speculate, I would find away to know for sure. E2 is definitely on the low side ... Any noticeable sides (fatigue, low libido, joints, ...)?
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05-01-2012, 05:08 AM #3Knowledgeable Member
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I tried the Clomid thing. It worked ok while I took it. Took it for several months. The problem I had was 1) it was only good while I was on it and once I stopped my Test went back down; 2) it killed my libido!
Some others in the past on this board have done the Clomid therapy w/o success. Not everyone has the libido issue from it, but many do. Something to consider.
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05-01-2012, 06:22 AM #4
also think it was a great first post
symptoms sound like me at age 36 unfortunately and 7 years later no regrets being on a shot a week
i havent heard a lot of posts with ppl in their 40's trying to fully recover rather than going on trt nor would I consider it knowing what trt can/has done and how easy it is BUT it IS a personal decision
welcome and best of luck
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05-01-2012, 06:58 AM #5New Member
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Thanks for the replies and the welcome!
I am having my LH and FSH tested today and should have the results in a few days. Thanks.
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05-01-2012, 07:05 AM #6New Member
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Yes - all of the above but not too bad. Where I really see the fatigue is in my Muay Thai classes at the gym. They are very intense contact-based classes and we usually spar towards the end of class. That is where I have recently noticed my stamina is not what it used to be - and a bad time to run out of gas!
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If I could personally start over, I would do a clomid option before T. I actually did transdermal testosterone as well. Didn't go that well at all.
However, fertility is important to me and that's a big reason I would prefer something like clomid or an AI. At 46, and if you don't want kids in the future, then testosterone would be your best bet, but that doesn't mean it's the only thing that will give you good results - just on average.
Testosterone is a far more cumbersome commitment, however, like you stated. You must see a physician yearly, must get a schedule 3 drug, must get a good doctor to work with you, must apply daily or inject regularly. With clomid, it's as easy as taking a vitamin.
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05-02-2012, 08:58 AM #8New Member
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Thanks for you reply HRTstudent. At 46, I have two great kids and fertility is something that no longer matters for me. Two kids are enough to have to put through college!
I should have my LH and FSH tests back hopefully by week's end. If those are low, my plan is definitely to try a clomid restart. If they are not low, I will be back asking more questions regarding whether a clomid restart is worthwhile trying.
I'm currently trying to figure out what protocol to use for a clomid restart in my situation. There's plenty of data for clomid protocol for PCT for guys ending an AAS cycle. Based on some of my reading, I don't think I need such high levels of clomid for my purposes but looking for advice on that protocol.
Any thoughts on that clomid protocol? Thanks.
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05-02-2012, 09:19 AM #9
Also talk to your doc about your tsh level. It's high. New standards are .3 - 3.0, not what is still on a lot of blood results. Do you have T3 and T4? Hypothyroidism can put you at risk of low test. Also take a look into Cialis for daily use to help with BPH. It has a lot of other benefits also. Read the below:
http://www.fda.gov/NewsEvents/Newsro.../ucm274642.htmLast edited by kelkel; 05-02-2012 at 09:36 AM.
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05-02-2012, 09:35 AM #10New Member
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Originally Posted by kelkel;5996***Last edited by DVC; 05-02-2012 at 09:38 AM.
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05-02-2012, 09:46 AM #11New Member
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Wow - got my test results back in one day.
FSH 3.2 mIU/mL normal range 1.5-12.4 MB
LH 4.0 mIU/mL normal range 1.7-8.6 MB
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05-02-2012, 12:16 PM #12
If T4 & T3 are low the pituitary will produce more TSH in effort to normalize your system. Read this excerpt:
Diagnosing all types of hypothyroidism is important, because treatment with thyroid hormone will improve symptoms in patients with hypothyroidism, but is unlikely to help those who do not have hypothyroidism. In primary hypothyroidism, the thyroid gland, located in the neck, is less able to produce the thyroid hormones, T4 and T3. The pituitary gland, located in the head, responds to this deficiency by secreting more TSH. Thus, in more mild cases of primary hypothyroidism, T4 and T3 levels are normal, but the TSH is high. In more severe cases, T4 and T3 levels drop. Although the normal range for TSH is often between 0.5 and 5 mU/mL, values at the high end of the normal range may be abnormal. T3 is the more bioactive hormone compared to T4, but T4 is more stable in the circulation.
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There is someone who is using the nolvadex /tamxifen restart with really good results. They just posted a couple weeks ago. It's similar to clomid.
The dosing of clomid is probably far less than what you read about on "steroid " forums. I tend to tell people to just ignore what they read there - it's far more likely to confuse you than help you. They also have far different goals than people on TRT - purely physique/strength vs quality of life.
If you would update us on your protocol I think it would be useful for many people here.
Judging by those numbers, if I was in your position I would be trying the clomid for a few months and take it from there.
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05-02-2012, 02:40 PM #14New Member
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05-02-2012, 07:13 PM #15
Good advice above. Take a look at this and see if you can glean some info from it that will help your particular case:
http://forums.steroid.com/showthread...Which-for-what
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05-02-2012, 09:54 PM #16Banned
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Hmmm, I don't know ... Your LH isn't all that bad IMO. Truthfully, based on the testosterone serum score you provided, I would have expected the LH to be in the low 2's, maybe high 1's. The whole point of Clomid is to restart a suppressed HPTA. It's just my opinion (for whatever that's worth), but I don't view your HPTA to be suppressed, at least to the point of needing Clomid therapy. I've seen guys with similar LH scores having 500+ serum scores.
This isn't to say that maybe your LH couldn't be a point or two higher, and things would be more optimal. However, I'm not convinced that part of your condition might also be testicular related (or at least partially), and truthfully I just don't see Clomid therapy doing anything miraculous to your HPTA that's going to increase and sustain endogenous production to a level that will be appreciated, especially considering you are 46yo. Don't feel bad, I'm 45 and was out of the game around 40.
That's just my .02, so if you can somehow get Clomid to give you a total test serum level of 600 or more, then all the power to it! If so, take labs right after the protocol, then again after another 6 to 8 weeks after being off of Clomid.
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05-02-2012, 09:58 PM #17New Member
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Thanks kekel. That thread contained this study: Clomid raises test in hypogonadism men by 146%: [apparently I can't put links in my post because I'm a new member with <25 posts. Sorry]
Which also lead me to a more recent, similar study: Clomiphene citrate is safe and effective for long-term management of hypogonadism: [apparently I can't put links in my post because I'm a new member with <25 posts. Sorry]
It looks like 25 mg is the base line used. Something that's not addressed is the effect on natty test if the patient stops taking clomid.
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05-02-2012, 10:11 PM #18New Member
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I'd take 500+! Interesting that the LH level are pretty OK.
I might try 25 mg of clomid for 6 weeks and get a reading. Four - six weeks was the initial eval period when T was remeasured in the first study cited in my post.
QUESTION: is the liquid clomid offered by the research companies (such as forum advertiser ar-r ) effective as the pill form? If not any suggestions appreciated (I don't want to run afoul of any "no source checks" rules, etc).
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05-02-2012, 10:39 PM #19Banned
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First, I'll vouch for AR-R and their products. Although, I've never used their Clomid, I've read plenty of threads over the years where it was tremendously successful. I've used several of their other products, it's the real deal! Take that to the bank!
If you go with the clomid, then definitely take the labs (LH/FSH, total & free test), but go back again two months after that and see if it's sustained.
Another thought ... Take this information to a good HRT doctor (A4M) and have him/her interpret this to you. Plenty of these doctors will go the Clomid route if they believe it will work. So, their experiences will probably be able to advise you if this is the correct path to take, and/or what success ratio you probably have.
I'm pulling for you, but considering everything presented, I just don't have the faith as others do in the Clomid therapy. IMO, I think you will be looking at HRT if you want to sustain serum levels above 500, but again, that's just my .02 amongst many knowledgeable members. Do as much research as you can ...
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05-03-2012, 08:05 AM #20
Well said Vette!
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05-03-2012, 09:43 AM #21New Member
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Gents - I sincerely appreciate your thoughts and help.
I have decided to give the clomid restart a try. If it's not successful, I will take the next step into TRT.
As soon as I get the clomid, I'll report and track my progress in this thread.
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05-03-2012, 01:14 PM #22
Please keep this thread alive. Very relevant!
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05-04-2012, 12:37 PM #23
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05-04-2012, 12:51 PM #24New Member
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Thanks for the replies.
I'm trying to get up to 25 posts so I can post links for some clomid studies. Absent the ability to post a link, here's the summary on a study on long term Clomid therapy:
Clomiphene citrate is safe and effective for long-term management of hypogonadism
Daniel J. Moskovic,
Darren J. Katz,
Ardavan Akhavan,
Kelly Park,
John P. Mulhall*
Article first published online: 28 MAR 2012
DOI: 10.1111/j.1464-410X.2012.10968.x
What's known on the subject? and What does the study add?
Clomiphene citrate (CC) has previously been documented to be efficacious in the treatment of hypogonadism. However little is known about the long term efficacy and safety of CC. Our study demonstrates that CC is efficacious after 3 years of therapy. Testosterone levels and bone mineral density measurement improved significantly and were sustained over this prolonged period. Subjective improvements were also demonstrated. No adverse events were reported.
OBJECTIVE
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To assess the efficacy and safety of long-term clomiphene citrate (CC) therapy in symptomatic patients with hypogonadism (HG).
PATIENTS AND METHODS
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Serum T, oestradiol and luteinizing hormone (LH) were measured in patients who were treated with CC for over 12 months.
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Additionally, bone densitometry (BD) results were collected for all patients. Demographic, comorbidity, treatment and Androgen Deficiency in Aging Men (ADAM) score data were also recorded.
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Comparison was made between baseline and post-treatment variables, and multivariable analysis was conducted to define predictors of successful response to CC.
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The main outcome measures were predictors of response and long-term results with long-term CC therapy in hypogonadal patients.
Patients were commenced on CC 25 mg every other day and were titrated to 50 mg every other day based on the treatment serum T level. The target total T level was arbitrarily set at 550 +/- 50 ng/dL.
RESULTS
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The 46 patients (mean age 44 years) had baseline serum testosterone (T) levels of 228 ng/dL.
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Follow-up T levels were 612 ng/dL at 1 year, 562 ng/dL at 2 years, and 582 ng/dL at 3 years (P < 0.001).
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Mean femoral neck and lumbar spine BD scores improved significantly.
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ADAM scores (and responses) fell from a baseline of 7 to a nadir of 3 after 1 year.
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No adverse events were reported by any patients.
CONCLUSIONS
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Clomiphene citrate is an effective long-term therapy for HG in appropriate patients.
•
The drug raises T levels substantially in addition to improving other manifestations of HG such as osteopenia/osteoporosis and ADAM symptoms.
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05-16-2012, 07:09 AM #25New Member
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Update - started clomid two days ago at 25 mg ED. I will get blood work done somewhere in the 4-6 week range.
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05-16-2012, 09:09 AM #26Associate Member
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I think it`s smart to give it a shot and see if it works.
I also did a trial with 25 mg per day and initially I got a great boost, but the bloodwork indicated that my free testosterone had not really increased by much because of increased SHBG, so I wonder if it may have been placebo. Who knows.
I`ve read a lot of mixed results about clomiphene therapy, but there are quite a few success stories and also several successful clinical trials where it stood side by side with exogenous testosterone. Some smart doctors also use it to diagnose whether you are primary or secondary.
Good luck!
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05-16-2012, 10:21 AM #27
Re your SHBG, add Vit D as well as stinging nettle root or avenacosides to help reduce it. Most people are low on D so make sure you get it tested on your next BW. Mine runs high to and it's what I'm doing. Will be testing soon to check progress.
http://www.ncbi.nlm.nih.gov/pubmed/20050857
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hey dvc , pm me a message, i cant send you a message because your account setings, id like to keep in touch im going thru the exaact situation as you and would love to find out how it progresses with you.
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Nice study DVC....
some related study that is very pertinent:
Clomiphene citrate and testosterone gel repla***ent therapy for male hypogonadism: efficacy and treatment cost.
http://www.ncbi.nlm.nih.gov/pubmed/19694928
Abstract
INTRODUCTION:
The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported.
AIM:
The aim of this article is to evaluate CC and testosterone gel repla***ent therapy (TGRT) with regard to biochemical and clinical efficacy and cost.
MAIN OUTCOME MEASURES:
The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy.
METHODS:
Men receiving CC or TGRT with either Androgel 1% or Testim 1% for hypogonadism (defined as testosterone < 300 ng/mL) or MI were included. Serum values were collected 1-2 months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire.
RESULTS:
A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8-40 months) vs. 46 months (TGRT, range 6-149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value < 0.001). The monthly cost of Testim 1% (5 gm daily) is $270, Androgel 1% (5 gm daily) is $265, and CC (50 mg every other day) is $83. Among CC patients, the average pretreatment ADAM score was 4.9 vs. 2.1 at follow up (P < 0.05). Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up (P < 0.05). There were no adverse events reported.
CONCLUSION:
CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT.
and
Outcomes of clomiphene citrate treatment in young hypogonadal men.
http://www.ncbi.nlm.nih.gov/pubmed/22044663
Abstract
Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Hypogonadism is a prevalent problem, increasing in frequency as men age. It is most commonly treated by testosterone supplementation therapy but in younger patients this can lead to testicular atrophy with subsequent exogenous testosterone dependency and may impair spermatogenesis. Clomiphene citrate (CC) may be used as an alternative treatment in these patients with hypogonadism when maintenance of fertility is desired. This study shows that CC is a safe and efficacious drug to use as an alternative to exogenous testosterone. Not only have we validated previous findings of other papers but have proven our findings over a much longer period (mean duration of treatment 19 months). This prospective study is the largest to date assessing both the objective hormone response to CC therapy as well as the subjective response based on a validated questionnaire.
OBJECTIVE:
• To prospectively assess the andrological outcomes of long-term clomiphene citrate (CC) treatment in hypogonadal men.
PATIENTS AND METHODS:
• We prospectively evaluated 86 men with hypogonadism (HG) as confirmed by two consecutive early morning testosterone measurements <300 ng/dL. • The cohort included all men with HG presenting to our clinic between 2002 and 2006 who, after an informed discussion, elected to have CC therapy. CC was commenced at 25 mg every other day and titrated to 50 mg every other day. The target testosterone level was 550 ± 50 ng/dL. • Testosterone (free and total), sex hormone binding globulin, oestradiol, luteinizing hormone and follicle stimulating hormone were measured at baseline and during treatment on all patients. Once the desired testosterone level was achieved, testosterone/gonadotropin levels were measured twice per year. • To assess subjective response to treatment, the androgen deficiency in aging males (ADAM) questionnaire was administered before treatment and during follow-up.
RESULTS:
• Patients' mean (standard deviation [sd]; range) age was 29 (3; 22-37) years. Infertility was the most common reason (64%) for seeking treatment. The mean (sd) duration of CC treatment was 19 (14) months. • At the last evaluation, 70% of men were using 25 mg CC every other day, and the remainder were using 50 mg every other day. • All mean testosterone and gonadotropin measurements significantly increased during treatment. • Subjectively, there was an improvement in all questions (except loss of height) on the ADAM questionnaire. More than half the patients had an improvement in at least three symptoms. • There were no major side effects recorded and the presence of a varicocele did not have an impact on the response to CC.
CONCLUSION:
• Long-term follow-up of CC treatment for HG shows that it appears to be an effective and safe alternative to testosterone supplementation in men wishing to preserve their fertility.Last edited by HRTstudent; 05-28-2012 at 09:37 PM.
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05-29-2012, 01:09 PM #30New Member
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05-29-2012, 01:23 PM #31New Member
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Update: I have been on CC for just over two weeks.
Sides: It has killed my libido. I am also emotional. I was fighting back tears watching the end of The Blind Side yesterday Also feel generally "down." I cut the dose from 25 mg ED to 12.5 mg ED (cutting the pills in half). The decrease helped the sides but didn't remove them. I need to be a little careful in drawing conclusions because I've also had a cold and cough for the last week.
I will continue on 12.5 and have blood test in a week or so.Last edited by DVC; 05-29-2012 at 01:42 PM.
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keep the feedback coming, im very interested
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05-29-2012, 07:09 PM #33New Member
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I lifted for the first time since having my cold/cough today. I thought I would be weak, but actually felt strong. Completely anecdotal of course . . .
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05-30-2012, 05:07 AM #34Associate Member
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I would give it some time.
Personally, I had no side effects on 25 mg per day, but I`ve heard of guys who could not do more than 12,5 per day and even EOD.
For me, libido actually improved some and my body felt stronger, not strange since it was very low before starting, but the libido issue is not rare with guys using clomid.
If you respond positively, i.e., increased testosterone levels , but still do not feel good on clomid, you`re probably a good candidate for HCG which you may respond differently to.
Keep us updated.
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Last edited by Simon1972; 05-30-2012 at 05:57 AM.
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05-30-2012, 10:43 AM #36Associate Member
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After reading some PUBMED articles, I convinced my doctor to let me try 25 mg clomiphene per day, since my LH/FSH was low in addition to low testosterone . It was the first time she ever heard of the treatment and here in Norway it is only known as fertility medicine for women.
Testosterone rose from 13,0 to 17,6, which is still not very high. I felt much better for a while, even though the bloodwork showed that free testosterone was pretty much unchanged because of increased SHBG. Eventually, the effects seemed to wear off and my doctor did not want to renew my prescription having read that there was a risk of ovarian cancer with women using it long-term. I did not argue, since I did not feel much better at that point.
Tried it one more time this year along with DHEA, but did not feel any better after 2 weeks, even worse, so I just quit. My blood work responded MUCH better to HCG .
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us guys need to watch out for that ovarian cancer!
but seriously, thanks for sharing your experience. I'd like to see more on the clomid stand-alones.
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05-30-2012, 05:08 PM #38Associate Member
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I considered telling her that I don`t think I have ovaries, but I figured she probably knew that. Then again, this is the same female doctor who googled "testosterone " in front of my very eyes telling me she does not know much about that stuff.
There is a reason we don`t hear that much about clomid and I think it`s called money. I`ve read quite a few promising studies and anecdotal reports on the internet, but consensus from users experience is that it is typically a hit or miss. Some feel great, but experience zero libido.
Clomifene citrate has been found very effective in the treatment of secondary male hypogonadism in many cases.[3] This has shown to be a much more attractive option than testosterone repla***ent therapy (TRT) in many cases because of the reduced cost and convenience of taking a pill as opposed to testosterone injections or gels.[4] Unlike traditional TRT it also does not shrink the testes and as a result can enhance fertility. Traditional TRT can render a man sterile (although with careful monitoring and low-dose hCG as an adjunct, this is both preventable and reversible for most men).[5] Because clomifene citrate has not been FDA approved for use in males it is prescribed off-label. According to Professor Craig Niederberger, because this drug is now generic, no drug company would pursue FDA approval for use in men now because of limited profit incentive, mostly due to the relatively small market potential.[6] However, the single isomer of clomifene "enclomiphene" under the brand name Androxal is currently under phase 2 trials for use in men.[7][8]
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LOL... I wouldn't even go back to that doctor and I'm being 100% serious. That's bad news... are you going to trust her medical expertise if something goes slightly off (and it's more than likely to happen!)?
Also, you are right about clomid... no money. Meanwhile, there is a new androgel (or other gel) study coming out regularly just in time when the old patents are about to expire!
Pretty sad, but you're right in that there are some seriously good studies pointing to the efficacy of clomiphene citrate solo. It sure would be nice to simply pop some clomid EOD than go through all the baggage that comes with Testosterone...
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05-31-2012, 03:05 AM #40Associate Member
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Well, at least she admitted that she lacked knowledge in that area, unlike my arrogant prior GP who told me everything was "normal" and that I should calm down. The same doctor that told me I had no reason to worry about bottom-range LH because that is a ladies hormone.
I then called a specialist in the private sector (we have public health care in Norway) who was supposed to be good, but he pretty much simply mocked me and said I should stop feeling inferior in the gym, because all of those guys are probably on steroids anyway. And that was without me even mentioning anything about the gym. His advice: Move to the city and have more girls in my daily life. That should do it.
My current GP, while liberal, is also pretty much clueless, with claims about exogenous testosterone being able to fire up my own production and so on. I have not been to an endocrinologist yet, but from what I`ve heard, most of them are just the same. So, I`m essentially self-medicating myself and persuading the doctor in my desired direction. Not ideal, but it`s all I got for now.
Did you never try clomiphene citrate? Androxal might be interesting when (if) it comes out.
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