Clomiphene citrate is safe and effective for long-term management of hypogonadism.

[AD]

hi guys,

has this article, or this topic, been discussed before?





BJU Int. 2012 Nov;110(10):1524-8. doi: 10.1111/j.1464-410X.2012.10968.x. Epub 2012 Mar 28.
Clomiphene citrate is safe and effective for long-term management of hypogonadism.
Moskovic DJ, Katz DJ, Akhavan A, Park K, Mulhall JP.

Source
Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Abstract

Study Type - Therapy (population cohort) Level of Evidence 2a 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:

•  To assess the efficacy and safety of long-term clomiphene citrate (CC) therapy in symptomatic patients with hypogonadism (HG).

PATIENTS AND METHODS:

•  Serum T, oestradiol and luteinizing hormone (LH) were measured in patients who were treated with CC for over 12 months. •  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. •  Comparison was made between baseline and post-treatment variables, and multivariable analysis was conducted to define predictors of successful response to CC. •  The main outcome measures were predictors of response and long-term results with long-term CC therapy in hypogonadal patients.

RESULTS:

•  The 46 patients (mean age 44 years) had baseline serum testosterone (T) levels of 228 ng/dL. •  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). •  Mean femoral neck and lumbar spine BD scores improved significantly. •  ADAM scores (and responses) fell from a baseline of 7 to a nadir of 3 after 1 year. •  No adverse events were reported by any patients.

CONCLUSIONS:

•  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.

© 2012 BJU INTERNATIONAL.

[Brohim]

That was low dose clomid. 50mg EOD - which shows you don't need a huge amount to boost natural Test level's. High doses of Clomid can cause vision problem's which is why I don't recommend going over 50mg during PCT.

[AD]

i thought the conclusion seems rather bold. i'm almost certain nobody here is on clomid. everyone is on test, one form or another.

has anyone tried this? clomid as "trt"?

[kmms]

"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 replacement 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."-wiki

i know we don't talk about prices here but i've personally found the wiki statement above regarding pricing to be the complete opposite.

what i just spent for 12wks worth of test e (500mg/wk) was nearly the exact same as a 10 day supply of clomiphene citrate @50mg per day. that was sticker price at the pharmacy.

i'll stick to test again.

[AD]

hi kmms, the price comparison you quoted seems a little extreme. where i come from, 10tabs of 50mg generic clomid cost the same as only a 1ml shot of test c(100mg/ml). but prices are definitely highly dependent on location.

what about the efficacy? anyone got any experience with clomid as "trt"?

[lovbyts]

Price is probably dependent on your location and availability.

Interesting subject and study. It would be interesting to see a longer study saying 3+ years.

[jasondd1]

I have been on test compounding cream and HCG for 2-3 months. I am about to get my levels checked and i am seriously considering trying a combo of HCG and Clomid instead of test cream/HCG. If it does not work i can go back to test but if it does it seems to be a better alternative to me. Am i missing something here? It seems like a no lose situation?

[jimmyinkedup]

I recently read this on another forum.
i think its good that all options are explored when it comes to test deficiency and i also think its good someone did a study on what guys like scally and guay have been saying for a long time re: clomid and its effects on T and restarting T production etc.
good post.

[HRTstudent]

There is a lot of strong evidence for clomid boosting T.

Unfortunately, many people take too much, thus they get too many sides. Beyond that, however, is the paradoxical phenomenon that men who take clomid or even aromatase inhibitors DO get the boost in testosterone , but they often do NOT get the subjective benefits of a higher testosterone. It is quite well known in the medical HRT community and even in the literature. We don't exactly know why this is, but for this reason you often see people go straight onto T.

If I could start my TRT over, I would actually opt for low dose clomid. There are tradeoffs, but clomid has so many advantages over testosterone. The end of it is, however, how good you feel on one vs the other. IMO, it's easier to start on clomid then switch to TRT than it is to do the reverse. (It's a shame we typically don't know this stuff when we begin!)

[jimmyinkedup]

There is a lot of strong evidence for clomid boosting T.

Unfortunately, many people take too much, thus they get too many sides. Beyond that, however, is the paradoxical phenomenon that men who take clomid or even aromatase inhibitors DO get the boost in testosterone, but they often do NOT get the subjective benefits of a higher testosterone. It is quite well known in the medical HRT community and even in the literature. We don't exactly know why this is, but for this reason you often see people go straight onto T.

If I could start my TRT over, I would actually opt for low dose clomid. There are tradeoffs, but clomid has so many advantages over testosterone. The end of it is, however, how good you feel on one vs the other. IMO, it's easier to start on clomid then switch to TRT than it is to do the reverse. (It's a shame we typically don't know this stuff when we begin!)

This is a great point and you see it echoed often by those that try clomid treatment. Ultimately you are right...regardless of the numbers it is a quality of life issue.

[TennTarheel]

This is definitely intriguing, especially since I am still weighing my options as I hunt down a good doc. So many variables and options to look at. I guess the gist of it is that everybody is unique in what they respond better or worse to and at whatever doseage. Hormone therapy is definitely a scientific art that continues to evolve. Yeah, that was profound lol

[AD]

Hi HRTstudent, according to this study, they claim to have observed improvement in patients' subjective symptoms too, as evident in the improvement in ADAM score pre and post treatment. Although it wasnt stated whether this improvement was stat significant.

[Lifted1]

There is a lot of strong evidence for clomid boosting T.

Unfortunately, many people take too much, thus they get too many sides. Beyond that, however, is the paradoxical phenomenon that men who take clomid or even aromatase inhibitors DO get the boost in testosterone , but they often do NOT get the subjective benefits of a higher testosterone. It is quite well known in the medical HRT community and even in the literature. We don't exactly know why this is, but for this reason you often see people go straight onto T.

If I could start my TRT over, I would actually opt for low dose clomid. There are tradeoffs, but clomid has so many advantages over testosterone. The end of it is, however, how good you feel on one vs the other. IMO, it's easier to start on clomid then switch to TRT than it is to do the reverse. (It's a shame we typically don't know this stuff when we begin!)

what subjective benefits do you not get by boosting T levels with clomid? interested because im getting my bw done tomorrow and will most likely be starting trt very soon. I would like to explore all my options. thanks

[AD]

here's another study from the same investigators, looking at younger patients, over a slightly shorter follow-up period. this one also claims an improvement to symptom scores.




BJU Int. 2012 Aug;110(4):573-8. doi: 10.1111/j.1464-410X.2011.10702.x. Epub 2011 Nov 1.

Outcomes of clomiphene citrate treatment in young hypogonadal men.
Katz DJ, Nabulsi O, Tal R, Mulhall JP.

Source

Male Sexual and Reproductive Medicine Programme, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

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.

© 2011 BJU INTERNATIONAL.

[jasondd1]

Does anyone have the protocol that has been mentioned here before regarding HCG and Clomid?

[lovbyts]

here's another study from the same investigators, looking at younger patients, over a slightly shorter follow-up period. this one also claims an improvement to symptom scores.




BJU Int. 2012 Aug;110(4):573-8. doi: 10.1111/j.1464-410X.2011.10702.x. Epub 2011 Nov 1.

Outcomes of clomiphene citrate treatment in young hypogonadal men.
Katz DJ, Nabulsi O, Tal R, Mulhall JP.

Source

Male Sexual and Reproductive Medicine Programme, Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

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.

© 2011 BJU INTERNATIONAL.

What were these symptoms? (besides height) Are they talking about number or real life how you feel? Weight loss, muscle gain, sexual performance?

[AD]

What were these symptoms? (besides height) Are they talking about number or real life how you feel? Weight loss, muscle gain, sexual performance?

the ADAM (Androgen Deficiency in Aging Male) questionnaire is a list of 10 questions with yes/no answers.

1. Do you have a decrease in libido (sex drive)?
2. Do you lack energy?
3. Is your strength or endurance decreased?
4. Have you lost height?
5. Have you noticed decreased "enjoyment of life"?
6. Are you sad or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Do you fall asleep after dinner?
10. Has there been a deterioration in your work performance?

[AD]

Does anyone have the protocol that has been mentioned here before regarding HCG and Clomid?

i have no access to the full text, but from the extracts, the protocol seems rather simple. baseline bloodwork is done to confirm diagnosis. ADAM questionnaire is also done pre-treatment. start clomid 25mg eod. repeat bloodwork is done to assess response to treatment. but the interval for checking bloodwork is not clearly stated. i assume 6-12wks after starting treatment. notice that they are aiming for the mid-range of normal, around total test of 550. if this is not achieved, the dose of clomid is increased to 50mg eod. that seems to be the max dose that was studied.

[jasondd1]

I seem to remember someone posting something that included HCG , Clomid as well as several other things. it wasn't from a study but form some Dr's own protocol. Maybe Crisler?

[HRTstudent]

what subjective benefits do you not get by boosting T levels with clomid? interested because im getting my bw done tomorrow and will most likely be starting trt very soon. I would like to explore all my options. thanks

It's not that a specific person will not get the subjective benefits. But as a population, it doesn't work as well as TRT.

I totally do not discourage clomid treatment. I would start over if I could and try clomid first. because hey, if it worked for me then I don't have to deal with all the baggage that goes with testosterone and far less medical/insurance "junk" to bother me. And it's easy to switch from clomid to injections if it doesn't work. it's a lot "harder" to come off TRT because you basically need to go through a brief period of time (months) where your hormonal status is in great flux as it tries to ramp production back up. Clomid is not suppressive like testosterone.

[Juced_porkchop]

i thought the conclusion seems rather bold. i'm almost certain nobody here is on clomid. everyone is on test, one form or another.

has anyone tried this? clomid as "trt"?

I have seen the studies showing positive results, but inless trying to conceive I would rec test hrt + pregnenoloneand DHEA supplementation.

I cant see feeling very good on it. but I have not tried it.

[Lifted1]

It's not that a specific person will not get the subjective benefits. But as a population, it doesn't work as well as TRT.

I totally do not discourage clomid treatment. I would start over if I could and try clomid first. because hey, if it worked for me then I don't have to deal with all the baggage that goes with testosterone and far less medical/insurance "junk" to bother me. And it's easy to switch from clomid to injections if it doesn't work. it's a lot "harder" to come off TRT because you basically need to go through a brief period of time (months) where your hormonal status is in great flux as it tries to ramp production back up. Clomid is not suppressive like testosterone.

thanks for the reply. i like the idea of having options that might work just as well, without the hassles of injecting testosterone .

[HRTstudent]

thanks for the reply. i like the idea of having options that might work just as well, without the hassles of injecting testosterone.

...injecting, extreme medical reliance, having a good doctor, greater potential for side effects, cost... those are the easy to identify ones.

If I KNEW clomid would give me the same effect as testosterone , I'd switch tomorrow. Unfortunately, if I want to find out if it does, I'd need to go through a month of pure shit then slowly get back to baseline and tinker with dosages after I'm finally making TRT worthwhile. It's just too much roller coaster for me to tackle at the current juncture.

[jasondd1]

Anybody got anything on HCG and Clomid combo instead of TRT?

[Badidea]

I've been on low dose clomid for almost 5 months. 12.5mg m,w,f. Free test has been staying close to 30. Total test has been ~1100. Basically doubled or better from where I began. Feel great. Getting stronger and much leaner. Best decision I've ever made in terms of health and well being. I believe the key with this drug is it only takes a small amount to trigger an Lh increase.

[Haritec]

God I hope the clomid I ordered online makes it into Canada and to my door. This is the last ditch effort for me to avoid TRT - hoping clomid gives similar results to what Badidea is getting.

[Badidea]

If it shows up, remember that this is not going to yield remarkable results over night. Be patient and don't be tempted by the usual more is better thought process (I am usually guilty of this). After two months I felt a ton better and after four months I started to see it in the mirror. I like the fact I'm producing my own testosterone . So far no issues with elevated E (strong morning wood and great libido, although I've never had any libido/Ed issues).

[AD]

If it shows up, remember that this is not going to yield remarkable results over night. Be patient and don't be tempted by the usual more is better thought process (I am usually guilty of this). After two months I felt a ton better and after four months I started to see it in the mirror. I like the fact I'm producing my own testosterone. So far no issues with elevated E (strong morning wood and great libido, although I've never had any libido/Ed issues).

thats great to know, man! you seem to be one of the first members here to have a positive result from clomid. its good to see that the results from research does correspond with real-life experiences.

[GFA]

I did the clomid stimulation test like 10 years ago. It did bring my test levels from around 300 to 700ish. This was after 2 weeks @50mg x2 a day I believe. I had vision problems though. I might be willing to try it again at a much lower dose like 25mg EOD or less.

Here is a blurb from another site that described the protocol.

A Clomid stimulation test is a standard protocol that has been used by
endocrinologists for years to test whether a man's hypogonadism is
primary or secondary. If the test is successful (i.e., if your T rises
significantly), that means that all of the organs in the feedback loop
(the testicles, pituitary and hypothalamus) are healthy and functional,
but for some unknown reason the system has gone dormant. A
successful test result also means that you are a good candidate for
HCG or Clomid, which in contrast to standard TRT, stimulate your
body to produce its own T. See:

Clomid (Clomiphene Citrate) doesn't lower estrogen; it "blocks" it.
Estrogen attaches to the receptors in the hypothalamus and that
signals that there's enough T in your blood, so your body reduces
its T production. Somehow the hypothalamus reacts to E as well
as T. Clomid attaches to these receptors but doesn't act like E.

I did a Clomid stimulation test in November 1999. Dr. Shippen gave me
100 mg/day (one 50 mg tablet in the morning and one in the evening
before bed) for a week. I took a blood test on the morning after the
last day. My test was successful, in that, my T went from about 200 to
600.

Clomid is most often used to promote fertility in women. Therefore, if
you research Clomid, the vast majority of the literature you find will
discusses the use of Clomid by women rather than men. In fact, when I
went to fill the prescription, the pharmacist was very leery and asked
me a lot of questions before dispensing the drug.

[AD]

I did the clomid stimulation test like 10 years ago. It did bring my test levels from around 300 to 700ish. This was after 2 weeks @50mg x2 a day I believe. I had vision problems though. I might be willing to try it again at a much lower dose like 25mg EOD or less.

that was a rather high dose, for a rather short duration. it must have been done more like a stimulation-test, than actual long term therapy. but good to hear that it worked for you.

so what treatment are you on since the clomid-test?

[Java Man]

This thread needs a bump!

I wasn't a member yet when this first went up so didn't see it. I do not have a low t problem that I know of but I do not know for sure. If I do, it would be secondary. I know my loop works. I've been on hcg for almost a year without a break. I have also cycled twice in that time. By my own assessment my loop is in fine shape but I'm getting a full hormone panel when I have been natty long enough to know that I'm in a stable natural hpa state so I get accurate numbers.

If I don't have a problem, I'll probably still experiment with hcg and clomid, alone and combined, to see how high I can get my natural test. I don't see any downside to these two compounds. I can speak from my own subjective experience only but these two have done wonders for me in the past year. The thing I did not do was get actual numbers. When I do that and start experimenting I'll start a log thread.

These compounds intrigue me:

Little to no side effects even when used continuously for several years

Proven to raise natural test levels in non primary patients with functioning hpa loops by sometimes 100+%. that's very impressive to me.

Does not suppress the hpa loop

Why would a secondary person contemplating trt not try this first?

[powerlifterty16]

hcg and clomid don't provide symptom relief for many people..i feel no different.

[Java Man]

I do, but like I said I'm probably not a trt candidate.

[dreadnok89]

I don't know if anyone said or saw the part where it said chlomid is an alternative for hrt to keep INFERTILITY INTACT. that's the tradeoff probably won't get as high as having test but you'll keep your balls

[dreadnok89]

I did the clomid stimulation test like 10 years ago. It did bring my test levels from around 300 to 700ish. This was after 2 weeks @50mg x2 a day I believe. I had vision problems though. I might be willing to try it again at a much lower dose like 25mg EOD or less.

Here is a blurb from another site that described the protocol.

A Clomid stimulation test is a standard protocol that has been used by
endocrinologists for years to test whether a man's hypogonadism is
primary or secondary. If the test is successful (i.e., if your T rises
significantly), that means that all of the organs in the feedback loop
(the testicles, pituitary and hypothalamus) are healthy and functional,
but for some unknown reason the system has gone dormant. A
successful test result also means that you are a good candidate for
HCG or Clomid, which in contrast to standard TRT, stimulate your
body to produce its own T. See:

Clomid (Clomiphene Citrate) doesn't lower estrogen; it "blocks" it.
Estrogen attaches to the receptors in the hypothalamus and that
signals that there's enough T in your blood, so your body reduces
its T production. Somehow the hypothalamus reacts to E as well
as T. Clomid attaches to these receptors but doesn't act like E.

I did a Clomid stimulation test in November 1999. Dr. Shippen gave me
100 mg/day (one 50 mg tablet in the morning and one in the evening
before bed) for a week. I took a blood test on the morning after the
last day. My test was successful, in that, my T went from about 200 to
600.

Clomid is most often used to promote fertility in women. Therefore, if
you research Clomid, the vast majority of the literature you find will
discusses the use of Clomid by women rather than men. In fact, when I
went to fill the prescription, the pharmacist was very leery and asked
me a lot of questions before dispensing the drug.

I would said shut your mouth and fill my order

[PJS19]

Clomid at 50mg everyday for 4 weeks gave me vision problems that I still have. Also, my levels dropped back down after using. If I try it again I want to try 25mg eod and hope the levels can be sustained.

What does it mean if clomid works, but then lh/fsh fall again?

[dreadnok89]

Clomid at 50mg everyday for 4 weeks gave me vision problems that I still have. Also, my levels dropped back down after using. If I try it again I want to try 25mg eod and hope the levels can be sustained.

What does it mean if clomid works, but then lh/fsh fall again?

That's why they say longterm use. Your on it your on it

[Megalodon6]

Clomid at 50mg everyday for 4 weeks gave me vision problems that I still have. Also, my levels dropped back down after using. If I try it again I want to try 25mg eod and hope the levels can be sustained.

What does it mean if clomid works, but then lh/fsh fall again?

Did you feel any better while taking the clomid??

[Megalodon6]

hcg and clomid don't provide symptom relief for many people..i feel no different.

Well that blows why even take it if you don't feel any better

[Java Man]

Clomid at 50mg everyday for 4 weeks gave me vision problems that I still have. Also, my levels dropped back down after using. If I try it again I want to try 25mg eod and hope the levels can be sustained.

What does it mean if clomid works, but then lh/fsh fall again?

What kind of vision problems do you have now that you did not have before cc therapy?