Dr Crisler's modified HPTA restart method...

[Mens_Rea]

Have a read guys, contains some very interesting pieces of information that could prove very useful for many of us…

@Dr. John Crisler

After a long Skype session a week ago with Dr. Shippen, I am rethinking the HPTA-Restart.

A number of my patients have responded well to the clomiphene challenge. This shows the HPTA is indeed intact. Yet when the SERM-class drug was withdrawn, testosterone levels once again plummeted.

With the proven benefit of low dose clomiphene, at 12.5mgs (1/4 tablet for convenience), or even less, I am now willing to maintain treatment, long term, on same.

Those who did not enjoy the subjective benefit of the on-treatment testosterone increase may have been sensitive to the estrogen agonism (mimic) half of the clomiphene, or zuclomiphene. Others experienced a sharp increase in SHBG (again, from the estrogen half of the drug), and so would have needed incredible–unattainable–gains in T just to produce bioavailable androgen levels sufficient to make them feel good.

Others simply have too much estrogen, either way.

For the latter example of therapy failure (by subjective report), we will add in aromatase inhibition, to hinder the conversion of T to E. For those with elevated SHBG, we can add in some oral Danazol to lower same. Once resultant dosages are titrated, we should be able to include all in the same cap, to save the patient money.

In my talks with Dr. Shippen, and well as Dr. Anna Cabeca (Functional Medicine physician extraordinaire) it is my belief residual toxic insult is the culprit behind resumption of the hypogonadal state once clomiphene stimulation of the HPTA is withdrawn.

Anyone who experienced good increases in T with clomiphene, without persistence upon drug withdrawal, is now welcome to go on clomiphene long-term. Depending upon the case, we may add in anastrozole and/or oral Danazol.

Keep in mind, “success” in previous restart attempt is defined merely as sufficiently increased testosterone production. Whether you felt better at the time or not is not reason for deferment. We can adjust estrogens and SHBG as necessary to yield positive subjective response.

My guys will tell you I have always been happy to try a restart. For those with failure to restart (meaning the system kept running once we stopped the clomiphene) we can try the new protocol. It would be great if we could NOT use TRT to restore health and happiness. Just call Renee, tell her what you want, and make an appointment. We’ll get started right away.

musclechatroom.com/forum/showthread.php?17612-For-My-Guys-Who-Have-Failed-the-HPTA-Restart

My thoughts?

Well as i posted in that thread…

I think its a massive prerequisite that everyone uses tailored protocols like what is suggested here. Simply prescribing clomid alone for everyone will and does harbour varying results.

I am actually a big believer in “prepatory” protocols before beginning the likes of clomid or tamoxifen so as to mould one’s hormones into something that should prove receptive to clomid from the outset. Such may include danazol, dostinex or whatever else necessary to help mitigate from “interference”.

I especially like the arimidex idea and it is something i am considering myself (im on arimidex now, but might incorporate clomid)

…

So, as far as it pertains to us guys, i think the writing is clearly on the wall. To respond to clomid you may need supplemental drugs to ensure your body is able to. I’ve preached about this before - the need for a elaborate protocol to complement your hormones. Dr C is on the money here massively; not just about clomid…i feel this rule applies generally to any drug that might be used in attempt to attain normalisaion. I want to see everyone on this board try protocol’s specific to their needs. He explains extremely well for instance, why some people dont respond to clomid at all. It’s so easy to conclude (as i see on this board all too often) that we’re “different” or the SERM’s just don’t work. The reality is many of us have several imbalances that might stop one stand-alone treatment from working…hence the need to a tailored protocol.

Lastly, its very interesting that Dr C is advocating long term clomid treatment. Some guys would definately benefit from this…

[visionquest99]

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[bluecloud87]

Are you under the supervision of a doctor Mens Rea?

[Mens_Rea]

@UK20

Are you under the supervision of a doctor Mens Rea?

Yes. 100% supervision with weekly bloods (or whatever i feel necessary) now i’ve begun arimidex.

[mariobros]

I don’t really understand, isn’t clomid carcinogenic if used long term? Wouldn’t it be better to just be on bio-identical TRT?

[Mens_Rea]

@mariobros

I don’t really understand, isn’t clomid carcinogenic if used long term? Wouldn’t it be better to just be on bio-identical TRT?

At 12.5mg ED i doubt this is a factor. But that’s just my opinion.

Not to mention i think most should be able to ween off it down the line. That’d be the hope, anyway.

[kazman]

@mariobros

I don’t really understand, isn’t clomid carcinogenic if used long term? Wouldn’t it be better to just be on bio-identical TRT?

mariobros, the attraction to clomiphene is that it restores > pulstatile < LH secretion from the pituitary for a significant majority of PFS sufferers who try it. I think the pulsatile portion is important - compared to T shots or creams or even hcG to an extent where things come through in a big wave, the pulsatile secretion is the natural form that the body is used to, and may result in less SHBG and /or estradiol formation (depending upon the sufferer - some have 5AR1 as well as 5AR2 supressed w/low DHT).

See my posts in My temporary Recovery Via Clomid for more info especially w/ links to long term studies. After trying topical T, hcG, and a wide variety of clomiphene dosages (I can basically now predict my total serum T based on the amount of clomiphene I’m taking) and feel it works best, plus coming off of clomiphene is a lot easier than stopping T or HCG… Does cloud the receptors a bit so breaks are warranted, as is determining the lowest possible clomiphene dose you need to get a significant bump in free T.

My whole regimen (drugs, diet, supplements) is based around increasing natural pulsatile secretion of various anabolic hormones, and decreasing/eliminating diet based ingestion of 5AR2 inhibiting substances. However, staying on one combination alone invariably leads to a return of symptoms, and I still have long periods of zero libido and many other common PFS sides.

Rather than danazol, my latest research shows avena sativa might be a first level thing to try for SHBG control. Do NOT use nettle root extract (5AR2 inhibitor).

kazman

[mariobros]

Ok, interesting. Have you looked into Toremiphene? It’s supposed to be a second generation SERM with lower toxicity than Clomid or Tamoxifen.

en.wikipedia.org/wiki/Toremifene

[kazman]

One of my endos suggested raloxifene, but I have not found any study using it for secondary hypogonadism (search help appreciated, drop me a pm of anyone finds anything). It does primarily act on estrogen receptor alpha (ER-a), leaving beta alone (ER-b), so narrower spectrum than clomiphene or tamoxifene.

Ultimately Androxal will be one of the better ways to go, maybe we should all buy stock in the company (Repros Therapeutics) to keep it afloat. It consists of enclomiphene only, so we avoid the negative (estrogen raising) effect of the zuclomiphene (both are co-isomers that make up clomiphene).