Am way overdue in updating this thread, thanks all of you for your PMs asking for updates and inquiring as to how I’m doing.
To answer an old question. prior to going on topical TRT in 2007-mid 2008 I had LH levels of less than 1 to about 1.5, and FSH readings in the 2-3 range (multiple tests), so definitely secondary hypogonadal according to two different board certified endos and one other doc doing bioidentical hormone replacement. My total serum T was in the 180 to 300 range when not on TRT. The topicals (tried two different ones) could get me to around 500 maximum. Found I always had to keep tweaking the dose higher, and although it helped functioning in the bedroom it did nothing for anorgasmia, which has slowly, steadily been getting worse since I quit fin (on fin for several months back in 2002)
To recap on the clomiphene, on 75 mg/week in 3 divided doses my T rose from the 250-300 range to the 700 range after about 3 months. These were peak values; typically I would take the clomiphene before bedtime then get drawn for T and E at around 7:30 AM the next morning. After three months I took a 24 hr urinary steroid profile. The T (testosterone) showed as below the normal range despite the upper range serum T. The doctor explained that the T in the urinary profile is either bioavailable or free, can not recall which he said it was. Bioavailable includes free and albumin (weakly) bound. Also, my FSH really had not budged, so he increased the dose to 100 mg/week.
When I last reported out, my T levels were supraphysiological, in the 900 to 1050 ng/dL range. This happened by upping my dose from 75 mg/week to 100 mg/week (divided doses). Note this is still much less than the 150 mg/week Dr. Andre Guay has used (see the linked article in an earlier post of mine). This period basically corresponded to the month of June. And what a month it was. Felt great, sense of humor returned, just felt good all around. Not since before fin have I been able to have intercourse every two days or so, and even when not actually in the act I had that low buzz of libido just being around her (and, to a lesser extent, around any attractive females)… Got to the point where she was actually shooing me away, quite a change from the less than once a month and only early in the morning thing I experienced while off of TRT in the second half of 2008, as well as before my hypogonadism was diagnosed. Also, finally, FSH rose to the 4 range.
Please do not for a moment think this somehow cured me. Anorgasmia was and still is extremely prevalent, with almost no sensation down there, and only very minor feelings in the brain, at climax. Function was excellent, easily aroused, but the reward at the end was a low fizzle. Still, I felt al around much better
Clomiphene is serious medication; the liver is taxed to eliminate it. The drug consists of two isomers, zuclomiphene and enclomiphene. The drug is mostly used for short runs of several days to help women ovulate and get pregnant. In this application I have read that the zuclomiphene is the more active portion (will try to update this post with a reference). In men the enclomiphene is the active portion, blocking hypothalamic receptors and making the hypothalamus secrete GnRH, thereby signally the pituitary to release LH (and hopefully, for us, FSH). There is a small pharmaceutical company, Repros Therapeutics, that is developing pure enclomiphene (called Androxal), Unfortunately, it may never come to market as one of their other drugs got turned down by the FDA in July and their stock price has plummeted. The zuclomiphene just acts as a synthetic estrogen in males, and is undesirable, I think this is why the bodybuilders get emotional when they take walloping doses of it to try restart their HPTA after a steroid cycle – they take 100 or 150 mg clomiphene and then load their systems up with synthetic estrogen none of us need. Maybe some wealthy secondary hypo or post fin sufferer will help the Repros company out and make enclomiphene a reality.
So what happened to me? All this time on clomiphene my estradiol slowly crept up, as was SHBG. In July function remained but the desire (libido) dropped. Did not pick up on the estradiol issue right away as I had mostly been running the ultrasensitive test. There are indications from the regular secondary hypogonadism, non post fin sufferers that this ultrasensitive test is not very accurate while on clomiphene. My doc is even starting to think the ultrasensitive is of little value at least for clomiphene treated patients. I had two readings in a week, one ultrasensitive, and one not, that differed greatly (mid 20s on ultrasensitive yet high 40s on regular). Anyway, even the ultrasensitive E was showing a steady increase over the months.
I was tempted to take nettle root to control the rising SHBG, which had gotten up to about the average of a man in his 70s. However, careful research of this supplement revealed it to also be a 5 alpha reductase type 2 inhibitor as well (under the impression that it is not as strong as saw palmetto). It is also very difficult to find hydromethanolic or methanolic extracts of nettle, which are the ones you need for SHBG control (ethanol extracts do not work according to at least one paper).
My doc decided to take me off clomiphene for a month to clear everything out, and start at a new, lower dose. Coming off clomiphene was much nicer than halting topical TRT. For the later (middle of last year) I felt like utter crap for a few weeks, sweats, fatigue etc. was glad I decided to stop during a vacation, and then the hypogonadal symptoms of course persisted. Clomiphene has a half life of about 5 to 7 days, and takes a few weeks to be processed out completely. This resulted in a much slower, gentler ramp down off the higher testosterone levels, only a few rounds of minor sweats. No, I did not restart my HPTA (will type about restarts another time) as T dropped to 500 over a couple of weeks (E to mid 20s, perfect), then T to a little over 300 in another couple of weeks. I added another week and a half, even though I felt very low on energy, so that I could take Adiol-G with nothing in my system, to get a baseline value. See the Adiol-G thread in the Stickied Blood and Hormone testing section. Felt a little short tempered and crabby during the last couple of weeks of the 5 week break.
Back on at a lower dose taken twice a week, after several weeks T has popped back up to 700, but E has risen also into the mid 40s (too high, bodybuilders suggest 20 to 25 is ideal with 18 being the lower limit to prevent osteoperosis. Will see the doc in November; great deal to talk about given the very low Adiol-G and low 5 alpha/5 beta urinary ratios.
Based purely on my own experience, do not overdue this drug, more is not better. Look at Voice’s thread, he tried as little as 10 mg. Best to take it only 3 or so times a week to give your liver a break, and to prevent blocking the hypothalamic receptors responsible for sexual stimulation. Still seems to be the most natural way to correct low LH, as clomiphene results in pulsatile LH and FSH (and thus pulsatile testosterone) secretion, rather than a gradual absorption you get from topical T (or huge sudden burst from an enthanate shot). .This is all my opinion and my own experience with my own physiology, I am not an MD and would recommend using clomiphene only under the care of a doctor (they need to check liver enzymes periodically).
which doc is treating you?
Lol… serious, no joke