Ok with tribulus man he complained of ED took tribulus to boost his testosterone felt good then crashed. Youāre right it sounds similar in nature. It sounds in a way the same thing that happens to us. He seems very sensitive to medications. Before he took anything he had ED. Maybe it was the start of hypogonadism and tribulus wasnāt enough to counteract this. In fact what if his testosterone was dropping leading to androgen hypersensitivity which upon giving a jolt with tribulus led to a change in gene expression and a degree of androgen resistance. He improves in most areas with testosterone implying it helps however:
I believe the androgen signal is probably not working the way it should in him which is why no matter how much he increases his T some of his side effects will persist. Obviously it may seem i am trying to tie too much into this idea but i am not sure how the liver theory would explain it. Be grateful if you gave a summary of this idea. Thanks.
Looking at gynae case i noted the following:
revealed a markedly decreased follicle-stimulating hormone (FSH), leutinising hor- mone (LH) and testosterone. FSH 0.59 IU/l (normal: 1.0ā7.0), LH 0.26 IU/l (normal: 1.0ā8.0), testoster- one 1.3 nmol/l (normal: 10ā50). Prolactin, oestra- diol and progesterone were within normal limits.
On closer questioning at this stage, the patient said that he had been taking a non-hormonal preparation derived from a plant called Tribulis terrestris, in the form of tablets as a steroid alternative to supplement his weight-training. On the assumption that this substance had caused the hormonal imbalance and hence gynaecomastia, he was advised to discontinue taking them. Two months later his sex-hormones were re-checked and they had improved, FSH 11 IU/l, LH 6.1 IU/l, testosterone 15nmol/l. The swelling in his left breast had also completely resolved.
Its mechanism of action is not fully clear. It is believed to have a central effect and increase secretion of LH and therefore increase testosterone levels. Alternatively, it may exert its effect by being metabolised into androgen-like products or stimulating the physiological transfor- mation of testosterone into more active dihydro- testosterone.11,12 In our patient both gonadotropins and testosterone were markedly reduced after taking this preparation in contrast to experimental studies on this product which showed enhancement of LH and testosterone.12 In the absence of signs or symptoms of pituitary insufficiency, in an otherwise healthy individual, we believe that this could either be due to the shut-down of the pituitary gonadal axis in the presence of exogenous substances or due to increased aromatisation and peripheral conver- sion into estrogens, both of which could contribute to development of gynaecomastia.
It seemed in this patient the tribulus lowered his testosterone causing the testosterone estrogen balance to weigh heavily in the direction of estrogen causing gynaecomastia. I donāt know why this happened but the results speak for themselves. He improved afterwards.
Maybe tribulus can lower testosterone production in a subset of people. Maybe this is what happened in the first case too although if this was his problem i would have expected a fuller recovery. Or maybe tribulus naturally boosts testosterone for a while and then stops working. Again this is a maybe.
As for the metformin and clomid case. Metformin drops testosterone and therefore DHT. It also increases SHBG. The idea of androgen hypersensitivity to low androgens crops up again as an explanation.
Thanks for your questions. Like you I want to get to the bottom of this. If you find my argument questionable do raise it. Only through a proper Socratic method will we make progress. We need to bash every theory to the ground and see if any are left standing. I have little time for pride so please bash away 
