How long should I wait?
- 01-14-2008, 04:54 PM
How long should I wait?
Currently using clomid (under a doctor's orders) at 100mg/day to see if it restores pituitary function. Been on clomid for 7 weeks as I was tapering off Androgel. Been off the gel for about 10 days. Blood test on Friday revealed the following:
TOTAL TESTOTERONE: 183 ng/dL (350-890)
LH: 0.5 (1.5-9.3)
FSH: 3.0 (1.4-18.1)
Prior to this, on the gel, I was maintaining a total testosterone level between 600-700 ng/dL. My LH tested at 0.5 2 weeks prior to this test and my FSH was at 0.3. As you can see, I have secondary hypogonadism. FSH moved up some and LH didn't budge.
The question is: How long do I wait it out on the Clomid? When do I say "enough is enough" and go back on the gel?
I'm 25 years old and this whole situation is starting to kill the relationship I have with my wife.
- 01-14-2008, 05:47 PM
I would do 380iu HCG E2D, every other day.
For 3 monts, then do these tests at Quest Diagnostics, blood drawn at Quest.
Estradiol, Free, LC/MS/MS (36169X)
Testosterone, Free, Bio/Total (LC/MS/MS)
Dihydrotestosterone, Free, Serum (36168X)
If you are ok, then, try to wean out of HCG
Continue another 2-3 monts if you have a doubts.
If you are not satisfied by 6th month,
Add external testosterone as need to get BAT in top of range.
If DHT is very low, use transdermal, Androgel every day.
If DHT is ok, use injectable test, use E2D schedule.
I'd give it a few months, play around with hCG, clomid, etc... and see where you are. 10 days is not long to be off of the gel, and I'd be willing to bet you're still suppressed to some degree.
Also - and bear in mind I've not read your other posts - you seem to think you're secondary. Why? Your LH/FSH is low, but that's exactly what you would expect to see being on exogenous T. Was your LH low before you started test? I don't quite understand the middle part of your post where you discuss this. And you wouldn't expect your LH/FSH to go up wile on test, just the opposite.
You just came off T, do your "post cycle", so to speak, and see how you are in a few months. I wouldn't judge anything today, because, though you tapered, you really just came off.
Get the "boys" up to their peak, see where you are, and then make the decision.
Secondary-- testicles are ok but do not have an order to produce.
he looks like secondary.
He is not loosing much time if he goes, as I advised in post above, with HCG trial.
If that does not work, without skipping a beat, he just adds T.
But it already looks that he is on HCG forever.
I would not go for any Clomid or some such.
You are far too young to go it alone on this.
I highly suggest you contact a specialist, like Dr' John Crisler in Lansing, Michigan. He is said to be very well versed in situations like yours.
You've too much to lose to **** around and chase wrong paths.
I do not think DR. Crisler charges are excessive. In fact, airfare may be more.
Either way, as I see you can't afford NOT to get the best help you can even if that means something else has to be put off. We're talking about you and your body- is there anything more valuable than that? Let's say the whole experience costs, say $1k. Not much, is it? Amortize that over the rest of your life and possibility that your health could be restored. Seems like a good investment to me. Find a way to get the money. The 50 year old you will kick you in what's left of your balls if you don't at least try.
But, being secondary, you are already suppressed.
That said, not all people get a satisfactory response (QOL, not labs) with just hCG and usually try hCG + test.
Sometimes, in primary hypogonadism, doctors will try to stimulate the testes or use clomid to see if endogenous production can get ramped up, but I don't even think many of these are successful.
So said another way, I believe that if you are secondary, the route is a little more clear. Certainly your endocrinologist would know better.
As far as what anyman said, and although I appreciate the economic component, I agree with him 100%. You might want to check with your insurance company about getting reimbursed for an out-of-network doctor. I would think your meds would be covered regardless, and the only question becomes the $300 initial consultation fee and the $50 follow up office visits. But really, when you see a specialist, you usually have a co-pay close to the $50. It's just worth thinking about is all.
Dr. John is one of the best, this is what he does.
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