Weak Response To Clomid

kris90

New member
So since March, I have been on treatment for secondary hypogonadism (low testosterone levels due to low LH/FSH). I had an MRI done to rule out pituitary damage/tumor. Results were clear. I was put on HCG @ 1000 IU MWF and stayed on this for about 3-4 months (ended up dropping to 250 IU/EOD). Here are a few sets of bloodwork while on the HCG:

April 2014:
LH: <1 IU/L (ref: 1-9)
FSH: <1 IU/L (ref: 1-19)
Prolactin: 11 ug/L (ref: 3-13)
Estradiol: 109 pmol/L (ref: 40-160)
Total Testosterone: 15.9 nmol/L (ref: 6.1-27.1)
Free Testosterone: 335 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.9 nmol/L (ref: 2.8-15.5)
SHBG: 32 nmol/L (ref: 13-89)

June 2014:
LH: <1 IU/L (ref: 1-9)
FSH: <1 IU/L (ref: 1-19)
Prolactin: 11 ug/L (ref: 3-13)
Estradiol: 64 pmol/L (ref: 40-160)
Total Testosterone: 16.4 nmol/L (ref: 6.1-27.1)
Free Testosterone: 330 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.7 nmol/L (ref: 2.8-15.5)
SHBG: 35 nmol/L (ref: 13-89)

So obviously I felt my best in June. My E2 was in check, and my T levels were around midrange. Around end of June, my Urologist and I agreed to switch to Clomid to try to restart my HPTA so I could eventually come off everything. So he had me on 25mg/ED, and I slowly tapered off the HCG. Fast forward to 2 months on Clomid and here is my bloodwork:

August 2014:
LH: 2 IU/L (ref: 1-9)
FSH: 2 IU/L (ref: 1-19)
Estradiol: 52 pmol/L (ref: 40-160)
Total Testosterone: 14.5 nmol/L (ref: 6.1-27.1)
Free Testosterone: 308 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.2 nmol/L (ref: 2.8-15.5)
SHBG: 31 nmol/L (ref: 13-89)

My 2 months on Clomid I haven't felt as well as on the HCG. Libido dropped, I had mood swings, physical performance and motivation decreased, I lost 10 lbs while gaining 0.5 inches on my waist. I was pretty shocked with the bloodwork. My T levels dropped (as did my E2 levels) and my LH/FSH barely rose. I was expecting them to be atleast 5 IU/L from the Clomid. My Urologist is actually happy with the results, he said my pituitary has "woken up" and I can try tapering off Clomid now, and get more bloodwork in 2 months. Won't my T levels drop off even further after Clomid? Why is my pituitary responding poorly to Clomid? I'm definitely not settling for a T level of 14.5 nmol/L, especially knowing that they might drop off further after Clomid. Should I just convince my Urologist to put me on TRT? Or atleast go back to HCG? I had high hopes I could recover my HPTA and produce a decent amount of T naturally, but it seems hopeless after all these years of always trying to recover. It seems like the only other options is to pull the trigger on TRT.

TL/DR:
-Went on HCG monotherapy for 3-4 months & had decent results, felt good
-Switched to Clomid for 2 months & felt a drop, bloodwork shows a drop & weak LH/FSH response
-What to do next?
 
Tough one. Leydig cells respond to lh but serms dont stimulate enough production. You may be a candidate for hcg monotherapy. Has this been discussed/considered? I dont think its the best option but Dr may be hesitant to prescribe injections seeing as your are not primary hypo.
 
StanleyG said:
Tough one. Leydig cells respond to lh but serms dont stimulate enough production. You may be a candidate for hcg monotherapy. Has this been discussed/considered? I dont think its the best option but Dr may be hesitant to prescribe injections seeing as your are not primary hypo.
Click to expand...

Yes it has been discussed. I decided to stay on the Clomid a little longer (since I am hoping for a restart, because my pituitary showed normal in an MRI scan). I bumped my dose up to 50mg, but I have absolutely no libido. Getting more bloodwork done in October.

If the Clomid doesn't do anything, I will go back to HCG monotherapy, and then TRT after my 2nd child.
 
kris90 said:
Yes it has been discussed. I decided to stay on the Clomid a little longer (since I am hoping for a restart, because my pituitary showed normal in an MRI scan). I bumped my dose up to 50mg, but I have absolutely no libido. Getting more bloodwork done in October.

If the Clomid doesn't do anything, I will go back to HCG monotherapy, and then TRT after my 2nd child.
Click to expand...

Got it. Id like to see how it goes for you. Be cool if you could update & I wish you all the best.
 
kris90 said:
So since March, I have been on treatment for secondary hypogonadism (low testosterone levels due to low LH/FSH). I had an MRI done to rule out pituitary damage/tumor. Results were clear. I was put on HCG @ 1000 IU MWF and stayed on this for about 3-4 months (ended up dropping to 250 IU/EOD). Here are a few sets of bloodwork while on the HCG:

April 2014:
LH: <1 IU/L (ref: 1-9)
FSH: <1 IU/L (ref: 1-19)
Prolactin: 11 ug/L (ref: 3-13)
Estradiol: 109 pmol/L (ref: 40-160)
Total Testosterone: 15.9 nmol/L (ref: 6.1-27.1)
Free Testosterone: 335 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.9 nmol/L (ref: 2.8-15.5)
SHBG: 32 nmol/L (ref: 13-89)

June 2014:
LH: <1 IU/L (ref: 1-9)
FSH: <1 IU/L (ref: 1-19)
Prolactin: 11 ug/L (ref: 3-13)
Estradiol: 64 pmol/L (ref: 40-160)
Total Testosterone: 16.4 nmol/L (ref: 6.1-27.1)
Free Testosterone: 330 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.7 nmol/L (ref: 2.8-15.5)
SHBG: 35 nmol/L (ref: 13-89)

So obviously I felt my best in June. My E2 was in check, and my T levels were around midrange. Around end of June, my Urologist and I agreed to switch to Clomid to try to restart my HPTA so I could eventually come off everything. So he had me on 25mg/ED, and I slowly tapered off the HCG. Fast forward to 2 months on Clomid and here is my bloodwork:

August 2014:
LH: 2 IU/L (ref: 1-9)
FSH: 2 IU/L (ref: 1-19)
Estradiol: 52 pmol/L (ref: 40-160)
Total Testosterone: 14.5 nmol/L (ref: 6.1-27.1)
Free Testosterone: 308 pmol/L (ref: 110-660)
Bioavailable Testosterone: 7.2 nmol/L (ref: 2.8-15.5)
SHBG: 31 nmol/L (ref: 13-89)

My 2 months on Clomid I haven't felt as well as on the HCG. Libido dropped, I had mood swings, physical performance and motivation decreased, I lost 10 lbs while gaining 0.5 inches on my waist. I was pretty shocked with the bloodwork. My T levels dropped (as did my E2 levels) and my LH/FSH barely rose. I was expecting them to be atleast 5 IU/L from the Clomid. My Urologist is actually happy with the results, he said my pituitary has "woken up" and I can try tapering off Clomid now, and get more bloodwork in 2 months. Won't my T levels drop off even further after Clomid? Why is my pituitary responding poorly to Clomid? I'm definitely not settling for a T level of 14.5 nmol/L, especially knowing that they might drop off further after Clomid. Should I just convince my Urologist to put me on TRT? Or atleast go back to HCG? I had high hopes I could recover my HPTA and produce a decent amount of T naturally, but it seems hopeless after all these years of always trying to recover. It seems like the only other options is to pull the trigger on TRT.

TL/DR:
-Went on HCG monotherapy for 3-4 months & had decent results, felt good
-Switched to Clomid for 2 months & felt a drop, bloodwork shows a drop & weak LH/FSH response
-What to do next?
Click to expand...

What were your labs before the hCG or CLOMID????????
Do you used opiates? ginseng?, Soy?, sesame seeds?
Your FT and TT numbers are pretty close to midrange on both the hCG and CLOMID.
50mg ED of CLOMID is a lot.
Do you have a history of AAS or ProHormone use?
 
Mr.TT said:
What were your labs before the hCG or CLOMID????????
Do you used opiates? ginseng?, Soy?, sesame seeds?
Your FT and TT numbers are pretty close to midrange on both the hCG and CLOMID.
50mg ED of CLOMID is a lot.
Do you have a history of AAS or ProHormone use?
Click to expand...

Yes I have used AAS before. from early 2012 to mid 2013 I was on and off cycle (did 3 cycles: SD/Test/Epi, Dbol/Test/Tren and Test/Var). I ended up cruising between the last 2 cycles, so was on for a total of 7 months. 4-5 months after coming off, my Bioavailable T was 3.7 nmol/L (scale was 2.7 to 19.2) and my LH and FSH were both at 1 IU/L. During that time, I was trying to get my wife pregnant. I ended up taking HCG on my own, and within 3 weeks, she was pregnant. I switched to Clomid after, but I felt lousy, so I decided to jump back on Test @ 200mg/week until I see a Urologist.

Saw the Urologist after a month or so of cruising @ 200mg/week, and explained everything. He had me stop the Test cold turkey and get bloods. Obviously my levels were crashed:

March 2014:
Prolactin: 10 ug/L (3-13)
LH: < 1 IU/L (1-9)
FSH: < 1 IU/L (1-19)
Estradiol: 47 pmol/L (40-160)
Total Testosterone: 3.9 nmol/L (6.1-27.1)
Free Testosterone: 111 pmol/L (110-660)
Bioavailable Testosterone: 2.6 nmol/L (2.8-15.5)
SHBG: 13 nmol/L (13-89)
TSH: 2.35 mU/L (0.3-5.60)

So after that I went on HCG monotherapy (which I posted my bloodwork for above). Also had an MRI done on my pituitary and it came back clear. Also, I don't use opiates, ginseng, eat very little soy, and sesame seeds.
 
I've been trying to find an explanation for a weak response to Clomid (i.e. low LH and/or FSH even after taking it). I found this interesting abstract:

Invalid Link Removed

It seems that primary hypothyroidism causes the pituitary to become less responsive to GnRH. Since we know Clomid works by boosting GnRH, could it be that I may have primary hypothyroidism which is preventing my LH from being boosted by Clomid? Going for a thyroid panel next week. My TSH has always been on the high side and I've always been suspicious of hypothyroidism (always have cold hands and feet, slow metabolism, and it runs in my family).

Any thoughts?
 
kris90 said:
I've been trying to find an explanation for a weak response to Clomid (i.e. low LH and/or FSH even after taking it). I found this interesting abstract:

Invalid Link Removed

It seems that primary hypothyroidism causes the pituitary to become less responsive to GnRH. Since we know Clomid works by boosting GnRH, could it be that I may have primary hypothyroidism which is preventing my LH from being boosted by Clomid? Going for a thyroid panel next week. My TSH has always been on the high side and I've always been suspicious of hypothyroidism (always have cold hands and feet, slow metabolism, and it runs in my family).

Any thoughts?
Click to expand...

Thyroid should always be checked when looking at a low T situation so it is a possibility, The high tsh could def indicate low thyroxine levels. If so the entire solution may be as simple as daily t4. Im guessing your BW never included a thyroid panel thus the tsh being the only statistical data you have?
 
StanleyG said:
Thyroid should always be checked when looking at a low T situation so it is a possibility, The high tsh could def indicate low thyroxine levels. If so the entire solution may be as simple as daily t4. Im guessing your BW never included a thyroid panel thus the tsh being the only statistical data you have?
Click to expand...

Well actually, I have had several thyroid panels done. Some were just TSH, and the most comprehensive was TSH, FT4 and FT3. Here are some of my results.

August 2012:
TSH: 5.69 (range: 0.35 - 5.00 mIU/L)

August 2012 (10 days later):
TSH: 3.76 (range: 0.35 - 5.00 mIU/L)
FT4: 14 (range: 12 - 22 pmol/L)
FT3: 4.3 (range: 2.6 - 5.7 pmol/L)

March 2013:
TSH: 4.86 (range: 0.35 - 5.00 mIU/L)
No FT4 or FT3

November 2013:
TSH: 4.36 (0.35 – 5.00 mIU/L)
FT4: 20 (12 – 22 pmol/L)
FT3: 5.1 (2.6 – 5.7 pmol/L)

December 2013:
TSH: 2.79 (0.35 – 5.00 mIU/L)
FT4: 17 (12 – 22 pmol/L)
No FT3

And then as you can see earlier in this post, I had TSH checked in March of this year and it was 2.35 mIU/L. So all over the map basically.
 
Guys, I really need some help. Here's more bloodwork:

October 2014:
LH: 2 IU/L (ref: 1-9)
FSH: 2 IU/L (ref: 1-19)
Estradiol: <37 pmol/L (ref: 40-160)
Total Testosterone: 13.0 nmol/L (ref: 6.1-27.1)
Free Testosterone: 233 pmol/L (ref: 110-660)
Bioavailable Testosterone: 5.5 nmol/L (ref: 2.8-15.5)
SHBG: 40 nmol/L (ref: 13-89)

TSH: 2.94 mU/L (ref: 0.3-5.60)
FT4: 10.7 pmol/L (ref: 7.0-17.0)
FT3: 4.0 pmol/L (ref: 3.3-6.0)

I feel like ****, always cold, brain fog, fatigue. And get this, my Urologist didn't think my Testosterone levels were all that low, and he then says my Estradiol is undetectable which is good. HOW IS THAT GOOD? What are the dangers of my low Estradiol? Also, my thyroid panel looks terrible. I suspect adrenal fatigue, but haven't gotten Cortisol tested. I started taking an adaptogen, B vitamins, and Magnesium, and switched my diet, and my temperatures are improving now (they were averaging 35.5 C per day, and now average around 36.5 C). But I am still very fatigued, low libido, and low energy. I sleep a lot, but never feel refreshed. I usually have to pee once in the middle of the night.

HELP!
 
I'd go see an endocrinologist and drop your urologist.
 
Going to a Naturopath on Friday to get 4x Cortisol/DHEA-S saliva test. Will probably end up supplementing DHEA-S if low. Also seeing my family doctor next Monday to go over Thyroid panel. Will ask for a trial of Synthroid, as primary hypothyroidism seems to commonly coincide with secondary hypogonadism.
 
Is that "adaptogen" Ginseng????? Ginseng is high in phyto-estrogen.

Test your D3 (Vitamin D3- 25-Hydroxy).

Do you eat Soy?

As for your thyroid, supplement iodine(if your thyroid antibodies are normal), iron, and selenium.
 
I didn't think Rhodiola Rosea was estrogenic. Anyways, my estro levels are very low.

I don't eat soy. I will look into testing my Vitamin D3.

My temperatures have been improving so far this week after supplementing with Rhodiola, Vitamin B complex, Vitamin C and Magnesium. I started adding iodized salt to my eggs, but haven't been tracking the amount. Here are some temps I recorded:

Oct 17:
9:00 AM - 35.2 C
12:00 PM - 35.1 C
3:00 PM - 36.9 C

Oct 18:
12:00 PM - 35.9 C
3:00 PM - 36.5 C

Oct 19:
8:00 AM - 36.2 C
12:00 PM - 36.0 C

Oct 20:
6:00 AM (waking) - 35.7 C

Started Rhodiola Rosea, B complex, Vitamin C and Magnesium.

Oct 21:
6:00 AM (waking) - 36.3 C
9:00 AM - 36.7 C
12:00 PM - 36.4 C
3:00 PM - 36.6 C

Oct 22:
6:00 AM (waking) - 36.0 C
9:00 AM - 36.8 C
12:00 PM - 36.6 C

Oct 23:
6:00 AM (waking) - 36.2 C
9:00 AM - 36.8 C
 
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