Simbarn wrote:
No problem. I'm happy that some of what I said might help.
Ok, I can understand a little more now.
It does appear that you may have a low T issue. Clomid was quite successful with stimulating a higher T level, nothing wrong with your testes, definitely sounds like a secondary hypo problem. Pituitary issue.
T levels do drop as we age as you know, it looks like yours has done this earlier.
Your ED may be a result of the low T. I am not convinced that the Clomid is not interfering with your sexual function though. It is notorious for doing this. Your “surly” endo should be aware of this.
If your ED was from low T and the increase of natural T which Clomid causes did not improve your erectile function, this could be from the estrogenic effects Clomid has while you take it. Clomid has this effect on many men.
I have no “qualifications” to offer you to present to your endo other that 20 years of experience of TRT and research into the many pitfalls of hormone replacement. I will say this, I have discovered after talking to many guys with low T in the past that frequently, endos did appear to be extremely behind the times when it comes to TRT for men. I saw one many years ago and vowed to never see another. He was also a surly character, brimming with arrogance and made me feel about 2 foot tall. I walked out and didn’t pay him a cent.
I have had much better experiences with doctors who have a keen interest in men’s sexual function and hormone issues. Perhaps some endo’s have become more progressive these days.
The information I gave you in the previous post regarding Clomiphene citrate versus Enclomiphene citrate (EC) is the main reason IMO that it would be preferable to use Enclomiphene.
A company called Repros Therapeutics tried over many years to get EC passed by the FDA for use in HRT for men with secondary hypogonadism. As it was the part of clomiphene citrate that did all the good work (Enclomiphene) without the part that causes all the issues (Zuclomiphene). A better drug for men to take on a long term basis. It would make good sense that the best form of HRT for men keeps the gonads and the HPTA functioning. All the hormones produced in this process are important, not only for sexual function but also for other processes in the body. LH has effects on the brain as well. Shutting down the “upstream hormones” of testosterone is not without its detrimental effects, not confined to loss of fertility. Some men just need a medication that will give the HPTA a push to produce higher levels of gonadotropins in order to increase T, this most likely will need to be used on a permanent basis. Clomid and Tamoxifen are not good to take permanently.
Unfortunately Repros was trying to get this approval at a bad time and for political reasons EC did not get approved. This was so unfortunate as many doctors still use the more harmful version of this drug frequently for HRT and restart protocols: Clomid, as you know well!
I have spoken with countless men over the years who have issues with T replacement, myself included. There are a number of main reasons for this: ignorant endos who put them on drugs like Nebido, or other forms of T replacement and don’t monitor other hormone conversions in the body, not adjusting the amount of T needed for that particular individual, the shutdown of upstream hormones as already mentioned and the fact that TRT just does not work as well as natural hormone function does for some men. From my experience it is the younger men that have most of the issues with TRT. By younger I mean men under 60. The issues are generally to do with sexual function and this is mostly caused from the loss of LH, FSH and GNRH. I eventually worked this out for myself as I could feel it in my own body. Something was missing, sexual function has never felt the same as it did when all my hormones were running and why should it?
Thus, if one could use a drug to keep it all running without too many side effects, this is the way to go IMO, far superior. Clomid is not a drug I would want in my body long-term. The work put in by Repros showed that EC was the better alternative, It raised T levels comparably to that of T gel administration and in reality a ENDOGENOUS testosterone level of the same amount as compared to a synthetic level, works far better for these reasons: the natural diurnal rhythm is maintained, this preserves receptor sensitivity for T on a daily basis (No form of TRT can match the finely tuned production of T the body does on a daily basis, it does this so you have two purposeful peaks in the day and more on demand if needed). Conversion to other hormones is maintained to the levels that maintain homeostasis and most importantly gonadotropins are all doing their bit too. The examiners judging the efficacy of EC were obviously completely ignorant of these important facts. I also heard that the FDA considered that another T producing medication was not needed in the market place if T gel was going to do the same thing. That’s just it, it didn’t!
Do some of your own research on EC. You do not have to mention that someone on the internet told you it was superior, find the information yourself and present the data. It will most likely be a waste of time with an endo IMO. Defy medical in the US I have been told do have access to EC. It is being compounded by a pharmacy related to them. So that could be an option if you decide you like the idea of trying it compared to Clomid. As I am in Australia, I cannot seem to find a reputable source to get the genuine product. I would try it in a heartbeat if I could.
Clomid made me feel awful, sexual function was a lot worse for me that on Testosterone. Nolvadex seemed a little better, but this is also not something one should take long term. These are restart drugs IMO.
So there you have my reasoning for EC.
How did you come off the Clomid last time when you stopped the therapy? Did you get some tests done at various intervals after cessation to see how the increased level held?
Low T may not be your only issue:
With regard to pelvic floor, I still think this should be investigated, even more so now that you have mentioned your years of doing very heavy squats and dead-lifts! I worked as a PT in a gym for a number of years as a young lad so I understand the sport of weight lifting well. It is not entirely healthy in IMO as the strain one puts on the body performing lifts like this can be counterproductive. The injuries I saw from guys doing these exercises over time made me question why do we do these things to ourselves? I also went through a period of training where I put a considerable amount of extra muscle on my body and pushed it to extremes as this was part of the gym culture. I knew deep down this didn’t feel right. It can become obsessive. I had a great bod, but at what cost? I train now with a very different attitude and motivation, you just have to as you get older.
I am impressed that you have been able to get your natural T up to a level over 1000 with the addition of “extra supplements”. What were these as they have been quite effective in combination with your SERM therapy?
Be mindful when trying to use a high testosterone level in order to feel like you felt when you were 20-25. Your body has aged since then and sometimes this can have side effects as in effect it can work like a drug, a band-aid so to speak, covering for the effects of aging. This happens more so with the use of exogenous T (as most people do find it difficult to do this naturally) where it is easy to administer more. Initially the person doing this can feel amazing for the first 3-6 months of having a very high T level until the body starts to desensitise to the T and side effects begin such as increase in aromatase enzyme and subsequent increase in E2 and other conversion hormones. Body builders are quite familiar with this phenomenon. It can happen at dosages far less that what they use.
You could of course be one of those not so common individuals who had a very high T level in your young years.
When I said pain does not always have to be present, I meant it doesn’t need to be present at all. Lack of sexual sensitivity and ED can be the only symptoms. The nerves that leave the sacrum travel a complex journey through ligaments and muscle in the gluteal region. They can become affected at various points and depending on where they are being compressed, the symptoms may vary. Pudendal nerve entrapment is a medically recognised condition and I did read a case of a young man presenting with just sexual numbness and he was subsequently diagnosed with this condition. The Pudendal nerve is responsible for sensory sensation in the penis as well as reflex erections; that is erections that are generated by touch to the penis itself. Psychogenic erections are generated by a different path of nerves a little higher up in the lower spine. These are the ones affected when the prostate is removed. Both pathways are needed for strong erectile function. Blood supply to the penis is also traveling in a similar area, so this as I have mentioned in my other post can be affected also.
Given the above it would be well worth your while to see someone experienced as I do not think you will be able to determine if you have or don’t have this problem by yourself.
Time to try something else…
Science is still trying to understand much about erectile function. There are so many processes (that we are currently aware of) that need to occur correctly for what looks to be a simple event to occur. When you start to dig deep into all these processes and the possible long list of dysfunctions that can interfere with erectile function, you begin to understand how difficult it is to know what is causing a problem. We do have one thing on our side and that is the body is continually striving to fix itself.
Sorry for the length again of this reply, I get carried away sometimes..
I just couldn't get in to see the doc (new job, no time off work) so he didn't renew my prescription and I just stopped. I had no side effects that I noticed then (over a year on it) or now....other than it, combined with these other test boosters, have made me feel like I used to.
My levels didn't hold though....in roughly 2.5-3 years...they were lower than previously. I was around 700-750 IIRC on Clomid. When I got off of it....dropped to 230ish.
DHEA was the first thing I added as studies showed it would work synergistically with Clomid to raise Test levels. 50mg per day at bed. 50 mg zinc, 500 mg Magnesium. I then added Test Boost Max from Sculptnation. I only tried it b/c it had a money back guarantee and I knew I'd be getting blood tested with a month or so, so I'd be able to see if it actually raised blood levels. It did, so I kept taking it. The last thing was recommended by a naturopathic doc....Raw Male by Natural Sources. Had another blood test....the levels went up again. It's ground up organ/glandular tissue from cattle. Obviously, the cattle could be injected with steroids, but, my liver results don't show any elevated enzymes and my testicles haven't shrunk at all (they actually are quite a bit fuller on Clomid), so I kind of doubt that's what's boosting my test levels.
I am guessing based on my strength levels in my youth that I probably had a very elevated T level, but obviously don't know since I was never tested for it since everything just worked.
Appreciate the guidance (on everything) but also on the pelvic floor stuff. Sounds like it's time to contact someone about it.
