Seeking input on bloodwork & current protocol (Clomid Mono + Adex)

[davesavvy]

Quick background: I'm 49 & secondary from Accutane's version of PFS (post finasteride syndrome) for past 6 years. But this thread is not about that...plenty of that already discussed elsewhere.

Purpose of this thread is to mainly seek input on optimizing E2 while on clomid monotherapy. I have been lucky as I've had no sides from the clomid after ~15 months. Low libido presently but that was same prior to going on clomid. Bottom line is I feel very good &this protocol seems to be the best that I have tried to date. As you can see below...I have attached my blood work from past year. I am currently 12.5 mg clomid & recently taking a 2 week break from Adex. There was some trial and error changes to my Adex over the year based on morning wood, how I feel, etc. Unfortunately more frequent blood work isn't always practical as most of us know. In Oct. 2015, I went to .5 mg adex E3D (1.5 mg week) after seeing my E2 up to 33. During this time my Levitra seemed to work MUCH better but that could be coincidence. Although I was planning to stay at 1.5 mg & get blood work soon, I started having joint pain in left elbow (maybe unrelated? E2 too low?) so I stopped taking adex immediately. I plan to resume in a week or so. Whatever my new protocol will be (likely .25 mg EOD), I want to do my bloodwork closer to 2 month mark to make sure I see new established baseline.

I have a Dr. apt. coming up & will be getting a script for bloodwork. Here are my questions...

1. As you can see in 2/27/15 blood work, it appears my E2 was in sweet spot. But was 1 month long enough to establish a good baseline?
2. My 9/28/15 results...the adex was .25 E3D for 5 months...& E2 crept up to 33. So going back to EOD, that is going from .75 mg per week to 1.0 mg. Will that slight increase of .25 mg get me back to ~20 E2?
3. Say I increase my Clomid to 18.75 mg for slight higher TT, think I should increase the adex a bit also?

Any other feedback is welcomed. But just remember, my situation is very different from AAS users and/or anit-aging hrt users. BTW- When I was on no meds, my TT was low 300's

Thanks in advance.

Ref:

 

[LW64]

Stop taking adex.

 

[davesavvy]

Stop taking adex.

I appreciate the reply but without any explanation it doesn't help much.

 

[LW64]

There is no 'sweet spot' for e2 other than a normal e2 level as a result of normalizing your T level with minimization/elimination of low T symptoms. Period.

As long as your e2 is in the normal range, why take adex? At 33, your e2 was still normal so adding in adex was not necessary and, as near as I can tell, it is still not necessary. You seem to be somewhat aware of this, since you've stopped the adex for now.

You're using clomid to give your hyp-pit just enough of a push to keep your T in the normal range (check!) without going so high that you get too much e2 (check!). Mission accomplished. Stop right there. No need to add another drug - especially when it is off-label use of a cancer drug that has nasty sides.

 

[davesavvy]

There is no 'sweet spot' for e2 other than a normal e2 level as a result of normalizing your T level with minimization/elimination of low T symptoms. Period.

As long as your e2 is in the normal range, why take adex? At 33, your e2 was still normal so adding in adex was not necessary and, as near as I can tell, it is still not necessary. You seem to be somewhat aware of this, since you've stopped the adex for now.

You're using clomid to give your hyp-pit just enough of a push to keep your T in the normal range (check!) without going so high that you get too much e2 (check!). Mission accomplished. Stop right there. No need to add another drug - especially when it is off-label use of a cancer drug that has nasty sides.

LW64...greatly appreciate the great input. And your replies make me want to ask more questions as I continue to learn new information...so bear with me lol

So, when I get the Estradiol "Ultra Sensitive" test (Quest Diagnostics) & the ref range is "> or = 29"...they show anything over 29 as high. So my 33 is considered high, right? I've read many posts about "20" being the ideal E2 level but maybe there is more to it than that?

Another part I'm trying to understand is that if someone uses just enough adex to get their E2 lower into that "20" range...isn't that better than being on the bit high side? Are there still sides to adex that offset that benefit? I always thought the main risk with AI's was not to crash your E2 too low. So why is titration of adex so bad if the goal is to simply get a better E2 level?

 

[LW64]

So, when I get the Estradiol "Ultra Sensitive" test (Quest Diagnostics) & the ref range is "> or = 29"...they show anything over 29 as high. So my 33 is considered high, right? I've read many posts about "20" being the ideal E2 level but maybe there is more to it than that?

Those ranges should read "< or = 29" and not "> or = 29", btw.

33 vs 29? Four points over? I wouldn't lose any sleep over it. You're better off skipping a dose of clomid every now and then rather than adding in another drug! Clomid's half-life is something like a WEEK; you will not tank your T level with an occasional, modest reduction in frequency.

There is no magic or one-size-fits-all e2 level everyone should target. You are trying to get a decent T level while also reducing/eliminating your low T symptoms. That's it.

Another part I'm trying to understand is that (1)if someone uses just enough adex to get their E2 lower into that "20" range...isn't that better than being on the bit high side? (2) Are there still sides to adex that offset that benefit? (3) I always thought the main risk with AI's was not to crash your E2 too low. So why is titration of adex so bad if the goal is to simply get a better E2 level?

(1) Not really. Its more important to get a decent rise in T level from clomid. If the associated e2 rise is more or less proportional (in your case, it is) and YOU FEEL OK, then you're done.

(2) Sides are: fatigue, hot flashes, joint pain, tendon pain, bone density reduction, osteoporosis and, possibly, loss of libido.

(3) That's one issue, another is the potential sides - see item #2 and another is: how sensitive are YOU to a drop in e2, even when its still in the normal range?

(4) Because there is no 'better e2 level' outside the context of 1, 2, and 3.

You should also be aware (if you're not already) that there are limits to what is possible with clomid when you want to have a high(ish) T level. You simply don't increase your clomid dose and counteract the e2 rise with as much AI as it takes until you get your T into (say) the 700s. If that's what you really want, then you switch to injections.

 

[Dr JIM]

There is no 'sweet spot' for e2 other than a normal e2 level as a result of normalizing your T level with minimization/elimination of low T symptoms. Period.

As long as your e2 is in the normal range, why take adex? At 33, your e2 was still normal so adding in adex was not necessary and, as near as I can tell, it is still not necessary. You seem to be somewhat aware of this, since you've stopped the adex for now.

You're using clomid to give your hyp-pit just enough of a push to keep your T in the normal range (check!) without going so high that you get too much e2 (check!). Mission accomplished. Stop right there. No need to add another drug - especially when it is off-label use of a cancer drug that has nasty sides.

You are absolutely CORRECT LW.

This a classic example of numeric therapeutic micromanagement, which by its very nature has no endpoint bc of natural hormonal fluctuations.

Good luck.

 

[Dr JIM]

Why bc of its cyclical nature this thread alone has made me "dizzy". However for some the means, or "process" becomes an end onto itself.

To that end, from a historical perspective the OP has been consistent, lol!

 

[foreveryoung]

do you actually feel any better now than you did when you had natural 330 testosterone level?

 

[davesavvy]

do you actually feel any better now than you did when you had natural 330 testosterone level?

I feel very good overall...almost normal but just with very low libido. I play basketball with guys half my age 2x a week. Gym another 3x week. Doubt I could do that with TT in 300's.

As of now, I'm going to stop the Adex. I may experiment with DIM or another natural anti estrogen supplement & monitor my next labs.

 

[foreveryoung]

I feel very good overall...almost normal but just with very low libido. I play basketball with guys half my age 2x a week. Gym another 3x week. Doubt I could do that with TT in 300's.

As of now, I'm going to stop the Adex. I may experiment with DIM or another natural anti estrogen supplement & monitor my next labs.

you say "doubt I could do that with TT in 300's" you didn't try when you were natural? there is a lot to be said for getting out there and doing some exercise, and low 300's isn't all that bad for natural, I think someone could get along fine and feel fine with those levels if they are doing other things to feel healthy and good

how bad did you feel when you were natural? and nothing else was going wrong lifestyle-wise at the time?