I am a 30 year old male, who about seven years ago was diagnosed with low T and secondary hypogonadism. Through this time, I have had some capable and less capable doctors and really been through the spectrum of treatments to include clomid monotherapy, HCG monotherapy, and joint HCG/injected-testosterone.
Previous protocols were HCG monotherapy 350iu 3x week. With anastrozole .5mg EOD. Got my total testosterone in the 900s. Estrogen was typically on the low-middle end of the scale.
HCG plus test crypt was HCG 200iu 3x week and test crypt 100 mg/ml with anastrozle .5mg EOD. This had my total testosterone around 1100. Estrogen was also typically on the low-middle end of the scale. Without anastrozole in both of these protocols, I would get ankle swelling and other high estrogen sides.
All of the above treatments led to increased strength and muscle mass and – all of the above treatments never resulted in me having a normal libido. I’ll add an emphasis to all this ---- besides the libido — I feel great in all regards such as strength, energy, cardiovascular ability, appetite, etc. I cannot masturbate for a month and still have no drive and never feel “horny.” Women are art instead of sex objections, and its awful. I have seen several specialists and everyone agrees that my labs look good and frankly I concur for what it matters with my medical training only including reading threads for years. I looked at porn way too much for many years, but have really curbed that habit over the last year.
Fast forward to the present, I have been currently on clomid monotherapy for about two years. I am in probably the best shape of my life and besides libido, I feel pretty good. I wake up energetic, not needing a drop of coffee, and perform well at work. I lift regularly and do intense cardio as well. I am currently seeing an endo who genuinely cares ((though unsure on how deep his knowledge is)), a therapist, psychiatrist, and I have a primary care.
My doctors/therapist are all convinced that my lack of libido is due to anxiety and/or depression, maybe directly related to almost a “sex-phobia.” The depression to me doesn’t really fit. The anxiety I can kind of believe, as I am certainly worry-prone and obsess about the missing the libido because I believe its destroying my life. My primary care wants me to try an SSRI, which I resist because the number one side effect is reduced libido. My Psychiatrist has convinced me to try Wellbutrin for a libido boost ((150 extended release)) and Buspar, but so far I am not noticing any differences.
QUESTION: All this said — does anyone on this board have any comments on whether moderate but sex-focused anxiety alone is enough to cripple a men’s libido to near zero? If it wasn't for all the bad press about clomid destroying one's sex drive -- I might believe the mental health cause a bit more. ((Or would you still side with their being an unknown remaining physical/hormonal issues?))
Current meds Levothyroxine 50mcg/3x week, clomid 50mg/4x week, Wellbutrin 150 extended releaser daily, multivitamin, fish oil, vitamin d.
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*** I am considering dropping the clomid dosage significantly and see if my testosterone stays up and maybe the libido improves. ---------Welcome comments on whether this is realistic.---------------------------
“”" It is used off label to treat hypogonadal men (HM) and exists as a 60/40 % racemic mixture of the stereoisomers enclomiphene (EN) and zuclomiphene (ZU), respectively. EN is a potent estrogen receptor antagonist reaching peak plasma concentration (Tmax) in 4 hours (hrs), with a half - life (T1/2) of 8 hrs."""
Based on the above ((which clearly many already know)) — the two isomers of clomid have extremely different half lives. With the enclomiphene ((the good isomer for men??)) having a short half life and the zuclomiphene ((the bad one for men??)) having an extremely long half life. So, as others have stated, many men feel good when they first take clomid and zuclomiphene is not too built up in their system, but once the zuclomiphene builds, libido and other factors grow worse. ((Correct me if I am wrong, no pride here))
By this reasoning, when one is dropping clomid dosage, the “good properties” of clomid get reduced in the blood very quickly and the “bad properties” take an extremely long time? So, any hypothetical positive aspects of a reduction in clomid dosage…probably take over a month to begin to come into affect??? Is this correct reasoning? Is clomid’s combine half life of 6-7 days basically irrelevant when you break it down to the two isomers?
So by this logic ((which could be false/welcome feedback)) — if one reduces clomid dosing and “feels better” as described above, is it all in your imagination unless a month or two has passed at the new lower dosage?
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Most recent labs below are not as comprehensive as I’d like and they are from May/July 2019. I am annoyed that a recent estradiol was not taken. I independently ordered estradiol sensitive today and will update when the result comes in.
F GLUCOSE 117 65-139 (mg/dL) QBA
-
- Non-fasting reference interval
-
F UREA NITROGEN (BUN) 14 7-25 (mg/dL) QBA
F CREATININE 1.13 0.60-1.35 (mg/dL) QBA
F eGFR NON-AFR. AMERICAN 87 > OR = 60 (mL/min/1.73m2) QBA
F eGFR AFRICAN AMERICAN 101 > OR = 60 (mL/min/1.73m2) QBA
F BUN/CREATININE RATIO NOT APPLICABLE 6-22 ((calc)) QBA
F SODIUM 140 135-146 (mmol/L) QBA
F POTASSIUM 4.2 3.5-5.3 (mmol/L) QBA
F CHLORIDE 105 98-110 (mmol/L) QBA
F CARBON DIOXIDE 28 20-32 (mmol/L) QBA
F CALCIUM 9.1 8.6-10.3 (mg/dL) QBA
F PROTEIN, TOTAL 6.1 6.1-8.1 (g/dL) QBA
F ALBUMIN 4.1 3.6-5.1 (g/dL) QBA
F GLOBULIN 2.0 1.9-3.7 (g/dL (calc)) QBA
F ALBUMIN/GLOBULIN RATIO 2.1 1.0-2.5 ((calc)) QBA
F BILIRUBIN, TOTAL 0.5 0.2-1.2 (mg/dL) QBA
F ALKALINE PHOSPHATASE 56 40-115 (U/L) QBA
F AST 26 10-40 (U/L) QBA
F ALT 20 9-46 (U/L) QBA
TSH 2.03 range 0.40-4.50 (mIU/L)
TESTOSTERONE, TOTAL, MS 672 range 250-1100 (ng/dL)
TESTOSTERONE, FREE 93.7 range 35.0-155.0 (pg/mL)
LH 6.8 range 1.7-8.6 (mIU/mL)
FSH 1,5 range 1.5 - 12.4
F WHITE BLOOD CELL COUNT 4.8 3.8-10.8 (Thousand/uL) QBA
F RED BLOOD CELL COUNT 5.43 4.20-5.80 (Million/uL) QBA
F HEMOGLOBIN 16.3 13.2-17.1 (g/dL) QBA
F HEMATOCRIT 49.0 38.5-50.0 (%) QBA
F MCV 90.2 80.0-100.0 (fL) QBA
F MCH 30.0 27.0-33.0 (pg) QBA
F MCHC 33.3 32.0-36.0 (g/dL) QBA
F RDW 12.9 11.0-15.0 (%) QBA
F PLATELET COUNT 233 140-400 (Thousand/uL) QBA
F MPV 10.5 7.5-12.5 (fL) QBA
PROLACTIN QST 9.0 ng/mL range 2.0 - 18.0 ng/mL
T4,Free(Direct) LC 1.42 ng/dL range 0.82 - 1.77 ng/dL
Triiodothyronine,Free,Serum LC 3.2 pg/mL range 2.0 - 4.4 pg/mL
CORTISOL, TOTAL QST 16.8 mcg/dL mcg/dL ((morning))
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0
Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0
Previous protocols were HCG monotherapy 350iu 3x week. With anastrozole .5mg EOD. Got my total testosterone in the 900s. Estrogen was typically on the low-middle end of the scale.
HCG plus test crypt was HCG 200iu 3x week and test crypt 100 mg/ml with anastrozle .5mg EOD. This had my total testosterone around 1100. Estrogen was also typically on the low-middle end of the scale. Without anastrozole in both of these protocols, I would get ankle swelling and other high estrogen sides.
All of the above treatments led to increased strength and muscle mass and – all of the above treatments never resulted in me having a normal libido. I’ll add an emphasis to all this ---- besides the libido — I feel great in all regards such as strength, energy, cardiovascular ability, appetite, etc. I cannot masturbate for a month and still have no drive and never feel “horny.” Women are art instead of sex objections, and its awful. I have seen several specialists and everyone agrees that my labs look good and frankly I concur for what it matters with my medical training only including reading threads for years. I looked at porn way too much for many years, but have really curbed that habit over the last year.
Fast forward to the present, I have been currently on clomid monotherapy for about two years. I am in probably the best shape of my life and besides libido, I feel pretty good. I wake up energetic, not needing a drop of coffee, and perform well at work. I lift regularly and do intense cardio as well. I am currently seeing an endo who genuinely cares ((though unsure on how deep his knowledge is)), a therapist, psychiatrist, and I have a primary care.
My doctors/therapist are all convinced that my lack of libido is due to anxiety and/or depression, maybe directly related to almost a “sex-phobia.” The depression to me doesn’t really fit. The anxiety I can kind of believe, as I am certainly worry-prone and obsess about the missing the libido because I believe its destroying my life. My primary care wants me to try an SSRI, which I resist because the number one side effect is reduced libido. My Psychiatrist has convinced me to try Wellbutrin for a libido boost ((150 extended release)) and Buspar, but so far I am not noticing any differences.
QUESTION: All this said — does anyone on this board have any comments on whether moderate but sex-focused anxiety alone is enough to cripple a men’s libido to near zero? If it wasn't for all the bad press about clomid destroying one's sex drive -- I might believe the mental health cause a bit more. ((Or would you still side with their being an unknown remaining physical/hormonal issues?))
Current meds Levothyroxine 50mcg/3x week, clomid 50mg/4x week, Wellbutrin 150 extended releaser daily, multivitamin, fish oil, vitamin d.
====
===
==
=
*** I am considering dropping the clomid dosage significantly and see if my testosterone stays up and maybe the libido improves. ---------Welcome comments on whether this is realistic.---------------------------
“”" It is used off label to treat hypogonadal men (HM) and exists as a 60/40 % racemic mixture of the stereoisomers enclomiphene (EN) and zuclomiphene (ZU), respectively. EN is a potent estrogen receptor antagonist reaching peak plasma concentration (Tmax) in 4 hours (hrs), with a half - life (T1/2) of 8 hrs."""
Based on the above ((which clearly many already know)) — the two isomers of clomid have extremely different half lives. With the enclomiphene ((the good isomer for men??)) having a short half life and the zuclomiphene ((the bad one for men??)) having an extremely long half life. So, as others have stated, many men feel good when they first take clomid and zuclomiphene is not too built up in their system, but once the zuclomiphene builds, libido and other factors grow worse. ((Correct me if I am wrong, no pride here))
By this reasoning, when one is dropping clomid dosage, the “good properties” of clomid get reduced in the blood very quickly and the “bad properties” take an extremely long time? So, any hypothetical positive aspects of a reduction in clomid dosage…probably take over a month to begin to come into affect??? Is this correct reasoning? Is clomid’s combine half life of 6-7 days basically irrelevant when you break it down to the two isomers?
So by this logic ((which could be false/welcome feedback)) — if one reduces clomid dosing and “feels better” as described above, is it all in your imagination unless a month or two has passed at the new lower dosage?
====
===
==
=
Most recent labs below are not as comprehensive as I’d like and they are from May/July 2019. I am annoyed that a recent estradiol was not taken. I independently ordered estradiol sensitive today and will update when the result comes in.
F GLUCOSE 117 65-139 (mg/dL) QBA
-
- Non-fasting reference interval
-
F UREA NITROGEN (BUN) 14 7-25 (mg/dL) QBA
F CREATININE 1.13 0.60-1.35 (mg/dL) QBA
F eGFR NON-AFR. AMERICAN 87 > OR = 60 (mL/min/1.73m2) QBA
F eGFR AFRICAN AMERICAN 101 > OR = 60 (mL/min/1.73m2) QBA
F BUN/CREATININE RATIO NOT APPLICABLE 6-22 ((calc)) QBA
F SODIUM 140 135-146 (mmol/L) QBA
F POTASSIUM 4.2 3.5-5.3 (mmol/L) QBA
F CHLORIDE 105 98-110 (mmol/L) QBA
F CARBON DIOXIDE 28 20-32 (mmol/L) QBA
F CALCIUM 9.1 8.6-10.3 (mg/dL) QBA
F PROTEIN, TOTAL 6.1 6.1-8.1 (g/dL) QBA
F ALBUMIN 4.1 3.6-5.1 (g/dL) QBA
F GLOBULIN 2.0 1.9-3.7 (g/dL (calc)) QBA
F ALBUMIN/GLOBULIN RATIO 2.1 1.0-2.5 ((calc)) QBA
F BILIRUBIN, TOTAL 0.5 0.2-1.2 (mg/dL) QBA
F ALKALINE PHOSPHATASE 56 40-115 (U/L) QBA
F AST 26 10-40 (U/L) QBA
F ALT 20 9-46 (U/L) QBA
TSH 2.03 range 0.40-4.50 (mIU/L)
TESTOSTERONE, TOTAL, MS 672 range 250-1100 (ng/dL)
TESTOSTERONE, FREE 93.7 range 35.0-155.0 (pg/mL)
LH 6.8 range 1.7-8.6 (mIU/mL)
FSH 1,5 range 1.5 - 12.4
F WHITE BLOOD CELL COUNT 4.8 3.8-10.8 (Thousand/uL) QBA
F RED BLOOD CELL COUNT 5.43 4.20-5.80 (Million/uL) QBA
F HEMOGLOBIN 16.3 13.2-17.1 (g/dL) QBA
F HEMATOCRIT 49.0 38.5-50.0 (%) QBA
F MCV 90.2 80.0-100.0 (fL) QBA
F MCH 30.0 27.0-33.0 (pg) QBA
F MCHC 33.3 32.0-36.0 (g/dL) QBA
F RDW 12.9 11.0-15.0 (%) QBA
F PLATELET COUNT 233 140-400 (Thousand/uL) QBA
F MPV 10.5 7.5-12.5 (fL) QBA
PROLACTIN QST 9.0 ng/mL range 2.0 - 18.0 ng/mL
T4,Free(Direct) LC 1.42 ng/dL range 0.82 - 1.77 ng/dL
Triiodothyronine,Free,Serum LC 3.2 pg/mL range 2.0 - 4.4 pg/mL
CORTISOL, TOTAL QST 16.8 mcg/dL mcg/dL ((morning))
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0
Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0