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Author Topic: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?  (Read 3588 times)

bbnoob25

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I am on a long-term opioid for chronic pain that is reducing my T levels to abysmal ranges (see test results below). My symptoms are weight gain, fatigue, loss of motivation and concentration, and complete loss of libido. I have already tried Clomid 25mg ED for 6-8 weeks, but my E3 skyrockets, which caused all my symptoms to remain.

Any recommendations for a non-fertility impacting TRT regimen (I plan on having kids) for me since I plan on staying on the opioid long-term? I see the doctor on Monday and it seems that I can pretty much recommend whatever I want and get it (not that that is actually a good thing), but the doctor has already mentioned hCG, Clomid, Novaldex as options, either as standalone treatment or in combination, but said we will talk more on Monday. So I want the real pros opinions!

After only 6 weeks of opioid use my Total T went from ~1,000 while on the Clomid to 215 while off the clomid. See most recent bloodwork:

Current Meds:
anastrozole .25mg EOD 6 weeks
Opioid a lot ED 6 weeks

Previous Meds
Clomid .25 ED for 12 weeks
Opioid a loto ED 12 weeks

11/23/2016 while off Clomid for 10 weeks and on Opioids for 6 weeks and .25mg EOD of anastrozole
TT: 216 ng/dL (Normal range: 250-1100)
FT: 28.4 pg/mL (Normal range: 35-155)
E2: 22pg/mL (Normal range: <39)
LH: 3.4 mIU/mL (Normal range: 1.5-9.3)
FSH: 2.8 mIU/mL (Normal range: 1.6-8)

10/7/2016 while on Clomid for 8 weeks and on Opioids for 12 weeks and zero anastrozole
TT: 1,225 ng/dL (normal range: 250-827)
E2: 54 pg/mL (normal range: <39)
FT, LH and FSH were not taken due to my old doctor being retarded
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

PeakT

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #1 on: December 02, 2016, 05:46:38 pm »
I am on a long-term opioid for chronic pain that is reducing my T levels to abysmal ranges (see test results below). My symptoms are weight gain, fatigue, loss of motivation and concentration, and complete loss of libido. I have already tried Clomid 25mg ED for 6-8 weeks, but my E3 skyrockets, which caused all my symptoms to remain.

Any recommendations for a non-fertility impacting TRT regimen (I plan on having kids) for me since I plan on staying on the opioid long-term? I see the doctor on Monday and it seems that I can pretty much recommend whatever I want and get it (not that that is actually a good thing), but the doctor has already mentioned hCG, Clomid, Novaldex as options, either as standalone treatment or in combination, but said we will talk more on Monday. So I want the real pros opinions!

After only 6 weeks of opioid use my Total T went from ~1,000 while on the Clomid to 215 while off the clomid. See most recent bloodwork:

Current Meds:
anastrozole .25mg EOD 6 weeks
Opioid a lot ED 6 weeks

Previous Meds
Clomid .25 ED for 12 weeks
Opioid a loto ED 12 weeks

11/23/2016 while off Clomid for 10 weeks and on Opioids for 6 weeks and .25mg EOD of anastrozole
TT: 216 ng/dL (Normal range: 250-1100)
FT: 28.4 pg/mL (Normal range: 35-155)
E2: 22pg/mL (Normal range: <39)
LH: 3.4 mIU/mL (Normal range: 1.5-9.3)
FSH: 2.8 mIU/mL (Normal range: 1.6-8)

10/7/2016 while on Clomid for 8 weeks and on Opioids for 12 weeks and zero anastrozole
TT: 1,225 ng/dL (normal range: 250-827)
E2: 54 pg/mL (normal range: <39)
FT, LH and FSH were not taken due to my old doctor being retarded

Here are the 3 ways that one can go:

http://www.peaktestosterone.com/testosterone_fertility.aspx
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Peak Testosterone Forum

Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #1 on: December 02, 2016, 05:46:38 pm »

Cataceous

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #2 on: December 02, 2016, 06:18:23 pm »
I'd suggest either trying a much lower dose of Clomid, like 12.5 mg EOD, or injecting testosterone along with low doses of hCG. The Clomid is easier, and many guys here have seen better results with lower doses.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

Boxcar

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #3 on: December 02, 2016, 06:47:38 pm »
I have been on opioids on-and-off for five years, so maybe I can help... Are you on immediate release or sustained release opiods?  I have only ever been on the former.  One thing I noticed -- when raising testosterone levels, the immediate release meds actually last longer (5 or 6 hours, vs 3-4 hours with low testosterone.  Even just raising testosterone without opioids will have a painkilling effect for me.  Did the clomid help with your pain at all?  If not, the AI might reduce the painkilling effect of testosterone for you.  (There is a theory that testosterone raises endorphin levels by increasing aromatization in the CNS.)  So if you can make the therapy work with little or no AI, that might be helpful, which leads me to...

You have a very robust response to the clomid, by lab values, but without therapeutic response.  Clomid has synthetic estrogen in it, which may be the cause of this.  As Cat suggests, simply lowering the clomid dose may work better.  And this may also allow you to get by without the AI as well.  Did the clomid ever help?  Sometimes guys notice improvement, which fades after some time. 
Age: 36
178 lbs 5'8''

Current Treatment: 50 mg testosterone cypionate IM, twice a week
Low T Symptoms: Chronic pelvic pain, and other neuropathic pain.  Mild anxiety, low energy and low motivation
Meds: Amitriptyline (for pain, not depression), Clonidine (for sleep, not blood pressure)

Sean Mosher

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #4 on: December 03, 2016, 08:02:55 am »
Boxcar,

I work for a pain management doctor who treats patients for both chronic pain and long-term opioid use.
Also, we end up talking with and referring patients for lowT treatment as well.
Is suboxone an option for you?
TRT with a healthy dose of hCG should keep you fertile.
I'm more concerned with the long-term opiate use as we are now learning more and more about the detrimental side effects of it.
I've seen it first hand.
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NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #4 on: December 03, 2016, 08:02:55 am »


bbnoob25

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #5 on: December 03, 2016, 12:45:13 pm »
Thanks for the reply everyone!

The medication I am on is actually Suboxone. I was on oxycodone for years and it eventually became ineffective, so the suboxone was used and it's been working great for the past 6 months, besides the low T of course.

I'm hesitant to do any form of real test because it sounds like I'll be locked in to that treatment for life, but I'll eventually come off the opioid if my condition clears up and then I won't need a TRT. Is it true that real test is a life long commitment?

In the meantime I'll dose clomid 12.5mg EOD and drop the AI  and test labs in 4 weeks. Is this a good approach? And if that doesn't work maybe consider test with hCG.
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

Boxcar

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #6 on: December 03, 2016, 02:29:34 pm »
Thanks for the reply everyone!

The medication I am on is actually Suboxone. I was on oxycodone for years and it eventually became ineffective, so the suboxone was used and it's been working great for the past 6 months, besides the low T of course.

I'm hesitant to do any form of real test because it sounds like I'll be locked in to that treatment for life, but I'll eventually come off the opioid if my condition clears up and then I won't need a TRT. Is it true that real test is a life long commitment?

In the meantime I'll dose clomid 12.5mg EOD and drop the AI  and test labs in 4 weeks. Is this a good approach? And if that doesn't work maybe consider test with hCG.

Hopefully someone else will comment on calibrating your AI with clomid (you may even want to start a new thread).  I don't have any personal experience with them -- but using less clomid and AI is the approach that I would take.

In terms of TRT being a lifelong commitment -- my doctor says that natural levels will resume 2-4 weeks after stopping.  Anecdotally, it definitely takes some guys longer.  You will hear some people say that there is long term impairment, but it is hard to judge if this really happens (my doc says no, but maybe for some guys taking steroids).  Fertility does take longer to recover (up to a year), and there seems to be long term impairment for about 1% of patients.  Using HCG will help counteract this, as others have said.  But I don't know if the effectiveness has ever been studied.  I also wonder if taking HCG alone (ie, HCG monotherapy) is actually better for fertility than Test + HCG.  In theory it should be, but I wonder if there is really a practical difference.

If you expect your cause for low T (opioid use) to end in the not-to-distant future, then it makes sense to give clomid another shot.  It is the easiest therapy to come off of (at least for guys who don't have serious side effects).

I am glad to hear that suboxone has worked for you.  May I ask, what type of pain do you have?

For my own pain, I plan to give Low Dose Naltrexone (LDN) another shot.  I tried it before, and all it did was give me sleep problems.  I am hoping that with TRT it would actually work, and with little or no effect on sleep.  Also, there is a female fertility study showing that women who did not respond to clomid alone would ususally ovulate with clomid + LDN.  This suggests the possibility that that LDN could improve the effectiveness of clomid in men.  It's a real long shot, but might be worth consideration for some guys (and not necessarily the OP, I am digressing here...)
Age: 36
178 lbs 5'8''

Current Treatment: 50 mg testosterone cypionate IM, twice a week
Low T Symptoms: Chronic pelvic pain, and other neuropathic pain.  Mild anxiety, low energy and low motivation
Meds: Amitriptyline (for pain, not depression), Clonidine (for sleep, not blood pressure)

Boxcar

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #7 on: December 03, 2016, 02:33:07 pm »
Boxcar,

I work for a pain management doctor who treats patients for both chronic pain and long-term opioid use.
Also, we end up talking with and referring patients for lowT treatment as well.
Is suboxone an option for you?
TRT with a healthy dose of hCG should keep you fertile.
I'm more concerned with the long-term opiate use as we are now learning more and more about the detrimental side effects of it.
I've seen it first hand.

Sean, thanks for the input.

Does suboxone work well for pain?  I know it's used to treat opioid addiciton, but I have not really considered it to treat my pain.

Aside from low testosterone and dependence, what other detrimental side effects have you seen with long-term opioid use?
Age: 36
178 lbs 5'8''

Current Treatment: 50 mg testosterone cypionate IM, twice a week
Low T Symptoms: Chronic pelvic pain, and other neuropathic pain.  Mild anxiety, low energy and low motivation
Meds: Amitriptyline (for pain, not depression), Clonidine (for sleep, not blood pressure)

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #7 on: December 03, 2016, 02:33:07 pm »

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bbnoob25

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #8 on: December 03, 2016, 03:47:01 pm »
Thanks for the reply everyone!

The medication I am on is actually Suboxone. I was on oxycodone for years and it eventually became ineffective, so the suboxone was used and it's been working great for the past 6 months, besides the low T of course.

I'm hesitant to do any form of real test because it sounds like I'll be locked in to that treatment for life, but I'll eventually come off the opioid if my condition clears up and then I won't need a TRT. Is it true that real test is a life long commitment?

In the meantime I'll dose clomid 12.5mg EOD and drop the AI  and test labs in 4 weeks. Is this a good approach? And if that doesn't work maybe consider test with hCG.

Hopefully someone else will comment on calibrating your AI with clomid (you may even want to start a new thread).  I don't have any personal experience with them -- but using less clomid and AI is the approach that I would take.

In terms of TRT being a lifelong commitment -- my doctor says that natural levels will resume 2-4 weeks after stopping.  Anecdotally, it definitely takes some guys longer.  You will hear some people say that there is long term impairment, but it is hard to judge if this really happens (my doc says no, but maybe for some guys taking steroids).  Fertility does take longer to recover (up to a year), and there seems to be long term impairment for about 1% of patients.  Using HCG will help counteract this, as others have said.  But I don't know if the effectiveness has ever been studied.  I also wonder if taking HCG alone (ie, HCG monotherapy) is actually better for fertility than Test + HCG.  In theory it should be, but I wonder if there is really a practical difference.

If you expect your cause for low T (opioid use) to end in the not-to-distant future, then it makes sense to give clomid another shot.  It is the easiest therapy to come off of (at least for guys who don't have serious side effects).

I am glad to hear that suboxone has worked for you.  May I ask, what type of pain do you have?

For my own pain, I plan to give Low Dose Naltrexone (LDN) another shot.  I tried it before, and all it did was give me sleep problems.  I am hoping that with TRT it would actually work, and with little or no effect on sleep.  Also, there is a female fertility study showing that women who did not respond to clomid alone would ususally ovulate with clomid + LDN.  This suggests the possibility that that LDN could improve the effectiveness of clomid in men.  It's a real long shot, but might be worth consideration for some guys (and not necessarily the OP, I am digressing here...)

Great info, thanks!

As far as the cause of my pain, it's a painful case of inflammatory bowel disease. Full agonoist Opioids did the trick for years, beginning with codeine and eventually ending with Oxycodone, but eventually I just kept neededimg more and more to dull the intense painful cramping so buprenorphine (suboxone) was tried and it has been great. I have actually decreased my dose from 8mg to 4mg and it has still maintained its pain reducing effects and has been great as reducing my frequent bowel movements. And the best part about the drug is it doesn't dull your senses as much as real opioids. It's not for everyone though 


EDIT: also, what kind of vision issues should I be looking out for while on Clomid? I actually had some vision issues the last time I was on it but I also just had LASIK surgery done a month or two before taking it so I just attributed it to that. My vision is good now so I'll keep an eye out for any changes but is there anything specific to look out for?

EDIT2: I just checked my medical records and I actually was having vision issues two months before I even took my first ever dose of clomid
« Last Edit: December 03, 2016, 07:31:44 pm by bbnoob25 »
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

bbnoob25

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #9 on: December 05, 2016, 06:58:36 am »
I go to the doctor today to discuss options, so I will definitely be suggesting Clomid 12.5mg EOD, but should I also suggest combining it with a short-term Novaldex dose to kick-start things, or should is it safer to just go with Clomid monotherapy and re-test labs in a few weeks to see where I am?
« Last Edit: December 05, 2016, 08:09:34 am by bbnoob25 »
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

Cataceous

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #10 on: December 05, 2016, 10:36:34 am »
I go to the doctor today to discuss options, so I will definitely be suggesting Clomid 12.5mg EOD, but should I also suggest combining it with a short-term Novaldex dose to kick-start things, or should is it safer to just go with Clomid monotherapy and re-test labs in a few weeks to see where I am?

Keep it simple: just use Clomid alone for now.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

bbnoob25

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #11 on: December 05, 2016, 11:58:56 am »
I go to the doctor today to discuss options, so I will definitely be suggesting Clomid 12.5mg EOD, but should I also suggest combining it with a short-term Novaldex dose to kick-start things, or should is it safer to just go with Clomid monotherapy and re-test labs in a few weeks to see where I am?

Keep it simple: just use Clomid alone for now.

Those were the exact words from my Dr, lol. Thanks for the sound advice! Clomid 12.5mg EOD it is. He recommended 25mg every other day, but I think I'd rather start low considering the affect it had on me at 25mg ED (215 to 1100)
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

PeakT

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #12 on: December 05, 2016, 07:07:46 pm »


Those were the exact words from my Dr, lol. Thanks for the sound advice! Clomid 12.5mg EOD it is. He recommended 25mg every other day, but I think I'd rather start low considering the affect it had on me at 25mg ED (215 to 1100)

Some guys do great on 12.5 3X per week and this will minimize the chance for sides.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

bbnoob25

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #13 on: December 14, 2016, 02:28:49 pm »
I had to stop the Clomid due to new eye floaters. I've had floaters for the past ten years and after going a week on the clomid at 12.5mg EOD I got new floaters in my right eye. They are pretty bad and very annoying. It's the thing you think that "will never happen to me", but it unfortunately  did. I went to the eye doctors and luckily I don't have any retinal detarchment. I'm going to let the Clomid clear my body over the next two months and consider Novaldex or mono HCG Therapy, but more than likely I will do nothing and just suck it up while on the long term opioid. Medication affecting your vision is scary :/.
Current protocol
Test cyp = 80mg E3.5D
hCG = 350iu 3x per week
Anastrozole = .25mg E3.5D

PeakT

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Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #14 on: December 14, 2016, 03:12:46 pm »
I had to stop the Clomid due to new eye floaters. I've had floaters for the past ten years and after going a week on the clomid at 12.5mg EOD I got new floaters in my right eye. They are pretty bad and very annoying. It's the thing you think that "will never happen to me", but it unfortunately  did. I went to the eye doctors and luckily I don't have any retinal detarchment. I'm going to let the Clomid clear my body over the next two months and consider Novaldex or mono HCG Therapy, but more than likely I will do nothing and just suck it up while on the long term opioid. Medication affecting your vision is scary :/.

Wow.  And you are on the lowest dose possible.
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

Peak Testosterone Forum

Re: 28yo Opioid Induced Low-T: What TRT to Use if Fertility is a Concern?
« Reply #14 on: December 14, 2016, 03:12:46 pm »