Peak Testosterone Forum

General Category => Testosterone, Hormones and General Men's Health => Topic started by: Gef on December 23, 2020, 12:01:13 pm

Title: Enclomiphene report
Post by: Gef on December 23, 2020, 12:01:13 pm
In response to Cataceous’s suggestion on my 12/17/20 posting I am offering the first of my enclomiphene progress reports and observations.                                   
  Some background -
I am not on TRT. Libido has been an issue throughout my adult life.
Last year I was doing ok with an imprecise protocol of Clomid 12.5 mg and DIM 200 mg (along with a tadalafil 20 mg assist) 3 to 4 times a month depending on how I felt. Total T in the 800s on average and with estradiol high normal to high.

For reasons unclear to me my estradiol tested <20 last December while my TT was tested out at 820, and FT at 98.5. My libido however had been stronger during this particular month but this could possibly be explained by a brief interlude with a woman of unusual tastes.

By July of this year my libido began to diminish. During the final week of July, I increased protocol to four times a week - a mistake. Labs on 08/07/20: TT 1283, FT 84, and estradiol 43, DHEA 171. I stopped everything for a month - a mistake too. By 10/05/20 my labs show that my TT dropped to 340, Free T to 34 and estradiol to 23. I felt it. 

I resumed my 3 times-a-week (including DIM) protocol and according to my LabCorp testing of 11/06/20 my levels quickly returned back to what they had been before. Unfortunately libido did not return as it once was. I made an appointment with Defy and later quit Clomid 12/07/20.

On 12/11/20 I began my new protocol prescribed by my doctor from Defy: 12.5 mg enclomiphene daily to keep my TT at upper limits to overcome effects of both high SHBG and low Free T, and 50 mg DHEA because my natural levels have been low.

Lab comparisons with Clomid:                                                                                                                                                                                                                             
Defy-LabCorp 11/06/20  –  Total T  924 ng/dL [264-916],   Free T  9.7 pg/mL [6.6-18.1],   Estradiol  37.5 pg/mL [8-35],   SHBG  106 nmol/L [19.3-76.4],   LH  5.8 mIU/mL [1.7-8.6],           DHEA-s 174.1 ug/dL [48.9-344].                                                                                                                                                                                                                                     
Quest 11/18/20:   Total T 878 ng/dL, [250-1100]   *Free T 81.2 pg/mL. [35-155]    Estradiol LC/MS 31 pg/mL, <OR=29 pg/mL 

Lab comparison with enclomiphene:                                                                                                                                                                                                                    
Quest 12/15/20:   Total T 822 ng/dL, [250-1100]     *Free T   66.7 pg/mL, [35-155]        Total estrogen 150.8 pg/mL. [60-190]

Quest 12/21/20:  Results still Pending – Total T,   Free T,   Estradiol,   SHBG,   and   DHEA.

Observations:
                                                                                                                                                                                                                                                                                       
 1- Previously, if I had taken 12.5 mg Clomid (instead of enclomiphene) 5 days in a row, my TT would have been higher. 2- My Free T has since become lower. I am wondering if these two conditions could be due to the introduction of 50 mg DHEA and/or residual zuclomiphene. Otherwise not much difference after only 5 days.

As of this writing, there is still no improvement with libido. Although occasionally there is a very subtle feeling of something on the verge. I’m thinking that residual zuclomiphene could still be exerting a negative influence due to its relatively long half-life. Hormone balance may still be in process. I found that three grams Citrulline helps a little for morning wood despite no libido. I’m thinking citrulline may be a good adjunct for tadalafil.
-
 In retrospect “more is not better”. In my case, increasing Clomid may have been a mistake. I should have taken “natural fluctuations” seriously and kept my Clomid dosage to a minimum. But then, from what I have read on the subject, there is the eventual possibility of zuclomiphene saturation – if I understand correctly. Or perhaps the delicate balance of T/E ratio was disturbed?        I think I may discontinue DIM. There is a lot of conflicting information concerning both DIM and DHEA.

At this point with so little information available to me, I can only post my observations/labs for those interested, patiently wait, and ride out this process until my 90 day supply is finished – for better or for worse. I plan for another lab after January 15.  Meanwhile I will post my 21/21/20 lab results when they become available.

 
Title: Re: Enclomiphene report
Post by: Cataceous on December 23, 2020, 01:35:06 pm
Thanks for the very detailed update. It's certainly interesting.

Some research has the half-life for zuclomiphene as about a month, which would have it lingering for a very long time.

I have concerns about taking that much DHEA, though nothing concrete. It's just that when we don't know what our optimal level is for a hormone I tend to think it's safest to target mid-range for healthy young men. In the case of DHEA-S this is going to be around 300 mcg/dL. I expect 50 mg of DHEA is going to put you way above this, and probably above any normal range.

I also took DIM for a while, but was never sure about it either.
Title: Re: Enclomiphene report
Post by: Gef on December 24, 2020, 07:26:22 am
I agree. I'm waiting until my lab results due next week to decide if I will continue DHEA or on an adjusted dosage.
Whenever I'm researching enclomiphene online I am reminded of the importance of unbiased sources for information. Like must things/ideas that are new I suspect enclomiphene is not in the best interests of certain well known groups involved with male hormones and TRT. Just a thought.
Title: Re: Enclomiphene report
Post by: ghce on December 24, 2020, 09:30:50 am
I have seen several different data points on the half life of Zuclomiphene ranging from 2 weeks to 6 months! I know that on the 3 different occasions I came off Clomid that at about the 3 week point there was a sweet spot where libido and EQ spiked high whereas when on Clomid both were tanked.
Title: Re: Enclomiphene report
Post by: Gef on December 30, 2020, 10:46:08 pm
I just got my test results of 12/21/20 (with enclomiphene) with minor but some odd variations.

DHEA:  417 mcg/dL,   Estradiol (sensitive) 26 pg/mL,   Total T 757 ng/dL,    Free T  75.4 pg/mL,   SHBG 74 nmol/L.

Since 11/06/20, (when I was on Clomid), all of my levels have dropped to some degree except DHEA. It’s still early but it seems enclomiphene has had some positive effect on my SHBG and Estradiol levels. DHEA is no mystery as my dosage was rather high. I’ll cut back.

What’s a little curious is in my last 2 labs my Total T has dropped despite the relatively high dosage compared to my previous Clomid dosage.  Before, Clomid 12.5 mg at 3 times a week would easily bring levels up towards 1000. Yet now, enclomiphene dosage at 12.5 mg 7 days a week, has lowered TT levels. Free T dropped a little too.
 
Otherwise I’ve been feeling some subtle improvements of libido, still low, but enough to be guardedly optimistic.  Perhaps hormone levels are still in process.
Title: Re: Enclomiphene report
Post by: Cataceous on December 31, 2020, 01:37:59 am
If that's DHEA-S then it's not quite as high as I was expecting. Nonetheless, reading more about DHEA reinforces my thought that it's safest to keep levels closer to mid-range for young men. The range of effects of DHEA is vast and incompletely understood. One interesting example is that DHEA activates the beta estrogen receptor as well as estradiol. That implies a pretty high potency and uncertain effects: "Remarkably however, DHEA acts as a full agonist of the ERβ with a maximal response similar to or actually slightly greater than that of estradiol, and its levels in circulation and local tissues in the human body are high enough to activate the receptor to the same degree as that seen with circulating estradiol levels at somewhat higher than their maximal, non-ovulatory concentrations; indeed, when combined with estradiol with both at levels equivalent to those of their physiological concentrations, overall activation of the ERβ was doubled."[R (https://en.wikipedia.org/wiki/DHEA#Hormonal_activity)]

I wonder if this could affect testosterone in individual cases? In general DHEA supplementation doesn't change testosterone or estradiol levels significantly, even at enormous doses: https://www.peaktestosterone.com/What_Hormones_Does_DHEA_Change/
As you say, things could still be in flux.
Title: Re: Enclomiphene report
Post by: ghce on December 31, 2020, 02:38:38 am
Lower T and free T but also significantly lower SHBG probably translates to a win as both your total T and free T look pretty reasonable and your E2 looks to be in a place that many find acceptable.
Title: Re: Enclomiphene report
Post by: Gef on January 26, 2021, 06:37:58 am
Test results 1/24/21
TT: 843 ng/dL   (Ref 250-827)
Free T: 51.9 pg/mL   (46-224)
Bioavailable T: 95.4 ng/dL   (110-575)
SHBG: 85 nmol/L   (22-77)
Estradiol, Ultrasensitive LC/MS: 41 pg/mL - High (< OR=29 pg/mL)
PSA: 2.6 ng/mL
CBC: Normal overall except: Red Blood Cell Count – 4.05 Million/uL (4.20-5.80) MCU – 27 pg (27-33).             Some improvement with TT since my last lab, Free T is still too low and SHBG is still too high.                                                       

Observations:
The equation seems off here.    I’m having doubts about the efficacy of this enclomiphene script.                                                                                                                                                      No real progress. So far I am not seeing any advantage of enclomiphene over clomiphene. I seem to be getting the same results with enclomiphene as I did with the lower dose, less frequent and faster acting clomiphene.   

Clomiphene, with a lower percentage of enclomiphene (60%) taken 3 times a week can produce similar (or better) results as a pure compounded enclomiphene that is taken 7 days a week at the mutual dosing of 12.5 mg. My clomiphene results typically take about a week but I have found that once a week usually to be sufficient in sustaining levels.

At this time my libido barely exists, sometimes not at all, anxiety/depression/fatigue has increased and ED is still an issue even with tadalafil and trazodone. Until August, (when I temporarily dropped clomiphene for one month), both of these meds usually gave me multiple night wood.  Unfortunately things did not return to what they once were before August.

It’s been about 7 weeks now since going on enclomiphene but I’m still willing to be patient and optimistic. However if there is no improvement by the end of February, when my scrip ends, I will make another appointment with Defy. Or, I may possibly return to a modified protocol of clomiphene, DIM and DHEA because my insurance covers clomiphene at about $10 a month* vs Enclomiphene at $225 without insurance, for 3 months.    *A month supply of clomiphene tablets are 50 mg each which can be split 4 ways, enough for months, depending on frequency. 

I’m also considering a topical generic through my physician but only as a very last resort. But I’m also concerned that I will get similar results as I did with clomiphene and enclomiphene.                                              Fortunately, because I am in a long distance relationship with an understanding woman (for which I am grateful) I still have opportunity for adjustments and experimentation – without too much pressure.
But then  arastirmaci’s post “Enclomiphene disappeared in DefyMedicalStore” may render all of the above moot.                                                     
Title: Re: Enclomiphene report
Post by: Cataceous on January 27, 2021, 02:03:19 pm
Various thoughts, not necessarily all coherent:

I would characterize Clomid as enclomiphene plus long-lasting estrogen. If you're low on estrogenic effects then maybe it makes sense to take it over enclomiphene alone. But I think most guys are not looking for more estrogen.

If zuclomiphene has a half-life of a month, then by Feb. 7 you will still have a quarter of the steady-state concentration left in your body.

I think you need to bite the bullet and get one of the accurate free T tests, ideally equilibrium dialysis. Although the calculated methods have their uses, I think they are less trustworthy at high and low SHBG. For example, the Vermuelen method is putting you at bottom-of-range, while the Tru-T calculator has you in the middle. They can't both be right. Given your symptoms the lower value seems more plausible, but it would be good to have confirmation.

Historically Clomid has a poor track record in treating hypogonadism. The clinical trials and anecdotal evidence for enclomiphene are suggesting that it lessens the risk of side effects vs Clomid, but still falls short in resolving all aspects of hypogonadism. Ostensibly this is why the FDA failed to approve it, though conspiracy theories abound.

I'm taking enclomiphene myself as part of an unusual multi-hormone replacement therapy. The results have been very good, which has me looking to understand why those on enclomiphene monotherapy with similarly good numbers are continuing to struggle. This ends in speculation, but maybe from speculation we can generate some testable hypotheses. One item is the lingering concern that enclomiphene is also blocking some useful estrogen receptors. Estrogen is important for libido, after all. Could it be that less frequent dosing would produce better results? The short half-life of enclomiphene means that even EOD dosing clears most of it before the next dose. I did switch from 12.5 mg daily to EOD with similar or better subjective results. I don't have objective data yet, but it wouldn't surprise me to learn there's been some reduction in the gonadotropin levels.
Title: Re: Enclomiphene report
Post by: Gef on January 28, 2021, 07:44:38 am
Random various thoughts were intended as a narrative. In my post I gave my lab results from Quest 01/24/21 - Free T: 51.9 pg/mL (46-224) and Estradiol Ultrasensitive LC/MS: 41 pg/mL - (< OR=29 pg/mL).                   Is Quest testing not reliable? As it is now, my current daily dose of enclomiphene is comparatively more than that contained in the clomiphene I had been taking up until December 7. Yet both give similar results only with clomiphene giving a slightly higher TT, even if taken twice a week.
But I’m still unclear about reducing the enclomiphene dose. If I understand you correctly, enclomiphene may have a tendency to block too much useful estrogen receptors and yet still be leaving me with too much estradiol? I wonder if DIM could have positive influence on this imbalance. AI?
Title: Re: Enclomiphene report
Post by: Cataceous on January 28, 2021, 01:17:42 pm
Nothing against Quest in general. This particular free T test from them is generating a calculated value using measured total T, SHBG and albumin. The calculation is perhaps some variant of the Vermeulen method. At least at this outlying SHBG level the most popular calculations are greatly contradicting each other, so none can be trusted until an accurate test like equilibrium dialysis favors one result or the other. You need to know if your free T is actually low. If so then you might concentrate more on it. While I don't think there are easy fixes for high SHBG, there may still be some things to try.

Don't get me started on the sensitive estradiol tests, regardless of vendor. They are capable of great accuracy, but they're also capable of generating enormous errors, like being off by a factor of two in my case. After calibrating the regular estradiol test against the sensitive one I now use the regular test exclusively.

I might speculate that your test results aren't showing anything too unusual. Enclomiphene alone may well increase aromatization a little, while the estrogenic zuclomiphene in Clomid could be preventing this increase and providing comparable estrogenic activity.
Title: Re: Enclomiphene report
Post by: Gef on January 29, 2021, 09:26:24 am
Well, once again I learned something new today; disparity among lab testing methods is more significant than I ever realized.

So while on enclomiphene after 7 weeks, Quest and the AndrogenHacker.com testing calculator had me at half of “normal” for both Free T and Bioavailable T and the Estradiol-Sensitive levels as a definite too high. In contrast, while on clomiphene, both Quest and LabCorp, which was recommended by Defy, had me at midrange of normal for Free T and for Estradiol-Sensitive as just above normal. Now I’m wondering what this says for enclomiphene. Frustrating.

I also wonder about the importance of Bioavailable T compared to Free T, as they both seem to be the same thing. My impression, from Bioavailable T, an assessment of the biologically active testosterone in serum, could be more relevant than Free T. Yet it hasn’t ever appeared on any of my previous labs, excepting Quest 01/24/21. Nor does it seem to be commonly included in discussions and various websites for men’s health and hormones.

At any rate I’m not happy with my condition which has not improved since August. Now I need to reevaluate my testing strategy and as you mentioned, “an accurate test like the equilibrium dialysis that favors one result or the other”.
So much wondering...
Title: Re: Enclomiphene report
Post by: Cataceous on January 29, 2021, 12:15:32 pm
In my opinion bioavailable testosterone is mostly a redundant parameter. It undoubtedly has value in understanding in detail the short-term pharmacokinetics of testosterone in plasma. But this is not something of immediate importance to the average guy on TRT. What matters in the end is free testosterone. With some interesting exceptions, it's likely that the vast majority of testosterone's interactions in the body initially require free testosterone molecules.

It's true that choosing one lab and one testing method is the best way to monitor one's situation. In time this may be less important, as there is work in progress to standardize test results among different vendors.
Title: Re: Enclomiphene report
Post by: Gef on February 15, 2021, 11:20:05 am
Test results: 02/11/21 with enclomiphene.
TT: 655 ng/dL    Free T: 61.9 pg/mL   Percent Free: 1.3%   
SHBG: 100 nmol/L
Estradiol: 38 pg/mL
Prolactin: 4.9 ng/mL
Progesterone: 0.5 ng/mL
It seems basic test averages of both clomiphene and enclomiphene are roughly about the same so far. However clomiphene was at a much lower dose than that of enclomiphene.
Title: Re: Enclomiphene report
Post by: Gef on February 15, 2021, 11:30:07 am
Protocol has been: 12.5mg enclomiphene qd, 200mg DIM qd, 50mg DHEA qod.
Title: Re: Enclomiphene report
Post by: Cataceous on February 15, 2021, 01:28:16 pm
With the most recent numbers both free T calculators put you on the low side. So you do have a possible reason for the lackluster subjective results.

The options for dealing with high SHBG aren't great. TRT is effective but extreme, since you're disabling the entire HPTA. Some guys have used SARMs, such as ostarine. It's possible that with the continued use of enclomiphene the suppressive effects would be reduced. I suppose AI use is also a possibility, though as a last resort. The E2/T ratio is only a little on the high side, so there's marginal leeway for some AI micro-dosing.
Title: Re: Enclomiphene report
Post by: Gef on February 15, 2021, 05:05:12 pm
I received my DHT test results an hour ago - 1383.3 pg/mL. It's has always been high in the past but never this high.
Title: Re: Enclomiphene report
Post by: Gef on February 16, 2021, 07:15:10 am
From what I have read on the subject, I suspect the DHEA supplements I have been taking may be the root cause of my sudden high level of DHT.
Title: Re: Enclomiphene report
Post by: Cataceous on February 16, 2021, 05:36:24 pm
You're probably right about that. I'd forgotten that that's one of the effects of DHEA, and you're taking a pretty hefty dose. For me, 12.5 mg daily puts DHEA-S around 300 mcg/dL.
Title: Re: Enclomiphene report
Post by: Gef on February 18, 2021, 10:41:54 am
I am currently at 505 mcg/mL. I have stopped taking DHEA of course, and hopefully it will soon drop to a more acceptable level. As for DHT, I am going to try Astaxanthin. Historically my DHT level has always been at the upper limits and sometimes beyond - with or without Clomid.
Title: Re: Enclomiphene report
Post by: Gef on February 19, 2021, 06:49:28 am
I’ve established that DHEA raised my DHT (and BP) significantly which could explain the disparity between Clomid and enclomiphene.                                                                                                                                           

I began taking DHEA at the same time as I did enclomiphene. So I’m thinking that too much of the raised testosterone level was being converted into DHT due to the effects of DHEA. In turn this conversion made it appear that enclomiphene is not quite as effective as Clomid in raising testosterone levels.

I’ve removed DHEA from my protocol and I will test again in about 2 weeks.
Title: Re: Enclomiphene report
Post by: Cataceous on February 19, 2021, 12:18:37 pm
It will be interesting to see what changes without the DHEA.
Title: Re: Enclomiphene report
Post by: Gef on March 22, 2021, 05:49:38 am
LabCorp results 3/10/21
Some notable changes from all previous labs.  Free T, estradiol, and SHBG levels have increased significantly since converting to enclomiphene. I am going to reduce enclomiphene 12.5mg from 7 days a week to 5 days a week.  Clomid gave similar TT results at 4 days week. At this point it seems I have responded better to Clomid overall. I’m not sure what to make of this yet.              Since my last lab of 2/11/21 I had a minor but temporary improvement to my libido after dropping the DHEA supplement. I had another minor but temporary improvement after taking 5mg tadalafil for 4 days. I’ve done this on two prior occasions with similar results. I may continue this experiment.
Total T -   1154 ng/dL        (264-916)      H
Free T -      33.58 ng/dL     (5.0-21.0)     H
DHEA -     223.1 ug/dL       (48.9-344.2)
Estradiol -  55.6 pg/mL      (8.0-35.0)     H
SHBG -      97.0 nmol/L     (19.3-76.4)    H
TSH -         2.05 ulU/mL    (0.450-4.5)
LH -            8.5 mlU/mL     (1.7-8.6)
Title: Re: Enclomiphene report
Post by: Gef on March 22, 2021, 08:49:50 am
Also % Free Testosterone 2.91  (1.50-4.20)
Title: Re: Enclomiphene report
Post by: Cataceous on March 22, 2021, 11:40:00 am
That's impressive testosterone production. It makes me wonder what your numbers would be with EOD dosing on the enclomiphene.
Title: Re: Enclomiphene report
Post by: Gef on March 23, 2021, 03:43:22 am
Yet my libido is still flat lining and no morning wood.
Title: Re: Enclomiphene report
Post by: Gef on March 23, 2021, 08:25:40 am
It seems I’m quite responsive to both Clomid and enclomiphene and my DHT has always been normally very high. So now my TT, and Free T is very high, and my prolactin, pregnenolone, DHEA, LH, FSH is still normal as usual. Other than SHBG and estradiol what’s left to be concerned about? Have you any thoughts on this Cataceous?
Title: Re: Enclomiphene report
Post by: seppuku on March 23, 2021, 10:17:48 am
Yet my libido is still flat lining and no morning wood.

Your response to clomid and enclomiphene is great. As to libido, maybe your testosterone is now actually too high?  I've heard of people who do steroid cycles actually having worse libido on cycle (not everyone, obviously). It could also be the enclomiphene / clomid itself dampening your libido due to its effects on estrogen receptors - if it was me and i was getting those results, i'd look at dropping down to the minimum amount that keeps me around 600 - 800 ng/dl and seeing how that affects libido. Estrogen's needed for libido / neurotransmitters, and if the clomid's blocking the receptors too much in the brain that could cause your problem. Also, something for dopamine might help - 2.5mg selegiiline (sublingual) spikes my libido every time, and my testosterone is currently a pathetic 10 nmol / l unfortunately (around 300 ng/dl). I'm jealous of your results as i'm on 12.5mg m,w,f of clomid, mid range LH but my balls are being stubborn!!
Title: Re: Enclomiphene report
Post by: Cataceous on March 23, 2021, 12:15:28 pm
I would say the same things as seppuku: Concern about the enclomiphene itself, which would be a reason to try EOD dosing; otherwise the neurotransmitters. I take selegiline with PEA—phenethylamine—and I really like the combination. You can also look at the things in JustAskin's stack: https://www.peaktestosterone.com/forum/index.php?topic=9644.0
Title: Re: Enclomiphene report
Post by: seppuku on March 23, 2021, 01:13:38 pm
I would say the same things as seppuku: Concern about the enclomiphene itself, which would be a reason to try EOD dosing; otherwise the neurotransmitters. I take selegiline with PEA—phenethylamine—and I really like the combination. You can also look at the things in JustAskin's stack: https://www.peaktestosterone.com/forum/index.php?topic=9644.0

Please be careful with that combo Cataceous - i tried it once, probably too much pea really as the effect was dramatic but scared the hell out of me. I had been taking the selegiline regularly, 2.5mg a day. I took some pea before a workout (it was loose powder so i'm unsure of the dose but probably between 250mg - 500mg i think). I had a wave of euphoria go through me, but also an extreme flushing of the skin, rapid heart beat. I came out of my gym to tell my wife how great i felt, and noticed i had zero sensitivity to pain - i reckon i could have put a skewer through my leg and wouldn't have felt it. I checked my blood pressure, and it was much higher than normal. I had to stop my workout as i was worried about my blood pressure, but also because the feeling of pleasure was just to great to want to do anything!!  I know you've been using this combo with success so you must be using a correct dosage, but i thought i should mention what happened to me because although it felt pleasurable, it also scared me off trying it again!! I'd taken pea before (without selegiline), and on its own had very little effect. With selegiline in the mix though, it needs cautious dosages of pea starting low.
Title: Re: Enclomiphene report
Post by: Cataceous on March 23, 2021, 02:34:36 pm
Apparently an MAO-B inhibitor greatly increases absorption of PEA. I was mindful of that study that used only 90 mg PEA daily with selegiline, and it's been a good dose for me. I did try 180 mg, but it was interfering with sleep. I started selegiline at 1.25 mg daily and gradually titrated up to 2.5 mg. I felt some benefits at the lower dose, but 2.5 mg crosses some threshold for me and results are now consistently good.
Title: Re: Enclomiphene report
Post by: seppuku on March 23, 2021, 04:37:59 pm
Apparently an MAO-B inhibitor greatly increases absorption of PEA. I was mindful of that study that used only 90 mg PEA daily with selegiline, and it's been a good dose for me. I did try 180 mg, but it was interfering with sleep. I started selegiline at 1.25 mg daily and gradually titrated up to 2.5 mg. I felt some benefits at the lower dose, but 2.5 mg crosses some threshold for me and results are now consistently good.

2.5mg selegiline is also my prefered dose, although i'm not consistant with it lately. I think of i'd tried PEA at around 90mg too, i might have had less scary results!
Title: Re: Enclomiphene report
Post by: Gef on March 24, 2021, 08:18:39 am
Seppuku your suggestion got me thinking. It never occurred to me that Clomid/enclomiphene could have a dampening effect on estrogen receptors! So I checked some old notes/labs I made Sept.2018 – Aug 2020. By mid-2019 and into June 2020 my libido was not great but acceptable. My protocol was still a work in progress at that time but it was generally around 12.5mg Clomid and DIM 200mg four to six times a month. Unfortunately I got too complacent and took only one lab for the year - December 2019. This lab was TT 820 pg/mL, Free T 84 pg/mL, estradiol <20 (?), SHBG 83nmol/L, LH 4.8 miU/ml etc. Unremarkable, almost normal.  Then in July 2020 I unfortunately tweaked the protocol a little and my libido declined. My 08/07/20 lab was TT 1283.1 pg/mL, Free T 98.5 pg/mL, estradiol 43 pg/ml, SHBG 85 nmol/L, LH 5.3 mlU/ml.  Hormones are truly a balancing act. Maybe someday...        Interesting idea about neurotransmitters, I’ll speak with my doctor concerning replacing my Wellbutrin with selegiiline.  Thank you.                                                                                           
Title: Re: Enclomiphene report
Post by: seppuku on March 24, 2021, 11:53:17 am
Seppuku your suggestion got me thinking. It never occurred to me that Clomid/enclomiphene could have a dampening effect on estrogen receptors! So I checked some old notes/labs I made Sept.2018 – Aug 2020. By mid-2019 and into June 2020 my libido was not great but acceptable. My protocol was still a work in progress at that time but it was generally around 12.5mg Clomid and DIM 200mg four to six times a month. Unfortunately I got too complacent and took only one lab for the year - December 2019. This lab was TT 820 pg/mL, Free T 84 pg/mL, estradiol <20 (?), SHBG 83nmol/L, LH 4.8 miU/ml etc. Unremarkable, almost normal.  Then in July 2020 I unfortunately tweaked the protocol a little and my libido declined. My 08/07/20 lab was TT 1283.1 pg/mL, Free T 98.5 pg/mL, estradiol 43 pg/ml, SHBG 85 nmol/L, LH 5.3 mlU/ml.  Hormones are truly a balancing act. Maybe someday...        Interesting idea about neurotransmitters, I’ll speak with my doctor concerning replacing my Wellbutrin with selegiiline.  Thank you.                                                                                         

No problem, and good luck!  I've been reading other peoples progress and experiences for years - most people seem to get the fat loss / muscle building effects etc from increased testosterone, but it's always libido that causes problems. It's such a tricky one and probably depends on many factors (hormones but also stress, sleep, diet etc etc). And it would seem that generally, very low e2 levels are worse than very high ones, but there's always a sweet spot.  Regarding clomid, for me, and more (or less) than 12.5mg three times a week, and i just don't feel right.
Title: Re: Enclomiphene report
Post by: Cataceous on March 24, 2021, 11:59:43 am
An appeal of selegiline, particularly for us older guys, is that it is counteracting the effects of MAO-B rising naturally with age. Selegiline is also associated with increased longevity in animal studies. Further reference: https://www.juicedmuscle.com/jmblog/content/selegiline-hcl
Title: Re: Enclomiphene report
Post by: Gef on March 31, 2021, 10:30:26 am
I have been taking 100mg trazadone for insomnia. Since cutting back on enclomiphene from seven days a week to three, I have been getting night wood 2- 3 times a night. Only a slight improvement in libido. But I am concerned about possible priapism. I have reduced dosage to 50 mg and I am considering stopping altogether. Is this common / normal?
Title: Re: Enclomiphene report
Post by: Cataceous on March 31, 2021, 11:40:58 am
I tried trazadone briefly as a sleep aid and I remember the prominent nocturnal erections. I don't know how to judge if they are excessive and reason to worry about priapism.
Title: Re: Enclomiphene report
Post by: Cronos on March 31, 2021, 09:47:42 pm
GEF why not just go on TRT? from what i have seen clomid seems to be a lot harder to dial in and get the same symptom relief vs TRT when properly done?
Title: Re: Enclomiphene report
Post by: Gef on April 22, 2021, 08:41:04 am
Update. I’ve revised my protocol twice since my last posting. Until today it had been 12.5mg enclomiphene and 200mg DIM twice a week and 9mg boron daily. It seems “less is more”. Though erratic there is tangible improvement in my libido since I began reducing dosage. A clear cause for optimism. After this latest lab result I will again reduce enclomiphene dosage to only once a week. My Estradiol and SHBG are still too high unfortunately.

On this latest lab I also included TPA (Thyroid Peroxidase Antibodies), and TBG (Thyroxine Binding Globulin). Four years ago I was told my antibodies were a little high and to keep watch on symptoms. As I understand it, thyroid issues can have negative influence on hormones as well as side effects such as chronic fatigue and depression. I may reconsider Anastrozole depending how I feel when my TT descends to 800-900 ng/dL. Finally, I have recently acquired two new scripts for 4mg Doxazosin and 2.5mg selegiiline. Too soon for observations.  I will wait 2 weeks before testing again.

Quest labs of 04/14/21:
TT – 1034 ng/dL   (250 - 827)   H
T Free – 57.2 pg/mL (46.0 - 224.0)
T Bio. – 107.7 ng/dL (110.0 - 575.0)   L
Estradiol – 49 pg/mL   (< OR = 29 pg/mL)   H   Previously 55.6 pg/mL
SHBG – 97 nmol/L   (22 - 77)   H - Unchanged
Thyroid Peroxidase Antibodies: 124   (<9 IU/mL)   H
Thyroxine Binding Globulin: 27.2 mcg/mL   (12.7 - 25.1) H
Title: Re: Enclomiphene report
Post by: Cataceous on April 22, 2021, 11:45:04 am
Testosterone is still impressive for only twice-weekly enclomiphene. Although the absolute level of estradiol is still elevated, it is normal relative to testosterone, at about 0.5%.

Have you measured your free thyroid hormones recently? Are these expected to be lower when antibodies are elevated?
Title: Re: Enclomiphene report
Post by: Gef on April 23, 2021, 08:51:24 am
My last tests for T3 (Total and free), and T4 were done 08/07/20 and they were normal as was the TSH. Most recent TSH testing results were normal last November and March.

Up until 08/07/20 my free thyroid tests and TSH had always been within normal range, even since first learning of my thyroiditis. However Graves and Hashimoto's disease (thyroiditis) can eventually reduce production of thyroid hormones. Whether they are affected or not apparently depends on the individual and antibody severity. Hence the physician advising me to be mindful of symptoms.

Studies have shown that supplementing with selenium reduces thyroid peroxidase antibodies (TPO), as well as the severity of hypothyroidism symptoms. I suppose I will have my levels tested once again for change and perhaps make an appointment to rule out any other possibilities related to thyroid.  Meanwhile I will continue fine-tuning my daily protocol.
Title: Re: Enclomiphene report
Post by: Cataceous on April 23, 2021, 03:04:38 pm
Always interested in reading about your progress...
Title: Re: Enclomiphene report
Post by: Gef on April 26, 2021, 08:19:27 am
Thank you Cataceous.
 I have another observation I hesitate to make. It may just be coincidental but trazodone seems to be acting as a sort of barometer for me. For a long time the effects of trazodone seemed strangely inconsistent and so I eventually quit this medication.  Then recently after renewing my 'script, I picked up on a familiar routine of sorts; the nightly effects of trazodone seemed to vary according to my T levels (during my trial-error adjustments).
Put another way, if my T is either too low or very high, trazodone does nothing in regards to nocturnal erections, alternately during times in between as in recent weeks after dropping my dosage, multi nocturnal erections become almost routine.
I've not been very successful researching this about trazodone and its connection with testosterone levels. So, I wonder if anyone else has experienced this odd side effect.

Title: Re: Enclomiphene report
Post by: Cataceous on April 27, 2021, 11:37:58 am
It's an interesting observation, and a connection seems plausible.
Title: Re: Enclomiphene report
Post by: Gef on May 26, 2021, 04:43:15 am
Update: Libido continues to slowly improve; at certain times very much more than others. I suspect hormones are still in process of reaching a kind of equilibrium. So, I’m going to hold steady on my current protocol a while longer until I test again in about two weeks. Maybe unrelated but my appetite has increased noticeably too. Fortunately, my weight remains unaffected and stable, as usual.

Enclomiphene 12.5mg twice a week, DIM 200mg three times a week, 2.5mg selegiiline daily, and Doxazosin 4mg daily.
Title: Re: Enclomiphene report
Post by: Cataceous on May 26, 2021, 11:35:51 am
Good to see things are going in the right direction. Hopefully that continues.
Title: Re: Enclomiphene report
Post by: averagestudent on June 10, 2021, 02:27:11 am
Hey Gef, keep up on the journaling! Would be curious to see how things are progressing. I will agree less is more with Enclomiphene. I went with 12.5 EOD and I was doing pretty good however due to wanting to try a high dose and thinking my libido might slowly be dropping I went to ED. However, I did have very good libido for a month or 2 but now it seems I'm back to square one and moving back to 12.5mg EOD. But I also want to say, it really does seem like estrogen could be at play based on your lab work, I think that is the issue with me which is why I am dropping back to EOD. Why not trial an AI to see how things turn out? If that is the case, you might get some assurance that reducing your dose would help.

However, since you seem to be seeing results with less frequent dosing, that might not matter.
Title: Re: Enclomiphene report
Post by: Gef on June 18, 2021, 08:52:43 am
Yes, I'll keep on with the journaling if it's helpful to anyone.
Averagestudent, as it happens I have been considering AI but at the moment I am rather confused as to increase or decrease my dose. I'll explain.

My Quest test results of 6/09/21. Enclomiphene 12.5 mg twice a week. DIM 200 mg 4x a week.
 
DHT - 100 ng/dL                         (Reference range 12-65)
Estradiol - 32 pg/mL                    (<OR=29 pg/mL)
Testosterone Total - 1004 ng/dL    (250-1100)
Testosterone Free - 87 pg/mL       ( 35 - 155 pg/mL)

As you can see the change from every day, to 3x a week, to 2x a week is not dramatic. As mentioned previously my libido gradually improved and was at times quite good. Then later, within a week, it diminished. I thought perhaps my TT was continuing to drop too far. Before receiving my test results I increased to 3X. After the 3rd dose my libido peaked yet again the following day while sleeping. Then it returned as before. My test results were unexpected in that my TT was higher than I anticipated. It's a dilemma, more or less? Maybe once a week with minimal AI perhaps. But even so, I am better now than I was before enclomiphene.
Title: Re: Enclomiphene report
Post by: Cataceous on June 18, 2021, 11:29:26 am
With these numbers estradiol is only about 0.3% of testosterone. This is at the bottom of the normal range of 0.3-0.6%. I wouldn't use an AI if I were you, as it could cause a more significant imbalance.
Title: Re: Enclomiphene report
Post by: Gef on June 21, 2021, 05:28:11 am
Thank you Cataceous.

Due to some confusion I've decided to start over by again reducing my 12.5 mg enclomiphene dosage to once a week and then go from there. My thinking is that since my most recent test levels have been very similar to each other I may need to drop my TT even more. Also, zuclomiphene and my previous DHEA supplementation will no longer have influence since they have long since cleared from my system. My confusion is that when I ingested that 3rd dose during the week in question my libido temporarily spiked the next day while sleeping, enough to wake me.

During the month of May and early June, twice a week seemed the ideal. It’s puzzling; I have no idea what changed. Though to be clear my libido has not yet slipped back into a coma. I’m in excellent health – no issues, I exercise, don’t smoke, and eat healthy. I don’t use recreational drugs, only an occasional beer or wine. So, I’m going with once a week for a while and will rely on how I feel. Due to travel, I won’t test again for another month. Unfortunately, I’m still not clear on how much time to allow for my body to adjust for a change in enclomiphene dosage.