Thanks for everyone's replies.
Regarding clomid dosing -
- my MD initially started me on 50 mg 3x/week; rechecked my total T at 900s - then backed down to 25 mg TID
- not much effect on clomid, then eventually my T was rechecked again --- still at 900s (at this point), but my weight went up too and my estradiol was in 70s. MD thought that I did not need clomid at all and that weight gain was likely due to estrogen
- so since off clomid for 2-3 months ---> T again dropped to 270. (felt more fatigued again) Estradiol normalized to 20s.
All the while, erectile function never normalized-- sure it improved with daily Cialis, but nothing like how it felt when I was in early college/high school.
Currently at 25 mg twice a week. With plans to recheck testosterone, estradiol, prolactin in 2 months (have not checked prolactin in the past -- MD thought that my levels were low but not too low which is typical for prolactinomas). MD was thinking that depending on my response, how I'm feeling -- to decide between continuing clomid and possibly adding an AI, versus switching to testosterone.
I worry about the testicular atrophy with testosterone -- is this fairly common?
If any of the seniors were in my shoes - would you pick clomid versus testosterone?
Last, I had somewhat normal testosterone in 2014 -- but now this has been low at least twice (documented). What could have caused this, other than the stress I have at work.. would be interested in your thoughts?
Will be adding vitamin D to my MV; thanks. Ive also been taking ZMA at bedtime because of the zinc content.
Roughly the same age with the same concerns prompting my go with TRT years back, I've tried nearly every TRT treatment regiment out there - Test Cyp Mono, Test Cyp + Arimidex, HCG Mono, Arimidex Mono, Clomid and, finally, Test CYP + HCG.
As always, since most of us here aren't Docs/medical professionals, the best advice anyone could give you is to get linked up with an expert practitioner. Dr. Saya with Defy Medical is the one I use (after having tried a few local options, each with their own drawbacks).
A few thoughts:
1) Would you be able/willing to post your labs? It is pretty common for Docs without expertise in this area to misinterpret results, and it may help folks here give you some educated advice. Also, what time of day were your Testosterone labs drawn?
2) 50mg Clomid 3x/week, and 25mg Clomid 3x/week both had me feeling wonky due to a mix of out of whack E2 and SHBG. 12.5mg Clomid EOD was great. Unfortunately, I had to discontinue my Clomid regimen after experiencing visual side effects (which have since subsided), which is pretty common after extended Clomid use and a strong indicator that Clomid isn't for you.
3) Test Cyp + HCG (titrating the dose in an attempt to manage E2 without Arimidex) injected IM 2x/week has been my favorite regimen thus far. I feel similar to how I did on 12.5mg Clomid EOD, but without the Clomid sides. E2 has been easily managed by using a CDG/DIM supplement 1x/day, and the regimen itself is pretty non-invasive as I use 29g insulin syringes injecting into the shoulder - can barely feel it. The addition of HCG helps to prevent testicular atrophy.
I can empathize with your situation - it is tough being a young guy and experiencing these symptoms. Unfortunately, the path to a treatment regimen appropriate for you can be a long and windy road, especially if your Doc isn't up-to-speed on what to look for and how to treat it. If I were in your situation today, now having the benefit of hindsight, this is exactly what I would do:
1) Go through Peak's testing protocol articulated on the main page of this site.
2) Get connected to a knowledgeable Doc/get the right testing done. I recommend Defy Medical (Dr. Saya specifically), at least as a starting point to get you pointed in the right direction (and just to be clear, I'm just a patient and do not benefit from making this recommendation in any way).
3) Bank some sperm in case you do end up going on TRT - that way you can be relieved of concerns related to fertility.
Regarding your issues with E.D., I also experienced this until I got on a sensible treatment protocol. Having been dependent on Cialis/Viagra for years, I was finally able to come off 6 months after coming back on TRT two years ago. It is definitely not like it was in high school or college, but it is about where I would expect to be in my 30s.
In the meantime, stay optimistic - there is definitely light at the end of the tunnel.