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Author Topic: Enclomiphene report  (Read 1905 times)

Gef

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Enclomiphene report
« 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.

 

Cataceous

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Re: Enclomiphene report
« Reply #1 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.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 59, Ht: 5'10", Wt: 154 lbs
Protocol: 2.4 mg T propionate subQ qd, 3.2 mg T enanthate qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

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Re: Enclomiphene report
« Reply #1 on: December 23, 2020, 01:35:06 pm »


Gef

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Re: Enclomiphene report
« Reply #2 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.

ghce

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Re: Enclomiphene report
« Reply #3 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.
Age:59, Height 6' 3" weight 92.5KG
2014 Androderm Patches
2014-2016 Oral Andriol 160mg Daily
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 
Reference Range Adult males  1000-6000 pmol/L

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Re: Enclomiphene report
« Reply #3 on: December 24, 2020, 09:30:50 am »


Gef

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Re: Enclomiphene report
« Reply #4 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.

Cataceous

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Re: Enclomiphene report
« Reply #5 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]

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.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 59, Ht: 5'10", Wt: 154 lbs
Protocol: 2.4 mg T propionate subQ qd, 3.2 mg T enanthate qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

ghce

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Re: Enclomiphene report
« Reply #6 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.
Age:59, Height 6' 3" weight 92.5KG
2014 Androderm Patches
2014-2016 Oral Andriol 160mg Daily
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 
Reference Range Adult males  1000-6000 pmol/L

Gef

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Re: Enclomiphene report
« Reply #7 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.                                                     

Cataceous

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Re: Enclomiphene report
« Reply #8 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.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 59, Ht: 5'10", Wt: 154 lbs
Protocol: 2.4 mg T propionate subQ qd, 3.2 mg T enanthate qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

Gef

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Re: Enclomiphene report
« Reply #9 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?

Cataceous

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Re: Enclomiphene report
« Reply #10 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.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 59, Ht: 5'10", Wt: 154 lbs
Protocol: 2.4 mg T propionate subQ qd, 3.2 mg T enanthate qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

Gef

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Re: Enclomiphene report
« Reply #11 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...

Cataceous

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Re: Enclomiphene report
« Reply #12 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.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 59, Ht: 5'10", Wt: 154 lbs
Protocol: 2.4 mg T propionate subQ qd, 3.2 mg T enanthate qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

Gef

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Re: Enclomiphene report
« Reply #13 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.

Gef

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Re: Enclomiphene report
« Reply #14 on: February 15, 2021, 11:30:07 am »
Protocol has been: 12.5mg enclomiphene qd, 200mg DIM qd, 50mg DHEA qod.

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Re: Enclomiphene report
« Reply #14 on: February 15, 2021, 11:30:07 am »