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View Full Version : The "Clomid" test: Request input on these and other results


anyman
06-22-2007, 01:50 PM
As some here may know, Dr. Shippen and others of his caliber sometimes use a low dose of Clomid to "rev" the HPTA, so to speak, and see what happens as a way of determining what part of the hypothalmic-pituitary-testicular axis went awry.

Just got my results and much to my amazement the brief 7 day low dose treatment made a difference. I saw a full 50% increase in T and even greater increases in FSH and LH. Here are the results as well as some other results which I'd appreciate input on as well:

Total T: 319 (up from around 200)
FSH: 2.4 (up a good 100%)
LH: 5.0 (up over 100%)

Here are some other results which are interesting and which I'd like info on as well:

Estradiol: <32 (ref range: <52 pg/ml)
Cortisol: 18.5 (ref range: (morning): 4.0-22)
DHEAS: 250 (ref range: 45-345 mcg/dL)
DHT: 18 (ref range: 25-75 ng/dL)
IGF-1 181 (ref range: 86-220)

I get the the clomid apparently "worked", at least to the extent that my system responded, but am a bit fuzzy as to what the means and what options, if any, I now have. I'm also a bit unclear as to what the DHEAS, DHT and IGF-1 results imply.

Any thoughts or ideas? As always, thanks in advance.

hayfarmer
06-22-2007, 04:57 PM
Clomid did nothing for me. I'm happy to hear it worked for you. The only number you have out of range is the DHT which is low and thats probably because you T is low too.

I think this all means your problem is in the hypothalmus. The hypothalmus has not been sending enough GnRH to the pituitary to tell it to make more LH. By using clomid the clomid binds to the receptors in the hypothalmus meant for T and blocks T (and more imporantly estrogens like estradiol) from binding. So now your hypothalmus thinks your T is way too low and it sends more GnRH. At least this is my understanding. So, you can now try a higher dose of clomid and possibly selegiline as a fix. See what Shippen says and let me know. I would love to know what he does for you. Ask him about testing for total estrogens.....he does not normally test for this and I don't know why. I do know he has said if clomid works you can just take that.

How do you feel? Any better? Your T is still low so it would not surprise me if you don't feel the diff yet.

anyman
06-22-2007, 05:17 PM
The clomid was used only as a test. The note he sent me said that it was a a low dose and merely intended to "rev the engine" (his words) to see exactly where the problem lies. I took half a 50mg (?? on the mg part) tablet for 7 days and then was tested on the morning of the 8th. This all took place about a month ago. Just got the results today.

I don't recall feeling all that different. I thought I was a small bit better, but for all I know it was the placebo effect. On the plus side, my wife and I had the best time we've had in some time today. Just our luck- on the occasion when I have some ejaculatory control our kids can't keep themselves occupied for as long as we'd like. Oh, well.....

Can you expound on DHT and what it is/does, etc? I am not familiar with it.

Either way, I'll keep you posted. I see him in about 4 weeks or so. Perhaps with our collective group mind we'll all get a better handle on our respective afflictions.

hayfarmer
06-22-2007, 08:02 PM
The clomid was only a test but he has told me if it works you can just be treated with clomid. I"m betting if you take 50 mg a day it might work better but we'll see what he says. Unfortunately it is expensive and my crappy insurance would not pay for it.

Like estradiol is a very potent form of estrogen, DHT is a very potent derrivative of testosterone. DHT is well know to make male pattern baldness worse if too high. There is some disagreement as to whether it is good or bad for the prostate but it has may positive function like testosterone does including being needed for erections.

I would not worry about it now since your T is still low.

I have good new in this. I have read about others who clomid has worked for and in some cases after being on clomid for a period of time they can stop the drug and they continue to function normally. So you at least have some small hope of getting back to normal. Ask the doc about this.....it may or may not be true. I'm jealous....I wish it worked for me.

Greentooth
06-23-2007, 12:40 AM
Good news anyman.
as HF asked.. how are you feeling. libido higher?
i have been thinking of starting this but my story is diff.
meds here in india are really cheap and easy to get but my endo is refusing to treat. so i am thinking of doing it myself.(the clomid part, definately not t replacement). doing anything to hormones without doc is stopping me from taking any action.
As you have no problem of higher E2, clomid 50 should work well but once total t reaches 600 or so you may need some sort of e2 lowering med.
Most interesting part of this is possiblity of being able to STOP and hpta taking care of itself.
kindly keep us posted.
GT

anyman
06-23-2007, 07:26 AM
Good news anyman.
as HF asked.. how are you feeling. libido higher?
i have been thinking of starting this but my story is diff.
meds here in india are really cheap and easy to get but my endo is refusing to treat. so i am thinking of doing it myself.(the clomid part, definately not t replacement). doing anything to hormones without doc is stopping me from taking any action.
As you have no problem of higher E2, clomid 50 should work well but once total t reaches 600 or so you may need some sort of e2 lowering med.
Most interesting part of this is possiblity of being able to STOP and hpta taking care of itself.
kindly keep us posted.
GT


The test was too short for me to say one way or the other. Plus, the Dr.only used 25mg, which I believe is a rather low dose. Seems he just wanted to see if I could respond, which I did. How strong a response is up for debate, as the test lasted for only 7 days and was at a low dose.

I am hoping this will get me some results, but won't know more till my appointment with the good dr. in about 3 or so weeks. Right now I am simply researching the results so I can ask intelligent questions. I'll keep the crew here posted when I get more info. In the interim, I'd appreciate any add'l comments or thoughts.

lowesclubmaker
06-23-2007, 10:36 AM
I just got my results back from the test directly from the lab (haven't heard from shippen yet) but my LH skyrocketed to over 12 (normally 4 or so) and total T went to almost 750 (300 or so before starting TRT, and about 550 on T-cream).

I didn't feel all that great while taking the pills, but have felt GREAT the week since.

be interesting to see what he says.

hayfarmer
06-23-2007, 01:22 PM
LowesClub, this was also from clomid? Wow, thats great. You probably won't hear from him until you go in.....unless you call to talk to the nurse.

anyman
06-23-2007, 09:44 PM
I see Lowesclubmaker went from the 300s to something like the 700s. I went from 200 +/- to about 319. In short, I saw a roughly 50% improvement iinstead of a 100% improvement with just clomid alone. My FSH and LH jumped as well. The LH went up over 100% to 5 and FSH up about 50-100% (depends on what I compare it to) to 2.4. Both FSH and LH are still low, but still far higher on a percentage basis.

Hmmm.....what does this mean? This is driving me nuts, slight pun intended.

lowesclubmaker
06-24-2007, 05:37 AM
this was also from clomid?

As far as I can tell it was. I stopped external cream (which had me in the upper 500's (Only time I was higher was at 800+ the first test after starting on the patch) and kept other supplements etc the same. After the draw for Shippen I have stayed off the external T and continue to feel very good. I am going to do weekly draws for a couple weeks (or as long as I still feel good and can stay off the T) as requested by a different doc. Someone along the way did tell me that stopping the external T may jumpstart the system and get it running again - fingers crossed.

I have already seen Shippen. I don't know why he waited to give me the clomid test until after our first meeting. I had some pretty extensive bloodwork going in to that, and our next appt should be by phone. He did say a couple times that my case is "interesting and unique" - I think because of the extent of muscle fatigue I was having in the winter (legs shaking after a flight of stairs) and the extreme testicle pain that went away pretty quickly when I started on the patch.

I do find it hard to deal with the fact that his office doesn't accept FAXes. I know I had the results days before he did as a result. I also have other germaine results from other docs/tests, but here in 2007 I don't really feel like writing and mailing a letter when I can at least FAX, if not email, the stuff to other docs. I can be a bit more patient since I am feeling well, so I guess I will just wait to hear something from their office.

lowesclubmaker
06-24-2007, 05:42 AM
I should also mention that the higher T on clomid is great, but not all is rosy. My SHBG which has regularly been quite high jumped even higher. My total estrogens (let's not argue about the validity of the test) went from nice and low to pretty darn high, and E2 went from really low to high.

Since I'm feeling better, I'm not too worried, but it does appear my system is having trouble finding a balance no matter what the treatment.

anyman
06-24-2007, 06:11 AM
I should also mention that the higher T on clomid is great, but not all is rosy. My SHBG which has regularly been quite high jumped even higher. My total estrogens (let's not argue about the validity of the test) went from nice and low to pretty darn high, and E2 went from really low to high.

Since I'm feeling better, I'm not too worried, but it does appear my system is having trouble finding a balance no matter what the treatment.

Interesting- seems like there a few correlations can be drawn between levels of SHBG & E2, etc and responses to the clomid test. I have rather low SHBG (11) and DHT and saw only a 50% increase in T. Too bad I am not educated enough to connect all the dots. I suppose that's why we have Dr. Shippen, et al.

Is there anyone who can connect the dots and explain the relationship amond SHBG, DHT, E2 and total T? While I am asking, what exactty does the clomid test indicate? Does it test between the hypothalmus and pituitary, or is there something else going on?

anyman
06-24-2007, 06:38 AM
Just when I thought there may be some hope, I am now beginning to realize that I may NOT have done all that well on the clomid test. I feel as though what little hope I had has been cut out from under me.

Not sure where this leaves me, but I don't think I'll like the answer......

What exactly does a "failed" test mean?

hayfarmer
06-24-2007, 12:42 PM
Lowesclub, I would not wait for Shippen's office to call. My experience is when they receive these results they just file them. I assume if something were drastically wrong they would call but I don't know. You need to call them. If they don't have you results yet they can call the lab for them. Then after the nurse talks to the doctor you call back to see what his instructions are.

Anyman, I think the clomid test means the problem is in your hypothalmus. I think I posted that above somewhere but maybe its in another thread. I think you have great hope since you did respond positively. You were only on 25 mg/day for some reason and he usually uses 50 mg / day for that test. He can also add seligiline in addition to increasing your clomid dose to see how you respond. I have just conversed with someone on another thread who also responded to the clomid and SHippen told him he might be completely cured in a few months and need no drugs. His response was dramatic though going from 300 to 850 T on 50 mg/ day of clomid for a week.

Relationship of total T, SHBG, Estradiol (E2) and DHT by my understainding: DHT is a derrivative of T so it will go up and down with T. It can also go up and down while on T replacement with the type of replacement being used but that does not apply to you here. But for example DHT will be higher with transdermanl T replacement then T shots. SHBG tends to be lower when your T is high and your E2 is low. If E2 is high it tends to push up SHBG with it. E2 is also a derrivative of T due to aromatase enyzyme converting some T to E2. So the higher the T the higher E2 is in general. Again if you are on replacement or even HCG, the treatment can make the E2 problem worse depending on what it is. Using the same example E2 tend to be not as bad with transdermal replacment versus T shots.....but it still can possibly be too high.

anyman
06-24-2007, 09:22 PM
Anyman, I think the clomid test means the problem is in your hypothalmus. I think I posted that above somewhere but maybe its in another thread. I think you have great hope since you did respond positively. You were only on 25 mg/day for some reason and he usually uses 50 mg / day for that test. He can also add seligiline in addition to increasing your clomid dose to see how you respond. I have just conversed with someone on another thread who also responded to the clomid and SHippen told him he might be completely cured in a few months and need no drugs. His response was dramatic though going from 300 to 850 T on 50 mg/ day of clomid for a week.

Relationship of total T, SHBG, Estradiol (E2) and DHT by my understainding: DHT is a derrivative of T so it will go up and down with T. It can also go up and down while on T replacement with the type of replacement being used but that does not apply to you here. But for example DHT will be higher with transdermanl T replacement then T shots. SHBG tends to be lower when your T is high and your E2 is low. If E2 is high it tends to push up SHBG with it. E2 is also a derrivative of T due to aromatase enyzyme converting some T to E2. So the higher the T the higher E2 is in general. Again if you are on replacement or even HCG, the treatment can make the E2 problem worse depending on what it is. Using the same example E2 tend to be not as bad with transdermal replacment versus T shots.....but it still can possibly be too high.

I got a msg from the famous "Dr John" on another bd wherein he says that this response may mean a "failure". I suppose what troubled me is that the word "fail" pretty much always has negative connotations. Perhaps, if I am lucky, it may not here and may simply mean we need to look in another direction.
I am starting to understand this a bit and wonder if much of the problem is centered on insulin & thyroid issues. I've now heard that both here and from the reproductive endo @ Mass General, although she was focusing on the potential insulin resistance.

Insulin issues/thyroid could make sense. The only problem is how to deal with them as it becomes a "chicken and egg" problem. How does one fix low T if insulin is a problem since low T CAUSES insulin issues and vice versa? Perhaps I need to give up my one cup/day coffee and diet soda habits.... One never knows. I've been off all this week and under less stress/BS and had a great time with my wife the other night plus did better at the gym today.

Either way, thanks again for the input. We'll all have to see where this goes and, of course, I'll share with the gang when I finally get to see him.

lowesclubmaker
06-25-2007, 06:17 AM
anyman, you need to work on having a more positive attitude, and no-one can do it for you. You've impressed me the last many weeks with the research you have done, taking charge of your situation and getting to in to see the best dox. But you simply can't live and die with each test.

This test has nothing to do with pass/fail, it simply helps identify potential problems. someone could respond to the drugs, but still have a much harder time getting to a better balance than someone who doesn't respond.

anyman
06-25-2007, 07:44 AM
anyman, you need to work on having a more positive attitude, and no-one can do it for you. You've impressed me the last many weeks with the research you have done, taking charge of your situation and getting to in to see the best dox. But you simply can't live and die with each test.

This test has nothing to do with pass/fail, it simply helps identify potential problems. someone could respond to the drugs, but still have a much harder time getting to a better balance than someone who doesn't respond.

With no small amount of introspection and perhaps a bit of embarassment, I must agree with you. I readily admit to being enormously PO'd at the situation, as I am one of those people who detests dependency, especially on a medical fix. I prize self reliance and am angry at the universe for inflicting what seems to be a stupid affliction on me. I am also angry at my body for failing me despite generally healthy habits and exercise. The situation is worsened by how I often feel emotionally, much as I hate to admit it. Despite my efforts to the contrary, I have hormonally influenced moods. At this rate I'll be just like my wife! :eek: It was the unexpected moods and irritability that first prompted my search. Didn't think it fair to inflict moods and irritability on the family. My kids will only have one childhood. I want to make it a good one for them.

Perhaps wrongly, I now realize, I took the clomid "test" as a personal affront. In my world the words "test" and "fail" have certain connotations. I may be better off looking at it as yet another diagnostic tool as opposed to a "test" as the term is generally used.

I'm far from done from a research perspective. There is more to be done and shared, as I feel an obligation to pass on what I've learned and will learn just as those here have done for me. Thanks for taking to the time to comment and post. Glad to see that you've got some positive results and have hope.

One more thing, if you don't mind- What does "lowesclubmaker" mean? I've been trying to figure out that one for awhile! Is it a Golf thing?

lowesclubmaker
06-25-2007, 04:44 PM
yeah, it's a golf thing, I just don't want to give away too many clues. Thanks for listening, I think, when I was at my worst, one of the best things that happened was when my wife had a talk with me about ******'ing too much. Sometimes, you have to force yourself to not obsess on it. I know how hard it was for me to not ****** 18 hours a day, but it was the right thing for me to back off of doing.

You have put yourself in the best hands out there, and will work towards a solution - we all have some kinda problem, and we all work to find the most livable way to deal with it.

421g
07-02-2007, 11:45 PM
anyman/lowesclubmaker, are you guys still doning the test and did your dr's say what the next step was if this worked?
lowesclubmaker,did you take 25mg two and did you take the test for a week?

i had testicle pain to before i started androgel .do you have any idea of why the pain whent away? i thought that it could be from the testicle being shut down.
why is it bad to have high shbg besides high e2?

im hoping that my new dr is willing to try clomid or hcg or something to fix the problem insted of covering it up.
421

lowesclubmaker
07-03-2007, 07:54 AM
still waiting to hear from shippen, so I don't know what he'll say. I stopped T-supplements and then I took 25mg of clomid once a day for 7 days. I've stayed off the T and have been doing weekly tests since (almost 4 weeks without T) and so far my T is higher than it has ever been.

I wish I could tell you what the link is between T, E, and testicle pain. I KNOW there was one in my case, but the docs just vaguely acknowledge it. I think it has something to do with T/E ratio, but can't give any more info than that. You will see on this, and other, board that I asked ???s about the pain and either go no reply, or jokes.

Although I need more time to be sure, I don't think it went away becauase the testicle shut down since, at this point, mine appear to be working great and it hasn't come back.

Most docs have told me that high SHBG and high E's are linked. If your body recognizes there are too many E's flying around, it makes more SHBG to try to suck them up. Ultimately, the problem with high SHBG is that it sucks up too much Testosterone, leaving not enough free for use.

hayfarmer
07-03-2007, 03:58 PM
Don't wait for Shippen to call you.....call him and ask for the nurse if you have an issue you need advice on.

421g
07-03-2007, 04:49 PM
lowesclubmaker,,glad to hear that your still doing the test and that its working for you that would be nice if you could do the clomid for some time and stop and not have to be on meds.your t looks like its in good place mine did not get over 371 when i was on 5g of androgel but still felt better and the pain did go away .about 3months after i stoped the trt i have had a little pain.did shippen tell you how long he wonted to run the test for and if he was going to stop it and see wear thing are now?
thanks for the reply it give's me some hope just hope that my dr is willing to work with me and know's about this. 421

anyman
07-03-2007, 08:20 PM
still waiting to hear from shippen, so I don't know what he'll say. I stopped T-supplements and then I took 25mg of clomid once a day for 7 days. I've stayed off the T and have been doing weekly tests since (almost 4 weeks without T) and so far my T is higher than it has ever been.

I wish I could tell you what the link is between T, E, and testicle pain. I KNOW there was one in my case, but the docs just vaguely acknowledge it. I think it has something to do with T/E ratio, but can't give any more info than that. You will see on this, and other, board that I asked ???s about the pain and either go no reply, or jokes.

Although I need more time to be sure, I don't think it went away becauase the testicle shut down since, at this point, mine appear to be working great and it hasn't come back.

Most docs have told me that high SHBG and high E's are linked. If your body recognizes there are too many E's flying around, it makes more SHBG to try to suck them up. Ultimately, the problem with high SHBG is that it sucks up too much Testosterone, leaving not enough free for use.


That certainly sounds like good news, if I am reading your post correctly. You may be on your way to a restart, assuming such is possible. More importantly, how do you feel? Performing any better?

I note you havn't heard from Shippen. If you have an appointment coming up then you likely won't until you see him in person. At least that's what they told me. My app't is in 2 weeks. I look forward to it--and dread it. Part of me is exceedingly anxious to get the ball rolling while another, perhaps smaller, part of me is unsure if I want to hear what he has to say. When is yours?

Right now I am starting to focus in on what appears to be very low SHBG and what my research says is it's most common source: insulin resistance. Seems kinda unlikely as I eat well and exercise, but every piece I read on low SHBG mentions this more than anything else.

As always, keep us posted and good luck.

lowesclubmaker
07-04-2007, 09:50 AM
I've already had my appt, and the test came afterwards. I am feeling well - if I wasn't, I would be hounding their office, now its just an experiment to see if they ever call. Since I am doing the weekly measurements for another Dr, I can monitor the situation on my own.

It is awfully nice to not be taking anything (neither clomid not TRT) and feel good again. Hope it lasts!

lowesclubmaker
07-04-2007, 09:54 AM
glad to hear that your still doing the test and that its working for you that would be nice if you could do the clomid for some time and stop and not have to be on meds.

I took the clomid for 7 days and stopped.

I've been off the TRT since right before that (coming up on 4 weeks) so at this point I am med-free as far as the hormone imbalance stuff, and doing well.

It will never be proven, but I am starting to believe that my anti-cholesterol statins were largely responsible for my problems over the winter, and the clomid "test" actually rebooted something.

KayakGuy
07-05-2007, 08:45 AM
Lowesclubmaker,

You're not alone. The Lipitor ads on the radio are starting to annoy me - portraying it as a safe, harmless drug.

I took statins for several years as prescribed by my family doc - I stopped about a month after the first T test which came up 222 total, 30.5 free. The doc insisted there was no link, but to his credit he was the one who tested T, prolactin, LH, FSH, TSH, etc. Then I sought out a urologist who prescribed 6 weeks of Clomid (25 mg every other day) which raised T to 872 total, 201 free. The uro reduced Clomid to 25 mg 2 times per week for 6 weeks and T was 707 total, 198 free. Now off Clomid 3 weeks, waiting 3 more weeks to test again. It appears Clomid increased T production.

Uro also ran an ACTH stimulation test and concluded the statins exhausted my adrenal reserves.

Since off statins, total cholesterol is up to 235. Cardiologist recommended an UFCT of the coronary arteries to assess calcium deposits and came up with a score of 0%. He says I can stay off the statins. I'm waiting to see if the T levels can maintain themselves. It is clear to me that the statins caused all of the T problems, and were prescribed by a family doc who was just going by the numbers and didn't understand the risks of statins. It's a lesson learned the hard way.

Greentooth
07-10-2007, 06:32 AM
I took the clomid for 7 days and stopped.
It will never be proven, but I am starting to believe that my anti-cholesterol statins were largely responsible for my problems over the winter, and the clomid "test" actually rebooted something.

I think you are right. have you checked your cholestrol after you stopped statins and took clomid (which raised your T).