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A Few Words About Clomid Therapy

Discussion in 'Random Thoughts from Dr. John' started by Dr. John Crisler, Jan 21, 2015.

  1. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    For some men, Clomid is just awful. For others, it works very well.

    The only way to find out to which group you belong is to try. And "try" means initiating therapy, waiting about 3 weeks, running labs, evaluating them, then making any necessary adjustments. That is because how you feel, AND how well it is working, may be worlds apart.

    Too many men just quit after a few days. They did not give things time to work. Having said that, vision changes is an automatic No Go for clomiphene therapy. We just don't mess around with our eyes.

    You have to watch LH and FSH--to see if it is working. That also decides your dose.

    Watch Total Testosterone level. IF LH is up, and T is not, are you suffering primary failure? And remember, LH production is very cyclical.

    You have to watch SHBG. IF it rises, you will need to produce more testosterone to overcome it.

    IF it just blocks estrogen--subjectively--you are usually all good. But some men get estrogenic symptoms with it. The chance of that happening is lessened by starting at a lower dose, such as 12.5mgs per day.

    "Start low/Go slow" never found a more poignant example. That way you know which direction to go when titrating dose.

    The bottom line is you need someone who really knows what they are doing to direct your care. But living well on just a single tab per day certainly has its benefits.
     
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  2. adr_59

    adr_59 Member

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    I'd like to know your opinion regarding cycling Clomid when using it long term?
    Let's say 11 months on, one month off?
     
  3. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    May I ask why you would want to?
     
  4. adr_59

    adr_59 Member

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    To avoid building a tolerance to the drug?
    It was the advice of the doctor who prescribed me Clomid 10 years ago.
    And I've been on 12.5mg/eod ever since, 11 months on, one off, hoping every time that my pituitary will pick up.
    Never happened.
     
  5. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    I'm not aware of tolerance to Clomid.
    IF 12.5mg QOD is not working, then it might be a good idea to increase the dose. Watch the LH/FSH.
     
  6. adr_59

    adr_59 Member

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    Wouldn't your body eventually develop tolerance to any drug, if you take it for a long time?
    12.5mg EOD keeps my T ~500-600, 12.5 ED brings it to ~800.
    What I also noticed is that when on Clomid, my lipid profile improves, when off Clomid, by the end of that month,
    lipids get worse - Cholesterol goes up, HDL down, LDL up and even hA1c goes up.
     
  7. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Taking a drug does not automatically cause tolerance, or tachyphylaxis, to itself.

    By your own example, taking more of the Clomid i(the same dose more frequently) increases your testosterone level.
     
  8. electrify

    electrify Member

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    Hello. New here. What is your opinion on other SERM's like Nolvadex (Tamoxifen) or Toremefine? Are these better than Clomid for people? Based on the steroid forums out there, it seems like people have used Toremefine for PCT with success but is it good for standard secondary hypogonadism?

    I know Androxal will be coming out hopefully end of this year but what exactly is the advantage vs existing anti-estrogenic SERMs like Torem?
     
  9. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    I can only prescribe from legit pharmacies, so that makes things pretty expensive if we are to use anything other than Clomid or Nolvadex.
     
  10. Kierkegaard

    Kierkegaard Banned

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    Hi Dr. Crisler, love your new book. What would you say is the success rate you've seen (not just labwork but feeling good) percentage-wise for guys who try Clomid?
     
  11. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Thank you. I hope it helps you.

    I honestly have never given it any thought. But in some cases, we really must try Clomid first.
     
  12. Kwerk

    Kwerk New Member

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    Hello, thank you for being a pioneer in this field, making a website that is an incredible resource, and I have a quick question if you don't mind:
    I am on a clomid protocol of 12.5 mg EOD and have been for a few weeks. Last night out to dinner with the family I thought I saw a bug out of the corner of my eye swirling around one of my guest's meals. I motioned to them to shoo it away, but no one else noticed a bug and after making an idiot of myself, I thought I may have a floater. Of course I will be vigilant of if this was actually a floater or just my imagination, but let's say that it is real.

    What do you do with your clomid patients who respond well in terms of lab tests but may be having vision effects? Hopefully not kick them out with a recommendation to avoid being hit by the door?
     
  13. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Anyone with any type of visual side effect immediately stops the Clomid. We just don't mess around with it.
     
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  14. Aki

    Aki Member

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    Dr. John,

    Have you considered that in men taking both clomid and arimidex, the "feeling bad" part might be due to the arimidex rather than the clomid?

    I was feeling pretty miserable after around two months on clomid and arimidex, but as soon as I cut out the arimidex I felt much better. I have since not touched arimidex - I have no idea what my estrogen values are - hopefully not sky high - but I have been feeling pretty decent, at least in comparison with how I was feeling before starting the clomid. Maybe my case is just an aberration, but arimidex did not suit me.

    (BTW we have had three AOCs, the last one over a year ago, and I would love to discuss all this with you over the phone - I'm hoping to get my finances in order so I can get a fresh set of labs and we can have another one sometime in the not-so-distant future. But until that happens I feel the best course of action is sticking with my low dose of clomid.)
     
  15. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Then you surely did not need the Arimidex in the first place.

    Glad you found what works!
     
  16. Aki

    Aki Member

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    Dr. John,

    Thanks for the response. If that's the case then I guess it just goes to highlight what you always emphasize on: testing estradiol using LC/MS/MS instead of ELISA, CLIA, etc.. My estradiol prior to starting arimidex had come out as 62 pg/mL but that was using CLIA, so in retrospect it could be that my true estradiol value wasn't anywhere near as high.

    Was just wondering if you saw any value in using Danazol to counter a moderate increase in SHBG due to clomid?
     
  17. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    I do try that. It seems to work, even though, technically, the Danazol should inhibit LH production.
     
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  18. drpepper68

    drpepper68 New Member

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    I just watched your video in the hangout section and that made me have more questions than before. :)

    Why would one start clomid to being with?
    Is it in lieu of taking Testosterone? In combination?
    Would someone who has been on TRT injectables for years want to go back and try clomid only if they didn't want to do shots anymore?
    In lab test results what would contraindicate beginning clomid therapy to being with?

    Thanks for all the info you share.
     
  19. adr_59

    adr_59 Member

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    Does anybody know what is the best time of day to take clomid - mornings, evenings, lunchtime?
    Also, bigger dose EOD or smaller dose ED?
     
  20. Bulldog

    Bulldog Administrator Staff Member Administrator

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    The time of day should not matter because the half life of Clomid is about 5-7 days. Please note that the Zuclomiphene isomer (the estrogen agonist half of Clomid) supposedly has a longer half life than the Enclomiphene isomer (the estrogen antagonist half of Clomid).
     

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