I just wanted to get everyone up to date on a relatively new way to boost testosterone for hypogonadal males whose cause of low testosterone is not a diagnosed primary (testicular failure) or secondary (issue with hypothalamus or pituitary gland).  In short, medical professionals call such states idiopathic, meaning cause unknown.  For example, some men with low testosterone suffer from insulin resistance, which can lower SHBG to levels low enough that free testosterone increases above the normal range, causing the homeostatic state to finally settle into a low total testosterone state as the body dumps the excess free T.  However, I am not aware of any study which conclusively proves this point.  Therefore, as in my case, decreasing insulin resistance by diet, exercise, and in my case the use of the over-the-counter product Ortho Molecular CM Core.  The later supplement decreased my A1C from 6.8 to 5.1 in about 4 months – an amazing result.

I recently attempted this approach, a therapy which consists of low dose Clomid at 25mg/day for 6 weeks.  In the past, many attempted high dose Clomid of 100mg-150mg/day for a few weeks to a month.  Side effects with dosages this high rarely are well tolerated and include seeing “tracers”, loss of libido, and mood swings.

Clomid is actually a selective estrogen receptor modulator, or SERM.  The drug, available by prescription only, acts on some tissues as an estrogen and in others this SERM will block estrogen. In males estrogen is blocked or inhibited in the hypothalamus resulting in an interesting effect:  the stimulation of Gonadatropin Releasing Hormone (GnRH) which then stimulates the pituitary gland to kick up its production of LH (leutinizing hormone) in the pituitary.  LH then stimulates the Leydig cells in the testicles to pump out testosterone.

One other side effect of Clomid to keep in mind is that over the long term, and especially at higher dosages, the pituitary gland is desensitized to GnRH.  Therefore, a short run of low dose Clomid,if successful in increasing testosterone production, is best looked at as a way to kick start the hypothalamus and pituitary gland into successfully working at full potential.  Upon cessation however, if the cause of low testosterone is still unknown or unaddressed, testosterone levels often drop to pretreatment levels.

One study of 36 men with average total testosterone of 248 ng/dl, placed the subjects on 25 mg/day of Clomid.  After 4-6 weeks the men’s average testosterone was a hefty 610 ng/dl.  This is a nice boost indeed, especially for what is considered a relatively low dose of Clomid.

My recent foray into this treatment ended unsuccessfully.  Prior to treatment, I ceased all TRT for two weeks.  Total T plummeted to 70ng/dL.  After six weeks my levels stood at a paltry 195ng/dL.  However, in my particular case, due in part to the length of time on TRT – over 15 years – the testicular atrophy due to such long use may have been addressed – and in my particular case has successfully been addressed in the past – with high dosages of Human Chorionic Gonadatropin (HCG) injected subcutaneously into the stomach fat using insulin needles.  Doses of 1000-1500IU every other day for 20 days are usually enough to really kick in Leydig cell production of testosterone assuming no issue exists with the function of these cells. At these dosages the need to control the conversion of testosterone to Estradiol or E2 (a potent estrogen) is sometimes necessary.  This conversion process, known as aromatization, typically occurs in the liver and body fat surrounding internal organs – also known as adipose fat.  Small dosages of the aromatase inhibitor Arimidex at .05mg/day usually keeps this process under control, and such dosages can be provided in capsule form by a good compounding pharmacy.  The amount needed varies from person to person, with some requiring more, and many hyper-responders requiring less.

The six week program of Clomid did increase my LH and follicle stimulating hormone to the high end of normal and quite possibly I could have seen an increase in testosterone given more time.  However the concern of desensitizing my pituitary to GnRH lead to the cessation of the Clomid and restarting the Testim for TRT.

Other protocols exist and mileage will vary.  Some add in Tamoxifen, another SERM, to work with the Clomid and also help combat the desensitization of the pituitary gland to GnRH.  I have seen so many protocols out there I can only conclude that the best protocol likely varies depending on the person and the underlying cause of idiopathic hypogonadism.

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Filed under: Testosterone Replacement

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