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Dr.’s Hrt method for lowering hemoglobin.

Thebigone

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My HRT doctor is pretty knowledgeable and up-to-date. She is a big believer in levels being in range but in the high-end of the range no matter what age you are. For example she agrees that every day intramuscular injections of testosterone cypionate are better than two or three shots a week. She has me on 20mg cyp IM everyday and .25mg adex 2x per week. Test comes back around 800 range 250-827. Estrogen at 22. Anyway like most of us I suffer from high hemoglobin even after doing phlebotomies every three months so what she told me today I found interesting. She said testosterone cypionate is metabolized by the liver which is the reason why hemoglobin can increase so high. She said test cream will not increase hemoglobin the same as cypionate will and you can still be in the 800 range. But then she said what she prefers even more that has the least likelyhood of increasing hemoglobin is replacing HRT with Clomid. She said she has patients on Clomid and their levels are in the 900s thousands and even 1200s without hemoglobin being increased. I found it interesting that the type of testosterone you take for HRT can effect hemoglobin. I’m thinking about dropping the cypionate and trying Clomid for a couple months with adex to keep estrogen in range and see what my levels are and what impact it has on my hemoglobin. Curious on your input?
 

thethinker48

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Man...if you can take clomid for extended period of time instead of HRT, more power to you. I don't think I've seen test esters cause different hemato/hemo levels; elevated estrogen yes can keep the erythropoietin activity from fully taking place but that's due to estrogen. Maybe someone else can chime in on this.

But I'd say most guys would go crazy using it that long. Clomid is like swapping your mind with a pregnant woman while simultaneously having some dust in your eye.

It's not something most guys can run for long periods of time; I remember running it once for PCT, and I would get emotional watching 300.

Sent from my Pixel XL using Tapatalk
 

OutToLunch

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Recipe for disaster for some. That it my endos trt method. If you can get past the emotional and mental issues with clomid more power to you. And shortly thereafter test levels do decline. I was on clomid for trt for almost 2 years. I regret it...
 

PoptartPsycho

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Injecting ED may be better, but that is just too much for a long term goal. I couldn't do it and would just quit after a few months.
 

Thebigone

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Man...if you can take clomid for extended period of time instead of HRT, more power to you. I don't think I've seen test esters cause different hemato/hemo levels; elevated estrogen yes can keep the erythropoietin activity from fully taking place but that's due to estrogen. Maybe someone else can chime in on this.

But I'd say most guys would go crazy using it that long. Clomid is like swapping your mind with a pregnant woman while simultaneously having some dust in your eye.

It's not something most guys can run for long periods of time; I remember running it once for PCT, and I would get emotional watching 300.

Sent from my Pixel XL using Tapatalk

She said the reason for the emotional side effects of Clomid is because of the estrogen increase it causes. When you take Adex at the proper dose to maintain estrogen you don’t have the emotional side effects Clomid causes. I don’t even know where to begin researching the effects Clomid or test cream has on hemoglobin versus cypionate but I’d rather switch to cream if that doesn’t cause the hemo increase. But this is the first I’ve ever heard of this so who knows what’s real.
 

MyNameIsJeff

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She said testosterone cypionate is metabolized by the liver which is the reason why hemoglobin can increase so high. She said test cream will not increase hemoglobin the same as cypionate will and you can still be in the 800 range.
I sure love when doctors draw broad conclusions from a handful of patients instead of practicing evidence based medicine. That argument makes no sense whatsoever.

The Clomid suggestion on the other hand is actually supported by evidence. A coupe studies show that Clomid significantly increases T levels while having no impact in hemoglobin or hematocrit.

Overall, 209 men were prescribed CC. Median duration was 17 months (IQR 7.5-26.5). Median age was 35 years (IQR 32-40). The median change in estradiol was 69% (IQR 20-131). Change in estradiol levels correlated, as expected, with post treatment total and bioavailable testosterone levels (p=0.006 & p=0.002, respectively), but also with lower pre-treatment LH & FSH (both p<0.0001). Fifty one (28%) patients had a highly elevated estradiol (>50pg/ml) two weeks after starting CC, and had to have the drug dose titrated or discontinued. These men had similar baseline estradiol, bioavailable testosterone and total testosterone levels compared to the rest of the cohort, but lower LH & FSH levels (p=0.013 & p=0.004 respectively). 122 patients followed up with a PSA level at 4 months, at which time the median PSA was 0.6ng/dl (IQR 1-0.5). Longer follow up (median 14 months, IQR7-26) in 67 men revealed a median PSA velocity of 0ng/dl/month (IQR -0.006-0). One (1.5%) patient developed prostate cancer and 3 (4.6%) other patients had CC discontinued due to concerning PSA elevation. At 4 months of treatment, none of 120 patients with hemoglobin assays developed erythrocytosis. Longer follow up (median 18 months, IQR 6.75-22) in 64 patients revealed a median change in hemoglobin over this time of -0.1g/dl (IQR -0.6-0.2), with no cases of erythrocytosis. 15 patients (7%) developed side effects from the medication and discontinued it. Common side effects included gynaecomastia, weight gain and muscle pain.
http://www.fertstert.org/article/S0015-0282(16)62099-X/fulltext

A total of 77 patients had recorded PSA, Hct, and/or
testosterone values. The mean (SD, range) age and body mass
index was 34 (6, 22–51) years and 31 (6, 22–52) kg/m2
, respectively. The mean (SD) follow-up was 358 (29) days.
Within this group, CC concentration was changed in 24
patients (31%) and was discontinued in 24 patients (31%).
The median (range) duration of CC therapy before
discontinuation was 127 (44–161) days. The use of CC
significantly raised both mean total and bioavailable
testosterone levels by 200 ng/dL and 126 ng/dL, respectively

(P < 0.001). This increase in testosterone had significant
clinical effects with improvements in Androgen Deficiency in
Aging Male questionnaire scores (P < 0.01) but not Sexual
Health Inventory for Men scores. CC had no effect on mean
PSA (1 ng/dL, 95% CI 0.8–1.1) or Hct (49%, 95% CI 41–53)
levels, which were within normal ranges.
Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels - Chandrapal - 2016 - BJU International - Wiley Online Library
 

maldorf

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Mine was really bad for about 2 years, but after 2 years of monthly phlebotomies my iron got low enough that now I only have to go once every 3 months and it never gets over 16. It takes time.
 

emeric delczeg

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My HRT doctor is pretty knowledgeable and up-to-date. She is a big believer in levels being in range but in the high-end of the range no matter what age you are. For example she agrees that every day intramuscular injections of testosterone cypionate are better than two or three shots a week. She has me on 20mg cyp IM everyday and .25mg adex 2x per week. Test comes back around 800 range 250-827. Estrogen at 22. Anyway like most of us I suffer from high hemoglobin even after doing phlebotomies every three months so what she told me today I found interesting. She said testosterone cypionate is metabolized by the liver which is the reason why hemoglobin can increase so high. She said test cream will not increase hemoglobin the same as cypionate will and you can still be in the 800 range. But then she said what she prefers even more that has the least likelyhood of increasing hemoglobin is replacing HRT with Clomid. She said she has patients on Clomid and their levels are in the 900s thousands and even 1200s without hemoglobin being increased. I found it interesting that the type of testosterone you take for HRT can effect hemoglobin. I’m thinking about dropping the cypionate and trying Clomid for a couple months with adex to keep estrogen in range and see what my levels are and what impact it has on my hemoglobin. Curious on your input?

What was your free level? you can just inject 8 to 10mg per day and you don`t need to take any adex.
 

Thebigone

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What was your free level? you can just inject 8 to 10mg per day and you don`t need to take any adex.

I was around 270ish Free and I think the range was 80-200 something like that. My goal would be to get test levels as high as possible without effecting hemoglobin. Apparently she says test cyp is metabolized by the liver which is the main cause for the hemo increase but gel and Clomid don’t.
 

Thebigone

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I sure love when doctors draw broad conclusions from a handful of patients instead of practicing evidence based medicine. That argument makes no sense whatsoever.

The Clomid suggestion on the other hand is actually supported by evidence. A coupe studies show that Clomid significantly increases T levels while having no impact in hemoglobin or hematocrit.


http://www.fertstert.org/article/S0015-0282(16)62099-X/fulltext


Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels - Chandrapal - 2016 - BJU International - Wiley Online Library

See that’s what I mean. I would much rather have high test levels from Clomid and not have the negative increase in hemoglobin if I’m going to get the same gains anyway. I’m surprised they didn’t just give Clomid as TRT to begin with. My wife has been taking test cream and the range for women is 2-45. She’s on the smallest amount of cream just one pump and one month later her total test is 252 lol. I told her to let the doctor know that when your levels are increased over 500% like that it could cause an increase in hemoglobin and the doctor said no it won’t because it’s not metabolized by the liver so she ran a CBC on her and her hemoglobin was actually the exact same before she started test. So now I’m really debating between cream or Clomid.

Until I figure out if I’m going to switch to a cream or Clomid for a trial run to see what it actually does and what its impact on hemoglobin is she told me to come in weekly to get IV infusions of Saline with minerals and vitamins, etc. she said doing that once a week will greatly hydrate my body and probably drop my hemoglobin two or three points my first appointment is tomorrow im excited to see how it feels. I could even do it twice a week as my insurance pays for it.
 
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Thebigone

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She also said the “range” is such a vast number with such a lack of research behind it you don’t really want to go off it that much. She said your average sedentary middle-aged male who wants to just feel better there’s nothing wrong with his level staying in the 700s or 800s that’s when he will feel is best. But she said if you’re an active bodybuilder or athlete then it makes no sense to have levels at the same range as the sedentary guy. You want your levels around 1200 or 1300 optimize yourself. A bodybuilder is meant to function off higher test.
 

thebigbus

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from personal experience prescribing these things, I've given clomid to a few guy who are still wanting to maintain fertility.

Their test levels get HIGH, but they don't feel any better. It's a last resort for me, and I don't push it on anyone unless they're young and worried about fertility.

It is an estrogen, and has agonist activities in certain tissues, so it makes sense it may not make a male feel that great even with high testosterone.
 

Thebigone

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from personal experience prescribing these things, I've given clomid to a few guy who are still wanting to maintain fertility.

Their test levels get HIGH, but they don't feel any better. It's a last resort for me, and I don't push it on anyone unless they're young and worried about fertility.

It is an estrogen, and has agonist activities in certain tissues, so it makes sense it may not make a male feel that great even with high testosterone.


If an AI is take to maintain E2 levels and test levels are high from it then how would it be any different in how they feel vs any other form of test
 

thebigbus

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If an AI is take to maintain E2 levels and test levels are high from it then how would it be any different in how they feel vs any other form of test

Not sure I fully understand what you're asking. but clomid and an AI are two totally different things.

also, AI only needed when estradiol is truly too high (symptoms, gyno, etc). otherwise it's best to let e2 rise with testo (to a point).

But again, clomid itself is an estrogen. AI's are not. Giving an estrogen to a male could have some deleterious side effects. And from personal experience I've seen this in many cases (not all).

Just something of which to be aware. Not saying clomid isn't an option.
 

Thebigone

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Not sure I fully understand what you're asking. but clomid and an AI are two totally different things.

also, AI only needed when estradiol is truly too high (symptoms, gyno, etc). otherwise it's best to let e2 rise with testo (to a point).

But again, clomid itself is an estrogen. AI's are not. Giving an estrogen to a male could have some deleterious side effects. And from personal experience I've seen this in many cases (not all).

Just something of which to be aware. Not saying clomid isn't an option.

Sorry what I meant was let’s say a patient is take 50mg Clomid ED and their test levels increase to the 800’s. Well obviously estrogen will increase as well but if you also add an AI like arimidex to balance estrogen then how would that be any different than say cypionate getting test levels in the 800’s while still using arimidex to control estrogen? Thanks
 

thebigbus

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Sorry what I meant was let’s say a patient is take 50mg Clomid ED and their test levels increase to the 800’s. Well obviously estrogen will increase as well but if you also add an AI like arimidex to balance estrogen then how would that be any different than say cypionate getting test levels in the 800’s while still using arimidex to control estrogen? Thanks

Main difference would still be that clomid is still "doing its thing", so to speak, activating certain estrogen receptors (likely in brain) while antagonizing others. I think that's where the "not feeling good" comes from with clomid. Not the total estradiol level, but what clomid is doing at the estrogen receptor itself. (And there are probably WAY more complex pathways going on with clomid and what it's doing to the pituitary, than what I said above.)

hope that made sense. in my head it does. :)
 

Thebigone

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Main difference would still be that clomid is still "doing its thing", so to speak, activating certain estrogen receptors (likely in brain) while antagonizing others. I think that's where the "not feeling good" comes from with clomid. Not the total estradiol level, but what clomid is doing at the estrogen receptor itself. (And there are probably WAY more complex pathways going on with clomid and what it's doing to the pituitary, than what I said above.)

hope that made sense. in my head it does. :)



Ahh I see that makes sense. What do u think about test cream vs cypionate for not effecting hemoglobin levels?
 

frink71

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I always wonder why nolva is never brought up in these situations at all

Studies show it to be a stronger test booster than clomid, and anecdotally not showing any of the negative mood/estrogen agonist action
 

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