Enclomiphene citrate for late-onset hypogonadism?

[Smarks42]

I recently tried a TRT gel for my hypogonadism, about one year following my RT for Gleason 3+4 PCa (no evidence of metastasis before or after treatment). But after just one week of the gel, I had scary heart-centered side effects, so my Uro told me to get off it. What then happened is that I had a big withdrawal reaction. In my weight training at the gym, I found that I had only about half my previous strength, and I too easily get out of breath. Again, I had only used the gel for 1 week! I feel done with synthetic T replacement strategies. I've now read up on some promising studies of Enclomiphene citrate, and I'm planning to tell Uro that I'd like to try it. Does anyone out there have any experience with that drug? Unlike the synthetic TRTs, it does not block the body's natural production of T. Instead, it stimulates your body to produce more T by raising your LH and your FSH gonadotropic hormone levels. I have two major concerns here: One is that my LH and my FSH are already significantly higher than the normal range, and yet my T remains quite low (253). What good will it do to make them still higher, when my body has already tried (unsuccessfully) to accomplish that? And second, one of the side effects of Enclomiphene is heat flashes. Hot flushing has been my most worrisome symptom of hypogonadism for the past 3 years, predating my PCa diagnosis and treatment. I surely don't want to make it worse, but I'm still eager to give this drug a try. I would much appreciate any reactions, suggestions, etc.

[fast_eddie]

I'm guessing that that compound is a new one for all of us. Let us know how it goes if your doctor(s) approve trying it.

[Smarks42 in reply to fast_eddie]

Quick update: My uro agreed to me trying the enclomiphene citrate for my hypogonadism, but he ordered clomid instead, probably because the latter is older and easier to get. The problem is that while they are similar, they are not the same. See this:

ncbi.nlm.nih.gov/pmc/articl...

Enclomiphene is relatively understudied, but there are indications that its side effects are less than clomid, and I'm a very drug-sensitive guy. I found a compounding pharmacy that would make me a minimum prescription of 30 tabs of 6 1/4 mgs for $45. The best study so far looked only at 12 1/2 and 25 mg dosages. My plan is to see if I tolerate the 6 1/4 and if I do, to then double the dosage. I will update.

[LowT]

I’m 8 years out from prostatectomy for 3+4 with EPE and neg SM. Began Tgel (low dose and close monitoring keeping TT in 400 range) 9 mo post surgery.

Long story but after 16 months of Tgel uPSA became detectable

I came to believe most of my low T symptoms were coming from high dose statin as after stopping statin these symptoms disappeared and my T stabilized between 500-700 with no TRT.

continue with 3x above normal range of LH & FSH with TT of 500 and extremely low free T of 2 with low end normal range beginning at 6.6.

The low free T may be of benefit in regard to my BCR beginning two years ago.

On AS with PSA presently at 0.35, neg PSMA PET but with enhancing nodule in prostate bed and slowly rising PSA. Contemplating SRT.

[LowT in reply to LowT]

BTW I’m also 83 and my Decipher was .69.

Sounds like we could be twins!!!

[LowT in reply to LowT]

I also tried Clomid for six weeks which resulted in my PSA shooting up to 9 from 5 which ultimately led to my PCa diagnosis in 2016.

See previous posts of my complex story.

[Smarks42]

I appreciate your input, LowT. It does seem like we have a lot of similarities. See my reply to Fast Eddie about clomid versus enclomiphene. Your comment about statins and T is interesting. I was recently put on the lowest dose of rosuvastatin, but my hypogonadism predated that. Stay tuned for updates.

[LowT]

I found that high dose statins lowered my T about 15%.

I recently began low dose Rosuvastatin (5 mg MWF) to lower my T (now runs in 400s) Lowering my cholesterol (a T precursor) may slow growth of my recurrence as T increased by around 20% as a result of the 5 aRI, which I also stopped 2 months ago

[janebob99]

You may want to consider using transdermal estradiol (E2) to eliminate your hot flashes and osteoporosis from ADT. It works very well. The standard dose is one, large patch per week of strength = 0.1 mg E2/24hr. Ask your PCP for a prescription. Some patch manufacturers recommend changing it twice a week. The best place to apply it is the hips or upper buttocks. Some men use estradiol gel, available from divigel.com or Estrogel.com (with a prescription). Estradiol "add-back" adds back the natural estradiol that is lost when you have very low testosterone on ADT.

[Smarks42 in reply to janebob99]

Thanks for this, Janebob. I think I'll try the Enclomiphene first, hoping that it will not only help with my heat but also my ED and my erratic sleep, all symptoms of hypogonadism. If I can't tolerate it or it doesn't work, I'll try the estradiol. Do you think there's a weaker dosage so I can ease my drug-sensitive body into it?

[janebob99 in reply to Smarks42]

That's a good decision.

As far as estradiol goes, it's a completely natural molecule that your body naturally makes by converting testosterone to estradiol via the aromatase enzyme. Having low T means your E2 is also low. Taking supplemental E2 just returns your E2 levels back to your normal levels that you used to have before doing ADT (or, having hypogonadism, in your case). Your body should tolerate the supplemental E2 "add-back" very well, with few side effects. It's not a synthetic drug.

I tried clomiphene for my hypogonadism, and it didn't do much for me. But, you may have a better outcome. Please keep me informed.

Bob in New Mexico

[Smarks42]

Again, thanks very much for your interest and additional information. It's great to have another option to look into if the enclomiphene doesn't work. I will update once I know how I'm doing.