This has been in use for 60 or so years but isn’t an FDA approved use of clomid. The primary reason is clomid is cheap to produce and not patented. It’s extremely safe and if you shop around you’ll find a urologist that’s aware of it and will prescribe it - but most urologists get marketing benefits from the rather expensive testosterone replacement products so not all are either aware or are willing to forego the lucrative marketing funds.

I switch to this about 10 years ago after starting testosterone for a few months. I wanted to have kids and I was very worried. I researched the biological processes for testosterone and stumbled on clomid as a relatively well known but unmarketed low T therapy. I went to a top urologist at NYU and he ranted about urologists that don’t use clomid. He gave me a prescription and it worked like magic. Two years later I had my first kid. I still take it at a low dose because I feel great. My testosterone levels are high normal range.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182219/

https://en.m.wikipedia.org/wiki/Clomifene (other uses section)

In my opinion it would be much safer to suggest recombinant FSH and LH. The brain testes axis seems to have the least amount of atrophy over time from anecdotal experiences of those online and in a few case reports. I do not think HCG should be used long term due to the non-bio identical nature, but it is a good short term LH mimic if my memory serves me correctly. Would be a great addition to a TRT protocol.

I thought LH/FSH is usually increased using HCG injections? Is there an oral route for LH//FSH? One of the benefits of clomiphene is it’s orally administered so no complex refrigeration / injectable requirements.

https://pubmed.ncbi.nlm.nih.gov/31216250/

No, that's not it, that's a very uncharitable interpretation and is unnecessarily dismissive . The real issue is that no one wants to pay for studies to turn off-label uses to on-label uses if there isn't money in it because the process is expensive, and so won't be done when there are better returns on investment.

There is plenty of peer reviewed research, but not all doctors are aware of all research and testosterone replacement is widely marketed with very lucrative contracts to urologists.

Feel free to read the research yourself

https://www.ncbi.nlm.nih.gov/pmc/?term=Clomiphene+testostero...

The FDA has a "new clinical investigation" program that is supposed to reward people running clinical trials. If you collect data showing efficacy of a new use of a previously-approved drug, you can "earn" the exclusive right to market it for that condition. Of course, someone has to actually do it...and the numbers don't always pan out.

For example, who would fund more studies on ginger? https://nutritionfacts.org/video/ginger-for-migraines/

Anastrozole or HCG (I forget which) should have prevented that

HCG is an injectable. Others may think differently but I’d rather take a once a day tablet than introduce an injectable to my life.

Honest question - how much exercise were you getting before you went to testosterone therapy?

The reason I ask is because of the studies that have shown that the decline in testosterone associated with aging is because of poor health, not age. Example:

https://www.sciencedaily.com/releases/2011/06/110607121129.h...

I am in the next decade after you and have noticed no decline. I do heavy weight lifting three days per week and burn about 1,000 calories per day with cardio. That seems to be a sweet spot - too little exercise or too much and your testosterone will take a hit. Rubbish diet will not help though either.

Part of what really tipped me off was my energy before and after the gym was much lower than it used to be. Also I would be tired starting around 2 PM in the afternoon, this isn't sleep related as I sleep like a baby, which I am grateful for. Also I never drank coffee or took lots of caffeine so I was perplexed as to why I would just crater in the afternoons.

After starting the treatment I am no longer tired in the afternoons, my mind feels sharper and I can tell I am recalling processing info better. The energy at the gym has improved as well.

There is a range that is considered normal testosterone except that range is HUGE, my results were at the very low end of that spectrum.

Part of the plan I am on I get tested every month for the first 3 months then every 3 months there after.

https://www.everlywell.com/products/testosterone-test/

(No affiliation, not an affiliate link)

Evidence of testosterone supplementation improving cognitive performance is weak despite many studies.

Evidence of sleep associated with cognitive performance is extensive and well documented.

The (not that helpful in the moment) good news is that kids get older and will eventually sleep more and more independently.

What about side / ill effects?

Could this be a placebo effect. I have low testosterone too. I've been doing "natural" ways by changing diet, cardio/weights, sleeping in a lot, trying to have sex regularly. But my numbers just don't seem to budge.

I think my only options now are TRT or just accept and make peace with it. If I do TRT, my impression is that you have stay on it for life. I am not sure i am ready for that kind of commitment.

Having done it I can see myself doing it until my late 50's at which point I should have the majority of my adventuring done as well as be out of the workforce so I will probably not be too concerned about lack of energy.

I am not sure if you go back to your previous baseline. I know athletes who do this have forever left with way lower testosterone than their previous baseline.