This is a subject that I know a lot about. Feb 2010 is when the doctor finally determined I had low testosterone. My test came back at 204. It is isn't something they typically look for in a 34 year old. I had never done steroids or any type of drugs. My GP referred me to a Urologist. The Urologist grilled me on steroid and drug use, then basically accussed me of doing steroids even though I hadn't. He put me on clomid. I was on it for 2 years straight and then decided I might as well run a cycle and see what happens. I can tell you all about clomid from my personal experience and from all the research that I've done over the last 2 years.
First of all there is no generally available study on men taking clomid long term to treat low testosterone. The reason is clomid isn't approved by the FDA to treat low testosterone in men. Clomid is a female fertility drug used to treat women. When it was first produced and went through FDA testing that is what it was tested and approved for. Now that it is a generic no one is going to pay for the additional FDA testing and approval. This is why insurance will not cover the drug, it is still classified as a fertility treatment for women.
The dose of clomid I was put on was 50mg a day. Clomid blocks the estrogen receptors but it does not eliminate or lower the estrogen levels. It works by breaking the negative feedback loop which causes the pituitary to produce a high level of LH and FSH. Before treatment my numbers were FSH 6.5 mIU/mL, LH 8.2 mIU/mL, and testosterone 204 ng/dL. Three months into treatment my numbers were 17.7 mIU/mL, 12.7 mIU/mL, and 758.ng/dL. Five months in my testosterone peaked at 1113 ng/dL. You ask why clomid makes you act like a girl, I will tell you. Not only was my testosterone level high my estridol level was sky high. The normal range goes up to 42.6 for men. The upper limit for adult women, outside the ovulation window, is 160. My level was 224!!! I talked the Urologist about it, he was not concerned and said it was fine. Clearly despite being a specialist he was an idiot when it came to what he prescribing and treating. You want to know how a man acts with estrogen at 224, have you ever had your girlfriend/wife break down crying over every little thing or blow up and go crazy over little things, or break down crying one minute and then blowing up at you the next? With estrogen levels that high you will be doing the same thing! Not to mention having a limp dick. Remember my T level was 1100, I wanted to screw like crazy but couldn't get it up. I swear that is the worst hell you can put a guy through.
After that peak my levels started to decline. Seven months in my numbers were FSH - 21.1 mIU/mL, LH - 9.1 mIU/mL, T 668 ng/dL, E2 165 pg/mL. So my body was still sending a strong signal to produce but my leydig cells decided they were going to take a break. Over the next year my T level dropped to 550. Then I added some zinc and ate better, it jumped to the 750-800 range. I also cut my dose in half, to 25mg a day. Long term I haven't noticed any vision problems or any other major problems. I think clomid will cause some ED issues but that could just be me.
Since the doctor more or less accused me of taking steroids and my GP was going to prescribe me testosterone injections at first, I decided to run my first cycle in March of this year. The extra testosterone shutdown my HPTA leaving me with an FSH of 0.6 and an LH of 0.1. I started my PCT, clomid and nolvadex and in 2 weeks my numbers were FSH - 15.5 mIU/mL, LH - 11.5 mIU/mL, testosterone 717 ng/dL. I ran my post cycle therapy (pct) 6 weeks. At the end of it my numbers were FSH - 19.6 mIU/mL, LH - 13.3 mIU/mL, testosterone - 1007 ng/dL. I will wait 4 weeks after I stopped taking them and see where I leveled out at.
I do not know why doctors don't run low T patients through a post cycle therapy (pct) treatment and see what happens. Shots for the rest of your life or maybe a month of pills; they ignore the month of pills and go for the shots because they get paid to write prescriptions. I would at least try the clomid and see what happens. Make sure if you do that you also have to the doctor running lab work for E2 and will give you something like Arimidex if it gets too high.
I fired my Urologist. Besides being an idiot, the last time I was in there he refused to run labs on free testosterone and estrogen, said they weren't important. So now I schedule my own labs and follow my own treatment routine to see how I respond. Most doctors when it comes to treating low T are useless.