Thus, Maximus does NOT use a lab test in advance to see if you qualify as “Low T.” Rather, we use a validated questionnaire to assess your symptoms and areas for improvement. Your doctor uses this info, along with your medical history and goals, to assess if the protocol is right for you.
If so, your doctor can prescribe an at-home lab test at the same time as personalized medications & supplements, to ensure you can get treatment in as soon as one week. Thus, the purpose of third-party lab testing is to provide you with an objective “before & after” 30 days to prove the protocol is working, and provide your doctor with additional info to optimize your treatment over time.
Testosterone Replacement Therapy (TRT) shuts down your body’s own production of testosterone and replaces it with synthetic testosterone that is typically injected, which results in testicular shrinkage, infertility, and dependence. However, a newer, cutting-edge approach is testosterone restoration, using oral medications to restore your body’s own natural production of testosterone without these adverse effects.3
Selective Estrogen Receptor Modulators (SERMs) act as estrogen antagonists—they block estrogen from binding to the estrogen receptor in the brain, at the hypothalamus and the pituitary gland.
So when the brain thinks that it’s not getting enough estrogen, it stimulates the production of the hormones luteinizing hormone (LH) and Follicle Stimulating Hormone (FSH), which increases the testes production of testosterone and sperm, respectively. This cleverly stimulates your body into producing more of its own natural testosterone!
Enclomiphene is the purified isomer of Clomid (Clomiphene Citrate), which has been FDA approved since 1967 for fertility in women, and has been commonly used off-label in men. Many research studies suggest Clomid “is safe and effective with few side effects when used as long-term treatment of hypogonadism (low testosterone)”4 and is an “effective and safe alternative to testosterone supplementation in [young] men wishing to preserve their fertility”.2
However, Clomid is actually made up of a mixture of two isomers: 38% zuclomiphene and 62% enclomiphene. Zuclomiphene is an estrogen receptor agonist (increases estrogen) that stays in your system a long time and accumulates much more over time than enclomiphene.5
Clomid is believed to cause some minor side effects such as mood swings, depressed mood, irritability, anxiety, gynecomastia, and libido issues that can develop in a small percentage of patients over time.6
The literature has suggested that most of the beneficial effects of clomiphene are due to the trans-isomer enclomiphene. Zuclomiphene contributes little to the intended outcomes.“7 Maximus’ cutting-edge innovation leverages purified Clomid to maximize the amount of enclomiphene present. Thus, using this new, purer form “maintains the androgenic benefit of clomiphene citrate without the undesirable effects attributable to zuclomiphene”, and has been shown to yield increased testosterone levels and maintain sperm concentration (unlike TRT).7
Experts believe enclomiphene should “become the primary medication for men with secondary hypogonadism (low T) who wish to preserve spermatogenesis (fertility)” and is “a very promising drug for patients with secondary hypogonadism and who are concerned about the negative effects of exogenous testosterone.”7
Studies using enclomiphene for testosterone restoration vs. testosterone gel for testosterone replacement therapy show why this approach is superior in individuals who still have normal testicular function. In obese, hypogondal (low T) men, enclomiphone increases testosterone more than testosterone gel and keeps levels more consistently stable:
In addition, enclomiphene stimulates the testes (and actually increases their size) to produce Luteinizing Hormone (LH) & Follicle Stimulating Hormone (FSH), which is how the body naturally and endogenously produces testosterone and sperm.
In contrast, testosterone gel has the opposite effect: significantly impairing LH & FSH production, thus inhibiting endogenous production of testosterone & sperm, which causes testicular shrinkage and external dependence on testosterone gel.8
The adverse effects of enclomiphene have been extensively studied during phase II and phase III clinical trials. The drug is generally well tolerated with side-effects occurring relatively rarely7
Fat-Soluble Vitamin Deficiencies are basically Hormone Deficiencies
While we maintain our position that supplements do not meaningfully increase testosterone on their own, they can address underlying hormonal deficiencies that may be limiting the efficacy of our protocol. In particular, most men are deficient in fat-soluble vitamins, which actually function as hormones in the body.
For example, our first validation study showed that 66% of our clients living in Los Angeles were Vitamin D deficient (<30 ng/dl) and 100% were below the optimal (>45-50 ng/dl) range. This is critical because as Dr. Sarfaz Zaidi put it, “vitamin D is not a vitamin but a hormone. Vitamin D deficiency is a hormonal deficiency—an extremely common endocrine disorder. Similar to other hormonal deficiencies, hormone D deficiency (HDD) has a wide range of ill effects.”
Maximus New ‘5-Star’ Supplement (KAGED)
To prevent these hormonal vitamin deficiencies, we provide our foundational supplement, KAGED, which not only has all the five critical fat-soluble vitamins/hormones you need, but has them in special bioavailable forms in higher clinical-level dosages, which are very hard to find together elsewhere.
1) Vitamin K1 (Phylloquinone): 2000 mcg & Vitamin K2/MK-4 (Menaquinone-4): 100 mcg
Vitamin K1 is the most abundant form of Vitamin K, which we consume from plant foods, while Vitamin K2 (MK-4) is consumed from animal sources. A recent study showed that no matter what form of Vitamin K you consume, the body converts it all into MK-4 in your tissues. MK-4 is “should be considered and consequently classified as a hormone” that activates a plethora of genes.9 Studies show that MK-4 stimulates testosterone production in rats through via activating CAMP & PKA, doubling testosterone levels compared to control, though this has not yet been replicated in humans.10 Vitamin K is also critical to take alongside Vitamin D to make sure calcium is going to the right places (i.e. your bones instead of soft tissues like your arteries). We use both forms–2000 mcg of Vitamin K1 to ensure conversion to MK-4–and 100 mcg Vitamin K2/MK-4 itself (Vitamin K has no upper limit and has been safely used at 45 mg (45,000 mcg) per day to treat osteoporosis).
2) Vitamin A (Palmitate): 3030 mcg RAE/10100 IU
Vitamin A functions in a hormone-like manner to regulate the expression of a number of genes and body functions, including testicular function and sperm production, and Vitamin A deficiency adversely affects testosterone secretion. In Dr. Chris Masterjohn’s article, “Vitamin A: The Forgotten Bodybuilding Nutrient”, he notes that Vitamin A “is essential to muscle-building and may be the bodybuilder’s most potent weapon… [given] diets very high in protein… deplete vitamin A reserves.”4 Vitamin A is necessary for the utilization of protein and the production of testosterone and other growth factors, and so we include it here at a higher dosage to balance the higher doses of the other fat-soluble vitamins/hormones.
3) Geranylgeraniol (“GG-Gold®”): 10 mg
Geranylgeraniol (GG) was discovered by Dr. Barrie Tan, the world’s leading expert on Vitamin E tocotrienols (who we hosted on the Maximus Podcast). GG is the side-chain of MK-4 that is likely responsible for its effects, and may also have unique benefits in promoting muscle protein synthesis (and is inhibited by prescription statin drugs, which is the likely explanation for why they cause muscle pain). In vitro and rat studies show that GG enhances testosterone and progesterone (its precursor) via cAMP/PKA signaling. Researchers concluded that GG has “potential benefits… as a therapeutic agent for low testosterone levels, such as late-onset hypogonadism in men.” 10 mg is the approximate physiological dose of Geranylgeraniol that is naturally produced by the human body and is thus included in our supplement to ensure optimal levels.
4) Vitamin E tocotrienols (“DeltaGOLD®” 90% delta-tocotrienol & 10% gamma-tocotrienol): 100 mg
Vitamin E actually has eight different chemical forms (alpha-, beta-, gamma-, and delta-tocopherol and alpha-, beta-, gamma-, and delta-tocotrienol) and is often misunderstood since 90%+ of research has been done on the tocopherol forms most commonly found in supplements. Dr. Barrie Tan discovered the tocotrienol forms, which are much more potent free radical scavenger and antioxidants. For over 100 years, Vitamin E has been known to be critical for fertility, as it is involved in the HPG Axis’ production of LH (which stimulates production) & FSH (which stimulates sperm) and nearly doubled the testosterone increase (from ~500 ng/dl to 1000+ ng/dl) in response to HCG stimulation (which functions similarly to enclomiphene). Studies also show tocotrienols specifically have synergistic effects with SERMs (Selective Estrogen Receptor Modulators) in regulating estrogen. Thus, 100 mg of this extra potent tocotrienol form of Vitamin E is included without any of the tocopherol form that may interfere with its function.
5) Vitamin D3 (Cholecalciferol): 250 mcg/10000 IU
Vitamin D plays a critical role in formation of hormones, bone, muscle function, immune function, glucose tolerance, and cardiometabolic function, as described in Dr. Neil Binkley’s article, “Is Vitamin D the Fountain of Youth?” Studies show that men with sufficient Vitamin D levels had significantly higher levels of testosterone and significantly lower levels of SHBG when compared to Vitamin D insufficient & deficient men. One randomized controlled trial also showed that daily supplementation of 3,332 IU vitamin D increased free & total testosterone levels by 20% & 25%, though this finding has not been consistently replicated.7 We find that almost all multivitamins significantly underdose Vitamin D (1-2,000 IU) and that a higher dose of 10,000 IU (the upper tolerable limit) is necessary to get most men from deficient to optimal ranges and ensure testosterone production.
Together, this five-key ingredient formulation comprises all the critical fat-soluble vitamins/hormones–K A G E D–to ensure prevention of deficiencies and provide the necessary building blocks for hormone production and optimal health & performance.
*Maximus makes no promise or guarantee of what medications or supplements are prescribed, as these are always determined by the judgement of your clinician to decide what is appropriate care for you.
- Soares AH, Horie NC, Chiang LAP, et al. Effects of clomiphene citrate on male obesity-associated hypogonadism: a randomized, double-blind, placebo-controlled study. Int J Obes (Lond). 2018;42(5):953-63.
- Katz DJ, Nabulsi O, Tal R, Mulhall JP. Outcomes of clomiphene citrate treatment in young hypogonadal men. BJU Int. 2012;110(4):573-8.
- McCullough A. Alternatives to testosterone replacement: testosterone restoration. Asian J Androl. 2015;17(2):201-5.
- Krzastek SC, Sharma D, Abdullah N, et al. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol. 2019;202(5):1029-35.
- Huang ES, Miller WL. Estrogenic and antiestrogenic effects of enclomiphene and zuclomiphene on gonadotropin secretion by ovine pituitary cells in culture. Endocrinology. 1983;112(2):442-8.
- Choi SH, Shapiro H, Robinson GE, et al. Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin. J Psychosom Obstet Gynaecol. 2005;26(2):93-100.
- Earl JA, Kim ED. Enclomiphene citrate: A treatment that maintains fertility in men with secondary hypogonadism. Expert Rev Endocrinol Metab. 2019;14(3):157-65.
- Kim ED, McCullough A, Kaminetsky J. Oral enclomiphene citrate raises testosterone and preserves sperm counts in obese hypogonadal men, unlike topical testosterone: restoration instead of replacement. BJU Int. 2016;117(4):677-85.