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      Clomiphene

      What is clomiphene?

      Clomiphene is a prescription treatment that increases testosterone levels by causing the brain to release more FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) by interfering with the ability of estrogen to block signals to release these hormones.  FSH and LH are essential for normal testicle function and testosterone production.1  Clomiphene is not FDA-approved as a treatment for low testosterone levels but is used “off-label” by physicians.  Off-label prescribing is the term used when a physician prescribes a medication for a specific condition different than the condition the medication was originally approved for. Off-label prescribing is common and approximately 20% of all prescriptions are done off-label. We only use medications off-label when there is high-quality safety and efficacy evidence available.


      Why is clomiphene part of my treatment regimen?

      Your Nimbus testing indicated clomiphene is an effective option for restoring normal testosterone levels because of suboptimal LH levels.  Clomiphene is an alternative treatment option that is effective in men younger than 55 who have low levels of LH.  LH is the hormone responsible for the production of testosterone in the testes.  Clomiphene effectively restores normal testosterone levels, especially in men younger than 55 who do not have diabetes, heart disease, or hypertension.2


      Is clomiphene effective for restoring normal testosterone levels?

      A retrospective study looked at clomiphene treatment for 400 men with low testosterone levels who had been on therapy for up to 3 years.  It found that clomiphene treatment restored normal testosterone levels in 88% of the men treated, and 77% reporting improvement in symptoms.3  Another study compared testosterone injections to clomiphene and found nearly equivalent levels of symptom improvement and satisfaction.4  Clomiphene is recognized as a viable alternative treatment to testosterone-based therapies.


      Are there potential adverse effects from taking clomiphene?

      Adverse effects have been reported in 8-11% of men taking clomiphene in clinical trials; however, these are all minor incidents.  Those trials reported fluid retention, breast tenderness, nausea, dizziness, fatigue, visual disturbances, and changes in mood as the adverse effects.3-5


      References

      1. Ramaswamy S, Weinbauer GF. Endocrine control of spermatogenesis: Role of FSH and LH/ testosterone. Spermatogenesis. 2015;4(2):e996025. Published 2015 Jan 26. doi:10.1080/21565562.2014.996025
      2. Guay AT, Jacobson J, Perez JB, Hodge MB, Velasquez E. Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?. Int J Impot Res. 2003;15(3):156-165. doi:10.1038/sj.ijir.3900981
      3. 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):1029-1035. doi:10.1097/JU.0000000000000396
      4. Ramasamy R, Scovell JM, Kovac JR, Lipshultz LI. Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy. J Urol. 2014;192(3):875-879. doi:10.1016/j.juro.2014.03.089
      5. Patel DP, Brant WO, Myers JB, et al. The safety and efficacy of clomiphene citrate in hypoandrogenic and subfertile men. Int J Impot Res. 2015;27(6):221-224. doi:10.1038/ijir.2015.21