An Alternative Solution for Low-T

Clomiphene Citrate: An Alternative to Testosterone

Clomiphene citrate, marketed in pill form as Clomid or Serophene, has long been used for female infertility to spur the ovaries to produce mature eggs. It works by stimulating a part of the brain (the pituitary gland) that controls production of two hormones key to reproductive health: follicle stimulating hormone (FSH) and luteinizing hormone (LH). Both hormones are also vital to men. FSH stimulates sperm production in the testicles, and LH stimulates testosterone production. So it made sense to a number of urologists who treat male infertility to try clomiphene citrate in men. A number of studies have now conclusively demonstrated that this strategy works—and it does so by working with the body rather than dumping extra testosterone on it from outside. The result? A much-reduced risk of impaired fertility. Indeed, judicious use of clomiphene citrate can stimulate sperm production and sperm quality in men with reduced testicular function. 

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In a recent case study, a group of men with below-normal levels of testosterone were studied. Their average testosterone level at the start of the study was about 250 nanograms per deciliter. The men were randomly assigned to get either clomiphene or a placebo (dummy pill). After two months, the testosterone levels in the clomiphene group had more than doubled while the levels in the placebo group had risen only modestly and were not statistically significant. Three-fourths of these men also reported increased libidos.

It’s important to point out that some of the warnings and caveats about testosterone mentioned above also apply to clomiphene. This treatment should only be used by men with below-normal testosterone and only for men who are not at risk for prostate cancer, cardiovascular problems, stroke or breast cancer. Men using clomiphene therapy still need to be regularly monitored for prostate problems with both a PSA test and digital rectal exams. These are sensible cautions, since we’re still in the early stages of research on this medication in men.

Clomiphene is an excellent way to raise the body’s testosterone levels — particularly in men using it to treat infertility. Other drugs similar to clomiphene are being developed that may provide similar benefits with perhaps lower risks (though clomiphene is, relatively speaking, a very safe drug). These drugs are called selective estrogen receptor modulators. Like clomiphene, they work by stimulating a man’s body to make more testosterone. Future research into these drugs and others like them may provide a new generation of medications to safely and effectively increase testosterone levels without the need for direct testosterone replacement therapy. 

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Murray’s Story

Murray came to me because he and his wife were having difficulty getting pregnant and a semen analysis showed he had a low sperm count. When I examined him I found a varicocele, which is the existence of distended veins in the testicles. Varicoceles are a common cause of impaired fertility because the extra blood in the veins around a testicle warms the testicle, which hurts the cells that produce sperm.

After surgically repairing the varicocele, I prescribed Clomid (clomiphene Citrate) to boost Murray’s testosterone levels, which, in turn, usually helps sperm production. About six months after the surgery, Murray’s wife got pregnant. Unfortunately, his wife had a miscarriage, but she got pregnant again soon after and that child was carried to term. The Clomid raised Murray’s testosterone and he liked how he felt on it. An avid runner, he noticed significant changes in his strength and energy.

“I felt more energized and stronger,” he says. “I noticed that I could do more pull-ups and my running times kept going down. I was running with more motivation and strength.”

Murray didn’t notice any differences in his mood or sex drive. The only side effects he noticed were some insomnia in the initial weeks of the treatment and a tendency to sweat more easily, particularly on his palms. He liked the feeling the Clomid gave him so much, he decided to stay on it after his wife got pregnant.