Because TRT gives the body testosterone directly, it tells the brain that no more testosterone needs to be made. TRT is often the first therapy people hear about when looking for ways to boost testosterone. These are not small questions, and the answers depend on how each treatment works inside the body. This difference is very important, especially for men who want to keep or improve their fertility while also treating low testosterone. Clomid, on the other hand, helps the body make more of its own testosterone. TRT gives the body testosterone from an outside source. For this reason, many men look for medical treatments that can help restore hormone balance. His bone densitometry T scores at the lumbar spine and hip were in the normal range and osteopenic range before clomiphene commencement with T scores of +0.1 and −1.1 respectively, and they did not significantly change from their baseline, when measured at 2 and 4 years after treatment onset. To date, our patient has continued on clomiphene citrate for a total duration of 7 years. However, despite maintenance of intensive lifestyle strategies and adjunctive use of sildenafil citrate, clomiphene dose reductions below 15 mg per day consistently precipitated the recurrence of symptoms including reduced libido and fatigue that significantly impacted on his daily function. Many men face confusion when learning about these treatments. The difference between follow-up times is different and may suggest differences in patient satisfaction between the two therapies, although this interpretation was not explored in this current study. Perceptions regarding the type of therapy prescribed could also have impacted patient's expectations. One confounding factor is that patient satisfaction may vary based on psychological perceptions about potential benefits conferred from therapy. Multiple hypothesis testing was not performed at this time due hypothesis-generating nature of the study. Therefore, we performed a prospective cohort study comparing hypogonadal symptoms and treatment efficacy in men receiving testosterone supplementation therapy (TST) and CC. Both clomiphene citrate (CC) and testosterone supplementation therapy (TST) are effective treatments for men with hypogonadism. Oestradiol levels related to (Fig. 1) and correlated with (Fig. 2B) clomiphene dose in our patient, who maintained a stable body weight over the duration of his treatment and did not require any additional therapy. ADAM, androgen deficiency in ageing men; CC, clomiphene citrate; LH, luteinising hormone; NA, not available; PCs, prospective cohort study; RA, retrospective audit; RAMC, retrospective age-matched comparison; TT, total testosterone. While prescribed dosages of clomiphene citrate have varied from 12.5 to 50 mg daily across studies, our case suggests an individualised weaning regimen that can identify the minimally acceptable dose-dependent response to manage a patient’s symptoms which may also help to optimise the benefit to risk ratio of this therapy.The effect of clomiphene on the testosterone to oestradiol ratio remains an interesting area for further research. Currently, he continues at his minimum effective dose of clomiphene citrate of 18 mg daily (25 mg 5 days a week) with maintenance of good symptomatic benefit and normal range testosterone levels. Clomiphene citrate is a selective oestrogen receptor modulator that acts centrally to increase endogenous testosterone production without causing adverse effects on fertility (2). Additionally, it is a pill typically taken every day, so no need to be poked with needles or cover oneself in gels.The downsides to Clomid therapy are that it is rarely covered by insurance as it is an "off label" use of the medication (however it is generic and very affordable). Clomid does not cause testicular atrophy, acne, gynecomastia, fertility issues and is less likely to influence red blood cell concentration causing polycythemia, reducing the risk of blood clots. Once testosterone has been produced it naturally converts to some estrogen. LH signals the testes to "go go go" and produce testosterone. So why is your doctor prescribing it for low testosterone? Most men, when initially prescribed, will google the medication and find that it’s used for women and fertility. This case highlights that clomiphene citrate has potential as a safe and titratable longer-term treatment option, and the need for further randomised control trials in therapy options to normalise androgen status. Besides lifestyle optimisation, androgen replacement remains the mainstay of treatment; however, its adverse effects on spermatogenesis and testicular atrophy are undesirable. Clinical care pathway for clomiphene citrate therapy with testosterone deficiency. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of clomiphene citrate therapy for men with hypogonadism. To preserve these testicular functions while treating male hypogonadism, clomiphene citrate is used as off-label therapy. How often you will need to receive your testosterone replacement therapy treatment will depend on your health and the exact treatment being administered. Data on patient characteristics, comorbidities and dosage at start of treatment, are provided in Table 1. In total, 173 male patients treated with CC were screened for inclusion. With the clinical knowledge in 2012 based on expert opinion at that time, men received CC, with a starting dosage of 25 mg every other day, or 25 mg a day in case of bodyweight above 100 kg. Hypogonadal symptoms were scored by the experienced treating physicians, no validated questionnaires were used. A retrospective, single‐centre study was conducted in the University Medical Center (UMC) Utrecht. For males, the United States Food and Drug Administration (FDA) did not approve the medicine with reason of unclear clinical effect because of the lack of well‐controlled and well‐powered controlled trials.14, 15, 16, 17 However, CC is described over more than 30 years off‐label to hypogonadal men, especially those with an active or future child wish, or hypogonadal males who do not want to use TTh.18 Compared to TTh, CC is easy in usage and comes with little costs.
