Clomiphene/Enclomiphene
What is clomiphene and Enclomiphene?
Clomiphene is a non-steroidal fertility medicine. It causes the pituitary gland to release LH and FSH which are needed to stimulate spermatogenesis and testosterone production. Traditionally used in women to aid in ovulation. Clomiphene is a dual action medication whereas Enclomiphene is a single action medication.
What is LH?
Luteinizing Hormone (LH) is made by your pituitary gland and plays a large role in sexual development and functioning. In men, LH stimulates testosterone release by the Leydig cells of the testes, which is important for producing sperm. Too little or too much of LH can cause a variety of problems, including fertility and low sex drive in men.
What if my LH is elevated?
High LH levels could mean: Your testicles have been damaged due to chemotherapy, radiation, infection, or alcohol abuse. Another reason could be Klinefelter's syndrome, a genetic disorder that affects sexual development in males. It often causes infertility.
What if my LH is decreased?
Low LH levels may mean you have a disorder of the pituitary gland or the hypothalamus, a part of the brain that controls the pituitary gland and other important body functions.
What is FSH?
Follicle-Stimulating Hormone (FSH) is made by your pituitary gland, a small gland located underneath the brain. FSH plays an important role in sexual development and functioning similar to LH. FSH helps control the production of sperm. FSH stimulates testicular growth and enhances the production of an androgen-binding protein by the Sertoli cells, which are a component of the testicular tubule necessary for sustaining the maturing sperm cell. We use FSH to help find the cause of infertility, find the reason for low sperm count, or find out if there is a problem with the testes.
What if my FSH is elevated?
Similar to LH, when FSH levels are elevated, your testicles could have been damaged due to chemotherapy, radiation, infection, or alcohol abuse, or You could have Klinefelter syndrome, a genetic disorder affects sexual development in males. It often causes infertility.
What if my FSH is decreased?
Low FSH levels may mean you have a disorder of the pituitary gland or hypothalamus.
Eros Health Clomiphene/Enclomiphene Education
Why Clomiphene or Enclomiphene over testosterone?
In some instances, some men are not ready to commit to weekly injections of testosterone or to having testosterone pellets inserted every 4-6 months. Clomiphene offers an effective alternative to traditional testosterone. Men who are symptomatic with low testosterone but maintain a total testosterone level between 400-550 this is a good first line therapy. Clomiphene citrate is also a good alternative to men who have not yet finished having children and do not want to jeopardize their fertility. Finally, clomiphene is used as an adjunct therapy with testosterone injections or testosterone pellets to preserve testicular function, in the way of not turning off the feedback loop between testosterone and LH/FSH production and section. Ultimately keeping the testes from atrophy (shrinking).
How to take Clomiphene or Enclomiphene.
These medications come in several dosages (12.5, 25,50, 51mg), most commonly prescribed as 50mg daily. Depending on your starting Free and Total testosterone level this could be reduced to three times a week (Monday, Wednesday, Friday). These medications should be taken once a day in the morning. If you have uncomfortable side effects can switch to taking in the evening.
Side effects:
Headache, gynecomastia, visual disturbances, dizziness, mood instability, deep vein thrombosis.
Most common side effect is headache; this has easily been remedied by switching to the evening. On going blood work (estradiol) will help with preventing gynecomastia.
Contraindications:
Hypersensitivity to clomiphene citrate or any of its components; liver disease or history of liver disease; uncontrolled thyroid or adrenal dysfunction; presence of an organic intracranial lesion such as pituitary tumor.
Conclusion:
Clomiphene citrate can be a safe alternative to traditional testosterone routes. Many men have reaped the benefits of this medication, in the way of boosting their testosterone levels to a physiological state, helping with mood, libido, and fatigue levels. Monitoring patients free and total testosterone, estradiol, and complete blood count can help reduce the risk of severe side effects. When patients have issues with elevated estradiol, headache, or increases in their Hemoglobin/Hematocrit they tend to switch to Enclomiphene due to a cleaner side effect profile. Patients can still have side effects with Enclomiphene but are less common.
Eros Health Clomiphene/Enclomiphene Education
Research Studies concerning Clomiphene’s usage in the male space:
Huijben M, Lock MTWT, de Kemp VF, de Kort LMO, van Breda HMK. Clomiphene citrate for men with hypogonadism: a systematic review and meta-analysis. Andrology. 2022 Mar;10(3):451-469. doi: 10.1111/andr.13146. Epub 2022 Jan 8. PMID: 34933414.
https://pubmed.ncbi.nlm.nih.gov/34933414/
Bryan J. Herzog, Hoang Minh Tue Nguyen, Ayman Soubra, and Wayne J.G. Hellstrom.
Clomiphene Citrate for Male Hypogonadism and Infertility: An Updated Review.
Androgens: Clinical Research and Therapeutics. Oct 2020.62-69. http://doi.org/10.1089/andro.2020.0005
https://www.liebertpub.com/doi/10.1089/andro.2020.0005
Krzastek SC, Sharma D, Abdullah N, Sultan M, Machen GL, Wenzel JL, Ells A, Chen X, Kavoussi M, Costabile RA, Smith RP, Kavoussi PK. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol. 2019 Nov;202(5):1029-1035. doi: 10.1097/JU.0000000000000396. Epub 2019 Oct 9. PMID: 31216250.