What is CLOMID? And how does it work?

What is Clomid and how does it work?

You may be wondering about testosterone replacement therapy (TRT) and fertility issues.

We know that Testosterone can reduce sperm production and impact fertility.  Very simply, the pituitary gland in the brain is the director of testicular function.  If it sees a high testosterone level, it stops telling the testes to produce testosterone. Sperm production is also affected.  This also explains why testes shrink a bit on TRT.  That is why we use HCG in our TRT programs to periodically stimulate the testes.   It reminds the testes that they do have a job to do other than just making testosterone.

Question:   If you want to boost testosterone levels but do not want to compromise fertility, what can you do.

Answer:  Clomid (clomiphene citrate). 

Clomid uses a different approach to increase testosterone AND spermatogenesis.  It was original developed and tested to increase ovulation and thereby improve fertility in women.  The result in men is a modest improvement in testosterone levels while preserving sperm production.  WE can usually achieve a 100% increase in T levels with Clomid.  In some cases one may see up to a 200% increase.  This is not as much as with pellets or injections but it can make a big difference depending on how low you are.  So if you had an initial level of 300, we would hope to see an increase to 600, +/-.  Some clients may even see a larger increase.

Question:  What are the benefits of Clomid over traditional injection or pellet TRT?

Answer:  Clomid stimulates the body’s own production of testosterone.  Clomid is a pill taken daily.  It is generic and cheap.  No shots.  It does not interfere with the body’s checks and balances of testosterone.  Fertility is preserved.  No testicular shrinkage.  It has few if any side effects and this is usually dose related.  Clomid, by increasing T levels, can produce the same/similar effects as traditional TRT.  Each patient is different and the response will be variable depending on the level obtained.  Inexpensive and usually covered by health insurance.

Question:  Is there any downside to Clomid therapy?

Answer:  The lower T level is one.  It takes longer to see the benefits of Clomid than with injection therapy.  It may not work, especially in patients over 60 and those with compound medical issue.  Some patients may not see an increase in libido as Clomid does have some mild estrogenic properties.  Of course, we follow the labs just like in TRT and would correct for an elevated estradiol level if needed (anastrozole).  There have been rare reports of vision changes.  If this happens, the patient should note very specifically what occurs, how long it lasts, etc. and then stop the Clomid until you speak with your doctor.

Question:  Who should use Clomid?

Answer:  A typical patient is younger and planning on having children soon or in the future.  Patients who just do not want to deal with injection or pellet therapy and are willing to accept a lower T level.  Patients who have been on TRT and have decided to have children but want to maintain some increase in testosterone levels.  Men who have known low sperm counts.  Patients who have a varicocele( a problem with the blood vessel around the testes) that can cause infertility.  

Also note that patients over 70 have lower rates of success compared to younger patients, especially in the area of sexual function. The lack of complete response occurred mainly in men over 55 y of age. It was also seen in the presence of common chronic conditions such as diabetes mellitus, hypertension, CAD, and the use of multiple medications. The fact that these conditions were also more prevalent in the older age group seems to indicate that the lack of clinical response may be the result of comorbid medical factors than of age alone.

Question:  What is a typical dose of Clomid?

Answer:  The dosage range is 12.5mg – 50mg per day.  I prefer to start at 25mg every other day for a short trial period and then increase to daily dosing.  Dosage can be adjusted based on any side effects, lab results and overall improvement in the “T-effect”.  You will read any number of protocols that involve more complicated patterns of dosing.  I prefer to keep it simple.  

Some authors recommend taking Vitamin E to improve the success of Clomid.  More than 400 iu is not recommended and a much smaller dose is fine.

How soon will fertility be improved with Clomid?

Answer:  It takes 90 to 108 days from the time that sperm is produced in the testicles until it is ejaculated. It takes time for a man to see fertility results from Clomid. As such, a man should not stop taking the medication unless there is no improvement by the fourth month of treatment.

Question:  Why is Clomid not prescribed more?

Answer:  Like traditional TRT, most physicians do not have a good understanding of TRT or even that Clomid is a treatment choice.  Most doctors think about Clomid as a “woman’s drug” and do not want to prescribe off-label.  It is generic and inexpensive, so there is little or no advertising.

- Marc DiJulio, MD
Medical Director, IMC Lynnwood

References

1.J Sex Med. 2005 Sep;2(5):716-21. Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadism.

Conclusion:  Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estradiol ratio in men with hypogonadism. This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway.

2.Chua ME1, Escusa KG, Luna S, Tapia LC, Dofitas B, Morales M. “Revisiting oestrogen antagonists (clomiphene or tamoxifen) as medical empiric therapy for idiopathic male infertility: a meta-analysis.” Andrology. 2013 Sep;1(5):749-57. doi: 10.1111/j.2047-2927.2013.00107.x.

3.George B1, Bantwal G. “Endocrine management of male subfertility.” Indian J Endocrinol Metab. 2013 Oct;17(Suppl1):S32-S34.

4.Ghanem H1, Shaeer O, El-Segini A. “Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial.” Fertil Steril. 2010 May 1;93(7):2232-5. doi: 10.1016/j.fertnstert.2009.01.117. Epub 2009 Mar 6.

5.Katz DJ1, Nabulsi O, Tal R, Mulhall JP. “Outcomes of clomiphene citrate treatment in young hypogonadal men.” BJU Int. 2012 Aug;110(4):573-8. doi: 10.1111/j.1464-410X.2011.10702.x. Epub 2011 Nov 1.

6.J Clin Endocrinol Metab. 2008 Jan;93(1):68-75.

7.J Sex Med. 2010 Jan;7(1 Pt 1):269-76.

8.BJU Int. 2012 Nov;110(10):1524-8.

9.Int J Impot Res. 2003 Jun;15(3):156-65.

10.Clomiphene Citrate (CC or Clomid) – A Testosterone Therapy Alternative for Men with Low Testosterone Levels