With the suspension of Cincinnati Reds pitcher Edinson Volquez for performance enhancing drug use and a swirl of rumors that the agent involved was clomiphene (also known as Clomid,) I thought it timely to write about how clomiphene works and how it’s used. From what I read on the internets, there is an enormous amount of misinformation floating around out there.
To understand how clomiphene works, you need to know how the pituitary controls the making of testosterone in the testis. Testosterone is made by Leydig cells in the testis, which I explained in my last post. The pituitary releases a hormone called luteinizing hormone (“LH”) that stimulates the Leydig cells to make testosterone. Testosterone is converted to the female hormone estrogen, (which I also explained in my last post,) and estrogen tells the pituitary to stop making more LH. This kind of negative feedback system is common when it comes to how hormones work. It’s just like a thermostat and heater. As the room gets warmer, the thermostat sends less electricity to the heater. When the room gets colder, the thermostat sends more electricity to the heater.
Clomiphene works by blocking estrogen at the pituitary. The pituitary sees less estrogen, and makes more LH. More LH means that the Leydig cells in the testis make more testosterone.
As I explained in my last post, giving testosterone to a man does just the opposite. The pituitary thinks that the testis is making plenty of testosterone, and LH falls. As a result, the testis stops making testosterone, and the usually high levels of testosterone in the testis fall to the lower level in the blood.
So clomiphene is a way to increase testosterone in the blood and the testis at the same time. It preserves testis size and function while increasing blood testosterone.
Unfortunately, clomiphene is not FDA approved for use in the male. Like most of the medications that we use to treat male fertility, the pharmaceutical company that originally sought approval by the FDA did it for women. Clomiphene is now generic, and it’s unlikely that anyone will pony up the hundreds of millions of dollars necessary to get it approved for the male. That’s the bad news. The good news is that it means that this medication is fairly inexpensive, cheaper than most forms of prescription testosterone. Can a doctor prescribe clomiphene for a man? Yes. It’s “off label”, meaning that it’s not FDA approved for use in men.
As a medication, clomiphene is usually well tolerated by men. In my experience, most patients don’t feel anything as their testosterone rises. Those that do feel an increase in energy, sex drive, and muscle mass, especially if they work out. Very rarely I’ve had patients report that they feel too aggressive, or too angry. Very very rarely (twice in the last 20 years) I’ve had patients report visual changes. That’s worrisome, as the pituitary is near the optic nerve in the brain, and visual changes suggests that the pituitary may be changing in size. Because the skull is a closed space, it’s alarming if anything in the brain changes in size. In the last twenty years, I’ve also had two patients who had breast enlargement (called “gynecomastia”) while using clomiphene. Needless to say, for any of these problematic side effects, the clomiphene is discontinued.
So that’s the story with clomiphene. It can be used in the male, either for fertility or low testosterone levels. It’s an off label prescription drug. It works, and is usually well tolerated by men who take it.
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Hey Doc,
This blog is great. I have had trouble finding info this thorough elsewhere. If a 34 y.o. man were receiving Testosterone replacement therapy for 2.5 years and then prescribed Clomid for fertility would the time on he spent on T replacement potentially have harmed his ability to produce sperm?
Thanks agian
Thanks! I’m sorry, that’s close enough of a personal question that I can’t answer it. If you live in the US, the FAQ has some good resources on finding doctors.
What happens when a man stops taking clomid after a course of clomid.
do testosterone levels stay up high or will they fall back to pre-clomid levels ?
Hi Na, that’s in the FAQ 🙂
So for twenty years, the worst side effects have been the two visual problems and the two gynecomastia incidents for your patients? Or is there anything else? The longest study was only 3 years and I’m looking for what might be expected when a young male begins using beyond 6mos to a year.
Also, it seems alot of doctors/patients seem to miss or ignore aromatase when the testosterone levels start dropping and the estradiol rises. Do you think an aromatase inhibitor would curb this problem (I have not looked into the medications cost or side effects whether its worth it or not)? I’m thinking that at least the known herbal and food aromatase inhibitors might help some.
To the first, yes 🙂 But as I wrote, we don’t have formal long term studies. To the second, a specialist familiar with aromatase inhibition in the male would be a good doctor to see for a man who was interested in it.
Hi
I have some questions regarding the estrogen that is blocked by the clomid:
Where does it go?
How is it used?
Thx
Andy
Men seem to need some estradiol, for example bone density appears to depend on it.
Hello Dr … great blog! I’d appreciate a little more elaboration on your answer to Andy’s question since I have the same concern. It seems that Clomid treatment would block my brain from recognizing the actual estrogen levels. In response, the testes kick out more testosterone which eventually results in elevated estrogen floating around.
Cutting to the chase, I don’t want to develop breasts or get all emotional from this potential imbalance. is this something you’ve ever noted as a side effect?
Hi Will, unfortunately I can’t answer personal questions about your own health. Please read the FAQ.
I must have phrased the question wrong if you thought I was seeking personal information. In your professional opinion, what goes on in the male body when the brain is unable to detect elevated levels of estrogen which would seem to be a side effect of Clomid treatment?
Men have differing internal workings when it comes to responding to medication. That’s why each needs to be under a doctor’s care if he’s taking it.
You mentioned that maintaining “Bone Density” relies on some Estrogen, however, I thought that was the purpose of Testosterone? Do they both work together in males on Testosterone Replacement Therapy to achieve the same purpose (maintaining bone density?), especially when there is some Testosterone to Estrogen conversion taking place?
Korey
Your reading was right, Korey: although scientists aren’t certain, it looks like estrogen is more important than testosterone in the male for bone density. Estrogen is a natural product of testosterone in the male body and is made by the enzyme aromatase. Read the other posts in this blog and especially the comments: you’ll find a lot of interesting information.
If my doctor is not familiar the topic, are there any medical articles that address use the medical uses of Clomid for men (e.g. dosage, counter-indications, etc) to which I can refer him?
Doctors interested in learning more about male reproductive medicine might find the 4th edition of Infertility in the Male or An Introduction to Male Reproductive Medicine useful. Both have Kindle editions. (Obvious disclosure: I’m an author of both, which we wrote to serve as resources for physicians.)
could clomid be used for treatment of klinefelters syndrome if no other treatment for the same was done in past… and is it safe????
are the side effects lesser or more than hormone replacement treatment!!!!
Men with Klinefelter syndrome have an extra X chromosome and often experience low testosterone. Clomiphene may be useful in some. Any man with Klinefelter syndrome who has low testosterone and is interested in treating it should see a physician experienced in working with men with Klinefelter syndrome.
Hi Dr. Niederberger;
I read several resources that indicate Clomid works on the estrogen receptors in the Anterior Hypothalamus and the Anterior Hypophysis, blocking them and causing increase production of GnRH, which then acts on the Pituitary causing increased LH and FSH production. Is this in addition to its direct action on the Pituitary, or is the Hypothalamus not part of the mechanism of action of Clomid?
Thank you, trying to understand what is happening in my body when I take Clomid as a treatment for hypogonadism.
It’s an interesting and open question, BB. The estrogen receptor has been identified in both the hypothalamus and pituitary, and clomiphene may affect both. LH and FSH both increase after treatment, suggesting a hypothalamic effect, but to variable degrees, suggesting a pituitary effect. There is much in science that we don’t fully understand, and your question is one 🙂
Do you have any actual studies of men who had been on testosterone previously and went on clomid to help boost fertility, of it actually working? I can’t seem to find that anywhere no matter how hard I look.
It’s really common to switch medications, and it works well, but it’s different for every man. Thant’s why a man should see his own doctor for treatment and monitoring.
Doc,
In your experience, what is the highest dose of clomiphene you have given a male with low T?
Thanks,
Kathryn
Hi Kathryn, I typically don’t prescribe doses of clomiphene beyond 100 mg daily.
I have read that Clomiphene can get rid of gynecomastia. Have you seen this in your practice?
Thank you.
Tom
Clomiphene typically increases both testosterone and estradiol. While the increase in estradiol may cause gynecomastia, which is why estradiol needs to be monitored by a doctor while a man is taking the medication, I haven’t observed anybody to have less gynecomastia while prescribed clomiphene, and it doesn’t make biological sense why that would happen.
Hello,
I have read where testosterone supplements may cause several side effects. When prescribing clomiphene citrate have any of your patients experience short or long term hair loss?
Thank you.
Hi Kevin! Look around these posts and their comments, and you’ll find lots that will answer your questions!
Dear Dr.Niederberger,
I am an athletic and active professional with 10% body fat ( 6’1/ 210 lbs). I recently discovered my sperm count was 2million/ per ml. My testosterone level was 91!! I have been placed on 50mg clomid for 2 week with repeat Testosterone levels at that time.
( FSH of .9).
1. Question: Can taking one month of steroids 8 years ago have caused this?
2. Question: I have no symptoms of low testosterone ( No fatigue, no depression, No decrease in Sex drive etc): Is this possible?
Thanks much
I’m sorry, Ari, but I can’t answer personal questions about your own health. Please read the FAQ. The doctor that is prescribing clomiphene should answer your questions; that’s his or her job 🙂
Hi Doc,
How do you advise your patients to come off Clomid. Do they taper off slowly or do they just stop taking the medicine ?
That’s a great question, Joe. If someone is prescribed steroids, typically there’s a tapering of the medication when it is discontinued to allow the body to catch up in making its own steroid hormones. It’s as if the pituitary goes to sleep and needs a little time to wake up. I haven’t seen such a need with clomiphene therapy, which acts to increase testosterone production rather than decrease it such as an external steroid would.
Dr. Niederberger
My question is this, do you know of any protocols to use both testosterone and Clomid? Where the Clomid is used to prevent “shrinkage”? versus replacing testosterone with Clomid. For instance, I have read of people using HCG a couple of times a week for this purpose, but not Clomid. In your opinion, could this be done safely?
Hi Jim, check out the FAQ where I talk about the pitfalls of using two different medications. Part of the problem is that every man comes with his own cookbook 🙂
Hi Dr. Craig,
Refering to your article on “How Clomid Works in Men”, can I say that if a patient’s pituitary is damaged / partially damaged by a brain tumor, Clomiphene will not work for him as a Testosterone Replacement Therapy, since his pituitary may not produce LH in the first place? What is the way to find out? Can we measure LH level in the blood?
If Clomiphene does not work in this case, is there any other alternative Testosterone Replacement Therapy that do not reduce sperm count? (I understand that testosterone replacement, eg., Nebido, does reduce sperm count).
Thanks so much,
Debbie.
Hi Debbie, I write about taking over the pituitary in this blog post. Keep reading and check out the entire blog and the comments: there’s a lot of great stuff in other places on this site!
Hi doc. Is it true that sperm motility determines whether you have a boy or a girl? I heard that if motility is high, then your more likely to have a boy. Is this just a myth?
Dr. I’ve heard of guys boosting T levels by combining clomid and stinging nettle root. What are your thoughts on that? I have ” text book” normal levels but have all the symptoms.
Hi Ritch, I’m unaware of controlled clinical trails of stinging nettle root for low testosterone in men. (They may be there: if they are, I’m unaware of them.) But I don’t typically recommend two different medications at the same time. For an explanation, read my FAQ 🙂
Hi, Dr. Craig Niederberger. Thanks for creating and continuing to participate in this informative blog.
Does clomiphene act as an estrogen agonist (active estrogen) in the liver?
If it does, would the estrogen promote the production of sex hormone binding globulin which then binds to testosterone hormones and render them inactive?
Would this result in a person having higher total testosterone levels but with actual bioactive testosterone being not so high? If this is the case, does it explain why most men taking clomiphene don’t feel an increase in well-being aspects that are associated with increased testosterone?
On a similar note, if clomiphene is an estrogen agonist in the liver, would this result in IGF-1 being reduced?
Hi Tom, as the liver breaks down drugs, there are a lot of studies about clomiphene, how it’s broken down in the liver, and its byproducts. There aren’t a lot of studies about clomiphene action in the liver. For most men, sex hormone binding globulin levels stay the same while taking the medication, but for a few, they rise. (A man’s doctor will monitor his blood chemistry while prescribed clomiphene.) Bioavailable testosterone typically increases with the medication. I wouldn’t say that “most men taking clomiphene don’t feel an increase in well-being” with clomiphene compared to testosterone. Some men prefer clomiphene for how they feel, and some prefer testosterone.
Hi Doc,
This is Joe again with another question that I don’t think has been asked.
Does Clomid increase the levels of Prolactin in men ?
That shouldn’t be a typical effect of the medication.
Hi Doc,
A follow up on your response about prolactin.
Could it be that long term use of Clomid causes the pituitary to grow and produce more prolactin ?
Cheers,
Joe
Hi Joe, I’m not aware of any studies that would support that.
Hi Doc,
You replied to Kathryn that you generally don’t prescribe above 100mg daily. What would be the potential benefits/side effects of going higher. Maybe 150mg or even 200mg daily?
Hi CJ, I’ve found that if someone doesn’t respond at that high of a dose, going higher doesn’t work. It means that the pituitary isn’t responding to the medication, and it’s time to try something else if possible.
I read that if the clomid didn’t raise the T levels than it could be primary hypogonadsm where the testes don’t produce for whatever reasons? All hypothetical of course!
Hi Alvin, I’ve written a lot about how the pituitary works on this blog in both the posts and comments. Check them out!
Hi! If I’ve understood things correctly clomiphene is also given to men despite normal & good testosterone levels who are having problems with their sperm. Does clomid, in those cases, raise testosterone just as it does when used treating hypogonadism? I’ve looked around for studies but I’m having trouble narrowing down the search.
Thank you for your time!
Hi Peter, I prescribe clomiphene for men with low testosterone and low sperm production that may possibly be related to low testosterone.
Hi Doc,
Great blog, chock full of good stuff.
May I ask you to write a column called “How Armidex works in men”. I think that would be very interesting
thanks
Androgel can sometimes lead to higher levels of hemoglobin. Have you seen any impact of clomiphene on hemoglobin levels?
I haven’t seen it, but I rarely see increased hemoglobin even with testosterone therapy. It likely has to do with my location at sea level in Chicago. We still monitor it for all therapies that increase testosterone, including clomiphene.
Hello Dr. Niederberger. Are there any problems with taking Clomid every other week in a pulse fashion?. How long does it take for the testosterone level to stabilize when taking 25mg daily? How fast does the Testosterone level drop when the treatment is stopped? Are there any negative or positive effects on the pituitary with pulse dosing?
Hi Ted, I wrote a bit about how sperm production works: read those posts and comments. It doesn’t make biological sense to prescribe clomiphene in that kind of pulse fashion. Usually by two weeks, the testosterone level is constant. I’ve written about what happens when clomiphene is discontinued: read through the comments, and you’ll find some really great questions that people have asked and their answers.
What is the mechanism for male hot flushes with Clomid and what can be given to prevent it.
Hi Rob, it’s really important for the physician prescribing clomiphene to know what the testosterone level is, as if it is in good range, hot flashes are infrequent and usually self limited.
Great information. Can you tell me exactly which tissues clomid acts as an estrogen agonist and which tissues it acts as an estrogen antagonist? I can find this Info anywhere.
I know it is antagonist in pituitary and hypothalamus but what about other tissues with estrogen receptors like bone, skin, hair, muscle, fat etc.
Hi Barry, here’s a nice article that discusses a bit of how clomiphene may work in both agonistic and antagonistic ways. You can get the article for free. Practically speaking, the conversion of testosterone to estrogen by aromatase is probably more meaningful in terms of estrogenic effects of the medication, which is why a prescribing physician might want to see what happens to estradiol for a man prescribed the medication.
Hi doc, had some general questions that I was hoping you might address:
(a) Should clomid be prescribed to someone with low testosterone (ostensibly due to secondary hypogonadism) and high estradiol? With or without an aromatase inhibitor?
(b) Some men on various forums complain that clomid reduced their libido even though their labs looked good. Any idea why that might be?
(c) If a young male has had a low testosterone + high estrogen problem for a long time (say, several years), how long should he expect to wait after his hormone levels (re)gain balance to feel the full benefits – in terms of energy, vitality, mood, sexual function, etc.
Thanks very much!
Hi AK, these are some pretty specific questions. I’d recommend that a man wondering about how a medication like this might be prescribed for his specific circumstances, (for example if he has high estradiol, experiences a side effect, or has had a problem for a long time,) should really see a doctor who can treat him like the individual that he is.
Thanks for the reply. I appreciate your unwillingness to address questions such as these. I actually have been getting clomid-based treatment as recommended by a medical practitioner specialising in these issues, having started several weeks ago. (My arrangement with the specialist is a bit atypical, because of geography – it’s a telephone consultation based on my labs, rather than a live visit.) What I was/am trying to do is just get your general opinion about these things, so I can proceed with as much info as possible.
In the past I’ve been bitten by indifferent specialists (for instance: starting from the first one four years ago who tells me that my 240 ng/dL testosterone at age 30 is “completely normal” despite my complaining of all the symptoms associated with low-T) and under-informed ones, who shot me up with testosterone without even checking whether my hypogonadism was primary or secondary (on a very poor protocol, to boot) – causing my t-levels to plummet: my last test results, before starting clomid, stood just a bit over 100 ng/dL total testosterone.
I do not wish to speak ill of these doctors – but I feel that my quality of life has suffered a great deal because of individuals holding qualifications who ought to be more concerned/thorough/know better. I’ve become rather cynical now, and I feel that being as informed as possible is better than getting into things without any knowledge at all. That’s why, even though I have a doctor now who deals primary with male issues, I want to get multiple opinions – even good doctors might have off-days!
Anyway, sorry for the rant..
Hi, I have posted general questions here asking about clomid use in men. Your level of knowledge on the subject always makes for good learning.
I have been doing research lately on 5 alpha reductase inhibiters. I came across the website propeciahelp.com. This website has over 3000 members who all claim they have taken a 5 alpha reductase inhibiter and have experienced long term negative sexual side effects. All of the men on this website believe that the 5 alpha reductase inhibiter that they took caused these long term side effects. Several members on this website only took the medication for a short period of time such as one month or less.
Seeing that you obviously have a level of understanding as to how men’s endocrine systems work that goes beyond what most doctors have I was thinking that maybe I could pick your brain on this issue to see what you think.
In your opinion if a man was to take a 5 alpha reductase drug such as propecia or avodart and experience long term negative sexual side effects such as decreased ability to achieve and maintain an erection, decreased libido, decreased semen, watery semen and loss of sensation in the penis do you think that a possible explanation as to why this might be is that the 5 alpha reductase type 2 enzyme in the prostate (and in other areas of the body) might be turned off because of the taking the 5 alpha reductase medication?
In order words if a man was really sensitive to this type of a drug is it possible that inhibiting this function could have some type of long term effect on some men?
Also if you feel that some type of long term 5 alpha reductase type 2 effect has taken place is it possible to reverse it or in other words turn this function back on, possible by using DHT in an attempt to increase 5 alpha reductase activity?
Hi Robert, there may be a small number of men whose fertility are affected by 5 alpha reductase inhibitors, but the risk is likely to be very small, around one in 200 if it exists. (See this paper.) The only way to know would be to discontinue the medication, wait three months, test sperm, (as it may not be purely a hormonal effect,) start the medication again, wait three months, and retest sperm. Even then, without a comparison group of men who are taking a sugar pill, you can’t be certain that the results wouldn’t be chance. At this point, I would say that an infrequent effect of this kind of medication has been raised for male fertility, and we should think about larger studies in the future to learn if it’s real.
Also in your opinion is it possible to measure a man’s body’s ability to convert testosterone to DHT via the 5 alpha reductase type 2 enzyme? I ask this questions because if a problem with this enzyme is to blame for long term side effects after taking a DHT inhibiter I am assuming that the first step in fixing this problem would be to find a way to measure it to know if this is actually what’s causing the problem or not
I have been doing research and if I understand what I am reading correctly it seems as if you can’t measure men’s ability to convert testosterone to DHT based off of checking DHT blood levels alone because it’s possible for a man to have normal levels of DHT floating around in the blood because their 5 alpha reductase type 1 enzyme in the skin and liver is working properly. (which is far as I know has no or little effect on sexual function) In other words just because a man has normal levels of DHT in the blood, it does not mean that the 5 alpha reductase type 2 enzyme function’s are working normally. Is this correct?
If this is correct do you know of a way to measure/test for the 5 alpha reductase type 2 enzyme function specifically?
Do you think testing for Androstanediol Glucuronide (3a-diol G) is helpful in judging 5 alpha reductase type 2 activity? Do you know if 3a-diol G is a metabolite of DHT?
How about THF/5-a-THF? have you heard of that being a way to test for it?
Was also wondering if you are aware of the study that’s going on at Brigham and Women’s hospital in Boston? Supposedly it’s a study involving men who have taken 5 alpha reductase type 2 inhibiters and who suffer from long term sexual side effects.
A thermostat doens’t send variable amount of energy to the heater. Its an on off device. In most cases when the temperature gets below the set temperature mercury closes an electric circuit and it sends “on” to the heater, until the temperature goes above the set temperature, which causes the thermostat to rotate slightly and the mercury moves and opens the connection, sending no signal to the heater. When you set the thermostat higher, it send the “on” message for longer periods of time.
I’ll need to change my metaphor, Steve 🙂 Suggestions?
Maybe a “Digital Inverter” is better metaphor.
hahah.
Thanks Doc for your efforts
🙂 Perhaps a negative feedback op amp?
Testosterone doesn’t have to be converted to estradiol in order to inhibit pituitary gonadotropes!
In vitro at non-physiologic concentrations, no. In vivo in the human, effectively that is the physiological consequence. When prescribed an aromatase inhibitor, estradiol levels decrease in the male, LH increases, and testosterone increases. Hence, the overall effect on gonadotropins is that the inhibition related to estradiol is significantly less in the human male in vivo than that of testosterone.
There are a lot of posts on this topic on this blog besides this one. You might find More Pills and Testosterone interesting. If you are curious about how hormones work in actual life in human men, take a look around!
If taking clomid were to raise a person’s estrogen to an abnormal level, would lowering the clomid dose lower the estrogen levels?
Hi Brian, typically yes, but every man is different, which is why having a doctor monitor his response to medication is so important.
How can we prevent the conversion of high T into dihydrotestosteron?
Hi Finan, there are medications that interfere with the enzyme 5-alpha-reductase that converts testosterone into dihydrotestosterone. I write about them in my post The Story of Testosterone, which is literally only a click away from this one: in fact, it’s the first link on this post. I’d really encourage you to read my other posts. There’s some great information in there, especially in the comments: read them too!
does the testosterone boosting potential of clomid decrease with age? for example, could someone in his seventies or eighties reasonably expect to receive any testosterone-boosting benefit from any type of clomid treatment?
Sonny boy, that’s a great question. We know that the parts of the brain where clomiphene works slow down with age, and so you could imagine that as men get older, those parts would be less sensitive to clomiphene. But we don’t have good data that identifies that as an effect or quantifies it if it exists. In my own practice, many older men respond to clomiphene, but some don’t. That, however, is true also of younger men 🙂
Hello, this is not a personal question, but it is a question about clomid for some research I am doing. In males, when clomid therapy is started for hypogonadism, meaning when it is used to improve testosterone levels and sperm quality, how long in general would a person have to wait before numbers increase(change) based on research or other data? I would assume that increases(changes) in testosterone would happen sooner since spermatogenesis takes approximately 2 and 1/2 months(correct me if I am wrong). I wondered what research shows with respect to how soon the sperm count would show the effects of clomid therapy in men? I hope this is an appropriate question. THANKS!
Hi Brian, generally studies include lengths of treatment of three months, as two to three months is considered how long it takes to make sperm. I write about that in the post “How Long is the Sperm Factory“.
Hello again, sorry, I forgot this question. I have read online that clomid can effect libido negatively in males, meaning that it can lower sex drive even when testosterone levels go up. If that is the case, or when that does happen, what can that be attributed to and is there a way to counter that other than stopping clomid therapy? I cannot find too much research on this specific question so I thought I would ask.
Hi Brian, please read under “Does (this drug or that treatment) cause (this unusual side effect)?” in the FAQ.
Dear Doctor,
Is there any diagnostic value in observing the estrogen (E2) levels for a patient on clomid? If clomid competes with “natural” estrogen to bind with estrogen receptors and has weaker estrogenic activity and/or an antagonistic effect (seems it can have both, which complicates things more), this would seem to imply that having an estrogen level of ‘x’ while on clomid is not the same thing as having an estrogen level of ‘x’ when not on medication, in terms of the estrogen’s effect on the body.
Hope my question makes sense..
Hi AK, clomiphene doesn’t compete like athletes compete, with another molecule losing. It’s a word scientists use to explain how nature works using our limited vocabulary. As for observing a patient’s estrogen while prescribed the medication, that’s best for a doctor to decide for an individual patient, given his response, symptoms, and overall medical condition.
Thanks for the reply, doc. Another question, if you don’t mind: Do you discontinue clomid after your patients’ hormone levels have become normalized, and if so, do these levels tend to “stick”?
I’m pretty sure that I answered that previously: you might want to read through the comments on this post and other related posts, as you may find useful information. In a nutshell, it’s variable according to the specific man. It’s one of the reasons I strongly encourage a man to see his doctor before, during, and after any kind of treatment.
Dr. Niederberger,
Regarding HPTA modification for treating low T males, any reason SERM’s seem to be the preferred class of drugs over aromatase inhibitors such as exemestane?
Thank you for your time and attention.
Great question. Mainly because estradiol appears to have health benefits for the male, (for example it appears to be at least somewhat responsible for bone density,) there is concern about decreasing it for longer periods of time. Some doctors have started to alter the dose of aromatase inhibitors to leave a little estradiol behind, which is an interesting and sensible strategy.
Thanks for the reply.
By stating “doctors have started to alter the dose of aromatase inhibitors to leave a little estradiol behind”, do you mean that the standard treatment already includes an AI along with the SERM when treating low T? I wasn’t aware of that (I’m currently earning my MLT and considering med school).
No, typically they’re prescribed separately.
Hey Doc – great info thanks! I was wondering what types of visual disturbances did the patients experience and in fact did the pituirltary grow? If it did change size did it return to normal after discontinuing the clomid?
I’d rather not discuss specific cases on this blog. Any man experiencing any side effects should see his physician to be treated individually.
Hello – Your wonderful blog is a great service to many, thanks for effort. Question: Would taking Clomid AND Androgel at the same time be working at cross purposes or would they tend to complement each other?
Thanks, Swope! Please read the FAQ.
Hey Doc, just want to say thanks for giving your valuable time to write these blogs! You really helped me make a choice, and seek a doctor willing to try something different! You rock!
Thanks, Michael!
Hello and thanks for the informative blog. I have a general question about Clomiphene Citrate and LH. Have you found Clomid effective for patients with low T, but normal/high LH levels? If I’ve understood correctly Clomid increases LH which leads to testosterone production. So, do patients with already normal/high LH levels benefit from the medicine? Thanks.
Hi Herbie, a man with normal testosterone would typically not benefit from clomiphene, but please read The Story of Testosterone, as total testosterone doesn’t tell the whole story. As clomiphene increases LH, a man with increased LH to begin would typically not be expected to benefit from the medication, but what constitutes increased LH is the subject of discussion for a man and his doctor.
Hi Doc,
Do you monitor GH/IGF-1 levels with your patients on clomid? I”m trying to determine if clomid lowers GH/IGF-1 levels in males. Tamoxifen, a similar medication, does, but i can’t find any info on clomid.
No. The data supporting an effect of tamoxifen on IGF-1 and growth hormone is not uniform, and so I would not make the statement with certainty that “tamoxifen, a similar medication, does.”
I am wandering in the use of Clomiphene in men would or could cause blood clots in the body.
Hi Jim, please read the FAQ on “Does (this drug or that treatment) cause (this unusual side effect)?” You may also want to read through the rest of the blog and comments: there’s a lot of information that you might find interesting beyond clomiphene use in men.
Hi Doc,
I just finished reading all 800+ comments. Very good information and I did not find an answer related to the following question. I would appreciate your views.
As Anastrozole has a relatively high half-life, does it not accumulate in your body rapidly if one takes your suggested dose of 1mg/day ?
Also, how long does it take to get back to a normal Estradiol level if you happen to completely “crash” your level to an undetectable limit ?
Hi Joe, how a medicine builds up and is broken down in the body is specific to a particular man. It’s one of the reasons that hormones need to be monitored while a patient is prescribed medication.
Hi Doc,
Do you frequently find the need to prescribe Anastrozole along with Clomid to control estrogen levels?
Also, considering that Clomid typically increases estrogen levels as well as testosterone levels, wouldn’t it be good to take anastrozole to reduce the likelihood of BPH in your elderly patients?
Hi Vic, believe it or not, I’ve answered this question many times before in other posts and in the comments. Anastrozole makes sense to be prescribed instead of clomiphene in a number of circumstances–I have a whole post devoted to that, check it out 🙂 As for older men, they’re just like younger ones in having their own specific hormonal stories, and benefit from their doctors treating them as such.
Hi Doc,
Thanks for your reply. I did read your posts and understand that you prefer a single drug regimen instead of a multi-drug regimen. That makes perfect logical sense in most cases as there are fewer side effects and interactions to worry about. But as a guy gets older, I am wondering if there is a specific reason why the combination of clomiphene and anastrozole may be better than either one alone. Here’s my analysis based on what I have read on your site and elsewhere and I would appreciate your opinion on it:
Clomiphene increases both testosterone and estrogen. While men need some estrogen, beyond a certain point it becomes harmful because it plays a significant role in prostate hyperplasia. Thus, for older men, it makes sense to get the testosterone boosting effects of clomiphene without the estrogen boosting effects of the drug.
However, this problem may not be easily solved by using anastrozole instead of clomiphene. Although anastrozole decreases estrogen and thereby increases testosterone levels, it may not sufficiently increase testosterone levels without, at the same time, reducing estrogen levels below the minimum required for good health.
Therefore, it may make sense to use clomiphene and anastrozole in combination to get the right balance between testosterone and estrogen.
Am I on the right track in my thinking or have I missed something?
Hi Vic, what is logical in biology and what actually happens in reality is an age old disconnect. The problem is that we have virtually no good data on clomiphene or anastrozole and prostatic enlargement in men. (We have reasonably good data on testosterone therapy and prostatic enlargement, but even that is incomplete.) Until we do (and even when we do) the best plan is for a man to be treated by his doctor and for his doctor to monitor for prostatic effects.
Hey,
Great blog, lots of useful info. I hope you don’t mind me reviving an old post. I have a question on whether there were any studies done on young males with Clomiphene/Clomid? All I can find are studies done on males 50+.
Thanks, Imonibus! As I’ve written, well designed and conducted controlled studies with clomiphene in the male are relatively few, and it would be of benefit to have more. However, in the large amount of literature about clomiphene in the male, men of all ages are represented.
Thank you for the great insights.
Is it normal for testical size to increase with clomephene? And how long does it take generally for men to feel the full effects of this medicine on their libido?
Testicle size is mostly related to how many sperm making cells are inside. If the problem with sperm production is low testosterone inside of the testis, increasing testosterone inside of the testis with a drug like clomiphene may cause an increase in testis size. For the second question, usually a man will feel differently within a couple of weeks if the problem is low testosterone. Often libido is due to other things besides testosterone.