As I’ve written before in this blog, clomiphene is an effective if off-label treatment for men with low testosterone who want to preserve their fertility. If used directly, testosterone itself actually decreases the making of testosterone and sperm in a man’s testis. Clomiphene increases testosterone production in the testis by increasing the pituitary hormones that tell the testis to make testosterone.
In the March issue of Fertility and Sterility, a journal that I co-edit with Dr. Antonio Pellicer, Drs. Kim and co-authors review the published medical literature on treating low testosterone with clomiphene and other drugs besides testosterone. They conclude that clomiphene is a safe and effective treatment for men with low testosterone and note that less than one year of treatment with testosterone is usually reversible if a man wants his fertility to return. Unfortunately, we don’t know all that much about longer treatments with testosterone, and many men who have been on testosterone for several years do not have sperm return even with other forms of treatment.
Drs Kim and co-authors give us a nice review that supports the use of clomiphene for men with low testosterone who want to preserve their fertility.
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Dr. Niederberger, thanks for the blog. How long does it take for testosterone replacement therapy to inhibit the body’s own testosterone production, both temporarily and irreversibly? I notice you address sperm production above, but not testosterone production.
Thanks, Sam. Inhibition of the body’s own testosterone production happens very quickly. Studies indicate that in most cases, it’s reversible if the testosterone is given for up to one year, and a few studies for two, but after that, we really don’t know when it becomes permanent.