Testosterone versus Clomid (clomiphene citrate) in managing symptoms of hypogonadism in men

[Nelson Vergel]

I could not see clomid dosages used.


This makes a big difference, as we now no too much zuclomiphene causes inverse effects. According to Dr Saya, this does not seem to happen in the low dose patients they see, which appears to be consistent with other doctors now using lower dose clomid.


Too bad enclomiphene is being held up, at least last I heard. This is an important tool for diagnosing younger men and/or boosting borderline TT levels that don't warrant full replacement.


Either way, nothing works as good as testosterone supplementation since you get a guaranteed bell curve of androgens after administration.

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Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men

Pranav Dadhich1, Ranjith Ramasamy2, Jason Scovell1, Nathan Wilken1, Larry Lipshultz1
1 Scott Department of Urology, Baylor College of Medicine, Houston, USA
2 Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA



Introduction: Both clomiphene citrate (CC) and testosterone supplementation therapy (TST) are effective treatments for men with hypogonadism. We sought to compare changes in symptoms and treatment efficacy in hypogonadal men before and after receiving CC and TST. Patients and Methods: 52 men who received TST and 23 men who received CC for symptomatic hypogonadism were prospectively followed for change in hormone levels and symptoms after treatment. These men were also compared to eugonadal men who were not on CC or TST during the same period. Comparisons were made between baseline and posttreatment hormone levels and symptoms. Symptoms were evaluated using the androgen deficiency in aging male (ADAM) and quantitative ADAM (qADAM) questionnaires. Results: Serum total testosterone increased from pretreatment levels in all men (P < 0.05), regardless of therapy type (TST: 281&#8211;541 ng/dL, CC: 235.5&#8211;438 ng/dL). Men taking TST reported fewer ADAM symptoms after treatment (5&#8211;2,P < 0.05). Similarly, men taking CC reported fewer ADAM symptoms after treatment (3.5&#8211;1.5,P < 0.05). Conversely, eugonadal men had similar T levels (352 vs. 364 ng/dL) and hypogonadal symptoms (1.5 vs. 1.4) before and after follow-up. When we evaluated individual symptoms, men treated with TST showed significant increases in qADAM scores in libido, erectile function, and sports performance. However, among the men who received CC, qADAM subscore for libido was lower following treatment (3.75&#8211;3.2,P = 0.04), indicating that CC could have an adverse effect on libido in hypogonadal men. Conclusions: Both TST and CC are effective medications in treating hypogonadism; however, our study indicates that TST is more effective in raising serum testosterone levels and improving hypogonadal symptoms. CC remains a viable treatment modality for hypogonadal men but its adverse effect on libido warrant further study.

 

[Nelson Vergel]

Why Clomid Fails: The Zuclomiphene Threshold

 

[Nelson Vergel]

Are guys that do well on low dose clomid unicorns...or do they really exist?

 

[Dr Justin Saya MD]

There are so many variables at play with Clomid (and really any SERM) treatment that complicate the ultimate outcome. These include the zuclomiphene effect, the interaction with E receptors in the CNS (both of these likely play a role in libido changes, either positive or negative), and the varying tissue-specific agonist/antagonist actions of the isomers.

I have guys who LOVE their Clomid regimen and are extremely grateful it has worked well for them...and then as we all see many who either respond subtly or not at all. There is really no way to predict in advance which of those outcomes will be the final result for any given patient (until they actually undergo treatment).

 

[TRTME]

Are guys that do well on low dose clomid unicorns...or do they really exist?

I actually did really well on Clomid for a while. That was after I tried HCG monotherapy and did horrible on that. After almost 2 years on Clomid I felt like things were declining and luckily it was time to make the switch to testosterone. My levels on Clomid were always good but my biggest complaint would be a few extra pounds of fat around my midsection that I just couldn't get rid of until I got off of Clomid.

 

[Tetol]

There are so many variables at play with Clomid (and really any SERM) treatment that complicate the ultimate outcome. These include the zuclomiphene effect, the interaction with E receptors in the CNS (both of these likely play a role in libido changes, either positive or negative), and the varying tissue-specific agonist/antagonist actions of the isomers.

I have guys who LOVE their Clomid regimen and are extremely grateful it has worked well for them...and then as we all see many who either respond subtly or not at all. There is really no way to predict in advance which of those outcomes will be the final result for any given patient (until they actually undergo treatment).

Thanks for the information doctor. Never heard of the "zuclomiphene effect".

 

[tareload]

Exogenous testosterone replacement therapy versus raising endogenous testosterone levels: current and future prospects

Guys are fortunate to have such nice review articles available lately. Also, to add to Table 2 you have testosterone troches available via compounding pharmacies (at least for now).

 

[Nelson Vergel]

Thanks, @readalot

Whoever finds an affordable way to increase endogenous testosterone AND libido will get rich. Clomiphene or enclomiphene are not that. hCG is great but now we have pricing and access issues. Let's see what happens when they release data on long acting hCG.

 

[Nelson Vergel]

I have never seen these data:

 

[tareload]

Ref 58 above:

Effects of aromatase inhibition in elderly men with low or borderline-low serum testosterone levels - PubMed

As men age, serum testosterone levels decrease, a factor that may contribute to some aspects of age-related physiological deterioration. Although androgen replacement has been shown to have beneficial effects in frankly hypogonadal men, its use in elderly men with borderline hypogonadism is...

pubmed.ncbi.nlm.nih.gov

Borderline significance and I'd have to really think about Group 1 vs Group 2 and the results shown.

1 mg/day is a whopper but the 2 mg/week group (group 2) saw the bigger increase (although there were 2 patients in that group that may have skewed the results?

 

[tareload]

Also looking this this study, it's nicely put together put clearly underpowered to make any definitive conclusions. Still so much to learn but rough rule of thumb is n>30-50 for each group if you start to really worry about type II error (getting in the weeds here but important to point out depending on what type of difference you are trying to pick up; alpha, beta, etc).

 

[tareload]

hCG is great but now we have pricing and access issues.

Adding a recent data point here. Do you homework if you still want hCG:

For the record, just received another vial of 10,000 IU Fresenius hCG from my specialty pharmacy ($125 based on my insurance rate). All out of pocket till I hit the deductible. So they aren't marking it up. GoodRX shows up to $400 for same bottle.

Solid specialty pharmacy (based on my relevant experience):

Fairview Specialty Pharmacy

Fairview Specialty Pharmacy supplies the same high-quality, FDA-approved medications found at our retail pharmacies.

www.fairview.org

Shipping included and they'll include the syringes (I use 23 g needle with 5 or 10 mL syringe to reconstitute and 30 g insulin pin to inject) and sharps container as part of the hCG price.

Ain't much of a coupon through GoodRx

Ok, I went and looked and the price is discounted rate with my insurance. So if you are retail then GoodRx still better than $383. Sad the difference between insurance and retail.