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The Lab: Clomid a TRT Alternative
What's known on the subject? and What does the study add?
Hypogonadism is a prevalent problem, increasing in frequency as men age. It
is most commonly treated by testosterone supplementation therapy but in younger
patients this can lead to testicular atrophy with subsequent exogenous
testosterone dependency and may impair spermatogenesis. Clomiphene citrate (CC)
may be used as an alternative treatment in these patients with hypogonadism when
maintenance of fertility is desired.
This study shows that CC is a safe and efficacious drug to use as an
alternative to exogenous testosterone. Not only have we validated previous
findings of other papers but have proven our findings over a much longer period
(mean duration of treatment 19 months). This prospective study is the largest to
date assessing both the objective hormone response to CC therapy as well as the
subjective response based on a validated questionnaire.
OBJECTIVE
•To prospectively assess the andrological outcomes of long-term
clomiphene citrate (CC) treatment in hypogonadal
men.
PATIENTS AND METHODS
•We prospectively evaluated 86 men with hypogonadism (HG) as
confirmed by two consecutive early morning testosterone measurements
<300 ng/dL.
•The cohort included all men with HG presenting to our clinic
between 2002 and 2006 who, after an informed discussion, elected to have CC
therapy. CC was commenced at 25 mg every other day and titrated to 50 mg every
other day. The target testosterone level was 550 ± 50 ng/dL.
•Testosterone (free and total), sex hormone binding globulin,
oestradiol, luteinizing hormone and follicle stimulating hormone were measured
at baseline and during treatment on all patients. Once the desired testosterone
level was achieved, testosterone/gonadotropin levels were measured twice per
year.
•To assess subjective response to treatment, the androgen
deficiency in aging males (ADAM) questionnaire was administered before treatment
and during follow-up.
RESULTS
•Patients' mean (standard deviation [sd]; range) age was 29 (3; 22–37) years. Infertility was
the most common reason (64%) for seeking treatment. The mean (sd) duration of CC treatment was 19 (14) months.
•At the last evaluation, 70% of men were using 25 mg CC every
other day, and the remainder were using 50 mg every other day.
•All mean testosterone and gonadotropin measurements
significantly increased during treatment.
•Subjectively, there was an improvement in all questions (except
loss of height) on the ADAM questionnaire. More than half the patients had an
improvement in at least three symptoms.
•There were no major side effects recorded and the presence of a
varicocele did not have an impact on the response to
CC.
CONCLUSION
•Long-term follow-up of CC treatment for HG shows that it appears
to be an effective and safe alternative to testosterone supplementation in men
wishing to preserve their fertility.
What's known on the subject? and What does the study add?
Hypogonadism is a prevalent problem, increasing in frequency as men age. It
is most commonly treated by testosterone supplementation therapy but in younger
patients this can lead to testicular atrophy with subsequent exogenous
testosterone dependency and may impair spermatogenesis. Clomiphene citrate (CC)
may be used as an alternative treatment in these patients with hypogonadism when
maintenance of fertility is desired.
This study shows that CC is a safe and efficacious drug to use as an
alternative to exogenous testosterone. Not only have we validated previous
findings of other papers but have proven our findings over a much longer period
(mean duration of treatment 19 months). This prospective study is the largest to
date assessing both the objective hormone response to CC therapy as well as the
subjective response based on a validated questionnaire.
OBJECTIVE
•To prospectively assess the andrological outcomes of long-term
clomiphene citrate (CC) treatment in hypogonadal
men.
PATIENTS AND METHODS
•We prospectively evaluated 86 men with hypogonadism (HG) as
confirmed by two consecutive early morning testosterone measurements
<300 ng/dL.
•The cohort included all men with HG presenting to our clinic
between 2002 and 2006 who, after an informed discussion, elected to have CC
therapy. CC was commenced at 25 mg every other day and titrated to 50 mg every
other day. The target testosterone level was 550 ± 50 ng/dL.
•Testosterone (free and total), sex hormone binding globulin,
oestradiol, luteinizing hormone and follicle stimulating hormone were measured
at baseline and during treatment on all patients. Once the desired testosterone
level was achieved, testosterone/gonadotropin levels were measured twice per
year.
•To assess subjective response to treatment, the androgen
deficiency in aging males (ADAM) questionnaire was administered before treatment
and during follow-up.
RESULTS
•Patients' mean (standard deviation [sd]; range) age was 29 (3; 22–37) years. Infertility was
the most common reason (64%) for seeking treatment. The mean (sd) duration of CC treatment was 19 (14) months.
•At the last evaluation, 70% of men were using 25 mg CC every
other day, and the remainder were using 50 mg every other day.
•All mean testosterone and gonadotropin measurements
significantly increased during treatment.
•Subjectively, there was an improvement in all questions (except
loss of height) on the ADAM questionnaire. More than half the patients had an
improvement in at least three symptoms.
•There were no major side effects recorded and the presence of a
varicocele did not have an impact on the response to
CC.
CONCLUSION
•Long-term follow-up of CC treatment for HG shows that it appears
to be an effective and safe alternative to testosterone supplementation in men
wishing to preserve their fertility.
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