Converting Men From Clomiphene Citrate to Natesto for Hypogonadism Improves Libido, Maintains Semen Parameters, and Reduces Estradiol

Men Converting from Clomiphene Citrate to Natesto with a Desire to Maintain Spermatogenesis Should Be Followed Closely

“…Although the difference in FSH levels did reveal a statistically significant difference, on Natesto FSH levels remained in the low normal range by reference range allowing for maintenance of intratesticular testosterone levels by continued LH secretion resulting in maintenance of spermatogenesis. 6 Although the purpose of this current study was to report on the individual patient who demonstrated suppression of gonadotropins and spermatogenesis on Natesto twice daily dosing, the data on a total of 49 men who maintained spermatogenesis with conversion from CC to Natesto was brought up to date, and a statistically significant difference was again noted in E2 levels, confirming the advantage of lower E2 levels on Natesto over CC. A statistically significant difference in semen volume was also demonstrated on CC (2.9 ± 1.3 mL) versus on Natesto (2.6 ± 1.3 mL).…”

“…We published a study in Urology (DOI https://doi.org/10.1016/j.urology.2020.11.047) revealing that 41 men converted from CC to Natesto for testosterone deficiency had improved libido, reduced E2, and maintained semen parameter values. 6 To date, from May of 2018 to March of 2021, this data has been carried out to 50 men and 49 of these men maintained gonadotropins and semen parameter values on Natesto, comparable to when on CC (Table 1). The mean age of these 49 men was 38 ± 8 years.…”

“…4 Although the majority of men treated with CC have normalization of their serum testosterone levels, E2 levels tend to rise, and symptomatic response to CC has been reported to be less optimal than on TRT, especially libido. 5,6 The short-acting intranasal TRT, Natesto, allows for maintenance of FSH and LH within normal ranges in most men. Natesto has also been shown to allow for maintenance of spermatogenesis when given to TRT naïve patients or after a washout period from other TRT modalities in most men.…”

“…Natesto has also been shown to allow for maintenance of spermatogenesis when given to TRT naïve patients or after a washout period from other TRT modalities in most men. 6,7…”

Effectiveness of Clomiphene Citrate for Improving Sperm Concentration: A Literature Review and Meta-Analysis

“…According to Kavoussi et al, hyperestrogenemia has been encountered in many patients and it had to co-administrate aromatase inhibitors. Other reported side effects have been fatigue, gynecomastia and weight gain [ 29 ]. However, according to Sharma et al, safe for long‐term treatment, clomiphene is safer and more cost-effective when compared to testosterone replacement therapy [ 10 ].…”