Efficacy of Non-Testosterone–Based Treatment in Hypogonadal Men: A Review

Raheem, Omer; Chen, Tony T.; Akula, Kole Prasad; Greenberg, Jacob W.; Le, Tan V.; Chernobylsky, David; Sikka, Suresh C.; Walsh, Thomas J.

doi:10.1016/j.sxmr.2020.08.003

Cited by 14 publications

(9 citation statements)

References 41 publications

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“…Therefore, recommendations are based on experience with exogenous testosterone therapy. Literature shows that TTh can lead to an increase in PSA, Hb and Ht 10,33 . In our study we found no increase in PSA and Hb, only two patients showed marginal elevated Ht (0.50 and 0.51) during treatment.…”

Section: Discussioncontrasting

confidence: 58%

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males

Huijben

Lock

Kemp

et al. 2023

Endocrino Diabet & Metabol

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Background Hypogonadism is a worldwide problem among men causing sexual, physical and mental problems. Testosterone therapy is the first‐choice treatment for male hypogonadism, with several side effects, that is, subfertility. Clomiphene citrate (CC) is an alternative off‐label therapy for a certain group of hypogonadal males, especially for those with an active or future child wish. There is scarce literature in usage of CC for men with hypogonadism. The aim of this retrospective study was to evaluate the effectiveness and safety of CC for hypogonadal males. Methods In this single‐centre study, men treated with CC for hypogonadism were evaluated retrospectively. Primary outcome was hormonal evaluation including total testosterone (TT), free testosterone (FT), luteinizing hormone (LH) and follicle stimulating hormone (FSH). Secondary outcomes were hypogonadal symptoms, metabolic and lipid parameters, haemoglobin (Hb), haematocrit (Ht), prostate specific antigen (PSA), side effects, the effect of a trial without medication and potential predictors for biochemical and clinical response. Results In total, 153 hypogonadal men were treated with CC. Mean TT, FT, LH and FSH increased during treatment. TT increased from 9 to 16 nmol/L, with a biochemical increase in 89% of the patients. In patients who continued CC treatment, an increased level of TT persisted after 8 years of treatment. With CC treatment, 74% of the patients experienced hypogonadal symptom improvement. LH at the lower normal range before CC treatment was predictive for better TT response. During CC therapy, few side effects were reported and no clinical important changes in PSA, Hb and Ht were found. Conclusion Clomiphene citrate is an effective therapy on short and long term, improving both clinical symptoms and biochemical markers of male hypogonadism with few side effects and good safety aspects.

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Section: Discussioncontrasting

confidence: 58%

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males

Huijben

Lock

Kemp

et al. 2023

Endocrino Diabet & Metabol

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“…In addition, in many men, testosterone starts to drop after the age of 30. According to Raheem et al, to confirm the diagnosis of hypogonadism, it is not enough for the patient to have low levels of total serum testosterone but also clinical signs [ 13 ]. Therefore, although it would seem logical as the main treatment be testosterone replacement therapy.…”

Section: Reviewmentioning

confidence: 99%

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

Puia¹,

Pricop²

2022

Cureus

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Demographic data regarding male infertility suggest an increase in prevalence. This is an entity with multifactorial etiology, hormonal causes are often encountered. Although treatment with clomiphene was advocated to stimulate gametogenesis, it is still used off-label. We aimed to evaluate data from literature related to the effect of clomiphene as a single therapy, on the improvement of sperm count in infertile patients. Out of the 4,017 results of the search, only eight articles have been selected. The selected studies have been published between 1983 and 2020, and have included a total of 616 patients. From data reported, the treatment with clomiphene lead to a significant improvement of sperm concentration compared with placebo or with the level before starting the therapy (p<0.00001). Out of the 616 patients, in 369 (59.90%) cases improved sperm concentration was reported. In our meta-analysis, the selected studies had a high heterogeneity (I 2 = 97%). Nevertheless, clomiphene is not an ideal treatment, paroxysmal effects have been reported. Our findings encourage the use of clomiphene on male infertility, although the potential side effects should be clearly explained to patients.

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“…Testosterone also exerts an important effect on body composition, increasing lean mass and decreasing fat mass (4, 10). In the wake of the recovery of physiological hormone levels, we can see response in the most different areas: decrease in negative thoughts, improvement in bone mineral density, increases in lean mass and in muscle strength (4,15,16). Overall, the recovery of normal hormone levels improves the quality of life of patients (3,11).…”

Section: Testosterone Replacement Therapymentioning

confidence: 99%

The role of clomiphene citrate in late onset male hypogonadism

Ros¹,

Ros

2022

Int. braz j urol.

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The World is getting old. Aging is associated with degenerative changes in multiple organ and systems. Yet, overall, men's life expectancy increased from 63.2 years in the 1990s to 70.5 years in 2017, what represents an increase of 7.3 years in this period (1). Men's life expectancy has always been lower than women´s, as several biological, ethnic and sociocultural factors weighed in, but lifestyle modifications, such as decreasing smoking and alcoholism, controlling weight and adopting physical activity, has helped to minimize this difference (2). In addition to the desire to live longer, people value more and more quality of life, and among health issues that involve quality of life, we have what concerns cognition, reasoning, libido and the feeling of well--being. These aspects are all tightly related to testosterone, which is the main male hormone, responsible for all of this and, still, for strength and muscle mass, maintenance of bone structure, penile erections, etc. Greater attention has been given to health in this group of older male patients, not least because there is a high prevalence of metabolic and psychological alterations related to aging among them (3).Symptomatic late-onset hypogonadism (LOH) is a clinical and laboratory syndrome that accompanies male aging and is associated with hormonal profile changes, which negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density, that is, it affects not only the

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Efficacy of Non-Testosterone–Based Treatment in Hypogonadal Men: A Review

Cited by 14 publications

References 41 publications

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males

Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males

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

The role of clomiphene citrate in late onset male hypogonadism

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