Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men

Abstract

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: 281–541 ng/dL, CC: 235.5–438 ng/dL). Men taking TST reported fewer ADAM symptoms after treatment (5–2, P < 0.05). Similarly, men taking CC reported fewer ADAM symptoms after treatment (3.5–1.5, 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 (3.75–3.2, 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.

Low Testosterone in Adolescents & Young Adults

“…Anastrazole, an aromatase inhibitor, is also employed to increase T levels and is beneficial for spermatogenesis if the serum T to estrogen ratio is < 10 (41, 42). While these medications are efficacious, using them for male hypogonadism treatment is considered off-label by the Food and Drug administration and carry side effects of decreased bone mineral density and libido (42).…”

Clomiphene Citrate for Male Hypogonadism and Infertility: An Updated Review

“…The qADAM score also had a positive correlation with total testosterone and with SHIM scores. 44 Dadhich et al 45 evaluated changes in hypogonadal symptoms after 3 months of receiving CC or TRT, and observed a significant improvement in qADAM scores in both the CC and TRT group. Investigators, through a randomized controlled study, also reported that CC and human chorionic gonadotropin therapy both improved qADAM score when these treatment regimens were used separately or as a combination.…”

Investigating the basis of sexual dysfunction during late-onset hypogonadism

“…Clomiphene citrate has been demonstrated to increase testosterone but also improve hypogonadal symptoms 69, 70 . However, one study indicated that the use of clomiphene citrate is less effective than TRT at increasing serum testosterone levels and improving hypogonadal symptoms and libido 71 . Enclomiphene citrate is a shorter-acting preparation of clomiphene citrate that has been shown to improve sperm counts but also testosterone levels equivalent to exogenous testosterone 72 .…”