Clomiphene citrate is a drug most commonly used in fertility treatments for women. It works by blocking estrogen receptors in the hypothalamus, as it is a selective estrogen receptor modulator (SERM).
However, it can also successfully stimulate the hypothalamus to cause an increase in testicular testosterone production in men.
As a result the body produces more gonadotropin hormones (GnRh) so the body responds with an increase in follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Stimulation with 50 mg of oral clomiphene three times per week can be both diagnostic and therapeutic.
If the patient does not respond with at least a 75% increase in testosterone and a 100% increase in LH, further evaluation of the hypothalamic-pituitary area is necessary.
The last two hormones are responsible for the production of follicles in the ovaries and for ovulation. In the man, FSH and LH are responsible for the production of testosterone.
By the increase of LH a higher level of testosterone is seen and by the increase of FSH a growth in sperm production is seen.
So the effect that clomiphene citrate has on men is similar to that of women.
It has long been established that testosterone is necessary for the libido in men and androgens are necessary for the physiological erectile response in the corpus cavernosum of the penis.
Likewise, they are necessary for the formation and activity of nitric oxide, which is considered the most important intrapenial chemical transmitter needed to achieve erection.
The response rate is higher in primary hypogonadism than in secondary hypogonadism.
In order to know if and how clomiphene works in men, a study was done, for example, with men who suffered from azoospermia.
In 64% of them, sperm appeared in the testicles after treatment with clomiphene.
The correction of the testosterone deficit can have other beneficial effects, such as increasing energy and well-being, as well as preventing anemia or bone loss, depending on the severity of the hypogonadism.
Clomiphene stimulation may provide a reasonable option for correcting hypogonadotropic hypogonadism, especially when it is functional in its etiology and may be temporary in nature.
An example of this is a man with hypogonadism and sleep apnea (a very common combination).
In these cases, testosterone therapy may be needed while he begins a weight loss program and undergoes treatment with nightly positive pressure therapy (CPAP).
As a side effect, the appearance of bright visual fields (palleanopsia) may occur, which disappears after stopping use, the PSA should also be monitored.
How to use Clomiphene for men:
Usually start with a dose of 25 mg or 50 mg and take one pill 3 times a week for about six months.
If no effect is seen, the dose can be increased to 50 or 100 mg per day.
-Clomiphene citrate tablets label» (PDF). Revised October 2012: FDA, from the original on September 27, 2016. Retrieved September 11, 2016.
-Clomiphene citrate is safe and effective for long-term management of hypogonadism. Daniel J Moskovic, Darren J Katz,Ardavan Akhavan,Kelly Park, John P Mulhall. 2012
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