The testes respond to pituitary hormones LH and FSH which are stimulated by GNRH from the hypothalamus. Clomid is a GNRH analogue which stimulates men’s pituitary glands to secrete LH which in turn stimulates men’s testicles to produce testosterone naturally. In addition, FSH is stimulated which causes sperm production and preserved fertility.

The beauty of Clomid therapy is that it is oral and substantially more physiological. I have never seen it cause polycythemia which is a concern with testosterone replacement. Clomid makes more sense, its oral as opposed to an intramuscular injection, it preserves fertility and increases testicular size as opposed to shrinking the testicles which is what we see in testosterone replacement.

Simply put, Clomid is a safe, easy, more physiologic alternative to testosterone replacement that is underutilized by physicians. I have included a recent abstract for you to review.

Judith Rubin, MD

Emerging medication for the treatment of male hypogonadism

Aydogan Aydogdu & Ronald S. Swerdloff

Abstract

Introduction: Male hypogonadism is characterized by inadequate production of Testosterone (T) (hypoandrogenism) and deficiencies in spermatogenesis. The main treatment of male hypogonadism is T replacement therapy (TRT), but for some of the patients, alternative drugs may be more suitable.

Areas covered: The available literature of T and alternative treatments for male hypogonadism are discussed.

Expert Opinion: Transdermal application of T gels are the most commonly used route of T administration. Some oral T formulations are either associated with hepatic toxicity (i.e. methyltestosterone) or short half-lives that require multiple doses per day (i.e. oral testosterone undecanoate). Short-acting, injectable T formulations are also available. If the patient prefers not to use daily drugs or short-acting injectable formulations, depot formulations such as injectable testosterone undecanoate (TU) may be a good alternative. If the patient has hypogonadotropic hypogonadism and desires fertility or if he is adolescent, instead of TRT, gonadotropins can be started to stimulate testicular growth and spermatogenesis. In obese patients or for the patients having high risks for TRT, off label aromatase inhibitors (AI) and clomiphene citrate (CC), may be considered to stimulate LH, FSH, and T levels. In patients with high prostate disease risk, selective androgen receptor modulators may be an alternative treatment but these latter treatments have not had high-level evidence.

Keywords: male hypogonadism, Testosterone Gel 1.62%, Testosterone 2% gel, Testosterone 5% cream, Testosterone Undecanoate (TU), Dihydrotestosterone (DHT), Human Chorionic Gonadotropin (hCG), Aromatase inhibitors (AIs), Clomiphene citrate (CC),

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