With the suspension of Cincinnati Reds pitcher Edinson Volquez for performance enhancing drug use and a swirl of rumors that the agent involved was clomiphene (also known as Clomid,) I thought it timely to write about how clomiphene works and how it’s used. From what I read on the internets, there is an enormous amount of misinformation floating around out there.
To understand how clomiphene works, you need to know how the pituitary controls the making of testosterone in the testis. Testosterone is made by Leydig cells in the testis, which I explained in my last post. The pituitary releases a hormone called luteinizing hormone (“LH”) that stimulates the Leydig cells to make testosterone. Testosterone is converted to the female hormone estrogen, (which I also explained in my last post,) and estrogen tells the pituitary to stop making more LH. This kind of negative feedback system is common when it comes to how hormones work. It’s just like a thermostat and heater. As the room gets warmer, the thermostat sends less electricity to the heater. When the room gets colder, the thermostat sends more electricity to the heater.
Clomiphene works by blocking estrogen at the pituitary. The pituitary sees less estrogen, and makes more LH. More LH means that the Leydig cells in the testis make more testosterone.
As I explained in my last post, giving testosterone to a man does just the opposite. The pituitary thinks that the testis is making plenty of testosterone, and LH falls. As a result, the testis stops making testosterone, and the usually high levels of testosterone in the testis fall to the lower level in the blood.
So clomiphene is a way to increase testosterone in the blood and the testis at the same time. It preserves testis size and function while increasing blood testosterone.
Unfortunately, clomiphene is not FDA approved for use in the male. Like most of the medications that we use to treat male fertility, the pharmaceutical company that originally sought approval by the FDA did it for women. Clomiphene is now generic, and it’s unlikely that anyone will pony up the hundreds of millions of dollars necessary to get it approved for the male. That’s the bad news. The good news is that it means that this medication is fairly inexpensive, cheaper than most forms of prescription testosterone. Can a doctor prescribe clomiphene for a man? Yes. It’s “off label”, meaning that it’s not FDA approved for use in men.
As a medication, clomiphene is usually well tolerated by men. In my experience, most patients don’t feel anything as their testosterone rises. Those that do feel an increase in energy, sex drive, and muscle mass, especially if they work out. Very rarely I’ve had patients report that they feel too aggressive, or too angry. Very very rarely (twice in the last 20 years) I’ve had patients report visual changes. That’s worrisome, as the pituitary is near the optic nerve in the brain, and visual changes suggests that the pituitary may be changing in size. Because the skull is a closed space, it’s alarming if anything in the brain changes in size. In the last twenty years, I’ve also had two patients who had breast enlargement (called “gynecomastia”) while using clomiphene. Needless to say, for any of these problematic side effects, the clomiphene is discontinued.
So that’s the story with clomiphene. It can be used in the male, either for fertility or low testosterone levels. It’s an off label prescription drug. It works, and is usually well tolerated by men who take it.
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Hey Doc !
I wanted to know if someone takes too much clomid regulary, will it cause the testosterone to keep on increasing(and therefore cause man boobs, excess facial hair and huge libido ?) or does the body respond by decresing production of testosterone, if someone kept on taking clomid at above normal frequency and amount ?
Hi Amid, the doctor who is prescribing it will be monitoring effects of the drug and blood levels of testosterone.
i am under dr care now,and take 2cc of testrone every month or 2 times amonth.problem is sexaul performance.usually is to quick and can,t preforme for a long time after. what can i use to enhance longer and better for my wife.or at least start over 10or 15 minutes later. thanks, les
I’m sorry, Les, but I can’t answer personal questions about your own health. Please read the FAQ.
Les,
I’m 34 and had low testosterone for the past couple of years. Quick finish and longer recuparation periods is usually a problem. I don’t have ED problems but taking ED medication gives me the boost I want in bed. I take 5-10mg of Cialis on the weekends and my sex life gets rejuvinated during the weekend.
I’m sorry, Dan, but this blog isn’t for personal details about your own health.
Good Afternoon
My husband recently started taking Clomid for fertility. He has been taking about 6 weeks now, 1/2 tablet a day. It did increase his T from 440 to 517, but his FSH also went up from 8 to 17! Is this normal? Is that too high?
I’m sorry, Jessica, but I can’t answer personal questions about your husband’s health. Please read the FAQ.
I’ve seen you describe how long it takes for clomid to affect both testosterone levels and then sperm production later. My question is, is there a typical amount of time that clomid will maintain or build on these positive effects before those levels either plateau or begin to reverse? Basically, how long after it begins to work does it stop working or become less effective?
Thanks
For men with low testosterone, clomiphene can be prescribed. The man’s doctor should monitor his testosterone level, which typically rises quickly within a week or two. For sperm production, because that takes two months or more, it can take several months before an effect is seen. And because sperm counts vary widely in any individual man, sperm counts can go up and down on treatment. These effects depend on the individual man, and should be monitored by his physician.
Is it correct to assume if testosterone level doesn’t rise quickly then clomiphene is not effective?
It’s different for every patient, and ultimately this is a patient related question that I can’t answer. Please read the FAQ.
i just ant to say and to ask my ? i want to know what would happen if i was taking it and him at the same he has low testosterone levels and i have a problem getting pregnant well i hope i get the answer i want to here o yes and could it be taking if he has heart problems his dr. wants me to do research lol i should of been a dr.
I’m sorry, Sunny, but I can’t answer personal questions about your husband’s and your own health. Please read the FAQ.
i have been diagnosed with pituitary failure as my Fh levels were extremely low, tesosterone level was a 65. I am a natural competitng bodybulder , well was until this health issue, my question is i was fine before i got rear ended in a car accident as a Tractor Trailer rear ended me, causing a concussion. Can this brain injury have caused my pituitary issue?
I’m sorry, Kevin, but I can’t answer personal questions about your own health. Please read the FAQ.
Hi doctor,
I am grateful for this blog there is a lot of bad information out there. One issue I am confused with is the different opinions on what dosage of clomid to take. Some websites suggest taking a higher dosage like 300mg for the first week or so then tappering down. I know you mentioned in one of your blogs that you usually prescribe 25mg at first and then go up if needed. Is this a safer approach?Would a higher dose work faster at increasing testosterone?
Hi Joe, I can’t really comment on how other doctors prescribe clomiphene, and I’ve put what I do on this blog. I’d really encourage you to read the rest of the blog, as there’s a lot of information here. Importantly, any man taking clomiphene should be under a doctor’s care.
Thanks doc,the reason I asked is because my endocrinologist just perscribed clomid 50mg a day for me. He said that he doesnt have much expierience in perscribing clomid and Im not sure if I should ask him to start me on a smaller dose.
If no blockage in a men but no sperm are ejaculated but being produced, could that be cause by low T?
Please read through the rest of my blog posts: you’ll find the answer there
Hi, I was just wandering if I’m correct in thinking the gynecomastia was caused by too low oestrogen, and more importantly, how low oestrogen causes gynecomastia. Any help, though especially in responce to the latter question, wouldbe greatly appreciated.
It really sounds to me like you’re asking a personal question, and unfortunately I can’t those kinds of questions. Please read the FAQ.
Greetings and Happy New Year!
In males with Low T, in addition to all the standard blood tests do you also routinely test for sleep apnea prior to making the determination to prescribe Clomid? In your experience, how severely can sleep apnea — in and of itself — occlude testosterone production? On a related note, how severely can an irregular sleep schedule impact testosterone production?
Thank you,
Scott
I have the same question like Scott. I have RLS and just went for a sleep study as my insomnia may also have to do with sleep apnea. I’m curios to find out if you are aware of any studies for the relationship of sleep apnea, RLS and azoospermia (due to low FSH and low T)
Hi Andrew, I can’t answer personal questions about your own health. Please read the FAQ.
Testing for sleep apnea depends on the individual patient. Your question about sleep problems affecting testosterone is a good one, and that too depends on the individual man.
Doc gud day i have question bout clomid i have took taht med when me. And my wfe were trying to conceive our first baby id taken clomid for 2months before and also my wife coz she diagnose to have pcos by her obgyne we had a baby by then and now he is 2 yr old were trying to have another baby til now but still theres none we.wwnt bacl to her ob and told us her pcos are gone but i discontinued taking clomid.doc must i continue taking clomid in order to impregnate my wife ialso was diag.nose to have low sperm count.before tnx.
I’m sorry, Plok, but I can’t answer personal questions about your own health. Please read the FAQ.
I have experience with Low testosterone and experience with taking Clomid to treat it. I am currently being treated by an endocrinologist who pretty much says the same things that you say about how and when you treat men with Low T with Clomid.
I am asking this question only because I am interested in researching how men react to taking Clomid.
I am confused as to why Clomid kills Labido in some men to the point were their sex drive is worse that in was before taking Clomid. Especially in men who’s blood lab results look as if the man has responded good to Clomid treatment. Do you have any explanations as to why this may be?
Does Clomid do more than block estrogen at the pituitary? Does it “act” as an estrogen in other ways that could possibly explain this?
I’m sorry, Robert, but I can’t answer personal questions about your own health. Please read the FAQ.
Hello Doctor,
What are the effects of Clomiphene after it is stopped? Are the changes permanent? Are any increases in testosterone production maintained, or do they diminish over time as the body adapts to lowering of estrogen levels?
Also, comparing Clomiphene to direct testosterone intake for men with with low T, which would you say is safer long term?
Hi Nick, read through the comments on this post and my other posts. I’ve answered those questions a few times.
Can this drug prevent or reverse man boobs?
Hi Brian, read through the comments and my other posts, and you’ll find that I’ve answered that a couple of times.
Doc, does the increase in testosterone production resulting from use of this drug cause a greater risk of things like prostate or testicular cancers? Thanks.
Hi Steve, I answered that question in my comments on this blog back in October
I have heard that zinc and vitamin c will also improve testosterone levels, is this true?
I am unaware of good data supporting that.
i have a low count of sperm.and need to have baby please help./.
I’m sorry, Abdoulaye, but I can’t answer personal questions about your own health. Please read the FAQ.
Hello Dr.,
Is there any published evidence that you may have come across relating to ocular toxicity and the use of clomid? I’ve read an offhand reference to the subject but currently doubtful about any related direct evidence.
Any updates on your experience with vision related issues and clomiphene? Over the 20yrs what kinds of numbers of male patients have you helped with clomiphene treatments?
In discussions and analysis with peers does it appear that the low incidence of vision related side effects may be related to changes with pituitary glandular size.
Thank you for the interesting blog.
James
Hi James, read through this post, its comments and the other posts on the blog. I talk about optical effects and clomiphene a bit.
Does taking Clomid necessarily decrease sperm count? I have read that taking Androgel, or using T injections dramatically decreases sperm count. There are many conflicting sites with information and I wondered if you had an answer! Thank you!
Clomiphene doesn’t typically decrease sperm count. There are many posts on this blog about how it works, how it’s used and its effects. You may want to read through the rest of this blog.
In have read the post and all the comments but have not seen any information on the typical duration that this drug is prescribed. Is it temporary or is it an on going treatment. Can it be used as an alteritive to testosterone treatment in those who have a deficiency?
Read other posts on my blog. There are many
Hi doc
Great blog!
I am interested to know what your opinion is of using human chorionic gonadotropin as another alternative to endogenous testosterone for the low testosterone chap?
Maybe this question deserves a new thread!?
Thanks
Bill
Thanks, Bill! Read the rest of the posts on this blog: there’s a whole one devoted to that question
Can you please comment on the differences between Clomid and Nolvadex in restoring testosterone loss? Thank you.
I have been asked and have answered that question a number of times. Please read through the comments on this post, and the rest of the posts on this blog. My blog isn’t only this one post!
Your emails subscription link says “unsubscribe” shouldn’t it be “subscribe”?
That means that you’ve subscribed to my email list
I haven’t sent out any emails. Someday I may, and you’ll be the first to get them!
Are the chances of multiple births increased while men use clomid?
I’m fairly sure I’ve already answered this question, so please read through the rest of the comments and other posts on this blog. But the short answer is, no. Clomiphene may cause more eggs to be released in the female resulting in multiple births, but making more sperm does not achieve that effect.
Hello, I was recently diagnosed with lowT. My levels were 142. My Dr immediately started me on test cyp injections every 2 weeks. I guess my main concern is that we went straight to treatment without investigating what is causing the problem. Are there other tests other than just blood work that might identify the cause and thus open up different treatment options?
I’m sorry, RWH, but I can’t answer personal questions about your own health. Please read the FAQ.
after reading through this page, i dont think you could answer any of my questions, you will either say you cant answer it or go look in my blog. dont want to wast my time reading useless info so i will go some were the person will realy help.
If you’re asking questions about your personal health that I can’t answer on a blog, then it’s really great that you will go somewhere where a doctor in person can really help!
Has there been any research or studies showing liver toxicity relating to clomid use in men? If so, can you comment or point to this information?
Thank You
Not specifically to my knowledge.
Clomid was not successful for my husband, but I have been doing research on Gonad F and Menotropins. What are your opinion on the pros and cons of these drugs?
I’m sorry, Eva but I can’t answer personal questions about your husband’s health. Please read the FAQ.
Are you aware of any studies or data regarding long-term use of clomid to treat testosterone deficiency vs. depot injection? I’ve asked two doctors and they are very uninformed on clomid in general, much less for using it in men.
That’s a really great question, Mike, and unfortunately we don’t have any long term data on the use of clomiphene in men. Because it would take years, it would be an expensive study, and as clomiphene is generic, there’s no financial interest from a drug company that would fund it. That leaves agencies such as the National Institutes of Health, and hopefully at some point it will become a funding priority.
Hi! You said that most of your patients don’t notice any change while their testosterone levels increase. So if one’s low energy and low libido because of low testosterone levels, shouldn’t clomiphene correct this?
It should, and if it doesn’t, the low energy and libido probably isn’t due to low testosterone.
Thank you
Hello Dr Niederberger,
I’ve read in different place that on the contrary of drugs like Arimidex or Femara that block the aromatase enzyme and therefore block the production of estrogen from aromatisation, Clomid blocks the estrogen receptors but do not block the “manufacturing” of estrogen. There it makes sense that you might have more estrogen in your bloodstream but that cannot go to their receptors. So my first question is if there cannot be a huge rebound effect when you stop taking Clomid with all those free estrogen with their receptors not blocked anymore and this brings my second question that is if it’s not preferable to enhance testosterone in Men to use Arimidex, Femara or yet Formestane. And if not, is it because of the side effects that can be more serious?
Thank you et best regards!
Pierre
Great questions, Pierre. I haven’t observed a “rebound effect” in clinical practice: it seems, with occasional exceptions, that the endocrine assays return to their pre-treatment levels. I am cautious to use an aromatase inhibitor like anastrozole as first-line therapy, as a certain amount of estradiol may be necessary for health in the male, including bone density and the prostate.
Dr Niederberger, thanks for your kind and interesting answer.
hi doc, I read that Anastrazole is sometimes used if clomid causes estrogen levels to be too high.
What are some possible problems that could happen if Clomid and Anastrazole are used together?
Please read my other posts, the comments, and the FAQ.
The reason i ask is because my endocrinologist put me on 25mg of clomid and in one month my testosterone went from 90 to 580 and sperm count and motility improved significantly as well. My only concern is that my estradol level increased from 11 to 32, which i was told was still in the normal range just in the higher range. Im hesitant about going off the clomid completely and going on anastrazole. My endocrinologist said a small dose of anastrazole every other day along with the 25mg of clomid shouldnt be a problem but im second guessing this option. Have you personally seen any problems with this?
Danny, I’m sorry, but I can’t answer personal questions about your own health. Please read the FAQ.
After clomid is discontinued, will an individuals testosterone remain at the same level, or will it drop back down to where it was?
Typically it returns to previous levels. Read through the other comments–I answer this more than once
Greetings,
I understand how clomid works in men while they are taking it. Is there any evidence or studies that have shown it to keep T levels at a higher level after the dosage has stopped?
Typically testosterone returns to previous levels. Read through the other comments–I answer this more than once
what is the difference between clomid and nolvadex ? i heard that nolvadex is better at preventing gyno, is that true?
Nolvadex is tamxoifen, and works in a similar way as Clomid. There’s just more data on Clomid so far in men. I’m assuming that “gyno” means gynecomastia in men. To my knowledge, there aren’t any controlled studies showing that one ore the other is better in preventing that side effect. If the estrogen becomes too elevated, other drugs, like anastrozole, can be used instead.
All Hormones are in the normal range but sperm count Zero and some time shows very very sperms (2) , My Doc write prescription for me:
-choriomon 5000iui Injection per week for 3 months
- Clomid One tab for 3 months.
Is that right to increase sperm counts >>>>I need your advise
I’m sorry, Bahraimi, but I can’t answer personal questions about your own health. Please read the FAQ.
Thanks Doc…. i would like to know one thing Doc ! Plz Is it oky to use both at the same time. I General Question .
Read this blog’s posts and comments. It’s answered more than once.
Do you know of any studies on long term use of clomephene citrate (if used more than 10 years). If one gets occassional blurring of vision how can one know if it is caused by age or sideeffects of Clomephene citerate?
For the first, unfortunately, no. For the second, that man–as anyone experiencing any side effects with any medication–needs to see a doctor.
I keep reading how important it is to be monitored by a doctor while taking Clomid. Besides making sure T is going up, what other issues are doctors looking for? What would be possible negative effects?
You’ll want to read my other posts on this blog: they talk about side effects and how testosterone is turned into estradiol, all of which should be monitored by a physician. All men are different, and different people may experience unusual side effects.