How Clomid Works in Men

April 28th, 2010 § 934 comments

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.

LH testosterone.png

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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§ 934 Responses to How Clomid Works in Men"

  • From Paris, France says:

    Thank you for a very informative blog post.

    I come back the question, twice asked above, about your statement:
    “In my experience, most patients donโ€™t feel anything as their testosterone rises.”
    Please don’t send me back to earlier replies, as I am quite confused.

    Should one conclude that if the main problems are “sex drive/ energy / ED” one should consider TRT and NOT Clomiphene?

    I am seeing my physician who recommends TRT. I far prefer a less aggressive solution and I wish to inform him of the clinical information available in the US about the use of Clomiphene. (I am 63 years old.)

    One author claims that Clomiphene will not acoomplish the same results as TRT for “sex drive/ energy / ED”. Do you agree?

    Thank you for your time.

    • maledoc says:

      Hi Paris, France. Most men who are taking clomiphene for fertility don’t experience other effects. If it’s not for fertility, then raising a low testosterone may affect other symptoms. It also may not, depending on the source of the symptoms. Take tiredness, for example. A man could be tired because his testosterone is low. Or he could be tired because he just changed jobs and is working twenty hour days.

      • From Paris, France says:

        Quoting from A. Morgentaler. “Testosterone for Life”:

        These oral medications [Clomid and anastrozole] improve testosterone levels fairly reliably in younger men and often in older men, too. Curiously, though, some men may develop excellent T levels but notice no improvement in their symptoms. Yet when these men are switched to other forms of testosterone, such as gels, their symptoms respond well. It seems regular testosterone has a more reliably beneficial effect on the brain than these pills, despite good circulatory levels of T.
        ————–
        [Emphasis mine]

        Would you please care to comment on this observation?

        Thank you, in advance.

        • maledoc says:

          I haven’t observed a difference in response if the testosterone concentrations in the blood are similar from clomiphene or external testosterone. Of course, if a man is resistant to clomiphene, then external testosterone may yield a higher level of blood testosterone and provide a different response.

  • Chuck says:

    First, thank you. Authoring a blog such as this is a quiet and unsung form of heroism. Second, my apologies if this question has been answered before. I searched but did not find it asked or answered in this direct articulation. As a general matter, can Clomiphene be used to “kick-start” the production (or increased production) of testosterone and then discontinued, with the result of ongoing elevated levels, subject of course to other variables? In addition, could the supplementation of HCG or HGH positively affect the efficacy? Your thoughts are very much appreciated.

    • maledoc says:

      Thanks, Chuck. Typically testosterone levels fall after discontinuation of clomiphene, but I’ve had quite a few patients whose levels remain elevated. My general answer to mixing medications can be found in the FAQ: you just don’t know which ones are working and how to adjust their dosages.

  • UT says:

    Why not use Nolvadex or Arimidex, why Clomid? Less side effects.

    • maledoc says:

      I’ve written about that many times in the comments of this post, in other posts, and in their comments. You might find it helpful to read through more of this blog.

  • T says:

    Hi Doctor – have you had male patients who’ve felt their libido suffered on clomid even while their T levels rose? Wondering about a push-pull factor that might happen there.

    And if so, do you feel lowering the dosage (say, from 50mg every other day, to 25mg every other day) helps in some cases to alleviate the libido issue, while at the same time at least maintaining somewhat higher T levels?

    thanks.

    • maledoc says:

      Hi T, patients have had unusual responses to medication, and on occasion we’ve altered the dose. For unusual responses, there aren’t general rules on what to expect, especially for something as complex as libido. I’d encourage any man having an unusual response to any medication to discuss it with his doctor.

  • Randy says:

    Hi doc, do you know if the drug androxal will be FDA approved any time soon?

  • Randy says:

    Thanks doc, I ran across a great YouTube video by dr karlis ullis that supports a lot of what you explain in your blog.he mentioned the drug androxal is in the 3rd phase of being FDA approved so hopefully it’s not to far away.

  • Jerry says:

    Dr. Niederberger, Thanks for writing this blog. I see where (even in older men with diminished testosterone) Clomid causes the pituitary to produce more luteinizing hormone and thus more testosterone. Does this mechanism also cause more 5 alpha reductase to be made? Where is 5 alpha reductase made?

    Thanks again,
    Jerry

    • maledoc says:

      That’s a great question, Jerry. Testosterone itself doesn’t cause more 5 alpha reductase to be made. It’s made mostly in the hair follicles and prostate, and a little in the liver. (I talk a little about it in this post. You may want to read it and other posts on this blog.) The more testosterone, though, the more dihydrotestosterone, because 5 alpha reductase has more testosterone to convert.

  • ken says:

    When one takes clomid for increasing testosterone…for how long can one take it?
    Does one need a break once in a while?

    • maledoc says:

      Hi Ken, welcome to this blog! Please read the rest of the comments and other posts and their comments, and you’ll find that I’ve written that we don’t have data on long term use of clomiphene, and so men who are taking it should be under the care of a doctor who can monitor its effects. You’ll also find that unlike in the female, in the male its given continuously, and a lot of other good information.

  • Paul says:

    Hi Doc, Is hair loss a side effect, and if so can it be prevented?

  • Fabian says:

    In your article you said that two men experienced a side effect in which they developed breast tissue or gynecomastia. However can taking clomiphene reduce or completely minimize gynecomastia in someone who’s had in for a long period of time?

  • cameron cox says:

    After taking Clomid for the space of a few months, is it at all possible that it can help “rewire” the body into continually producing a desirable amount of testosterone, even long after ending usage of the medication?

    • maledoc says:

      Hi Cameron, welcome to my blog! You’ll find that answer and much, much more by reading through the comments of this post, my other posts, and their comments. Enjoy!

      • Shane says:

        Doc. You are rude. You spend more time telling people that its in the blog and to keep reading than it would to answer your question. Jerk…..

        • maledoc says:

          Sorry you feel that way, Shane. I put a lot of effort writing posts and responding to comments. I think it’s reasonable to ask people to read what I’ve written. They might even find interesting and useful information, too!

  • Simon says:

    Hi
    I understand that the half time of Clomid in the body is less than a week (assuming 50 mg per day). Is there any data about Clomid liver toxicity? How much of clomid gets stored in liver?
    Thanks,
    Simon

    • maledoc says:

      Clomiphene appears to be metabolized by the liver, so its metabolism is affected by liver disease. As with all drugs metabolized by the liver, there is a potential risk for liver toxicity. In clinical use liver toxicity is infrequent. All men taking clomiphene should be under the care of a physician who can monitor for any side effects or problems with the medication.

  • Hank says:

    As a meta comment: it would be very useful if you (or any other moderator) would remove/unpublish all comments/questions that are personal (and that you mark as such).

    That would probably take out 75% of the comments and leave the useful ones ๐Ÿ™‚

    You have made it clear enough in the FAQ (and can state it again in the last paragraph of every post) that personal questions/cases will not be answered, so I would not even publish them.

    • maledoc says:

      Thanks, Hank. My policy now is not to publish them at all. On starting the blog, I felt that it would be helpful if I reminded people about it in the FAQ, but now, you’re right, it shouldn’t be necessary. Hope you find the rest of it useful.

  • James says:

    How effective is clomid on a low sperm patient

    • maledoc says:

      Hi James, that’s what many of the posts on this blog are about. Read through them and you’ll find lots of answers. Don’t forget to read all the comments: they’re a great source of information, too.

  • joe says:

    You have written about how to prescribe Clomid. How do you prescribe anastrozole?

  • joe says:

    Doc,

    While in the topic of anastrozole, do you know of any long term effects of using anastrozole for a long time ?

    • maledoc says:

      Unfortunately, good long term studies are not available for anastrozole. Men should be under a doctor’s care while on it to monitor their individual responses and any problems that may arise.

  • BC says:

    I had heard that a male or female taking a product like “clomid” to inrease fertility/sperm count can have a negative affect on a child’s hormone levels later in life. They have a higher risk of suffering from a hormonal imbalance as a result of his/her parents supplementing with “clomid”. Can you speak to this? Thanks.

    • maledoc says:

      The question of whether clomiphene can cause birth defects is a good one. It’s unlikely that birth defects would be caused by a male taking the medication, but for a woman carrying an embryo, it’s possible but by no means definite. This study is a recent one investigating the possibility, and it’s worth noting its limitations.

  • AR says:

    Hi Doctor

    I attempted a “restart” recently with hcg/hmg approx 40 days ago. I just found out I will not be able to acquire the hmg which is quite expensive and this means that my restart protocol will have run approx 50 days.

    My protocol was stopping testosterone therapy a week before starting hcg/hmg. My goal is to produce viable sperm to have a child.

    500IU hCG EOD
    75-150IU hMG EOD

    I was planning on running this protocol at least 3-4 months since it takes approx 75 days to produce sperm. I’m forced to stop hMG at around day 50 but I can and will continue hCG.

    My question is… In your opinion, do you think a “restart” might of been initiated already at end of 50 days and that I could possibly be on my way to producing viable sperm. And… Can adding Clomid after day 50 help this cause or should I just leave it alone??? Any thoughts or opinions would be appreciated. Thank you.

  • PaulP says:

    Hi Dr,

    What is your experience been with young men taking Clomid (due to Low T) to boast their libido and ED issues. In your blog, you mention that most people dont feel anything, does that suggest Clomid may not be working well for them?

    • maledoc says:

      It’s really variable depending on the man. If the clomiphene results in an increase in testosterone into an adequate range as determined by a blood test, and the man is still having problems with libido, his problems with libido may be related to other issues rather than his hormonal system.

      • PaulP says:

        Thanks for the reply doctor. One more question though, I read in your blog that Clomid restricts estrogen levels, which increase LH and in turn, the testosterone. However, I see a lot of doctors prescribing Arimadex to control estrogen level, which seems contrary, as Clomid is already suppose to block E2. Was not able to understand the connection. Would be helpful to get your opinion on this.

  • Paulo says:

    Thank you for all the info doctor, but doesn’t the use of clomid raises LH and estradiol?
    If someone’s levels are high what would you do? Discontinuing use or changing the approach?

    • maledoc says:

      Hi Paulo, different men have different responses to any medication. A doctor will judge what the response is and make adjustments or change medication.

      • Paulo says:

        Well, the Doctor is not confortable with this line of treatment. He pulled me out of it and doesn’t want to replace Witt anything. I’m 30 and didn’t want to go on TRT replacement.
        What would my opitions be?
        Thank you so much for your help. All I need are guidelines.

  • Leigh Roberts says:

    Thanks for all the info doc, great resource here.

    I have a couple of questions purely out of curiosity as i’ve just begun my studies in this field. Thanks in advance if you can find the time to answer.

    1. If LH is already “high” prior to clomid treatment (high in your opinion anyway) does a lack of total T indicate an issue with Leydig cells? Are there remedies for any of the issues here. ( i think i have seen some data on viagra resulting in leydig cell repair)

    2. I’m interested in how cholesterol could play a role in high / low t. i.e. Do you think it reasonable to assume that low T could be causing an increase in cho as the body attempts to create addition substrate? Perhaps explaining the increase in cho as T lowers in ageing men? If plausible i would presume that clomid therapy might be associated with a cho decrease (all things being equal) as T levels rise

    3. Is it possible that lower LH could be caused by an issue “higher” in the cascade i.e. not enough GnRH, and would clomid have a “pull” effect in this regard?

    Ive also seen a case study where a “bodybuilders” T was restored with the use of Triptorelin. Any thoughts on this as an option?

    • maledoc says:

      Good questions, Leigh. Elevated LH generally means a problem with production of testosterone in the testes. As the body is taking care of itself, there’s not much that can be additionally done to stimulate the testes. (I’m sure that you can find lots of anecdotes, but the science isn’t there yet.) The cholesterol question is an interesting one. As there are so many steps between cholesterol and testosterone, many things can happen between. Other organs such as the adrenal and liver are involved in cholesterol metabolism. Lower GnRH appears to play a role in lower LH especially as men age. Good luck with your studies!

  • AAK says:

    Can we use Mesterolone, Vitamin-C and Vitamin-E with Clomid to increase sperm count and quality?

    • maledoc says:

      I’m sorry, AAK, but I can’t comment on personal questions about your own health. Please read the FAQ. There’s also a FAQ there on multiple medications.

  • Rj says:

    Hi Doc,
    Very interesting and useful blog.I want to ask few questions,
    May peoples use clomid as PCT after they are on cycle of anabolic steriods like Deca and sustanon(or both together) for bulking. How does the clomid really works for them?
    will it cure all the negative effects caused from steroids?
    will the loss of libido and less sperm count will be only cured till one use clomid?
    I also heard that Zinc and other vegetable metarials which includes zinc/iron/vitamins.(mainly zinc) can be useful in preventing blocking the effects of estrogen.
    Can Zinc suppliments be also suggested to restore T-levels and libido over Clomid to be on a safer side?
    I am asking all these things because 1 of my friend is on the cycle and I am worried about his health.
    Thanks in advance Doc.

    • maledoc says:

      Hi RJ, I’m not a fan of medical treatment for anything but treating a medical problem. I talk about using multiple medications in the FAQ. Read through the entire blog and the comments on the posts, and you’ll find that I’ve answered many of your questions.

  • Jon says:

    If a person has a high T level because of HRT; say 1300; would 30 days off HRT be long enough to lower test levels to a natural low in a 56 year old man? Would 30 days of no hrt be a good time to use Clomid to cause testies to start there own production in the body? This question if for male society as a mean or average cause and effect.

  • RMJ says:

    When tapering off clomid after 4 months at 12.5mg qd for low T (41y.o. Male) if side effects are aches, sensitivity to cold temperature and weakness is that a normal sign as the pituitary/hypothalamus axis begins to normalize or a sign that I’m headed back to low T levels?

  • KF says:

    Two questions. What is the suggested / typical taper regimen off of 180 days of clomid for low T? Also what percent of patients in your practice or experience fall back to prior T levels vs stay elevated? Thanks

  • Bgt says:

    Hi, my hubby had a vasectomy reversal done 2 years and we have still not fallen pregnant. His sperm count has improved but the doc says its still what they would class as low. Would his sperm count improve if he was taking 1/2 25mg tablet clomid daily?? This was suggested by our family friend but the doctor wouldn’t even consider it… Please help

  • computer_geek says:

    Hi doc,

    Good to see your blog is back up and running.

    What happened ?

  • Peter says:

    Hi Doctor,

    I started the Clomid last week (Tuesday, Thursday, Saturday – 1/2 pill). I have urinated very little today despite drinking about 50 ounces of water. I have also not had a bowel movement. Can Clomid cause these side effects.

    Thanks.

    Peter

  • Amir Timur says:

    Dear Doc,
    I have a sperm count of about 35 mill and want to get it up to 70 mill. I suspect I have enough testosterone(Hirsute, oily skin with pimples, well muscledetc). Would taking clomiphene help the sperm count? Would it take testosterone to problematic levels? Would discontinuing clomiphene then lead to a drop in T levels/Testicular function? Does it increase vulnerability to testicular cancer? I felt blurry vision and a sense of dazedness after my first dose of 25 mg today. Should I discontinue?
    Amir

  • malee says:

    Hi Dr.

    I am 36 years and not married and suffering from ED. these are my blood test results: fsh 0.84mIu/mL, Lh 2.42 mIu/mL, Prolactin 9.86 ng/ml, estradiol 52.74 pg/ml, testosterone 3.18ng/ml. the doctor has recommended the following drugs: andriol 40mg, clomiphen citrate, yohimbe. I am planning to start the dosage next wednesday 16 jan.

    the point is that i can’t do it, it is too weak. Any observations and reactions?

    I appreciate your response.

    malee

  • Dave says:

    Hi Doc,

    Ive read some horror stories from men using Clomid (Clomiphene), where they said they devolped extreme depression and/or anxiety while taking the drug. Have you ever heard of any such psychological side effects?

    Thanks!

    • maledoc says:

      Rare side effects can occur with any medication, and the only way to know for sure is for the medication to be discontinued. If the side effect goes away, then that’s evidence it may be due to the medication. It’s a big reason to always be under a doctor’s care with any medication, so if something unusual happens, the doctor can help.

  • Larry says:

    Hi Doctor,

    Has clomid been found to help with azoospermia?

  • Herk says:

    Doc, I have been hypogonadic for 15 years at least and used to be on oral T (methyl 10 mg BID) but it caused too many problems so I quit it. My symptoms are now so life altering I must do something but I cannot find a doctor willing to try me on Clomid. My provider is the VA and my primary is a former cardiac surgeon that does not believe in andropause, thinks I should grow old gracefully, claims testosterone is a sure fire cause of prostate cancer, and generally will not discuss the subject. I am assigned to this doctor and cannot simply choose to go to a different doctor.

    I did find a doc that had me on transdermal T from a formulating pharmacy and I did much better on that, but the blood tests they required to justify the use of a controlled substance just got prohibitive for my fixed income to absorb so I quit, now that doctor is retired. Both oral and transdermal T caused rages and hair loss though, the oral (from 1999-2000) cause acid reflux that was permanent, I am still on Omeprazole.

    To make matters more difficult I am about equidistant from Portland and San Francisco, quite remote so not a lot of physicians on the hoof here, it would be hard to see a doc in either region on a regular basis. Don’t trust Mexican pharma, Canada requires an American physicians’ script unless you go there and pick it up personally, then you have to smuggle it back. Why is it so damned hard to get treatment for obvious and easily remedied symptoms? I am not ready for the bingo hall and assisted living just yet. I will be 55 in May and weigh 165 at 6 feet tall. No chronic medical conditions, there is no reason men’s hormones should be treated like a criminal enterprise or for the government to be involved. Might I suggest we need a Roe v. Wade for men and their privacy regarding their relationship with their doctors?

    Thanks and I appreciate any suggestions.

    • maledoc says:

      Herk, I really feel for your predicament. (Unfortunately I can’t answer personal questions about your own health: see the FAQ.) We and a handful of other urology training programs are educating specialists in male reproductive medicine so that it’ll be easier in the future to find one nearby. But it’s a slow process that I’ve been at for twenty years!

      • Herk says:

        Thanks Doc, I was mostly venting and know you can’t do medicine over the net, but really, why is testosterone considered such a dangerous drug that a very few others like LSD are the only ones considered more dangerous on the drug classification scale? We stuff women with estrogen like it was Pez, mostly for the convenience of guys so they don’t have to worry about paternity or condoms, but a guy getting helped with endocrine imbalances from the medical community (which the AMA STILL does not require any courses in endocrinology in medical schools) is next to impossible, prohibitively expensive, and generally subjects guys to ridicule and condescension.

        I look forward to the day when I am in control of my body and it’s functions and the government has no part in that, doctors then can be trusted and respected advisors rather than paternal god-complex-know-it-alls (not you, my Doc at the VA) that think they can tell me what to do and how to live. I suppose my only realistic economical option is to buy Clomid from the trunk of some guys car and experiment on my own. Who knows what I will be buying, but if there is a thriving black market it is not my doing but the controls that assume we know least what we need or what is good for us. It is my body/life and I will make the decisions nobody else. Give me advice, not orders.

        • SJ says:

          You’ll still need a prescription, but you can get 15 generic clomiphene citrate (clomid) for $24 at a Target pharmacy. This is less than half the price of many standalone drugstores.

        • Michael Anderson says:

          I’m not a religious man but can I just say, Amen!

  • CRHII says:

    Sir,

    Has any link been found between testicular cancer and Clomid use? Are there any biological reasons that support the possibility of such a link?

    Thank you

    • maledoc says:

      Nothing compelling. However, keep in mind as I wrote in this post and others that clomiphene is off label for use in the male because studies like that haven’t been done. All men taking the medication should consequently do so under a doctor’s care.

  • dan len says:

    if there is a change in lh how does that affect thyroid and other glands. have you had any clients with diabetes and has that effected their care?

    • maledoc says:

      Dan, those are really good questions. Scientific evidence suggests that thyroid hormones play a role in the making of sperm, but it’s pretty uncommon to have thyroid problems be the sole reason for sperm factory problems. (It does happen.) Likewise, diabetes interacts with thyroid hormones, and might be a problem, but the biggest problem with diabetes and reproduction is that it causes problems with erections. Probably the best answer to your questions is that if there are problems with a man’s thyroid or if he has diabetes, then these problems should be treated for general health reasons, and fertility may benefit.

  • Joe says:

    Doctor Thanks for great Blog,

    Do you believe there is a correlation between topical corticosteroids used to treat skin conditions such as eczema negatively affecting testosterone levels?

    • maledoc says:

      Thanks, Joe. I don’t believe in general that there is a significant correlation between topical steroids and testosterone levels.

      • Trevor Smith says:

        Can SSRI anti depressants reduce testosterone levels?

        • maledoc says:

          That’s a really great question. There have been some limited data in humans and in basic science studies published that they might, but it doesn’t appear to be a common effect. That said, I’ve seen men where they seem to be related. It might be a very individual response to a specific SSRI for a particular man.

          • Trevor Smith says:

            Thanks. I have read articles suggesting SSRIs have some sort of influence on the pituitary gland. Is there any evidence to bear this theory out?

  • Jason W says:

    Clomid is very effective at raising testosterone in males without noticeable side effects, specially at low doses (<=25mg). The only issue I've noticed secondary to clomid usage is the sharp increase in SHBG that comes along with it which may be the reason that most males don't feel the way their lab numbers (high T) suggests they should.

    After using testosterone (cyp) for several years, I've noticed that I've developed metabolic issues, fatigue, and brain fog. Essentially, hypothyroidism and low cortisol (or as a result of low cortisol). This seems to be a significant trend among males on TRT.

    Doc, what are your thoughts on combining both an exogenous form of T along with low dose clomid to keep the pituitary "functioning" and providing the testes with stimulation via LH?

    LH analogues like HCG work well, but not necessarily as well as a sustained pulsatile release of LH from the pituitary of course.

    Considering that the LH and the testes are not only responsible for the production of testosterone but also p450scc activity it would seem that it's absolutely critical to keep the testes "active" for overall metabolic health.

    Without p450scc activity we're no longer effectively able to produce sufficient serum levels of pregnenolone (after 3 years on TRT all of my pregnenolone tests were at or below the range) which could very well be the reason for the fairly common metabolic and "adrenal fatigue" issues among males on TRT.

    I'm personally experimenting with this right now in hopes to avoid having to supplement my protocol with hydrocortisone.

    Would really like to hear your thoughts on it or any other thoughts you may have on the adrenal / metabolic issues that a lot of men on TRT end up facing.

    Hope this isn't an inappropriate place to post this question. Thanks for your time, Doc!
    -Jason

    • maledoc says:

      Hi Jason, there’s an entry in the FAQ about combining medications. The reference to “experimenting” is concerning, as any medical therapy is best done under a doctor’s care.

  • Alex says:

    In regard to sperm production, you mentioned that “weโ€™ve argued that 7.6 IU/L is a good threshold for FSH.” Does testosterone level come into play here as well or is an FSH level by itself a favorable indicator toward sperm production.

    Are there more favorable results when clomid is given to someone whose LH & FSH are low versus someone with normal levels?

    • maledoc says:

      Great questions, Alex. LH and FSH aren’t tightly coupled in the male as they are in the female. FSH levels will rise with clomiphene treatment, presumably as a result of overall pituitary stimulation, but that’s an effect of treatment. Regarding prescribing clomiphene for men with low FSH versus high FSH, the much more important factor is that man’s LH level.

  • Joe says:

    Doc, if clomid blocks estrogen at the pituitary, how does the possibility of gyno occur in a patient?

    • maledoc says:

      Hi Joe, if you mean gynecomastia, as testosterone levels rise, the enzyme aromatase turns testosterone into estradiol, and that can cause breast enlargement. It’s variable in different men, which is why it’s so important for a doctor to monitor an individual man’s response to clomiphene therapy. Check out my posts and comments on aromatase. (You can use the search box above.)

  • Trevor Smith says:

    Can clomid be as effective as traditional testosterone replacement therapy in men?

    • maledoc says:

      If you mean increasing testosterone levels to a natural normal range, yes, that’s exactly what it does. Both should be prescribed by a doctor so that any side effects can be detected and treated.

  • Laura says:

    Hi doc,

    I live in Italy and I found your site searching news about clomid side affects in men. My husband is taking clomid for infertility problems. But it seems to cause weigh loss (more or less 11 lbs in a month, that’s the more worrying effect), weakness, hands shaking, hot flashes and constipation.
    Do you think it’s possible?

    Thanks a lot.

    • maledoc says:

      Hi Laura, I’m sorry, but I can’t answer personal questions about your husband’s health. Please read the FAQ. If you’re anywhere near Bari, Ettore Caroppo is a world’s expert on male hormones. He’s written chapters in my books.

  • Laura says:

    Sorry doctor, i didn’t mean to ask personal questions nor to have diagnosis via web. I asked the question in the wrong way. What i meant to say is that If fda didn’t approve clomid in men, probably there aren’t sufficient researches on side effects. So it’s still possible that clomid causes unknown side effects like those i described.
    Anyway, we have a good doctor in Rome where we live.
    Many thanks

  • Mark says:

    I think it is interesting how the body has conserved the use of these hormones in the male and female – and tied them to similar systems. Of course, one would expect this since it is likely less complex and “cheaper” in an evolutionary sense.

    Anyway, to my questions. In the female body, if I recall correctly, LH and FSH follow a monthly cycle, which implies that their lifetime in the blood is relatively short. In a male, how long would elevated LH or FSH last if the clomid were discontinued? Would there be some sort of “crash” like PMS style symptoms?

    Second, it seems like there’s more and more incidence of low Testosterone being uncovered. I imagine a big part of it is that now we’re looking for it, but, while that is a legitimate answer, it seems too simplistic. Could an additional rise in low-T be attributed to an increase in environmental “phyto-estrogens” which, with relatively low efficiency, nevertheless do exert some pressure on the feedback system you target with Clomid? I mean, if there is an excess of exogenous estrogenic compounds, some of them might trick the pituitary into thinking that the real estrogen is too high, and down-regulate testosterone production. A small effect compounded over a long time can result in a big effect.

    Anyway, thank you for all your work on this. I enjoy your blog!

    • maledoc says:

      Great questions, Mark. From observation, most men return to their original hormonal levels after discontinuing treatment, but some actually improve. You’re absolutely right about the possible reasons for increasing incidence of low testosterone, from heightened public awareness to environmental effects. Niels Skakkebaek of Copenhagen has done some interesting work addressing the latter.

  • Frank says:

    Doc, I appreciate all the great info you provide. If clomid is successful in markedly increasing T levels, is that definitively an indication that the testes are normal at least so far as the ability to produce T? Also has clomid use been known to increase testicle size(volume)? Thanks again

    • maledoc says:

      If a man’s testosterone increases with clomiphene, then it means that the testosterone making machinery in the testis is intact. Testis volume is mostly sperm, so if the size of the testis increases, it often means that sperm production is increasing.

  • Swede-to-be says:

    Hey doc!
    So my man and I live in Sweden although I moved here from the USA(Chicago actually). I consider the Swedish care system to be quite primitive and close-minded. That’s what happens when mess are free. I am a nurse and I am well aware of off-label drugs and we have been looking into clomid for my man’s low testo levels (tested three times). We are on the verge of maybe getting testo gel for him but are also trying to conceive. I am reading everywhere about how any testo replacing therapy can cause infertility. That’s our only option here but we bought clomid ourselves. Can you tell me what your opinion is on testo gel and trying to conceive? And can you compare from experience between testo gel and clomid? Would you prescribe testo gel to a couple trying to conceive ( we told the doc here we are)? And what is the normal testo gel dosage prescribed in the USA for low testo? His testo in USA levels was 290 and here in Sweden was 7 once and 9 the other. I hope you don’t consider my questions to be to personal. I tried to stay general. Thanks much!

    • maledoc says:

      Hi, those are really personal questions ๐Ÿ™‚ I feel for your difficulty in finding a European doctor who specializes in male reproduction. For some reason, there aren’t as many in Europe as in the rest of the world. (Doctors who specialize in female reproduction in Europe are excellent and plentiful, and many are called upon to do male reproductive medicine by default. We’re trying to train doctors from Europe who will return and provide state-of-the-art care there, but as you can imagine, it’s a slow process.) Ettore Caroppo in Bari, Italy was trained here and does some of the best male reproductive hormonal doctoring in the world, but that’s a really long trek for you. All I can say is that the answer about the difference between testosterone as a therapy and clomiphene is definitely in this blog in more than one place. You can find it here as well as in other posts and comments. Good luck!

  • Chalie says:

    Hi doc: I am curious as to why most men on clomid “don’t feel anything as their testosterone rises.” In your estimation, is this an inherent difference between clomid-induced and natural testosterone, or rather the estrogenic effects of clomid on the brain?

    • maledoc says:

      Hi Chalie, keep in mind that was referring to clomiphene for male fertility. For men who are prescribed the medication for loss of libido and low testosterone, more feel a difference. It’s not 100%, but it’s greater.

  • Joe says:

    Hi Doc,
    Thanks for addressing this issue, it is hard to find reliable information on this topic. I have a few questions is was hoping you could answer.
    1. What effect does clomiphene or even exogenous testosterone have on platelet leves ( I know they can increase red blood counts, but I have had a hard time finding their effect on platelet levels.

    2. What effect would clomiphene/exog. T have on Psoriasis, I know corticosteroids have an effect on psoriasis, but I have been unable to find what effect if any anabolic sterioids or using clomiphene to increase a patient to normal testosterone levels would have on psoriasis.

    Thanks for the information.

    • maledoc says:

      Hi Joe, great questions. I think that you’re having a hard time finding reliable information on those associations is that they haven’t been systematically studied. There’s a little information on platelets and clomiphene in the female, but nothing in the male. I just checked again in the scientific literature, and there’s nothing there for either.

  • Iris says:

    Hi Dr. I wanted to know can the male and female take clomid at the same time to conceive.

    • maledoc says:

      It’s not infrequent that a woman is prescribed clomiphene for ovulation and a man for low testosterone at the same time while they’re trying to conceive.

  • Danny says:

    Do you think Clomid could potentially reduce the size of male breasts in relation to gynecomastia – considering it lowers estrogen levels? Why or why not?? Thank you for any information Doc. This blog is extremely helpful.

    • maledoc says:

      Thanks for the nice words, Danny. Clomiphene does not lower estrogen. In fact, as testosterone rises, the enzyme aromatase makes more estrogen. That’s why a doctor measures estradiol when a man is prescribed clomiphene to be sure that it doesn’t go too high.