Is Clomiphene Safe?

January 27th, 2013 § 20 comments

As I’ve written in earlier posts, clomiphene is a medication that a doctor can use to increase a man’s production of testosterone in his own body. (I’ve also written about how doctors can prescribe it. If you think that you’d benefit from this medication, you should see a doctor. I can’t answer personal questions about a man’s health on this blog. Medical care is always done best in person.) But clomiphene is “off-label” for use by men and didn’t go through the rigorous series of studies that the FDA mandates for a drug for a particular use.

One good question is whether clomiphene is safe for long term use by men. John Mulhall, a great doctor in New York, recently published a report in the British Journal of Urology studying the use of clomiphene for up to three years in 46 men diagnosed with low testosterone. Blood testosterone, bone scans, and symptom scores all improved, and men did not report problems with the medication.

There are limitations to this study. It wasn’t controlled, meaning that there wasn’t a group of men treated with a placebo, or sugar pill. 46 isn’t a lot of men, and three years isn’t really a very long time. But this kind of study is what needs to be done with more men and for a longer time to really determine the safety of clomiphene for long term use in men.

Clomid surely has its advantages compared to testosterone for use in men with low testosterone. It’s a pill, and other treatments are either shots or cumbersome skin applications. It also saves sperm, as testosterone itself reduces sperm production. But information about its use is less than that of testosterone, which puts men and their doctors in a kind of Catch-22. Mulhall and colleagues are to be commended for expanding what we know of the safety of this medication.

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§ 20 Responses to Is Clomiphene Safe?"

  • Phil says:

    Recently, I’ve read on Clomid use for men. Do you know of any non-prescription alternatives, either OTC or natural, that also act as an anti-oestrogen? I’m not in the medical field but from what I’ve gathered, Clomid blocks the oestrogen receptors in the hypothalamus which counteracts the negative feedback loop in the HPG axis and results in continued production of GnRH in the hypothalamus and LH & FSH in the pituitary gland. Additionally, although slightly off topic, what are your thoughts on aromatase inhibitors as a method to decrease the conversion to estradiol? Thanks.
    -Phil

    • maledoc says:

      Welcome, Phil! I’ve written a lot about how clomid works and alternatives. Just put “clomid” in the search box in the upper right corner, or click on “clomid” or “clomiphene” in the word cloud on the lower right hand side of this page. Don’t forget to read the comments: there’s a lot of extra information in there, too. Enjoy!

      • Phil says:

        Doc,

        Two things:

        1) I’ve skimmed through all 700+ comments from “How Clomid Works” and did not find anyting on non-prescription Clomid alternatives. I will re-read this and other articles, but I do not recall reading anyting about OTC or natural alternatives.

        2) Would it be possible to add “aromatase” to the word cloud?

        Thanks!

        • maledoc says:

          Sorry, Phil, I thought that you were asking about alternatives in general. In terms of non-pharmaceutical alternatives, I’m not aware of well investigated ones. Unfortunately, nutraceuticals nowadays can make all sorts of claims without being verified. As for the word cloud, it’s automatically populated :) Thanks for reading and commenting!

  • Erica says:

    I have been browsing your site. 1. Thank you for writing such an informative blog. It is difficult to find good information from a professional and not just your average joe who has a passion, but may not be the best educated on a subject. 2. After some searching, I do not see a place where you have previously addressed the interaction of clomid and weight gain in men. Clomid supresses the absorbtion of estridiol in the pitutary gland, but as a result the body produces an increased amount of estridiol. If there is already obesity, and fat holds/contains more estrogen, how does the even higher estridol levels effect weight loss/gain?

    • maledoc says:

      Hi Erica, if estradiol increases too much, that’s a reason for a doctor to prescribe another drug. A lot of men report increasing weight while taking clomiphene due to increasing muscle mass and increasing appetite. Sometimes the appetite exceeds the muscle, and fat gets added.

  • Dave says:

    Doc, thank you so much for this blog. My doctor prescribed Clomid for me and I was extremely skeptical at first (b/c/o it’s traditional use w/ women). Your blog was fantastic in helping me understand what it does & why it can work.

    Quick question though: after almost doubling my testosterone count (low 200s to low 400s) in the FIRST month, the testosterone count leveled off in the 2nd month, only increasing 5%.

    I know you can’t provide medical advice on the blog. However, I’m wondering if “plateaus” are common, based on your experience. And if so, is there typically an increase after the plateau?

    • maledoc says:

      Thanks for the nice words, Dave. Unfotunately, I can’t answer personal questions about your own health, and the question is one even if asked generally. Good to hear that you’re under the care of a good doctor.

  • Andy says:

    Hi, I have a question regarding healthy males that have a lowish testosterone level for their age (320-380 and late 30′s – early 40′s) who would want to increase their libido.
    Can clomid in small doses (25mg) and maybe once or twice a week work as a very gentle way of achieving this?
    If so, could this dosage/frequency be used continually or would there be any benefits to cycling?
    Thanks for your time
    Andy

    • maledoc says:

      Hi Andy, I would urge such a man to see a doctor who can do more extensive testing and prescribe whatever medication is required, as all men with those characteristics are different. Cycling doesn’t make sense from a physiological or biological viewpoint. I think I’ve mentioned that in the comments previously, and I’d encourage you to read my posts on how clomid works in a male. It’s similar in many ways to how it works in a woman, but with significant differences. Men don’t have periods.

  • Will says:

    Have you read any studies tracking Clomid use on infertile men who are trying to conceive? I have seen testimonials from people who have experienced increased testosterone levels and higher sperm counts … yet I haven’t seen a case where a man had low a sperm count, underwent Clomid treatment, and was able to successfully conceive without IUI or IVF.

    • maledoc says:

      Hi Will, there are definitely reports in the scientific literature, ours included. It also depends on how low the counts are. For example, going from no sperm whatsoever to enough sperm to avoid in vitro fertilization or intrauterine insemination happens, but it’s not frequent.

  • Harry says:

    Hello Doc

    Does clomid cause hair loss? Any insight on this possible side-effect?

  • Thercio says:

    Hello Doc,

    What is your take on using GnRH analogues, such as Triptorelin, in a single and very small dose to stimulate the pituitary gland to increase LH release and thus increase T levels ?

    • maledoc says:

      Hi Thercio, the problem with using GnRH analogs in the male is that they’ve been well studied in the male to deplete pituitary hormones for diseases such as prostate cancer but not for that low dose that would presumably sustainably maintain pituitary hormones. So we don’t know at this time how to dose those drugs with the intent to maintain or increase pituitary hormones instead of knocking them out.

  • Thercio says:

    Also,

    Which one is more effective in increasing LH production, clomiphene or tamoxifen ?

    Thanks !

    • maledoc says:

      Hi Thercio, I’m pretty sure that I’ve answered that question before: read through the other posts and especially the comments, as you might find useful information in there. The bottom line is that there have been more studies with clomiphene, but for an individual man, it’s impossible to say. That’s a good reason why a man needs to see his doctor to have the drugs prescribed and monitored.

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