Male Health

As I’ve written before in this blog, clomiphene is an effective if off-label treatment for men with low testosterone who want to preserve their fertility. If used directly, testosterone itself actually decreases the making of testosterone and sperm in a man’s testis. Clomiphene increases testosterone production in the testis by increasing the pituitary hormones that tell the testis to make testosterone.

In the March issue of Fertility and Sterility, a journal that I co-edit with Dr. Antonio Pellicer, Drs. Kim and co-authors review the published medical literature on treating low testosterone with clomiphene and other drugs besides testosterone. They conclude that clomiphene is a safe and effective treatment for men with low testosterone and note that less than one year of treatment with testosterone is usually reversible if a man wants his fertility to return. Unfortunately, we don’t know all that much about longer treatments with testosterone, and many men who have been on testosterone for several years do not have sperm return even with other forms of treatment.

Drs Kim and co-authors give us a nice review that supports the use of clomiphene for men with low testosterone who want to preserve their fertility.

While this isn’t specifically male health, I do write from time to time about important developments in reproductive medicine. Dr. Munire Akar from Aktinez University In Antalya Turkey reports in Fertility and Sterility the results of the world’s first human uterus transplant from a multiorgan donor. While transplant surgery has been around for a while and is a well accepted form of medical therapy, reproductive organs have come late to transplantation. This is undoubtedly the beginning of a new world for men and women previously unable to conceive for reasons of anatomy. If you’d like to hear Dr. Munire Akar talk about her work, click here. If you’d like to participate in a discussion on her article, click here.

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.

Most of the readers of this blog read it in a browser. Modern browsers are incredibly powerful and are literally computers within computers. Unfortunately, this means that the same kind of malware that haunts the operating system on which a browser runs can do the same in the browser.

Java, a computer language that was designed to run on different operating systems, was a natural fit for browsers. It also turns out to be a perfect way to introduce malware, so much so that the Department of Homeland Security recently recommended that it be disabled in your browser. How do you do that? Gizmodo has a great guide for all of the popular browsers. Check it out, and safe browsing!

Google is an amazing place. It seems like almost everything is there. A traditional way for doctors and scientists to search published studies is by using the National Library of Medicine’s PubMed site. I use it a lot, as it contains only peer-reviewed medical studies. Google has a similar resource called “Google Scholar.” I made a Google Scholar profile, and you can see what I’ve written there. Check it out!