From the Guidelines
For treating hypogonadism in men, enclomiphene (clomiphene) is typically prescribed at a starting dose of 25 mg taken orally every day or every other day. The dosage may be adjusted based on the patient's response, with some men requiring up to 50 mg daily. Treatment duration varies, but often continues for 3-6 months initially, with testosterone levels monitored every 2-4 weeks during the first few months to assess efficacy and adjust dosing as needed. Enclomiphene works by blocking estrogen receptors in the hypothalamus, which increases the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), ultimately stimulating the testes to produce more testosterone naturally. This medication is particularly beneficial for men who wish to preserve fertility, as it does not suppress sperm production like exogenous testosterone therapy. Patients should be aware that common side effects may include visual disturbances, headaches, and gastrointestinal discomfort. Regular monitoring of testosterone, estradiol, LH, and FSH levels is important during treatment to ensure appropriate response and minimize adverse effects, as noted in various studies 1. Key considerations in the management of hypogonadism include the evaluation of symptoms, measurement of testosterone levels, and assessment of the benefits and risks of treatment, including the potential impact on fertility and cardiovascular health. The choice of treatment, including the use of enclomiphene, should be individualized based on the patient's specific needs and circumstances. It is essential to follow the most recent and highest-quality guidelines for the management of hypogonadism, such as those provided by the American College of Physicians and the Endocrine Society, to ensure optimal patient outcomes. In clinical practice, the dosing of enclomiphene may vary, and the medication should be used under the guidance of a healthcare provider, with careful monitoring of the patient's response and adjustment of the treatment plan as needed. Overall, enclomiphene can be a valuable treatment option for men with hypogonadism, particularly those who wish to preserve fertility, and its use should be considered in the context of a comprehensive treatment plan that takes into account the patient's individual needs and circumstances.
From the Research
Enclomiphene Male Dosing
- The recommended dosing of enclomiphene for treating hypogonadism in men is not strictly established, but studies suggest various doses have been used effectively 2, 3, 4.
- A study published in BJU International in 2013 found that daily oral doses of enclomiphene citrate (6.25mg, 12.5mg, and 25mg) increased serum total testosterone levels and luteinizing hormone in men with secondary hypogonadism 2.
- Another study published in The Journal of Sexual Medicine in 2013 compared oral enclomiphene citrate to topical testosterone and found that enclomiphene citrate increased testosterone and sperm counts in men with low testosterone 3.
- The dosing of enclomiphene citrate used in this study was not specified, but it was noted that enclomiphene citrate consistently increased serum testosterone into the normal range and increased luteinizing hormone and follicle-stimulating hormone above the normal range 3.
- A review of the literature on enclomiphene citrate for the treatment of secondary male hypogonadism found that initial results support the conclusion that enclomiphene citrate increases serum testosterone levels by raising luteinizing hormone and follicle-stimulating hormone levels, without negatively impacting semen parameters 4.
Dosing Considerations
- The optimal dose of enclomiphene citrate for treating hypogonadism in men has not been established, but doses ranging from 6.25mg to 25mg per day have been used in clinical studies 2, 3.
- The duration of treatment with enclomiphene citrate can vary, but studies have shown that treatment for 3-6 months can be effective in increasing testosterone and sperm counts 3, 5.
- Enclomiphene citrate has been shown to be safe and effective for long-term treatment of hypogonadism, with few side effects reported 5, 6.
Clinical Studies
- A phase II study published in BJU International in 2013 found that enclomiphene citrate increased serum total testosterone levels and luteinizing hormone in men with secondary hypogonadism, with a mean concentration of total testosterone of 604 ± 160 ng/dL at the highest dose of 25mg per day 2.
- A phase IIB study published in The Journal of Sexual Medicine in 2013 found that enclomiphene citrate increased testosterone and sperm counts in men with low testosterone, with sperm concentrations in the 75-334 × 10(6) /mL range 3.
- A retrospective review published in The Journal of Urology in 2019 found that clomiphene citrate, which includes enclomiphene as an active ingredient, was safe and effective for long-term treatment of hypogonadism, with 88% of men achieving eugonadism and 77% reporting improved symptoms 5.