From the Guidelines
Clomid (clomiphene citrate) may be prescribed to men primarily for treating male infertility caused by low testosterone levels or low sperm counts, particularly in cases of hypogonadotropic hypogonadism (HH) or idiopathic infertility. The typical dosage ranges from 25-50mg daily or every other day for 3-6 months, as suggested by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) guidelines 1. Men might use Clomid when they have hypogonadism (low testosterone) but wish to preserve fertility, as traditional testosterone replacement therapy can suppress sperm production. Clomid works by blocking estrogen receptors in the brain, which tricks the body into producing more luteinizing hormone and follicle-stimulating hormone, ultimately increasing natural testosterone production and sperm count 2.
Some key points to consider when prescribing Clomid to men include:
- The medication may also be prescribed off-label for men recovering from anabolic steroid use to help restore natural hormone production.
- Side effects can include visual disturbances, mood changes, and rarely, gynecomastia (breast tissue development).
- Before starting Clomid, men should have hormone levels tested and discuss with their doctor whether this medication is appropriate for their specific situation, as other treatments might be more suitable depending on the underlying cause of infertility or low testosterone.
- The benefits of Clomid administration, particularly in the patient population with idiopathic infertility, are small and may be outweighed by the distinct advantages offered by other forms of medically-assisted reproduction (eg, IVF), which include higher pregnancy rates and efficiencies with respect to the earlier timeframe of conception 2.
It is essential to note that Clomid is not currently FDA-approved for use in men, and its use is based on expert opinion and clinical experience 1, 2. Additionally, the cost-to-benefit ratio of this treatment is questionable, as men are typically treated for 3 months or more to effect spermatogenesis, and the incremental increase in pregnancy rates using Clomid injection therapy for this subset of men with idiopathic infertility is small 2.
From the FDA Drug Label
There are no adequate or well-controlled studies that demonstrate the effectiveness of clomiphene citrate in the treatment of male infertility. In addition, testicular tumors and gynecomastia have been reported in males using clomiphene The FDA drug label does not answer the question.
From the Research
When to Use Clomid
A male may use Clomid in the following situations:
- Hypogonadism: Clomid can be used to treat hypogonadism, a condition where the testes do not produce enough testosterone 3, 4, 5, 6, 7.
- Fertility preservation: Clomid is particularly useful for men who want to preserve their fertility, as it does not suppress the hypothalamic-pituitary-gonadal axis like testosterone replacement therapy does 3, 6.
- Alternative to testosterone replacement therapy: Clomid can be used as an alternative to testosterone replacement therapy, especially for men who are interested in preserving their fertility or who have concerns about the side effects of testosterone therapy 4, 7.
Benefits of Clomid
The benefits of using Clomid include:
- Increased testosterone production: Clomid can increase testosterone production and serum levels 4, 5, 7.
- Preservation of fertility: Clomid can help preserve fertility in men with hypogonadism 3, 6.
- Few side effects: Clomid has been shown to have few side effects, making it a safe and well-tolerated treatment option 4, 5, 6, 7.
- Lower cost: Clomid may be a more cost-effective treatment option compared to testosterone replacement therapy 7.
Situations Where Clomid May Not Be the First Choice
Clomid may not be the first choice for treatment in the following situations:
- Men who do not desire fertility preservation: Testosterone replacement therapy may be a more suitable option for men who do not want to preserve their fertility 4.
- Men with certain medical conditions: Clomid may not be suitable for men with certain medical conditions, such as liver or kidney disease, or men who are taking certain medications 6.