In order to evaluate the effect of regulation induced by estradiol on the hypothalamic-pituitary-gonadal HPG axis, we studied the pulsatility of LH and FSH in two aromatase-deficient men called subject 1 and subject 2 , in which the production rate of estrogen both local and circulating is completely, or at least severely, impaired. Changes in seminal parameters, gonadotropin levels, serum testosterone, and pregnancy. The level of sex hormone binding globulin is suppressed. September 6, at 1: September 21, at 6: Supplemental Content Full text links. I had more interest in things as well I am not looking for a specific diagnosis, but has anyone ever had an experience with Testosterone not working?
Epub Aug Clomiphene citrate and testosterone gel replacement therapy for male hypogonadism: Taylor F, Levine L. The efficacy of oral clomiphene citrate CC in the treatment of male hypogonadism and male infertility MI with low serum testosterone and normal gonadotropin levels has been reported. The aim of this article is to evaluate CC and testosterone gel replacement therapy TGRT with regard to biochemical and clinical efficacy and cost.
Serum values were collected months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Average age years was 42 CC vs. Average follow up was 23 months CC, range months vs. Average pretreatment ADAM sexual function domain score was 0. There were no adverse events reported. CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT.
Cunningham and Shivani M. Toma Baylor College of Medicine and St. Enclomiphene, an estrogen receptor antagonist for the treatment of testosterone deficiency in men. Enclomiphene Androxal , in development by Repros Therapeutics Inc, is a non-steroidal estrogen receptor antagonist that promotes gonadotropin-dependent testosterone secretion by the testes.
Enclomiphene constitutes the trans-stereoisomer of clomiphene citrate, a drug that has been widely prescribed for several decades for the treatment of female ovulatory dysfunction. Because of the antagonistic effects of enclomiphene, the drug has the potential to increase serum testosterone levels in men with secondary hypogonadism by restoring physiological endogenous testosterone secretion while maintaining testicular volume and, potentially, spermatogenesis.
In clinical trials conducted to date, enclomiphene demonstrated significant efficacy in the physiological restoration of testosterone levels in males with secondary hypogonadism. Short-term clinical safety data for enclomiphene have been satisfactory and equivalent to safety data for testosterone gels and placebo. Enclomiphene demonstrates promise in the management of secondary hypogonadism associated with obesity, metabolic syndrome and, possibly, infertility, and should undergo placebo-controlled, randomized clinical trials for these indications.
Expert Opin Investig Drugs. Clomiphene citrate and enclomiphene for the treatment of hypogonadal androgen deficiency. Kaminetsky J, Hemani ML. Hypogonadism has a number of important clinical consequences related to androgen deficiency and impaired spermatogenesis. The cause of this condition is multifactorial and can result from hypothalamic, pituitary or gonadal dysfunction as well as factors that affect hormonal signaling along the hypothalamic-pituitary-gonadal axis.
While testosterone replacement is the most common treatment, it can paradoxically lead to infertility , and may be a less physiologic therapy for patients with secondary hypogonadism due to pituitary dysfunction. Clomiphene citrate, and its derivatives, may allow for restoration of gonadal function by restoring physiologic pituitary function in a subset of patients with hypogonadism. Complete reversal of adult-onset isolated hypogonadotropic hypogonadism with clomiphene citrate.
Inhibition of pituitary gonadotropin secretion in men by T is principally mediated by aromatization to estrogen E , which inhibits hypothalamic secretion of GnRH. We hypothesized that adult-onset isolated hypogonadotropic hypogonadism IHH might result from an altered central set-point for E-mediated negative feedback.
Longitudinal clinical investigation unit-based evaluation of the clinical and biochemical response to E-receptor blockade. A year-old man presenting with an month history of sexual dysfunction resulting from severe adult-onset IHH LH 1. Initial therapy with 50 mg of clomiphene citrate CC three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential.
On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect. Epub Sep Select patients with hypogonadotropic hypogonadism may respond to treatment with clomiphene citrate. To review the management of male hypogonadotropic hypogonadism HH and evaluate the efficacy of clomiphene citrate CC. Two university-based urology clinics. Ten patients referred for male infertility evaluation. Patients were treated with either clomiphene citrate or injectable gonadotropins.
Changes in seminal parameters, gonadotropin levels, serum testosterone, and pregnancy. Ten men who were evaluated for infertility were diagnosed with HH. Eight patients were azoospermic, and two were oligospermic on presentation. Semen parameters in this group also improved, and two of the three men achieved pregnancies with CC alone. Out of the ten men actively attempting conception, four pregnancies were achieved. Three pregnancies two with CC and one with gonadotropins were in men diagnosed with adult-onset idiopathic forms of HH.
Select patients with adult-onset idiopathic forms of HH may benefit from a trial of clomiphene citrate. Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse. Tan RS, Vasudevan D. To report a case of symptomatic hypogonadism induced by the abuse of multiple steroid preparations that was subsequently reversed by clomiphene. Clomiphene citrate, mg challenge for 5 days, followed by treatment at same dose for 2 months.
Reversal of symptoms, normalization of T levels with LH surge, restoration of pituitary-gonadal axis. Clomiphene citrate is used typically in helping to restore fertility in females. This represents the first case report of the successful use of clomiphene to restore T levels and the pituitary-gonadal axis in a male patient. The axis was previously shut off with multiple anabolic steroid abuse. Idiopathic hypogonadotropic hypogonadism in a male runner is reversed by clomiphene citrate.
To assess the efficacy of estrogen antagonist therapy on the function of the hypothalamic-pituitary-testicular axis in a young male runner with significant morbidity attributable to idiopathic hypogonadotropic hypogonadism. An uncontrolled case study. The outpatient endocrinology clinic of a university tertiary referral center. A year-old male who has run 50 to 90 miles per week since 15 years of age and who presented with a pelvic stress fracture, markedly decreased bone mineral density, and symptomatic hypogonadotropic hypogonadism.
Clomiphene citrate CC at doses up to 50 mg two times per day over a 5-month period. The patient experienced improved erectile function, increased testicular size and sexual hair growth, and an improved sense of well being. Exercise-induced hypogonadotropic hypogonadism exists as a clinical entity among male endurance athletes, and CC may provide a safe and effective treatment option for males with debilitating hypogonadism related to endurance exercise.
Symptomatic late-onset hypogonadism is associated not only with a decline in serum testosterone, but also with a rise in serum estradiol. These endocrine changes negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density. Currently, the most common treatment is exogenous testosterone therapy. This treatment can be associated with skin irritation, gynecomastia, nipple tenderness, testicular atrophy, and decline in sperm counts.
Each patient was treated with a daily dose of 25 mg clomiphene citrate and followed prospectively. Analysis of baseline and follow-up serum levels of testosterone and estradiol levels were performed. The mean age was 39 years, and the mean pretreatment testosterone and estrogen levels were By the first follow-up visit weeks , the mean testosterone level rose to There were no side effects reported by the patients.
This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway. Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses.
Although testosterone has a role in erections, its importance in erectile dysfunction ED has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate , but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use.
Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.
Impotence related to anabolic steroid use in a body builder. Response to clomiphene citrate. Anabolic steroid induced hypogonadism treated with human chorionic gonadotropin. A case is presented of a young competitive body-builder who abused anabolic steroid drugs and developed profound symptomatic hypogonadotrophic hypogonadism. With the help of prescribed testosterone Sustanon he stopped taking anabolic drugs, and later stopped Sustanon also.
Hypogonadism returned, but was successfully treated with weekly injections of human chorionic gonadotropin for three months. Testicular function remained normal thereafter on no treatment. The use of human chorionic gonadotropin should be considered in prolonged hypogonadotrophic hypogonadism due to anabolic steroid abuse. To observe the efficacy of human chorionic gonadotrophin hCG and hCG plus human menopausal gonadotropin HMG for central hypogonadism in male patients.
The testis volume enlarged significantly [ 3. If judged by the testis volume, 52 patients For male patients with the central hypogonadism, hCG and hCG plus HMG can promote the pubertal development and maturation of second sex characteristics, as well as enhance the physical strength; in some patients both androgen production and spermatogenesis can be achieved. Hormonlaboratoriet Aker sykehus, Oslo. We describe two case histories that highlight some of the endocrine effects of doping with androgenic anabolic steroids.
The main endocrine effect observed after use of androgenic anabolic steroids is the development of hypogonadotrope hypogonadism , characterized by low levels of gonadotrophins, suppression of testosterone production and azoospermia. If testosterone is used alone, or in combination with synthetic anabolic steroids, the circulating levels of testosterone are normal or high.
Oestrogen levels may be elevated owing to aromatization of testosterone. The level of sex hormone binding globulin is suppressed. These endocrine parameters are of practical use in evaluating patients misusing androgenic anabolic steroids. Epub Feb 8. Management of male hypogonadotrophic hypogonadism. Gonadal function was evaluated in 64 persons homozygous for the HLA-linked hemochromatosis allele. Of 41 men, 10 had reduced libido or impotence and 6 had testicular atrophy.
Before treatment, 5 men had below normal testosterone concentrations, 4 of whom also had low gonadotrophin levels. Four hypogonadal men were reevaluated after iron depletion treatment. In 2, 1 with primary and another with secondary hypogonadism, testosterone levels returned to normal after phlebotomy and were accompanied by a return of normal sexual function. Clomid for Male Infertility Clomid is typically taken once a day, with a staring dose of 25 mg per day.
However, the dosage often needs to be adjusted later on, as the individual response to the medication varies. It is essential to find a dosage that supports optimal hormone production, because too high testosterone levels can decrease sperm count and cause other serious side effects. Testosterone, LH and FSH levels are typically re-tested within a few weeks after the therapy is started, and the dosage of clomiphine citrate is adjusted accordingly.
Popular subjects covered include: Patients from over 30 countries visit Dr. Can it Cure Low Sperm Count? The conversation around infertility has evolved in the past decade as a growing… Read More. Five Male Fertility Goals for Do you have any fertility goals for this year? Taking care of fertility and… Read More.