Many young and aging men suffer from low testosterone levels. This results in low sperm counts, which directly influence male fertility.
Although it sounds logical to treat this condition with testosterone replacement therapies (to raise the numbers), this will only lead to more significant fertility problems since one of the primary side effects of testosterone replacement therapies is infertility caused by a considerable reduction of sperm.
In the brain, the pituitary gland directs testicular function by producing LH (luteinizing hormone) to stimulate testicular testosterone production and FSH (follicle-stimulating hormone) to stimulate sperm production. When there are high testosterone levels, this gland stops sending the order to the testicles to produce testosterone, directly affecting sperm production.
So for men with low testosterone levels but who wish to conceive, there are other therapies to treat both situations. Clomid, also known as clomiphene, is a fertility-preserving alternative to testosterone replacement therapy. Clomid binds to receptors in the brain in both men and women to increase FSH and LH production. Recalling that, in men, FSH leads to an increase in sperm production, and LH leads to a rise in testosterone production.
What is Clomid?
Clomid is clomiphene citrate. It is a non-steroidal fertility drug.
How does it work?
Clomid blocks the interaction of estrogen with the pituitary gland and causes an increase in FSH and LH secretion. This leads to an increase in both sperm production and testosterone secretion.
When estrogen interacts with the pituitary gland, less LH and FSH are produced, leading to a decrease in testosterone and thus a decrease in sperm production. Because Clomid blocks the interaction of estrogen with the pituitary gland, we can use it for male infertility.
They initially developed Clomid to promote female fertility by increasing ovulation.
The result in men is a modest improvement in testosterone levels while preserving sperm production. We can achieve a 100% increase in T levels with Clomid. Sometimes, an increase of up to 200% can be seen. This increase is not as high as that of pellets or injections, but it can make a big difference depending on how low it is.
Does it work?
Multiple studies and trials show this option’s efficacy, regulating testosterone levels while preserving fertility.
An example is the ongoing studies conducted by the Texas Fertility Center over the years. One study involved administering Clomid 25 mg/day to men with low FSH, LH, and testosterone levels for at least 110 days.
That study showed significant increases in FSH, LH, and testosterone levels. In addition, an important finding was observed, the average sperm concentration increased from 15.2 million/mL to 62.8 million/mL; sperm motility also increased significantly.
Another gratifying finding was that an important percentage of men studied were planning, together with their partner, to undergo other fertility and conception methods such as in vitro fertilization (IVF), and with Clomid 58.3% were able to conceive without IVF due to the tremendous increase in sperm quality that we achieved with Clomid.
Another recent study focused on evaluating the administration of Clomid and vitamin E, showing an increase in pregnancies in infertile men compared to placebo.
Also, in a third 2015 study, researchers divided participants diagnosed with male infertility into three groups:
- Group A: Participants taking only vitamin E.
- Group B: Participants taking Clomid alone.
- Group C: Participants taking both Clomid and vitamin E.
The result was an increase in the average concentration of spermatozoa that stood out in group C (a more significant increase).
Another recent review suggested that the population most likely to benefit from Clomid treatment are men with unexplained infertility and normal or below average sperm motility and shape.
Finally, it is concluded that using Clomid in men with low sperm count and testosterone hormone levels is favorable for treating both problems. Clomid is now a well-accepted treatment for many men with male factor infertility.
Who can take it?
- Patients with low testosterone levels are young men who plan to have children soon.
- Patients who do not want to deal with an injection or pellet therapy will accept a lower testosterone level.
- Patients who have been on TRT and have had children but want to maintain some increase in testosterone levels.
- Men with low sperm counts.
- Patients with varicocele (a problem with the blood vessel around the testicles can cause infertility).
How to take it?
The treating physician should always show dosages and modes of administration according to the needs of each patient. However, there are standard roses that were obtained because of several studies: an initial dose of 25 mg three days a week and then slowly adjusting until the quantity is 50 mg per day as needed.
We should never forget that, although this drug can be administered to both women and men, the mode of administration is different. For women, it is based on the menstrual cycle, while men need to take Clomid every day because sperm production occurs daily.
The typical starting dose for a man is 25 mg of Clomid, or half a pill, every day.
Other specialists manage a standard dosage ranging from 12.5 mg to 50 mg per day. Variations always depend on the patient and their response to treatment. Usually, the increase in medication is done gradually based on side effects, laboratory results, and an overall improvement in the “T-effect.”
As mentioned above, some doctors recommend taking vitamin E to enhance the success of Clomid.
How long does it take to see results?
The average time ranges from 90 to 120 days or 3 to 4 months to see optimal results. However, improvement of testosterone deficiency symptoms can start earlier.
This time is because it takes 90 to 108 days from the time sperm is produced in the testicles until ejaculation, so it takes time for a man to see results from Clomid. A standard time of 4 months is proposed to see improvement.
- Clomid stimulates the body’s testosterone production.
- It is easy to adhere to therapy because Clomid is a pill that is taken daily.
- Being a generic drug, it is affordable.
- It does not interfere with the body’s testosterone checks and balances.
- It preserves male fertility.
- There is no testicular shrinkage as an adverse effect.
- It has few side effects usually associated with the dose.
- Increasing T levels can produce the same or similar effects as traditional TRT.
The disadvantages of Comid are few, among the most important of which are:
- In patients with shallow testosterone levels and very marked symptoms, it takes longer to see the benefits of Clomid, unlike intramuscular testosterone injection therapy.
- It may be ineffective in patients over 60, so it is more appropriate for younger patients who wish to preserve their fertility.
- Some patients may not see an increase in libido and sexual desire.
Among the most described are:
- Pectoral muscle tenderness.
- Vision disturbances are caused by inflammation of the pituitary gland (rare).
Who should not take it?
Clomid is contraindicated in patients with prostate cancer as it may speed up its growth.
One of the first choices in fertility-preserving drugs will always be Clomid. Clomid is ideal for young men with testosterone deficiency who wish to have children, and the evidence shows that it is possible. Clomid not only preserves fertility but also helps improve testosterone levels by promoting testosterone production, improving the symptoms of other men with testosterone deficiency.
We should not forget that if you were already on testosterone therapy and now wish to conceive, Clomid is also an option for you. With your doctor, you can make the switch from one therapy to another, and you can enjoy the benefits that this drug offers.
At HRT Doctors Group Clinic, our team of experts specializes in TRT and Clomid. Don’t wait any longer, schedule your consultation today and take the first step towards becoming a parent!
Dr. Jenell Ruth Decker
Dr. Decker graduated from the Marshall University Joan C Edwards School of Medicine at Marshall University in 1996. She works in Pullman, WA and 3 other locations and specializes in Family Medicine. Dr. Decker is affiliated with Pullman Regional Hospital.
Education & Training
- Vidant Medical Center/East Carolina University Vidant Medical Center/East Carolina University – Internship, Family Medicine, 1997 – 1999
- Marshall University School of Medicine Marshall University School of Medicine – Internship, Transitional Year, 1996 – 1997
- Marshall University Joan C. Edwards School of Medicine – Class of 1996