Clomid and Testosterone

Sometimes the best offense is a good defense.  The applies to the world of hormones at times as well. For example, the most obvious way to solve low testosterone, or hypogonadism, is to add testosterone, right? Well, there's another way:  add an anti-estrogen such as Clomid (clomiphene citrate) instead. In other words, lower estrogen and you'll naturally get more testosterone due to the body's feedback mechanisms.

Actually, it's a little more complicated than that because Clomid is actually a SERM, which means that it will in some tissues act as an estrogen and in others block estrogen. However, the bottom line is that in males it generally works its hormonal magic by blocking or inhibiting estrogen at the hypothalamus which, in turn, stimulates GnRH and, further downstream, LH (leutinizing hormone) in the pituitary.  Males can see their low testosterone levels double or more, especially if you have secondary hypogonadism.

Some decent research and years of clinical practice have born this out. For example, one study put 36 men with average total testosterone of 248 ng/dl on 25 mg/day of Clomid and after 4-6 weeks the men's average testosterone was a hefty 610 ng/dl. [1] This is a nice boost indeed, especially for what is considered a relatively low dose of Clomid.  The authors also point out that the all-important testosterone to estrogen ratio was raised from 8.7 to 14.2.

We have had a couple of Peak Testosterone Forum member who were enthusiastic Clomid users.  Look at what this guy wrote:

"Yep, seems like i 'passed' the Clomid challenge. February i had a reading of total T at 270 ng/dl. Today's results, after 5 1/2 weeks on Clomid: 627 ng/dl!! Wow, so that was really good news..." [3]

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Clomid also has certain advantages over standard testosterone therapy.  HRT requires shots or topicals that require time and potential risks for family members.  It's nice just to take a simple pill, eh?

So how safe is this convenient Clomid?  In the short term, Clomid seems quite safe and that is one reason that some doctors are increasingly prescribing it for hypogonadism. Clomid has been taken for years by males as a fertility treatment due to its FSH-stimulating powers. So it has a reasonable track record considering that it has been out for awhile.

One other crowd that has used Clomid for an extended period of time are steroid users and certain athletes.  Steroid users will use Clomid during their cycles to maximize testosterone and minimize estrogen, a common side effect of steroid abuse.  It is also used commonly upon completion of a steroid cycle to "jump start" testosterone.  Often testosterone will collapse after steroid use and Clomid is the only thing that will bring back testosterone and estrogen within normal physiological ranges.  This was documented when one study discussed Clomid's effective use to do just this with a "steroid abuser". [2]

The bottom line is that Clomid has been used extensively by several off label and even non-legal users and all have found it to be reasonably well-tolerated with low side effects for short term use.  NOTE:  Clomid does not always work.  For reasons not really understood, Clomid will have a negligible effect with some patients.

CAUTION:  Many men now want to use Clomid long term.  Talk to your doctor, but I think this is unwise for a variety of reasons that I go into detail about in my link on Your Risks with Long Term Clomid Usage.  Below I give a quick summary, though, of the issues involved:

1) Vision.  A surprisingly common side effect of Clomid is blurred vision.  Is this drug doing some kind of subtle long term damage within the eye that we do not understand yet?  We just don't know.  However, cases of spontaneous retinal thrombosis (clotting), spasms and detachment have been reported.  This is such a potentially major long term issue that I have created a page called Clomid and the Risk to Your Long Term Vision. on the subject.

2) Moodiness and Estrogen. Clomid is actually estrogenic in some cases and  moodiness and mood swings are fairly commonly reported.  The bottom line is that Clomid's effects are poorly understood and likely vary from individual to individual.

3) Thyroid.  Some of Clomid's common side effects match up quite well with those encountered during various thyroid issues.  This has some wondering if Clomid does subtely affect thyroid function in some way.

4) Nausea.  This is a very common side effect with Clomid.  Again, one can't help but ask what it is doing long term.  Subtle changes in inflammation, pH, etc. can have long term consequences in gastrointestinal land.

5) Peripheral Neuropathy and Paresthesia.  One commonly reported side effect of clomid are the symptoms of nerve damage, such as tingling, numbness, burning, itsching, etc.  This usually discontinues several months after stopping the drug, but one can't help but wonder how much damage has been done. 

REFERENCES:

1) J Sex Med, 2005 Sep, 2(5):716-21, "Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadism"

2) Fertility and Sterility, Jan 2003, 79(1):203-205, "Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse"

3) http://peaktestosterone.com/forum/index.php?topic=229.msg2032#msg2032