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Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 14-18

Clinical practice guidance for the use of clomiphene citrate in Male Hormone Replacement Therapy (HRT)

Senior Director, Health Economics & Outcomes Research, Risk Management Consulting, Oak Ridge, Tennessee, U.S.A

Correspondence Address:
Michael A. S Guth
116 Oklahoma Ave, Oak Ridge, TN, 37830-8604
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Source of Support: None, Conflict of Interest: None

DOI: 10.5530/ami.2015.1.4

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Introduction: Inhibition of pituitary gonadotropin secretion in men by testosterone (T) is principally mediated by aromatization to estrogen (E), which inhibits hypothalamic secretion of gonadotropin-releasing hormone (GnRH). Material and Methods: Longitudinal clinical investigation unit-based evaluation of the clinical and biochemical response to E-receptor blockade. Initial monotherapy with 50 mg of clomiphene citrate (CC) daily for a period of 9 months, with diurnal morning peak testosterone and luteinizing hormone (LH) levels evaluated at three-month intervals thereafter. The patient then resumed hormone replacement therapy (HRT) using T cream with adjuvant CC therapy. Main Outcome Measures were Baseline and stimulated T and LH levels; effect on sexual function. Result(S): CC therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. Conclusion(S): Isolated hypogonadotropic hypogonadism (IHH) 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. Reversal of gonadotropin deficiency with CC was found to have a similar biological effect.

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