More than 13.1 million men in the United States are diagnosed with hypogonadism, or low testosterone, annually. A great number of these men are not done having children. Traditional testosterone replacement, giving the man’s body testosterone by means of gels, shots, or pellets under the skin; is a perfectly reasonable treatment for hypogonadism, ONCE A MAN IS DONE HAVING CHILDREN. The issue is, when a man is given testosterone replacement, his body thinks he made that testosterone and in turn, the signaling hormones telling the testicles to work, think they are already doing a great job and they turn off, decreasing testicular function. If the majority of men on testosterone replacement have a semen analysis done, it would reveal no sperm or very low sperm counts. If a man is on testosterone replacement for a significant period of time and then decides he is ready to build his family and comes off of testosterone, the majority of men will rebound to some level of sperm production 3 months later, but perhaps not to the level where they first started before taking testosterone. The bigger concern is, there is a smaller percentage of men, who’s sperm count remains at zero after stopping testosterone which poses a much larger challenge to that couples fertility.
Clomid Citrate has long been used as an off-label means to increase testicular testosterone production in a way that is fertility preserving and not detrimental for sperm production. This has been proven to be an effective treatment in a number of studies over the years and it is used very commonly clinically. Dr. Parviz Kavoussi recently published a mutli-institutional study in which he collaborated with the Urology Department at the University of Virginia to further investigate the safety of use of Clomphene Citrate in men. One of the most concerning potential side effects of giving a man direct testosterone replacement is the risk of polycythemia, increasing red blood cell production in blood vessels, which can come with certain risks. Dr. Kavoussi performed a study comparing men on Clomid Citrate with men on testosterone replacement and found similar rises in testosterone levels with the use of Clomid Citrate when compared to testosterone, however, there was no significant risk of polycythemia in men treated with Clomid Citrate when compared to testosterone replacement. Dr. Kavoussi states, “We were very excited with our findings. We see that we can get testosterone levels just as high with Clomid Citrate as we can with direct testosterone replacement, while helping men on treatment maintain fertility potential, and this is the first study that has proven that there is not a significant risk of polycythemia on Clomid Citrate, unlike with the treatment with direct testosterone replacement.” This is further reassurance that Clomid Citrate is an excellent option to treat hypogonadism in men who want to maintain the ability to father children.
To read more about the study published by Dr. Kavoussi in the Journal of Urology go to http://www.jurology.com/article/S0022-5347(16)31612-3/abstract