Does This Medication Mean the End of Low T?

November 14, 2019

Testosterone levels in men normally slowly decline with age. Levels typically decrease by 1-2% each year beginning at the age of 40. However, testosterone may also drop quickly due to medical illnesses such as stroke, trauma, diabetes, liver disease, kidney disease, obesity, heart attacks or medications. Before any testosterone treatment is considered, a full health evaluation should always be conducted.

Studies suggest that men 50 years of age and older with low testosterone levels may be at higher risk of death within 20 years than men with normal levels of testosterone. Men with low testosterone had a 33% higher risk of death from any cause than men with normal testosterone levels regardless of age, physical activity, or lifestyle.

The takeaway message is that having low testosterone symptoms aren’t just about feeling crummy, having difficulty with erections, low libido, fatigue, mood changes, drops in energy in the afternoons, sleeping problems or difficulty maintaining muscle mass– it can also have an impact on your cardiovascular and bone health.

Choosing the Right Testosterone Treatment

Any type of testosterone treatment or therapy is lifelong. This means that in most cases, in order for low levels of testosterone to be increased, it is dependent on the medication that is taken throughout one’s life.

Traditionally, men diagnosed with low testosterone were started on testosterone replacement therapy (TRT or ART). This included injections, compounded creams, gels, and implantable slow-release pellets. However, it was found that there was an alternative to “replacing testosterone” which resulted in similar results but was a more “natural” method.

Along came Clomid (Clomiphene Citrate). Well studied and researched backed, it became the preferred initial treatment option for men diagnosed with low testosterone. And the best part was that it didn’t require being poked with a needle, drowning oneself in gels and creams or having to go into the urologist’s office every few months for implantable pellets.

Traditional testosterone replacement therapy, although produces good results, also has the downside of basically “turning off” the body’s memo to make testosterone– as it is artificially provided by the medication. This can result in testicular atrophy, fertility issues, acne, gynecomastia (breast enlargement), polycythemia (increased risk of blood clots) and a shutting off of the body’s natural system of producing its own testosterone.

Additionally, if a man using testosterone replacement therapy discontinued the medication, their levels of testosterone would immediately drop and their bodies would have to restart making its own testosterone. How long that may take and how long symptoms of low testosterone return until the body returns to its normal low levels is not definitive. The timeline is a guess and often dependent on how long testosterone replacement therapy has been in play. Clomid does not work this way.

What’s Different About Clomid?

Clomid has been around for quite some time. And most men, when initially prescribed will google the medication and find it used for women and fertility. So why is your doctor prescribing it for low testosterone? Clomid is used (off label) to help increase a man’s testosterone levels more “naturally.”

Clomid is a different approach to increase testosterone and fertility in men. In men, Clomid works by stimulating the body’s own production of testosterone, effectively helping signal the testes to produce testosterone and thereby increase testosterone levels (assuming the cause of the initial problem is not in the testes’ ability to make testosterone).

To explore this in-depth, get your science book back out because we are about to go to school. The endocrine system comes into play, which can seem slightly complex. It’s called the hypothalamic-pituitary-testicular axis.

In men with normal levels of testosterone, the pituitary gland in the brain releases luteinizing hormone (LH) into the bloodstream. LH signals the testes to “go go go” and produce testosterone. Once testosterone has been produced it naturally converts to some estrogen. Estrogen acts as a “stop stop stop” signal to the pituitary telling it to cease making LH.

What Does Clomid Do?

Clomid works by blocking estrogen at the pituitary and hypothalamus. So, with Clomid on board, the estrogen message to “stop stop stop” production of LH is silenced, and the pituitary makes more LH, increasing the “go go go” to produce testosterone in the testes.

When treating with traditional testosterone replacement therapy, the hypothalamus and pituitary are told there is plenty of testosterone being made in the testes and it doesn’t need to make anymore. So, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes also stops. Clomid does the opposite.

Clomid is an alternative to testosterone replacement therapy and excludes many of the side effects of TRT. Clomid does not cause testicular atrophy, acne, gynecomastia, fertility issues and is less likely to influence red blood cell concentration causing polycythemia, reducing the risk of blood clots.

Additionally, if one chooses to discontinue Clomid testosterone therapy they aren’t “dropped off.” The body is still producing its own testosterone and will slowly return to baseline lows over time. Additionally, it is a pill typically taken every day, so no need to be poked with needles or cover oneself in gels.

What Are the Downsides to Clomid?

The downsides to Clomid therapy are that it is rarely covered by insurance as it is an “off label” use of the medication (however it is generic and very affordable), the lower the testosterone level, the longer it may take to see the benefits of Clomid versus traditional testosterone therapy, and some men may not respond (often seen in men over the age of 70 and with multiple medical issues) and therefore may not be candidates. Side effects are few and may include temporary/reversible vision changes.

For most men, Clomid is a good alternative to both short and long-term testosterone replacement therapy– and just like testosterone replacement therapy, Clomid must be prescribed and monitored by your doctor. To learn more about low testosterone diagnosis and treatment options, make an appointment at Austin Urology Institute at 512-596-5057 with a provider to discuss symptoms and explore options.