Why is My Urologist Prescribing Clomid for Low Testosterone?

July 9, 2021

Testosterone levels in men tend to decline slowly with age. Levels typically decrease 1-2% each year beginning at the age of 40. However, testosterone may drop quickly due to medical illnesses such as stroke, trauma, diabetes, liver disease, kidney disease, obesity, heart attacks or certain medications.

Studies suggest that men over 50 years of age with low testosterone levels may be at a higher risk of death within 20 years than men with normal levels of testosterone. Men with low testosterone have 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 is not 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.

Any type of testosterone supplementation is lifelong. Meaning that, in most cases, in order for low levels of testosterone to be increased, it is dependent on a medication taken consistently and 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, a more “natural” method for “replacing testosterone” that produced similar results was found. Along came Clomid (Clomiphene Citrate). Backed by research and thoroughly studied, it became the preferred treatment option for men diagnosed with low testosterone. 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.

Clomid has been around for quite some time. Most men, when initially prescribed, will google the medication and find that it’s used for women and fertility. So why is your doctor prescribing it for low testosterone?

Clomid is used (off label) to help increase men’s testosterone levels more “naturally.” While traditional testosterone replacement therapy produces good results, it has the downside of basically “turning off” the body’s memo to make testosterone because it’s artificially produced by the medication. This can result in testicular atrophy, fertility issues, acne, gynecomastia (breast enlargement), polycythemia (increased risk of blood clots) and can shut off the body’s natural system for producing testosterone. Additionally, if a man using testosterone replacement therapy discontinued their medication, their levels of testosterone would immediately drop and their body would have to restart making its own testosterone. The length of time it would take for the body to restart making its own testosterone and any subsequent symptoms 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.

Clomid is a different approach to increase testosterone and fertility in men. Originally it was used to increase ovulation and improve fertility in women. 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 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.

Here’s where Clomid comes into play: 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 any more. 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 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.

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). Also, the lower the testosterone level, the longer it may take to see the benefits of Clomid versus traditional testosterone therapy. Some men may not respond (often seen in men over the age of 70 and with multiple medical issues) and therefore may not be ideal candidates. Side effects are few and may include temporary/reversible vision changes.

Clomid for men is a good alternative to both short and long-term testosterone replacement therapy. 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 512.694.888 with a provider to discuss symptoms and explore options.