InfertilityBaseline Gonadotropin Levels and Testosterone Response in Hypogonadal Men Treated With Clomiphene Citrate
Section snippets
Study Population
A retrospective review of data from all hypogonadal men treated with CC in 2 high-volume centers was performed from 2013 to 2018. Patient age, body mass index (BMI), and baseline hormones (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol [E], and total testosterone [TT]) were obtained. All hormone levels were based on early morning blood draws. Patients were excluded if they (1) were diagnosed with known genetic causes of primary hypogonadism (eg, Klinefelter syndrome);
RESULTS
A total of 332 men met the inclusion criteria with 66% also having a male infertility complaint. Mean ± SD age was 36.2 ± 8.2 years. Median FSH and LH levels at baseline were 4.3 mIU/mL (IQR: 2.7-7.3) and 4.2 mIU/mL (IQR: 2.8-6.2), respectively. Median baseline TT before treatment was 249.5 ng/dL (200.5-298.0). Baseline variables were not significantly different between the 2 centers except for patient age (38.2 ± 9.9 vs 35.4 ± 7.3 years, P = .005); ADAM scores were only available from one
DISCUSSION
This study confirms that CC is an effective treatment for increasing testosterone concentration in hypogonadal men and provides an inexpensive orally available alternative to exogenous testosterone and other injectable regimens. Seventy-three percent of men achieved at least 200 ng/dL increase in TT compared to their baseline levels. However, neither baseline LH nor FSH levels were strong predictors for biochemical response to CC treatment and we were not able to find an LH or FSH threshold
CONCLUSION
Treatment with CC results in a significant increase in testosterone levels in most men. However, pretreatment LH and FSH serum concentrations are not strong predictors of biochemical treatment response to CC. We were not able to find an LH or FSH threshold that provides a meaningful distinction between those who will or will not have a biochemical response to CC. Thus, adequate biochemical response with CC trial can be expected in most patients with normal or slightly elevated baseline
References (24)
- et al.
Evaluation and management of testosterone deficiency: AUA guideline
J Urol
(2018) - et al.
Hormonal evaluation of the infertile male: has it evolved?
UrolClin North Am
(2008) - et al.
Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association
J Urol
(2012) - et al.
Alternatives to testosterone therapy: areview
Sex Med Rev
(2018) Benefits and health implications of testosterone therapy in men with testosterone deficiency
Sex Med Rev
(2018)- et al.
Clomiphene citrate for the treatment of hypogonadism
Sex Med Rev
(2019) - et al.
On-label and off-label drugs used in the treatment of male infertility
Fertil Steril
(2015) - et al.
Is there a special subgroup of males with adult-onset idiopathic hypogonadotrophichypogonadism who may respond with increases in sperm concentration after clomiphene citrate?
Fertil Steril
(2007) Clomiphene citrate in the management of male hypofertility: predictors for treatment selection
Fertil Steril
(1977)- et al.
Predicting biochemical response to clomiphene citrate in men with hypogonadism
J Sex Med
(2014)
Medical treatments for hypogonadism do not significantly increase the risk of deep vein thrombosis over general population risk
Urology
A randomized prospective double-blind comparison trial of clomiphene citrate and anastrozole in raising testosterone in hypogonadal infertile men
J Sex Med
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Financial Disclosure: The authors declare that they have no relevant financial interests.
Statement: The abstract of this work is presented at the 20th annual Fall meeting of the Sexual Medicine Society of North America (SMSNA), October 24-27, 2019, in Nashville, TN, USA.
Conflict of Interest: None of the authors declare any conflicts of interests related to this work.