How Clomid®* Can Treat Low Testosterone and Infertility
If you’re struggling with low T or getting your partner pregnant, clomiphene citrate might help.
- By Michelle Konstantinovsky
- Medically reviewed by Joshua Calvert, M.D.
- November 21, 2023
Fast Facts
- Clomiphene citrate is most commonly known as a medication used to treat female infertility but it can also treat male infertility.
- In men, the medication tells the brain to produce hormones that trigger sperm and testosterone production.
- For men with low testosterone who are interested in starting a family, clomiphene citrate can treat symptoms while preserving fertility.
Most people who have heard of clomiphene citrate (often marketed commercially under the brand names Clomid® and/or Serophene®) associate the medication with one specific use: to induce ovulation in women who are experiencing infertility. And while that’s the most common reason why the drug is prescribed, it’s not the only one. Clomiphene citrate can also be prescribed for “off-label” use to treat infertility in men—specifically in men who are experiencing symptoms of low testosterone levels or low T.
Testosterone replacement therapy (TRT) is the go-to treatment for men with testosterone deficiency. It’s safe and very effective. But it can cause side effects that make it difficult to father children.
That’s where clomiphene citrate comes in.
Here’s everything you need to know about low testosterone levels and clomiphene citrate for men, including dosage, side effects, and more.
What Is Low Testosterone?
Testosterone is the main male sex hormone that plays a major role in regulating sex drive, your body’s ability to store and burn fat, the production of red blood cells, and even your mood. It’s also integral to fertility. Your body needs testosterone to produce sperm.
As men age, their testosterone naturally drops, about 1 percent per year after the age of 35. However, if your testosterone levels continue to dip at a higher rate than this normal decline, it’s a sign of a condition called hypogonadism, where the testes don’t produce enough testosterone.
If your T levels dip too low, so will your sperm count. A lower sperm count does not necessarily cause infertility but it can make it more difficult to conceive (1).
About 6.1 million couples in the United States experience infertility, and in about half of those cases, the infertility is a result of low sperm production, abnormal sperm function, or other factors related to the male partner.
Men who are on testosterone will likely develop a return of healthy sperm to the ejaculate when they stop the testosterone, says Calvert, but there are no guarantees that it will return, or how long it may take to do so.
Fortunately, that doesn’t mean that you have to live with symptoms of low T if you want to have children. Clomiphene citrate is often a good option for treating low T while preserving fertility.
Identifying and Treating Low T
If you have low T, you’ll start to notice a host of symptoms, including a decline in your sex drive, a lack of energy, and a loss of muscle mass. You may also struggle to get your partner pregnant if you’re trying to conceive.
The only way to truly know if your testosterone levels are low is to test your hormone levels. Hone has an at-home analysis that provides a definitive look at your hormones. If the test shows that you have low T, you can consult with a doctor about what the results mean. (Here are some tips on talking to your doctor about low T).
Testosterone replacement therapy (TRT) is often prescribed for men with low T. But if you’re thinking about starting a family, it may not be the right option for you. TRT can lead to a lower sperm count because when your brain registers an influx of testosterone, it sends a signal to the pituitary gland to decrease a hormone called follicle stimulating hormone (FSH), which triggers sperm production.
“If you’re thinking about starting a family in the new future, I would recommend against the use of TRT,” says urologist Joshua Calvert, M.D. “In fact, In the 1990s the World Health Organization tested testosterone as a male birth control and found that it was close to 97 percent effective.”
Young healthy men who are on testosterone will likely develop a return of healthy sperm to the ejaculate when they stop the testosterone, says Calvert, but there are no guarantees that it will return, or how long it may take to do so.
Fortunately, that doesn’t mean that you have to live with symptoms of low T if you want to have children. Clomiphene citrate is often a good option for treating low T while preserving fertility.
What Is Clomiphene Citrate?
Clomiphene citrate is an oral tablet that belongs to a class of medications called ovulatory stimulants, and in women, it works similarly to estrogen, a female hormone that causes the ovaries to develop and release eggs (aka ovulation).
But studies have shown that clomiphene citrate may also help address fertility issues in men who are experiencing hypogonadism.
Male hypogonadism is typically characterized by low testosterone, which can occur for a variety of reasons including age, medications, chronic health conditions, and more.
Hone delivers treatments for low T—including clomiphene citrate—to your doorstep, if prescribed.
The first step: Order an at-home hormone assessment, which comes with a free telehealth consultation.
How Does Clomiphene Citrate Work?
Some women take clomiphene citrate as part of fertility treatment like in vitro fertilization (IVF) or intrauterine insemination (IUI), but the medication can also be taken on its own. Its main purpose is to stimulate specific parts of the brain (the hypothalamus and pituitary gland) to increase levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are important in ovulation.
Clomiphene Citrate for Men
In men, LH stimulates Leydig cells in the testicles to produce testosterone. FSH stimulates Sertoli cells to assist in sperm development.
“Clomiphene citrate is a selective estrogen receptor modulator (SERM),” explains Amin Herati, M.D., assistant professor of urology at the Johns Hopkins University School of Medicine, and Director of Male Infertility and Men’s Health for the Brady Urological Institute. While estrogen is the primary female sex hormone, men need it too, in small amounts. Extra estrogens can trigger your body to produce less testosterone.
For men, clomiphene citrate works on your estrogen receptors—proteins that bind to estrogen in the blood—to make your brain think there’s a lack of testosterone in your system, says Herati. As a result, your body produces more FSH and luteinizing hormone (LH), which trigger sperm and testosterone production.
Signs Clomiphene Citrate is Working
In addition to boosting sperm production through this mechanism, clomiphene citrate may also help boost libido and alleviate erectile dysfunction (2) in some men since these issues can sometimes be rooted in low testosterone.
The medication is often prescribed for men who have low T and are experiencing infertility, says Herati. “It can also be taken as an oral therapy option for men with low testosterone who want to preserve their fertility potential.”
How Long Does It Take Clomiphene Citrate to Start Working?
You won’t notice the first effects until about a month into treatment, per functional medicine doctor Anastasia Jandes, M.D.
“The half life of clomiphene is five to seven days. As a general rule, it takes five half lives for a drug to begin to have its full effect,” Jandes explains. “Men will notice a gradual decline in low T symptoms beginning at this time.”
To get the full benefits, clomiphene citrate must be taken regularly for three months. At this point, you can expect a significant improvement in low testosterone symptoms. If you’ve ever been on TRT, you may find that your symptoms improve slower than when you were on your previous treatment protocol, Jandes says.
However, Jandes notes that this drug is occasionally less effective than TRT in treating low libido and muscle loss associated with low T.
“If these two areas don’t improve on enclomiphene to the patient’s satisfaction, I often add low dose TRT to [resolve] these symptoms,” Jandes says.
Clomiphene Citrate Dosage for Men
While optimal dosing has not been established, one review recommended(3) patients start with a dose of 25 mg three days per week and then slowly adjust up to 50 mg if needed.
Clomiphene citrate can help boost libido and alleviate erectile dysfunction.
Clomiphene Citrate Side Effects in Men
Like all medications, clomiphene citrate does carry a risk of side effects, and some research has shown what kind of side effects are more likely for men, specifically.
While one 2019 study (4) found the medication to generally be “safe and effective with few side effects when used as long-term treatment of hypogonadism,” there were some potential negative effects including mood changes, blurry vision, and breast tenderness.
“Side effects can occur with this medication among men who take it,” Herati says. “Headaches, nausea, bloating, mood swings, and diminished sex drive can occur.
Rarely, sperm counts can paradoxically decrease with clomiphene citrate , which can be reversed by changing to another type of estrogen blocker, such as tamoxifen.
“Men who want to take this medication should have a full hormone panel drawn, inclusive of testosterone, LH, and FSH. If the LH and FSH are already elevated, then this medication would be less likely to be helpful,” says Calvert.
How Well Does Clomiphene Citrate Work for Increasing Fertility?
The most recent meta-analysis (5) on selective estrogen receptor modulators like clomiphene citrate significantly increase sperm concentration, total sperm count, and LH, FSH, and total testosterone levels.
A 2016 review (6) suggests that the men most likely to reap the benefits of clomiphene citrate are those who have unexplained infertility and normal to below-average sperm motility and shape. Experts believe men in this camp could potentially use the medication to achieve a sperm count that would improve their success rates using artificial insemination.
What Happens If You Stop Taking Clomiphene Citrate?
Stopping the medication is totally safe. “Because It works by tricking your body into making more of its own testosterone (and thus increasing sperm count), stopping it will just take you back to normal levels of production,” says Calvert.
However, when you do stop taking clomiphene citrate, your pre-medication symptoms will reappear. “This can be a shocking change for some guys to go back to the symptoms that they used to have. Before starting this drug, I tell my patients that they should anticipate transitioning to TRT after they are done having kids,” adds Calvert.
Other Treatments for Male Infertility
For men who choose to take another route to treat infertility or increase their testosterone, there are alternatives to clomiphene citrate.
It’s important to work closely with your doctor as the type of treatment is largely dependent on the individual, the cause of infertility, and other factors. For example, some men might need surgery to correct a physical cause of infertility (such as a varicocele, an enlargement of the veins within the scrotum). In other cases, medications like antibiotics may help treat infections that impair fertility.
Low testosterone isn’t the only cause of infertility in men there are so many causes ranging in severity from infection to tumors that the only reliable way to diagnose the issue and seek appropriate treatment is to work with your healthcare provider to find a treatment that’s most likely to be effective, safe, and sustainable.
*CLOMID is a registered trademark of Cosette Pharmaceuticals and is not affiliated with Hone Health.
The Bottom Line
In men, clomiphene citrate tells the brain to produce hormones that trigger sperm and testosterone production. For men with low testosterone who are interested in starting a family, this medication can treat symptoms while preserving fertility.
Hone delivers treatments for low T—including clomiphene citrate—to your doorstep, if prescribed.
The first step: Order an at-home hormone assessment, which comes with a free telehealth consultation.
References
1. Sharpe, Richard M. “Sperm counts and fertility in men: a rocky road ahead. Science & Society Series on Sex and Science.” EMBO reports vol. 13,5 398-403. 1 May. 2012, doi:10.1038/embor.2012.50
2. Guay, A., Jacobson, J., Perez, J. et al. Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?. Int J Impot Res 15, 156–165 (2003). https://doi.org/10.1038/sj.ijir.3900981
3. Ring JD, Lwin AA, Köhler TS. Current medical management of endocrine-related male infertility. Asian J Androl 2016;18:357-63
Krzastek SC, Sharma D, Abdullah N, Sultan M, Machen GL, Wenzel JL, Ells A, Chen X, Kavoussi M, Costabile RA, Smith RP, Kavoussi PK. Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism. J Urol. 2019 Nov;202(5):1029-1035. doi: 10.1097/JU.0000000000000396. Epub 2019 Oct 9. PMID: 31216250.
4. Cannarella R, Condorelli RA, Mongioì LM, Barbagallo F, Calogero AE, La Vignera S. Effects of the selective estrogen receptor modulators for the treatment of male infertility: a systematic review and meta-analysis. Expert Opin Pharmacother. 2019 Aug;20(12):1517-1525. doi: 10.1080/14656566.2019.1615057. Epub 2019 May 23. PMID: 31120775.
5. Ring JD, Lwin AA, Köhler TS. Current medical management of endocrine-related male infertility. Asian J Androl 2016;18:357-63
