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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Clomid to Reset Hormonal Axis After Anabolic Steroids
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<blockquote data-quote="Nelson Vergel" data-source="post: 7624" data-attributes="member: 3"><p>[ATTACH]741[/ATTACH]</p><p></p><p></p><p><strong>Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse </strong></p><p></p><p>Robert S. Tan, M.D., and Deepa Vasudevan, M.D. </p><p></p><p>Programs in Geriatrics and Andrology, Department of Family and Community Medicine, University of Texas Health Sciences Center, Houston, Texas </p><p> </p><p><strong>Objective: </strong>To report a case of symptomatic hypogonadism induced by the abuse of multiple steroid preparations that was subsequently reversed by clomiphene. </p><p></p><p>Design: Case report. </p><p></p><p><strong>Setting:</strong> University-affiliated andrology practice within family practice clinic. Patient(s): A 30-year-old male. </p><p></p><p><strong>Intervention(s): </strong>Clomiphene citrate, 100-mg challenge for 5 days, followed by treatment at same dose for 2 months.</p><p> </p><p><strong>Main Outcome Measure(s)</strong>: Clinical symptoms, androgen decline in aging male questionnaire, total T, FSH, </p><p>LH. </p><p><strong></strong></p><p><strong>Result(s)</strong>: Reversal of symptoms, normalization of T levels with LH surge, restoration of pituitary-gonadal </p><p>axis. </p><p></p><p><strong>Conclusion(s)</strong>: Clomiphene citrate is used typically in helping to restore fertility in females. This represents </p><p>the first case report of the successful use of clomiphene to restore T levels and the pituitary-gonadal axis in </p><p>a male patient. The axis was previously shut off with multiple anabolic steroid abuse. (Fertil Steril 2003;79: </p><p>203-5. ©2003 by American Society for Reproductive Medicine.) </p><p></p><p></p><p></p><p><strong>DISCUSSION</strong></p><p></p><p>Clomiphene citrate is an orally administered, nonsteroidal </p><p>ovulatory drug typically used in female infertility manage-</p><p>ment. It has both estrogenic and antiestrogenic properties. </p><p>Clomiphene citrate initiates a series of endocrinologic events </p><p>that cause a gonadotropin surge, which in turn causes an </p><p>increase in steroidogenesis. Clomiphene citrate is thought </p><p>not to have any inherent androgenic or anti-androgenic ef-</p><p>fect. In this case, we were challenging the pituitary gland to </p><p>produce a surge of gonadotropins to help restore function to </p><p>the Leydig cells to produce T.</p><p></p><p>Clomiphene citrate has been shown to increase T levels in </p><p>both normal and impotent hypogonadal men probably re-</p><p>flecting the primacy of estrogen over T in the feedback </p><p>regulation of male gonadal function. In a small, double-</p><p>blind, placebo-controlled, crossover study of clomiphene </p><p>against placebo in impotent men with secondary hypogonad-</p><p>ism, there was a significant rise of LH, FSH, and T with </p><p>clomiphene (2). However, the study in these 17 men did not</p><p>reveal any improvement of sexual function as measured with</p><p>questionnaires and penile tumescence and rigidity testing. </p><p>Another study investigated the hormonal response to clomi-</p><p>phene in alcoholics with hypogonadism (3) and found that </p><p>clomiphene can increase androgens and estrogens. The rise </p><p>in estrogens was thought to be due to peripheral conversion </p><p>of androgens to estrogens. Paradoxically, one study failed to </p><p>show that clomiphene could restore pituitary testicular re-</p><p>sponsiveness in hypogonadotrophic hypogonadism but suc-</p><p>ceeded with human chorionic gonadotropin (4).</p><p>Clomiphene citrate has been used successfully in the </p><p>treatment of idiopathic hypogonadotrophic hypogonadism </p><p>induced by excessive exercise such as marathon running (5). </p><p>In that case report, reestablishment of the physiologic hypo-</p><p>thalamic-pituitary-gonadal axis with the return of normal T </p><p>and gonadal function was achieved with clomiphene citrate </p><p>(50 mg, 2 times per day) over 5 months. In our case, the </p><p>reestablishment of eugonadal status was achieved with just a </p><p>short challenge of clomiphene citrate 100 mg over 2 weeks, </p><p>but the patient relapsed. He needed a longer course of 2 </p><p>months of clomiphene citrate to maintain eugonadal status. </p><p>Both cases, including ours, suggest that early intervention </p><p>with clomiphene can restore the hypothalamic-pituitary-</p><p>gonadal axis. We are still continuing to follow up our patient </p><p>to establish long-term effects. The patient did not suffer from </p><p>any hot flashes or other side effects from clomiphene citrate. </p><p> There have been no previously documented cases of </p><p>clomiphene citrate improving exogenous steroid-induced</p><p>testicular failure. The mechanism of initial testicular failure</p><p>could be due to the suppression of LH due to the use of </p><p>exogenous steroids, which in turn leads to decreased T </p><p>levels. We postulate that clomiphene citrate can reestablish </p><p>the axis even after steroid abuse has initially shut down the </p><p>axis. It can induce the gonadotropin surge, initiate T levels to </p><p>increase, and improve gonadal function and reverse symp-</p><p>toms. This was possible in this case as the patient was </p><p>relatively young and presumably had a more elastic axis.</p><p></p><p><strong>References</strong></p><p><strong></strong></p><p>1. Tan RS, Philip P. Perceptions of and risk factors for andropause. Arch </p><p> Androl 1999;43:227-33.</p><p>2. Guay AT, Bansal S, Heatley GJ. Effect of raising endogenous testoster-</p><p> one levels in impotent men with secondary hypogonadism. J Clin En-</p><p> docrinol Metab 1995;80:3546 -52.</p><p>3. Martinez-Riera A, Sanolaria-Fernandez F, Gonzalez Reimers E, Milena </p><p> A. Alcoholic hypogonadism: hormonal response to clomiphene. Alcohol </p><p> 1995;12:581-7.</p><p>4. Weinstein RL, Reitz RE. Pituitary-testicular responsiveness in male </p><p> hypogonadotrophic hypogonadism. J Clin Invest 1974;53:408 -15. </p><p>5. Burge MR, Lanzi RA, Skarda ST, Eaton RP. Idiopathic hypogonatrophic </p><p> hypogonadism in a male runner is reversed by clomiphene citrate. Fertil </p><p> Steril 1997;67:783-5.</p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 7624, member: 3"] [ATTACH=CONFIG]741[/ATTACH] [B]Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse [/B] Robert S. Tan, M.D., and Deepa Vasudevan, M.D. Programs in Geriatrics and Andrology, Department of Family and Community Medicine, University of Texas Health Sciences Center, Houston, Texas [B]Objective: [/B]To report a case of symptomatic hypogonadism induced by the abuse of multiple steroid preparations that was subsequently reversed by clomiphene. Design: Case report. [B]Setting:[/B] University-affiliated andrology practice within family practice clinic. Patient(s): A 30-year-old male. [B]Intervention(s): [/B]Clomiphene citrate, 100-mg challenge for 5 days, followed by treatment at same dose for 2 months. [B]Main Outcome Measure(s)[/B]: Clinical symptoms, androgen decline in aging male questionnaire, total T, FSH, LH. [B] Result(s)[/B]: Reversal of symptoms, normalization of T levels with LH surge, restoration of pituitary-gonadal axis. [B]Conclusion(s)[/B]: Clomiphene citrate is used typically in helping to restore fertility in females. This represents the first case report of the successful use of clomiphene to restore T levels and the pituitary-gonadal axis in a male patient. The axis was previously shut off with multiple anabolic steroid abuse. (Fertil Steril 2003;79: 203-5. ©2003 by American Society for Reproductive Medicine.) [B]DISCUSSION[/B] Clomiphene citrate is an orally administered, nonsteroidal ovulatory drug typically used in female infertility manage- ment. It has both estrogenic and antiestrogenic properties. Clomiphene citrate initiates a series of endocrinologic events that cause a gonadotropin surge, which in turn causes an increase in steroidogenesis. Clomiphene citrate is thought not to have any inherent androgenic or anti-androgenic ef- fect. In this case, we were challenging the pituitary gland to produce a surge of gonadotropins to help restore function to the Leydig cells to produce T. Clomiphene citrate has been shown to increase T levels in both normal and impotent hypogonadal men probably re- flecting the primacy of estrogen over T in the feedback regulation of male gonadal function. In a small, double- blind, placebo-controlled, crossover study of clomiphene against placebo in impotent men with secondary hypogonad- ism, there was a significant rise of LH, FSH, and T with clomiphene (2). However, the study in these 17 men did not reveal any improvement of sexual function as measured with questionnaires and penile tumescence and rigidity testing. Another study investigated the hormonal response to clomi- phene in alcoholics with hypogonadism (3) and found that clomiphene can increase androgens and estrogens. The rise in estrogens was thought to be due to peripheral conversion of androgens to estrogens. Paradoxically, one study failed to show that clomiphene could restore pituitary testicular re- sponsiveness in hypogonadotrophic hypogonadism but suc- ceeded with human chorionic gonadotropin (4). Clomiphene citrate has been used successfully in the treatment of idiopathic hypogonadotrophic hypogonadism induced by excessive exercise such as marathon running (5). In that case report, reestablishment of the physiologic hypo- thalamic-pituitary-gonadal axis with the return of normal T and gonadal function was achieved with clomiphene citrate (50 mg, 2 times per day) over 5 months. In our case, the reestablishment of eugonadal status was achieved with just a short challenge of clomiphene citrate 100 mg over 2 weeks, but the patient relapsed. He needed a longer course of 2 months of clomiphene citrate to maintain eugonadal status. Both cases, including ours, suggest that early intervention with clomiphene can restore the hypothalamic-pituitary- gonadal axis. We are still continuing to follow up our patient to establish long-term effects. The patient did not suffer from any hot flashes or other side effects from clomiphene citrate. There have been no previously documented cases of clomiphene citrate improving exogenous steroid-induced testicular failure. The mechanism of initial testicular failure could be due to the suppression of LH due to the use of exogenous steroids, which in turn leads to decreased T levels. We postulate that clomiphene citrate can reestablish the axis even after steroid abuse has initially shut down the axis. It can induce the gonadotropin surge, initiate T levels to increase, and improve gonadal function and reverse symp- toms. This was possible in this case as the patient was relatively young and presumably had a more elastic axis. [B]References [/B] 1. Tan RS, Philip P. Perceptions of and risk factors for andropause. Arch Androl 1999;43:227-33. 2. Guay AT, Bansal S, Heatley GJ. Effect of raising endogenous testoster- one levels in impotent men with secondary hypogonadism. J Clin En- docrinol Metab 1995;80:3546 -52. 3. Martinez-Riera A, Sanolaria-Fernandez F, Gonzalez Reimers E, Milena A. Alcoholic hypogonadism: hormonal response to clomiphene. Alcohol 1995;12:581-7. 4. Weinstein RL, Reitz RE. Pituitary-testicular responsiveness in male hypogonadotrophic hypogonadism. J Clin Invest 1974;53:408 -15. 5. Burge MR, Lanzi RA, Skarda ST, Eaton RP. Idiopathic hypogonatrophic hypogonadism in a male runner is reversed by clomiphene citrate. Fertil Steril 1997;67:783-5. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Clomid to Reset Hormonal Axis After Anabolic Steroids
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