Clomiphene (Clomid) vs Testosterone Replacement Comparison Study

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Nelson Vergel

Abstracts printed from

Authors: Nathan Wilken, Jason Scovell, Ranjith Ramasamy*, Dolores Lamb, Larry Lipshultz, Houston, TX
Abstract: PD45-02
Introduction and Objectives
We sought to compare satisfaction and treatment efficacy in men (age range 35 to 75) with symptomatic hypogonadism (total testosterone < 300ng/dL and > 3 (+) symptoms on the Androgen Deficiency in the Aging Male - ADAM questionnaire) before and after receiving testosterone supplementation.

We prospectively followed a total of 52 men on T injections and T gels (n=27 on injections, n=25 on gel) and 23 men on clomiphene citrate (CC, 25mg once a day) from 2013 - 2014. These men were then age-matched to eugonadal men (T > 300ng/dL and < 3 (+) symptoms on ADAM) with a similar comorbidity profile who were not on CC or TST (controls) followed during the same time period. Comparisons were made between baseline and post-treatment variables, and multivariable analysis was conducted to define predictors of successful response to CC or TST (age, comorbidities, TST modality, and hormone levels).

Median serum total testosterone increased from pre-treatment levels in all men (p<0.05), regardless of therapy type (T injections= 252.5 to 606 ng/dL, T gels= 263 to 445.5ng/dL, CC 235.5 to 438 ng/dL). Men taking TST reported fewer ADAM symptoms after treatment (5 to 2, p < 0.05). Similarly, men taking CC reported fewer ADAM symptoms after treatment (3 to 1, p < 0.05). Conversely, eugonadal men had similar T levels (352.1 vs. 364.3) and hypogonadal symptoms (1.5 vs. 1.4) before and after follow-up. When the types of hypogonadal symptoms were evaluated, both sexual, and psychological symptoms responded to CC or TST. However, physical symptoms did not appear to improve with therapy. A similar proportion of men receiving TST responded (> 3 symptoms improved on ADAM) to therapy (52%) as compared to men who received CC (44%). On multivariable analysis, only younger age was positively associated with response to therapy (OR = 6.449, p = 0.02). Interestingly, neither modality of therapy (T injections vs. T gels vs. CC) nor post-treatment testosterone levels were associated with symptom improvement. Some strengths of this study include the prospective design, availability of control group, and comparisons of symptoms and hormone levels before and after commencement of CC and TST. The study is limited by its relatively small sample size and short follow-up (~ 3.5 months).

Testosterone supplementation and clomiphene citrate regimens are efficacious for improving both hypogonadal symptoms and serum total testosterone levels. Clearly, younger men appear to respond better following therapy for hypogonadism.
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