50 mg/day Clomid (Clomiphene) plus High Dose HCG Study in Men

[Nelson Vergel]

Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short‐course randomized study


Objectives


To compare serum testosterone response and symptom improvement in men with hypogonadism in response to treatment with clomiphene citrate (CC), human chorionic gonadotropin (hCG), or a combination of both therapies.

Patients and Methods
A total of 282 men with hypogonadism, wishing to preserve their fertility, were randomized to one of three treatment arms: CC 50 mg (n= 95); 5 000 IU hCG injections twice weekly (n = 94); or a combination of both therapies (CC + hCG; n = 94). All participants had complete medical history and had undergone thorough physical examination, including body mass index (BMI) assessment. Laboratory tests included serum total testosterone and glycated haemoglobin (HbA1c) measurements. Quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire scores were also recorded. Morning samples of total serum testosterone levels were assessed at three time points: baseline, 1 and 3 months.

Results
Testosterone levels increased at 1 and 3 months in all three groups. The mean baseline testosterone level was 2.31 ± 0.66 nmol/L, BMI was 30.8 ± 6.2 kg/m2, and qADAM score was 20.5 ± 3.8 (50 means perfect quality of life and sexual function). Testosterone levels increased in all groups at all time points, with a final mean value of 5.17 ± 1.77 nmol/L (223% increase) with no statistically significant difference among the groups. qADAM scores had increased in all groups at 1 month (CC group: 6.36; hCG group: 5.08; CC + hCG group: 7.26) and at 3 months (CC group: 12.73; hCG group: 11.82; CC + hCG group: 15.13) with a significant difference in intergroup analysis for the CC + hCG group compared with the other two groups (P < 0.01).

Conclusions
All three treatments were equally effective in restoring testosterone levels. Single‐agent CC is simple, cheap and may be used as treatment for hypogonadism when maintenance of fertility is desired. This approach seems to be as effective as either hCG alone or a combination of hCG and CC.


Reference:

Habous, M. , Giona, S. , Tealab, A. , Aziz, M. , Williamson, B. , Nassar, M. , Abdelrahman, Z. , Remeah, A. , Abdelkader, M. , Binsaleh, S. and Muir, G. (2018), Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short‐course randomized study. BJU Int. . doi:10.1111/bju.14401

 

[Vince Carter]

Too bad there was no monitor of Estrogen levels which would have most certainly been high, with Group B being subjected to the worst possible scenario of too much Clomid and high dose HCG.

 

[Nelson Vergel]

Clomid and HCG together

Was just wandering if anyone on here just uses clomid and hcg to boost testosterone unstead of Trt. Is clomid plus hcg successful for you? also is clomid plus hcg a smart protocol because I thought hcg was suppressive?

www.excelmale.com

 

[Nelson Vergel]

Combining human chorionic gonadotropin (hCG) and clomiphene citrate (Clomid) for men with hypogonadotropic hypogonadism (HH) offers several benefits, particularly for those who wish to preserve or enhance fertility. Here are the key benefits based on the provided sources:

### 1. **Increased Testosterone Levels**
Both hCG and clomiphene citrate independently stimulate testosterone production, but their combination can be particularly effective. hCG acts as an LH analog, directly stimulating the Leydig cells in the testes to produce testosterone. Clomiphene citrate, a selective estrogen receptor modulator (SERM), increases the release of gonadotropins (LH and FSH) from the pituitary gland, which also stimulates testosterone production. The combination of these two mechanisms can lead to a significant increase in serum testosterone levels[1][3][11].

### 2. **Improved Spermatogenesis**
The combination therapy supports spermatogenesis by maintaining or increasing intratesticular testosterone (ITT) levels, which is crucial for sperm production. hCG directly stimulates the testes, while clomiphene increases endogenous gonadotropin levels, both of which are essential for normal spermatogenesis. Studies have shown that this combination can result in the presence of sperm in the semen of men with HH, although the quality and motility of the sperm may vary[1][3][8].

### 3. **Preservation of Fertility**
Unlike exogenous testosterone therapy, which can suppress spermatogenesis and reduce fertility, the combination of hCG and clomiphene citrate helps maintain or improve fertility. This is particularly beneficial for men who wish to father children, as it avoids the negative feedback suppression of the hypothalamic-pituitary-gonadal (HPG) axis that is associated with exogenous testosterone[1][5][10].

### 4. **Symptomatic Improvement**
Men undergoing combination therapy often experience improvements in symptoms associated with hypogonadism, such as increased energy levels, improved mood, enhanced libido, and better erectile function. These improvements are linked to the normalization of testosterone levels and the overall hormonal balance achieved through the combined treatment[1][4][11].

### 5. **Safety and Tolerability**
The combination of hCG and clomiphene citrate has been shown to be safe and well-tolerated in clinical studies. Common side effects are generally mild and may include mood changes, gynecomastia, and injection site pain for hCG. Long-term studies have demonstrated the safety of clomiphene citrate for up to several years of use[1][3][8].

### 6. **Cost-Effectiveness**
Clomiphene citrate is an oral medication and is generally less expensive compared to injectable testosterone therapies. hCG, while more costly than clomiphene, can be used in lower doses when combined with clomiphene, potentially reducing overall treatment costs. This combination can be a cost-effective alternative to traditional testosterone replacement therapy, especially for those concerned with fertility[1][4][13].

### Clinical Evidence
- A study involving 19 patients with hypogonadotropic hypogonadism treated with hCG and clomiphene citrate showed significant improvements in testosterone levels and secondary sexual characteristics. After 12 months, 47.4% of patients had sperm present in their semen, although many of the sperm were deformed[3][8].
- Another study comparing clomiphene citrate, hCG, and their combination found that all three treatments were equally effective in restoring testosterone levels. However, the combination therapy showed a significant improvement in symptom scores compared to the individual treatments[11].

### Conclusion
Combining hCG and clomiphene citrate offers a synergistic approach to treating hypogonadotropic hypogonadism in men, particularly those who wish to maintain or improve fertility. This combination effectively increases testosterone levels, supports spermatogenesis, improves hypogonadal symptoms, and is generally safe and cost-effective.

Citations:
[1] https://www.wjgnet.com/2220-6124/full/v4/i2/245.htm
[2] Male Fertility Drugs
[3] Evaluating the Combination of Human Chorionic Gonadotropin and Clomiphene Citrate in Treatment of Male Hypogonadotropic Hypogonadism: A Prospective Study - PubMed
[4] Clomiphene citrate: A potential alternative for testosterone therapy in hypogonadal males
[5] Does Clomid Increase Fertility for Men?
[6] https://www.endocrinepractice.org/article/S1530-891X(20)35830-4/fulltext
[7] https://onlinelibrary.wiley.com/doi/full/10.1111/andr.13146
[8] Evaluating the Combination of Human Chorionic Gonadotropin and Clomiphene Citrate in Treatment of Male Hypogonadotropic Hypogonadism: A Prospective Study
[9] UpToDate
[10] Male Hypogonadotropic Hypogonadism: The Emerging Role of Clomiphene
[11] https://pubmed.ncbi.nlm.nih.gov/29772111/
[12] https://edm.bioscientifica.com/view/journals/edm/2023/1/EDM22-0242.xml
[13] https://alphahormones.com/hcg-and-clomid-to-treat-low-testosterone-in-men-who-desire-fertility
[14] https://www.urologytimes.com/view/anti-estrogen-may-benefit-some-men-idiopathic-hh
[15] https://medicine.yale.edu/news-article/newly-released-guidelines-for-male-infertility-part-2/
[16] https://tau.amegroups.org/article/viewFile/19649/19636
[17] https://www.maleinfertilityguide.com/hcg
[18] https://www.tandfonline.com/doi/abs/10.2147/RRU.S315056

 

[Seagal]

@Nelson Vergel , have you heard of desmosterol?

https://www.reddit.com/r/trt/s/N7I0e6Rl5s

 

[Jucaro]

My own experience is: HCG alone or combined with testosterone (HCG in fertility doses) kills libido and worsens erectile dysfunction, testicles decrease in size with continuous and constant moderately high doses of HCG.

Clomid alone: kills libido, LH and FSH do not increase significantly, I am left hypogonadal.

Clomid (25 mg EOD) + HCG dose for fertility (1000 - 1500 IU EOD), with or without exogenous testosterone: much better sense of well-being, higher libido, larger testicles, better erectile function, significant increase in sperm count.

So, in my own experience, there must be a synergistic action between HCG and clomid at the testicular level, independent of LH/FSH levels.

 

[Seagal]

My own experience is: HCG alone or combined with testosterone (HCG in fertility doses) kills libido and worsens erectile dysfunction, testicles decrease in size with continuous and constant moderately high doses of HCG.

Clomid alone: kills libido, LH and FSH do not increase significantly, I am left hypogonadal.

Clomid (25 mg EOD) + HCG dose for fertility (1000 - 1500 IU EOD), with or without exogenous testosterone: much better sense of well-being, higher libido, larger testicles, better erectile function, significant increase in sperm count.

So, in my own experience, there must be a synergistic action between HCG and clomid at the testicular level, independent of LH/FSH levels.

Have you tried testosterone + Clomid and observed any change in testicle size?

 

[Jucaro]

No, I haven't, I just tried:
- clomid alone,
- HCG alone,
- HCG + Clomid,
- HCG + Clomid + Testosterone.

Since I want to remain fertile, I am not interested in treatment with testosterone alone, and adding Clomid to testosterone does not make sense, even clomid alone does not do much for me, much less in the presence of exogenous testosterone.