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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Treating Low Testosterone with Clomid, hCG and Aromatase Inhibitors: A Review of the Data
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<blockquote data-quote="madman" data-source="post: 175780" data-attributes="member: 13851"><p><span style="color: rgb(184, 49, 47)">The SERM most studied in the treatment of testosterone deficiency is clomiphene citrate (CC). CC has long been used as a treatment to restore testosterone levels and promote or preserve spermatogenesis in men with testosterone deficiency desiring to preserve fertility, and multiple studies have shown that CC effectively raises testosterone to eugonadal levels (50-56).</span> <span style="color: rgb(184, 49, 47)">This medication is an oral compound administered at doses ranging from 25 mg every other day, to 50 mg daily, based on testosterone response.</span> <span style="color: rgb(184, 49, 47)"><strong>Moskovic et al. reported on 29 men with a baseline total testosterone level of 228±48 ng/dL treated for >3 years with CC. They demonstrated improvements in testosterone to a mean of 582±227 ng/dL (P<0.001), as well as significant improvements in ADAM questionnaire response (P=0.01) and mean BMI (P<0.05) (50).</strong></span> <span style="color: rgb(26, 188, 156)"><strong>Similarly, Taylor and Levine demonstrated that</strong> <strong>compared to testosterone gel therapy, CC treatment resulted in equivalent, significant improvements in testosterone levels at a fraction of the cost, as well as significant improvements in ADAM questionnaire scores. No patients discontinued CC treatment due to side effects, and no adverse events on CC were reported.</strong></span> <strong><span style="color: rgb(26, 188, 156)">Additionally, patients on CC treatment did not experience changes in hemoglobin, PSA, or cholesterol levels while on treatment (51).</span></strong> <span style="color: rgb(147, 101, 184)"><strong>Ramasamy et al. have also demonstrated that</strong> <strong>quantitative ADAM scores were similar among patients treated with CC as compared to those treated with testosterone gels or injections, with improvements in testosterone levels while on CC treatment to physiologic levels (54).</strong> </span></p><p></p><p><span style="color: rgb(184, 49, 47)"><strong>Still, CC has not historically been offered as a first line treatment for testosterone deficiency in men not desiring fertility preservation given its off-label use and lack of long term data regarding safety and efficacy.</strong></span> <span style="color: rgb(184, 49, 47)"><strong>In the setting of these limitations, ongoing studies are being conducted to establish long-term treatment outcomes. </strong>CC is well tolerated. Rare side effects include headaches, visual changes, and gynecomastia (50). Additionally, CC use has shown to have significantly less risk of increased hematocrit as compared to testosterone therapy (57). <strong>Preliminary data on men treated for testosterone deficiency on CC for as long as 7 years show that over 80% of men achieve testosterone levels >450 ng/dL, with 78% of men reporting subjective improvement in hypogonadal symptoms, and only 9% reporting side effects from CC treatment with no significant adverse events (58). </strong>This data together suggests that CC may be a safe and effective treatment option for the long-term management of testosterone deficiency, and consideration should be made to offering this therapy to men as a first-line treatment option for testosterone deficiency, regardless of the patient’s desire for fertility preservation.</span></p><p></p><p><span style="color: rgb(44, 130, 201)">Enclomiphene citrate (EC) is a trans-isomer of CC and is not currently FDA approved in the United States. Like CC, EC has been shown to raise testosterone and gonadotropin levels, while preserving spermatogenesis (59). <strong>Additionally, EC treatment may deliver the androgenic effects of CC without the side effects associated with CC, though further studies need to be conducted to determine if EC has clinically superior selectivity (60).</strong></span></p><p></p><p><span style="color: rgb(184, 49, 47)">Like CC, tamoxifen has been shown to increase testosterone and gonadotropin levels, and preserve spermatogenesis, and this SERM is an acknowledged alternative treatment option for testosterone deficiency in men (1,61).</span> <span style="color: rgb(184, 49, 47)">Tamoxifen has been used to stimulate gonadotropin production, and to treat gynecomastia in the setting of anabolic steroid-induced hypogonadism or hCG treatment (62).</span> <strong><span style="color: rgb(184, 49, 47)">However, the adverse effects associated with tamoxifen appear to be greater than those associated with CC use, including gastrointestinal distress, venous thromboembolic events, and other cardiovascular outcomes (63). As such, tamoxifen is less commonly used for the treatment of testosterone deficiency.</span></strong></p><p></p><p></p><p></p><p></p><p>When searching the literature it would seem from the studies done using CC as an alternative treatment for hypogonadal men that many end up experiencing improvements in low-t symptoms with minimal side effects.</p><p> </p><p>Judging by the amount of men we see on the forums that use CC as sole therapy to treat hypogonadism the overall beneficial effects tend be a hit or miss as some do feel better (not many), others feel not much difference and many end up feeling horrible.</p><p></p><p>There is still lack of long-term data regarding the safety and efficacy of CC aside from preliminary data on men that were treated for low-t using CC for up to 7 years with a large percentage of those men reporting subjective improvement.</p><p><span style="color: rgb(184, 49, 47)">[URL unfurl="true"]https://www.ncbi.nlm.nih.gov/pubmed/31216250[/URL]</span></p><p></p><p><span style="font-size: 26px"><strong>Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism.</strong></span></p><p></p><p></p><p><span style="font-size: 18px"><strong>Abstract</strong></span></p><p></p><p><strong>PURPOSE:</strong></p><p>Clomiphene citrate may be used as an off label treatment of hypogonadism. <span style="color: rgb(184, 49, 47)"><strong>There are few long-term data on clomiphene citrate efficacy and safety when administered for more than 3 years. </strong></span>We assessed improvements in testosterone and hypogonadal symptoms while on clomiphene citrate for extended periods.</p><p></p><p><strong>MATERIALS AND METHODS:</strong></p><p>We performed a retrospective review to identify patients treated with clomiphene citrate for hypogonadism (baseline testosterone less than 300 ng/dl) at a total of 2 institutions from 2010 to 2018. We assessed the duration of clomiphene citrate therapy, serum testosterone levels, symptom improvement and clomiphene citrate side effects.</p><p></p><p><strong>RESULTS:</strong></p><p><span style="color: rgb(184, 49, 47)">A total of 400 patients underwent clomiphene citrate treatment for a mean ± SD of 25.5 ± 20.48 months (range 0 to 84). Of the patients 280 received clomiphene citrate for 3 years or less (mean 12.75 ± 9.52 months) and 120 received it for more than 3 years (mean 51.93 ± 10.52 months).</span> <strong><span style="color: rgb(184, 49, 47)">Of men on clomiphene citrate for more than 3 years 88% achieved eugonadism, 77% reported improved symptoms and 8% reported side effects. </span><span style="color: rgb(44, 130, 201)">Estradiol was significantly increased following clomiphene citrate treatment.</span><span style="color: rgb(184, 49, 47)"> Results did not significantly differ between patients treated for more than 3, or 3 or fewer years. </span><span style="color: rgb(44, 130, 201)">The most common side effects reported by patients treated more than 3 years included changes in mood in 5, blurred vision in 3 and breast tenderness in 2.</span></strong> There was no significant adverse event in any patient treated with clomiphene citrate.</p><p></p><p><strong>CONCLUSIONS:</strong></p><p>Clomiphene citrate is not typically offered as primary treatment of hypogonadism in men who do not desire fertility preservation. <span style="color: rgb(184, 49, 47)"><strong>These data demonstrate that clomiphene citrate is safe and effective with few side effects when used as long-term treatment of hypogonadism.</strong></span></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p></p><p>Enclomiphene (EC) may very well be more effective overall.....let alone minimize any potential side-effects but again rigorous long-term studies are lacking. </p><p><span style="color: rgb(184, 49, 47)">[URL unfurl="true"]https://www.excelmale.com/forum/threads/enclomiphene-citrate-a-treatment-that-maintains-fertility-in-men-with-secondary-hypogonadism.18710/[/URL]</span></p><p></p><p></p><p>Use of tamoxifen and aromatase inhibitors have their own potential downfalls and although many try either hCG mono or clomid.....those using hCG mono tend to not feel as good overall compared to trt.</p></blockquote><p></p>
[QUOTE="madman, post: 175780, member: 13851"] [COLOR=rgb(184, 49, 47)]The SERM most studied in the treatment of testosterone deficiency is clomiphene citrate (CC). CC has long been used as a treatment to restore testosterone levels and promote or preserve spermatogenesis in men with testosterone deficiency desiring to preserve fertility, and multiple studies have shown that CC effectively raises testosterone to eugonadal levels (50-56).[/COLOR] [COLOR=rgb(184, 49, 47)]This medication is an oral compound administered at doses ranging from 25 mg every other day, to 50 mg daily, based on testosterone response.[/COLOR] [COLOR=rgb(184, 49, 47)][B]Moskovic et al. reported on 29 men with a baseline total testosterone level of 228±48 ng/dL treated for >3 years with CC. They demonstrated improvements in testosterone to a mean of 582±227 ng/dL (P<0.001), as well as significant improvements in ADAM questionnaire response (P=0.01) and mean BMI (P<0.05) (50).[/B][/COLOR] [COLOR=rgb(26, 188, 156)][B]Similarly, Taylor and Levine demonstrated that[/B] [B]compared to testosterone gel therapy, CC treatment resulted in equivalent, significant improvements in testosterone levels at a fraction of the cost, as well as significant improvements in ADAM questionnaire scores. No patients discontinued CC treatment due to side effects, and no adverse events on CC were reported.[/B][/COLOR] [B][COLOR=rgb(26, 188, 156)]Additionally, patients on CC treatment did not experience changes in hemoglobin, PSA, or cholesterol levels while on treatment (51).[/COLOR][/B] [COLOR=rgb(147, 101, 184)][B]Ramasamy et al. have also demonstrated that[/B] [B]quantitative ADAM scores were similar among patients treated with CC as compared to those treated with testosterone gels or injections, with improvements in testosterone levels while on CC treatment to physiologic levels (54).[/B] [/COLOR] [COLOR=rgb(184, 49, 47)][B]Still, CC has not historically been offered as a first line treatment for testosterone deficiency in men not desiring fertility preservation given its off-label use and lack of long term data regarding safety and efficacy.[/B][/COLOR] [COLOR=rgb(184, 49, 47)][B]In the setting of these limitations, ongoing studies are being conducted to establish long-term treatment outcomes. [/B]CC is well tolerated. Rare side effects include headaches, visual changes, and gynecomastia (50). Additionally, CC use has shown to have significantly less risk of increased hematocrit as compared to testosterone therapy (57). [B]Preliminary data on men treated for testosterone deficiency on CC for as long as 7 years show that over 80% of men achieve testosterone levels >450 ng/dL, with 78% of men reporting subjective improvement in hypogonadal symptoms, and only 9% reporting side effects from CC treatment with no significant adverse events (58). [/B]This data together suggests that CC may be a safe and effective treatment option for the long-term management of testosterone deficiency, and consideration should be made to offering this therapy to men as a first-line treatment option for testosterone deficiency, regardless of the patient’s desire for fertility preservation.[/COLOR] [COLOR=rgb(44, 130, 201)]Enclomiphene citrate (EC) is a trans-isomer of CC and is not currently FDA approved in the United States. Like CC, EC has been shown to raise testosterone and gonadotropin levels, while preserving spermatogenesis (59). [B]Additionally, EC treatment may deliver the androgenic effects of CC without the side effects associated with CC, though further studies need to be conducted to determine if EC has clinically superior selectivity (60).[/B][/COLOR] [COLOR=rgb(184, 49, 47)]Like CC, tamoxifen has been shown to increase testosterone and gonadotropin levels, and preserve spermatogenesis, and this SERM is an acknowledged alternative treatment option for testosterone deficiency in men (1,61).[/COLOR] [COLOR=rgb(184, 49, 47)]Tamoxifen has been used to stimulate gonadotropin production, and to treat gynecomastia in the setting of anabolic steroid-induced hypogonadism or hCG treatment (62).[/COLOR] [B][COLOR=rgb(184, 49, 47)]However, the adverse effects associated with tamoxifen appear to be greater than those associated with CC use, including gastrointestinal distress, venous thromboembolic events, and other cardiovascular outcomes (63). As such, tamoxifen is less commonly used for the treatment of testosterone deficiency.[/COLOR][/B] When searching the literature it would seem from the studies done using CC as an alternative treatment for hypogonadal men that many end up experiencing improvements in low-t symptoms with minimal side effects. Judging by the amount of men we see on the forums that use CC as sole therapy to treat hypogonadism the overall beneficial effects tend be a hit or miss as some do feel better (not many), others feel not much difference and many end up feeling horrible. There is still lack of long-term data regarding the safety and efficacy of CC aside from preliminary data on men that were treated for low-t using CC for up to 7 years with a large percentage of those men reporting subjective improvement. [COLOR=rgb(184, 49, 47)][URL unfurl="true"]https://www.ncbi.nlm.nih.gov/pubmed/31216250[/URL][/COLOR] [SIZE=26px][B]Long-Term Safety and Efficacy of Clomiphene Citrate for the Treatment of Hypogonadism.[/B][/SIZE] [SIZE=18px][B]Abstract[/B][/SIZE] [B]PURPOSE:[/B] Clomiphene citrate may be used as an off label treatment of hypogonadism. [COLOR=rgb(184, 49, 47)][B]There are few long-term data on clomiphene citrate efficacy and safety when administered for more than 3 years. [/B][/COLOR]We assessed improvements in testosterone and hypogonadal symptoms while on clomiphene citrate for extended periods. [B]MATERIALS AND METHODS:[/B] We performed a retrospective review to identify patients treated with clomiphene citrate for hypogonadism (baseline testosterone less than 300 ng/dl) at a total of 2 institutions from 2010 to 2018. We assessed the duration of clomiphene citrate therapy, serum testosterone levels, symptom improvement and clomiphene citrate side effects. [B]RESULTS:[/B] [COLOR=rgb(184, 49, 47)]A total of 400 patients underwent clomiphene citrate treatment for a mean ± SD of 25.5 ± 20.48 months (range 0 to 84). Of the patients 280 received clomiphene citrate for 3 years or less (mean 12.75 ± 9.52 months) and 120 received it for more than 3 years (mean 51.93 ± 10.52 months).[/COLOR] [B][COLOR=rgb(184, 49, 47)]Of men on clomiphene citrate for more than 3 years 88% achieved eugonadism, 77% reported improved symptoms and 8% reported side effects. [/COLOR][COLOR=rgb(44, 130, 201)]Estradiol was significantly increased following clomiphene citrate treatment.[/COLOR][COLOR=rgb(184, 49, 47)] Results did not significantly differ between patients treated for more than 3, or 3 or fewer years. [/COLOR][COLOR=rgb(44, 130, 201)]The most common side effects reported by patients treated more than 3 years included changes in mood in 5, blurred vision in 3 and breast tenderness in 2.[/COLOR][/B] There was no significant adverse event in any patient treated with clomiphene citrate. [B]CONCLUSIONS:[/B] Clomiphene citrate is not typically offered as primary treatment of hypogonadism in men who do not desire fertility preservation. [COLOR=rgb(184, 49, 47)][B]These data demonstrate that clomiphene citrate is safe and effective with few side effects when used as long-term treatment of hypogonadism.[/B][/COLOR] Enclomiphene (EC) may very well be more effective overall.....let alone minimize any potential side-effects but again rigorous long-term studies are lacking. [COLOR=rgb(184, 49, 47)][URL unfurl="true"]https://www.excelmale.com/forum/threads/enclomiphene-citrate-a-treatment-that-maintains-fertility-in-men-with-secondary-hypogonadism.18710/[/URL][/COLOR] Use of tamoxifen and aromatase inhibitors have their own potential downfalls and although many try either hCG mono or clomid.....those using hCG mono tend to not feel as good overall compared to trt. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Clomid for PCT, fertility or low T
Treating Low Testosterone with Clomid, hCG and Aromatase Inhibitors: A Review of the Data
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