James K. Rone, MD, FACP, FACE

Clomid Doesn't Work for Every "Low-T" Patient

May 17, 2014

Tags: Testosterone, Hypogonadism in Men

I was contacted via email by a gentleman providing very little information other than he has a low testosterone level, and that he wanted to try Clomid, and did not want testosterone replacement. Going on, he wrote: “Who can get that done for me…Need a doctor that will make it happen. Can’t find any.” And that was it—a man of few words.

Clomid is a drug usually used as a female fertility treatment. In certain cases it can raise testosterone levels in men by blocking estrogen receptors that inhibit release of LH, the pituitary hormone that drive testosterone production by the gonads. In part here is my reply to my emailer:

(1) I realize physicians tend to be a pretty conservative lot--by that I mean it can be difficult to find one willing to color outside the lines of standard care and evidence-based medicine (what's proven to work and be safe by published mainstream research), even in cases where common sense might make such an unproven therapy seem like a good idea. There are legitimately reasons for that, but it can frustrate patients. In my own case, I have a lot of knowledge and experience with difficult hypothyroidism cases. Based on that, I'm sometimes willing to handle things differently than the average doctor. In areas where my knowledge and experience is average compared to my peers, however, I'm as conservative (read: stubborn?) as the next guy.

(2) Clomid use in men is non-standard. There is increasing interest in it as a male fertility therapy, and I have used it that way a couple of times. Fertility treatment though is always short term—once pregnancy occurs, treatment stops. Use of Clomid as a long-term treatment for permanent hypogonadism (low testosterone, or "Low-T") presents different issues. I doubt anyone knows whether it's safe for men to take it for a long time. In fact, as an estrogen blocker, there is real concern that it weakens bones, causing fractures. Remember, estrogen strengthens women's bones—same with men. With that in mind it may well be that no good physician would agree to what you're asking. I wouldn't, not without there having been quality research proving long-term safety. Now, were there reason to believe this might be short-term therapy, Clomid might be a consideration, but you've given no details to suggest that's the case. The right therapy for anything is highly dependent on details.

(3) Which leads to my last point: Just because you want something does not make that something medically appropriate—always a primary concern of a good physician. And no good physician ought to promise a certain therapy without seeing and evaluating you. The only doctor who would promise to "make it happen" would most likely be a quack.

The simple fact is, there are causes of "low T"—most causes perhaps—where Clomid would not work. These include any serious defect in the testes interfering with testosterone production, and any serious damage to the pituitary gland's ability to make LH, which tells the testes to make testosterone. All Clomid does is block estrogen-caused inhibition of LH production, but after that the pituitary still has to be able to make LH and the testes still have to be able to make T. Sometimes it's obvious from a complete set of labs what the situation is, other times not.

Dr. Rone

Fiction: Mystery
PI Sherry Russell vs. the reigning "Miss Nazi" in 1968 Huntsville, during the run-up to the Apollo moon landings
Dr. Rone's 1st Southern Noir novel
Hate crimes in 1967 Alabama; unflinching follow up to 'No Nice Girls'
Nonfiction: Health & Medicine
"A really good read for those that have been told they don't have a thyroid problem."

Quick Links

Find Authors