Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?
Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses. Although testosterone has a role in erections, its importance in erectile dysfunction (ED) has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate, but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of 178 men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Sexual function improved in 75%, with no change in 25%, while significant increases in luteinizing hormone (P<0.001) and free testosterone (P<0.001) occurred in all patients. Multivariable analysis showed that responses decreased significantly with aging (P<0.05). Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use. Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.
Guay
A T
AT
Center for Sexual Function (Endocrinology), Peabody, Massachusetts 01960, USA. andre.t.guay@lahey.org
Jacobson
J
J
Perez
J B
JB
Hodge
M B
MB
Velasquez
E
E
D000375:Aging; D001008:Anxiety Disorders / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications; D002996:Clomiphene / Q000627:therapeutic use*; D003075:Coitus; D048909:Diabetes Complications; D007172:Erectile Dysfunction / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007006:Hypogonadism / Q000097:blood* / Q000150:complications* / Q000188:drug therapy; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013739:Testosterone / Q000097:blood*; D016896:Treatment Outcome
D002996:Clomiphene; D013739:Testosterone; D007986:Luteinizing Hormone