title: CLOMIPHENE CITRATE IN THE TREATMENT OF IDIOPATHIC OR FUNCTIONAL HYPOGONADOTROPIC HYPOGONADISM IN MEN: A CASE SERIES AND REVIEW OF THE LITERATURE.
abstract: OBJECTIVE
  Late-onset hypogonadotropic hypogonadism (LOH) is a complex, heterogeneous entity. Whenever treatment is indicated, the endocrine literature has recommend testosterone replacement. We present our experience with clomiphene citrate treatment in patients with LOH and a review of the literature.
  
  
  METHODS
  This retrospective case series included 18 male patients with hypogonadotropic hypogonadism, roughly according to the European Male Aging Study criteria for LOH, attended at an academic hospital outpatient clinic. Data were retrieved from the patients' electronic medical records.
  
  
  RESULTS
  The patients' mean age (±SD) was 44.3 ± 6.3 years (range 21-67 years) referred for evaluation of low testosterone together with decreased libido, erectile dysfunction, fatigue or tiredness, anxiety, and osteoporosis. Clomiphene was initially prescribed at doses between 25 mg 3 times a week and 50 mg/day. At 6 to 8 weeks following initiation of treatment, mean basal total-testosterone increased from 7.6 ± 2.6 to 19.3 ± 5.2 nmol/L (P<.0001). Mean basal luteinizing hormone (LH) increased from 2.7 ± 2.1 to 8.3 ± 3.5 nmol/L (P<.0001). Mean basal follicle-stimulating hormone (FSH) increased from 4.2 ± 3.6 to 8.6 ± 6.2 nmol/L (P = .007). Testosterone and LH responses were invariably observed, including 2 patients with history of nonpituitary cranial pathologies, 2 with somewhat elevated FSH, and 1 with an eating disorder. Twelve (67%) patients reported improvement in symptoms. Side effects included transient nipple tenderness in 1 patient.
  
  
  CONCLUSIONS
  Available data suggest that clomiphene is an efficient and convenient alternative to testosterone replacement therapy in a substantial subset of patients with LOH. Additional long-term controlled studies should further establish the role of clomiphene in LOH.
  
  
  BACKGROUND
  FSH = follicle-stimulating hormone LH = luteinizing hormone LOH = late-onset hypogonadotropic hypogonadism.
authors.forename: Yair
authors.initials: Y
authors.lastname: Liel
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D001007:Anxiety / Q000188:drug therapy; D002996:Clomiphene / Q000009:adverse effects / Q000627:therapeutic use*; D007172:Erectile Dysfunction / Q000209:etiology; D005221:Fatigue / Q000188:drug therapy; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000188:drug therapy*; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy; D012189:Retrospective Studies; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use*; D013739:Testosterone / Q000097:blood / Q000172:deficiency; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D013739:Testosterone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone