title: A Comparison of Secondary Polycythemia in Hypogonadal Men Treated with Clomiphene Citrate versus Testosterone Replacement: A Multi-Institutional Study.
abstract: We evaluated the relative prevalence of secondary polycythemia in hypogonadal men treated with clomiphene citrate or testosterone replacement therapy.
  
  
  
  In this retrospective, multi-institutional study, we included 188 men who received clomiphene citrate and 175 who received testosterone replacement therapy with symptomatic hypogonadism. The overall prevalence and ORs of secondary polycythemia for clomiphene citrate treatment vs testosterone replacement were primarily measured, as were baseline characteristics. Subset analysis included polycythemia rates for different types of testosterone replacement therapy.
  
  
  
  Overall, men on testosterone replacement therapy were older than clomiphene citrate treated men (age 51.5 vs 38 years). Men on testosterone replacement had longer treatment duration than clomiphene citrate treated men (19.6 vs 9.2 months). For testosterone replacement therapy and clomiphene citrate the mean change in hematocrit was 3.0% and 0.6%, and the mean change in serum testosterone was 333.1 and 367.6 ng/dl, respectively. The prevalence of polycythemia in men on testosterone replacement was 11.2% vs 1.7% in men on clomiphene citrate (p = 0.0003). This significance remained on logistic regression after correcting for age, site, smoking history and pretreatment hematocrit.
  
  
  
  The prevalence of polycythemia in men treated with clomiphene citrate was markedly lower than that in men on testosterone replacement therapy. The improvement in absolute serum testosterone levels was similar to that in men on testosterone replacement. There is no significant risk of polycythemia in men treated with clomiphene citrate for hypogonadism.
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia. Electronic address: kmw8g@virginia.edu.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wheeler
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.affiliation: Burnett School for Biomedical Sciences, University of Central Florida, Orlando, Florida.
authors.forename: Raj A
authors.initials: RA
authors.lastname: Kumar
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia.
authors.forename: Shaan
authors.initials: S
authors.lastname: Setia
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, Virginia.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Costabile
authors.affiliation: Department of Reproductive Urology, Austin Fertility and Reproductive Medicine, Austin, Texas.
authors.forename: Parviz K
authors.initials: PK
authors.lastname: Kavoussi
mesh_terms: D000328:Adult; D000728:Androgens / Q000009:adverse effects* / Q000627:therapeutic use; D002996:Clomiphene / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D007006:Hypogonadism / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011086:Polycythemia / Q000139:chemically induced*; D012189:Retrospective Studies; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects* / Q000627:therapeutic use; D013739:Testosterone / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000728:Androgens; D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D013739:Testosterone
keywords: clomiphene; hypogonadism; polycythemia; testis; testosterone