Treating Male Infertility Through Hormones
Male fertility pills can change a man’s hormones (the endocrine system) in many ways. These medications can get your fertility back on track by increasing the amount of bioavailable testosterone and decrease the amount of estradiol (a form of estrogen). The drugs used for this purpose are the following:
- Clomiphene or Clomid
- Anastrazole or arimidex
- hCG (human chorionic gonadotropin) or hMG (human menopausal gonadotropin)
Most of these fertility drugs are taken by mouth except hCG and hMG, which are injections. As with any medication, these drugs do have side effects, but don’t worry, our goal is to find the best medication for your body and its needs.
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What Is Clomiphene?
Clomid is the brand name for clomiphene and is currently FDA-approved for female infertility, but doctors can also prescribe clomid for men for off-label use. It’s usually given to men who have a low sperm count caused by low testosterone levels.
How Does Clomiphene Work?
The pituitary gland in your brain secretes certain hormones into your blood stream to help your reproductive system. Clomiphene is used to increase the hormones released from the pituitary gland, which in turn, stimulates the production of testosterone and sperm within the testes. Boosted levels of these reproductive hormones will reduce the symptoms of hypoandrogenism (low testosterone), increase sperm count, and potentially help to improve non-obstructive azoospermia, a blockage that prevents the sperm from entering the semen.
How Effective Is Clomiphene?
Large-scale studies have found sustained increases in testosterone and strength, reduced fatigue, and improved erectile function among men who have hypoandrogenism. Research also showed that up to 10 percent of azoospermic men saw a return of sperm to the ejaculate after three months of taking clomiphene.*
Clomiphene Side Effects
If you take Clomiphene, side effects may include the following:
- Changes in libido (sex drive)
- Changes in mood
- Changes in energy level
- Increased aggression
- Male-patterned baldness
- Blurred vision
- Increase in hemoglobin (a blood protein that transports oxygen and adds viscosity, or thickness, to your blood)
- Enlargement of the prostate gland
- Pectoral (or breast muscle) tenderness
- Mild acne
* Moskovic D, Katz D, Akhavan A, Park K, Mulhall J. Clomiphene citrate is safe and effective for long-term management of hypogonadism. BJU Internat. 2012 Nov; 110(10):1524-28.
* Hussein A, Ozgok Y, Ross L, Niederberger C. Clomiphene administration for cases of nonobstructive azoospermia: a multicenter study. J Androl. 2005 Nov-Dec;26(6):787-91.
What Is Anastrozole?
Anastrozole or arimidex was originally developed for breast cancer, but has become a viable off-label drug for specific groups of infertile men. Unlike the other fertility drugs, anastrazole blocks the enzyme, aromatase, which prevents testosterone from changing into estradiol. This mechanism helps testosterone levels rise and lowers estrogen levels.
Throughout the course of your therapy, we will monitor your hormone levels and testosterone to estradiol ratio to evaluate the drug’s effectiveness.
How Effective Is Anastrozole?
Anastrozole has been found to reduce male hypoandrogenism symptoms such as low energy, reduced muscle mass, low libido, and erectile dysfunction. It’s also been shown to improve sperm production and sperm recovery rates in men who are azoospermic or have a low sperm count.*
Anastrozole Side Effects
You may notice side effects while taking Anastrozole such as:
- Bone pain
- Increased red blood cell count
- Increased liver enzymes
And rare but serious side effects that have been reported include:
*Kim E, Crosnoe L, Bar-Chama N, Khera M, Lipshultz L. The treatment of hypogonadism in men of reproductive age. Fertility and Sterility. 2012 Mar;99(3):678-79.
*Kim E, Crosnoe L, Bar-Charma N, Khera M, Lipshultz L. The treatment of hypogonadism in men of reproductive age. Fertility and Sterility. 2013 Mar;99(3):718-24.
What Is Human Chorionic Gonadotropin (hCG)?
Human chorionic gonadotropin (hCG) is a hormonal treatment that can also be used to increase testosterone levels in men who suffer from symptoms of low testosterone or hypogonadism (testosterone deficiency). This drug is typically a last resort treatment because it requires two to three injections per week, which most patients would rather avoid.
How Does hCG Work?
Human chorionic gonadotropin works by directly stimulating the testes to make its own testosterone and improve sperm production. It’s important to preserve the body’s natural production of testosterone inside the testes because it’s needed to maintain testis size and sperm production.
If your sperm count hasn’t improved after six months, we may suggest adding human menopausal gonadotropin (hMG) injections to your regimen. Menotropins like hMG are a mixture of hormones — naturally produced by the pituitary gland — that help your reproductive system. You may need to take these medications together for up to 12 additional months to see results.
How Effective Is hCG?
Research has found hCG to increase energy, libido, strength, and mood in hypogonadic men. This has been found in men who are hypogonadic for unknown causes as well as in men with lower testosterone production due to long-term testosterone replacement therapy. According to another study, the boost in testosterone production from hCG can also raise the likelihood of successful sperm retrieval in men with non-obstructive azoospermia.*
hCG Side Effects
Side effects may include the following:
- Pain at the injection site
- Changes in libido (sex drive)
- Changes in mood
- Changes in energy level
- Weight gain
- Increased red blood cell concentration and risk for blood clots
- Prostatic enlargement
*Shinjo E, Shiraishi K, Matsuyama H. The effect of human chorionic gonadotropin-based hormonal therapy on intratesticular testosterone levels and spermatogonial DNA synthesis in men with non-obstructive azospermia. Andrology. 2013 Aug;1(6):929-35.
What Is Coenzyme Q10?
Coenzyme Q10 isn’t a prescription drug, but it is a molecule that we make in our bodies from eating food or taking it as a nutritional supplement. It’s also a powerful antioxidant that has been shown to be beneficial for a variety of health conditions including male fertility.
How Effective Is Coenzyme Q10?
In men with abnormal sperm parameters, it has been shown to improve both sperm integrity and sperm motility. It may also benefit men with pyospermia, an elevated number of white blood cells in the semen. It’s important to follow up with semen analyses and doctor office visits to evaluate the effectiveness of the medication.
Coenzyme Q10 Side Effects
Even though Coenzyme Q10 is a supplement, there may still be side effects from taking it at increased doses. Possible side effects include, but are not limited to the following:
- Itching or rash
- Nausea or vomiting
- Low blood pressure
- Altered heart rate
- Decreased appetite
Please notify our offices if you are experiencing any side effects that are limiting your quality of life with these medications. We may be able to change your dosage or alter other medicine to help limit these side effects.
*Mancini A, Balercia G. Coenzyme Q(10) in male infertility: physiopathology and therapy. Biofactors. 2011 Sep-Oct;37(5):374-80.
*Balercia et al. Coenzyme Q10 treatment in infertile men with idiopathic asthenospermia: A placebo- controlled, double-blind randomized trial. Fertility and Sterility. 2009 May;91(5):1785-92.
*Safarinejad. Efficacy of coenzyme Q10 on semen parameters, sperm function, and reproductive hormones in infertile men. Journal of Urology. 2009 Jul;182(1):237-48.
We ask that patients on any of these medications return after two weeks for lab testing and a clinic visit so we can make sure these medications are working properly.
At each of these visits, we check PSA (a prostate gland protein), hemoglobin, and testosterone levels and ensure there are no adverse side effects. For the first year of treatment, we will schedule appointments every four months and then reduce your visits to once a year.