Overview

Treating Male Infertility Through Hormones

Treating Male Infertility Through Hormones

Drugs used to treat male infertility change male hormones (the endocrine system). The goal of using these medications is to increase the amount of bioavailable testosterone and decrease the amount of estradiol. The medications used to do this are the following:

  • Clomiphene citrate or Clomid, which is used off label for male treatment as it is FDA approved only for use in women
  • Anastrazole or arimidex
  • hCG or hMG

All of these are taken as oral medications—except hCG and hMG, which must given as injections. All of these drugs also have side effects. We will discuss the specific side effects with you during your consultation with us.

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Clomiphene Citrate/Clomid

Clomiphene Citrate/Clomid Clomiphene citrate, or Clomid, works by blocking estrogen’s effect on the pituitary gland. Normally, estrogen tells the pituitary to produce less LH and FSH, which decreases testosterone and causes poor spermatogenesis or sperm production. Clomiphene citrate blocks this negative feedback, causing the pituitary to increase the LH and FSH it is producing. It also causes increased testosterone.

Side Effects

Side effects of clomiphene include, but are not limited to the following:

  • pectoral (or breast muscle) tenderness,
  • irritability,
  • mild acne,
  • possible ability to accelerate prostate cancer growth if cancer is present,
  • and, rarely, changes to your field of vision caused by pituitary swelling.

All of these side effects are reversible if a man stops taking clomiphene. Please stop taking clomiphene and notify us immediately if you experience any of these side effects.

Most men notice positive side effects from the clomiphene citrate such as:

  • improved erections,
  • increased sex drive,
  • increased muscle mass,
  • more energy,
  • and weight loss.

hCG & hMG

A small percentage of men will not respond to clomiphene citrate. We put these men on hCG or hMG. While these drugs are delivered by injection, they have very similar side effect profiles to clomiphene citrate. They work by directly stimulating the testes to make testosterone and improve spermatogenesis. We do not start with these drugs because they require injections, which most patients would rather avoid.

Anastrazole/Arimidex

Anastrazole or arimidex is a drug that was originally developed for breast cancer that has become an excellent drug for specific groups of men with male factor infertility. Arimidex prevents testosterone from changing to estradiol inside the tissues. Specifically, it blocks the action of aromatase, the enzyme (or biochemical machine) that converts testosterone to estradiol.

If estradiol is higher than it should be and if testosterone is lower, we will use anastrazole or arimidex to decrease the estradiol and increase the testosterone.

Medication Monitoring

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. We then have patients see us every four months for the first year they are using medication. After the first year, we ask patients to come in for an appointment once a year.  

At each of these visits, we check PSA, hemoglobin, and testosterone levels to check that the medication is working properly and that there are no adverse side effects.