Clomiphene Citrate for Hypogonadism

Diagnosis and Classification

Hypogonadism is classified into primary hypogonadism, characterized by testicular failure with elevated gonadotropins, and secondary (central) hypogonadism, characterized by hypothalamic-pituitary dysfunction with low/normal gonadotropins, as defined by the European Urology guidelines 1
Diagnosis of hypogonadism requires assessment of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to determine the type, according to the European Urology guidelines 1
Evaluation of symptoms, including reduced libido, erectile dysfunction, decreased morning erections, fatigue, and decreased physical strength, is necessary for diagnosis, as recommended by the European Urology guidelines 2

Testosterone replacement therapy (TRT) is the first-line treatment for most hypogonadal men, available as transdermal, injectable, or implantable preparations, as stated by the European Urology guidelines 1
TRT is contraindicated in men seeking fertility, as it suppresses spermatogenesis, according to the Journal of the National Comprehensive Cancer Network guidelines 4
The European Association of Urology recommends that TRT is not recommended for men with active prostate cancer, as stated in the Journal of the National Comprehensive Cancer Network guidelines 4
Clomiphene citrate is not recommended for men with active breast cancer due to its estrogen receptor modulation, as advised by the European Urology guidelines 1

Monitoring of testosterone and gonadotropin levels is necessary after 2-3 months of clomiphene citrate treatment, and then twice yearly, as recommended by the Gastroenterology guidelines 3
Clomiphene citrate has a lower risk of polycythemia compared to TRT and no risk of transference to others, as stated in the Gastroenterology guidelines 3
The Gastroenterology guidelines suggest that clomiphene citrate may be more cost-effective than some TRT options 3