Is it possible to raise testosterone levels with something other than testosterone? The answer is “yes.” Clomiphene (brand name called Clomid) has been used with much success in raising testosterone levels in men. This is good news as direct testosterone replacement, while very effective and safe in raising testosterone levels, does have potential drawbacks not seen with clomiphene.
What is Clomiphene?
Clomiphene, also known as Clomid, is best known as a fertility drug that is used to treat both female and male infertility disorders. It has been used since the early 1970s to treat infertility. Clomiphene is classified as a selective estrogen receptor modulator (SERM). It blocks the actions of estrogen in several of the body’s tissue organs. High estrogen levels shut off testosterone production in males. By blocking estrogen, clomiphene improves testosterone production.
In females, clomiphene stimulates ovulation thereby improving fertility. In men, clomiphene indirectly works on the testes to make both more testosterone and produce more sperm (leading to improved male fertility).
How Does Clomiphene Work to Raise Testosterone Levels?
To understand how clomiphene works to raise testosterone levels, we have to review the normal physiology of testosterone in men. Testosterone production involves the function and interplay of the hypothalamus, the pituitary, and the testes. The hypothalamus and pituitary glands sit in the brain. The hypothalamus releases GnRH or gonadotropin-releasing hormone. GnRH activates the anterior pituitary gland to produce two hormones; follicular stimulating hormone (FSH) and luteinizing hormone (LH).
FSH stimulates the Sertoli cells in the testes to make sperm. LH stimulates the Leydig cells in the testes to make testosterone. As men age, they lose both Sertoli and Leydig cells. The Leydig cells produce testosterone. Once the body has enough testosterone some testosterone becomes converted to estradiol (estrogen). Estradiol signals the anterior pituitary to shut off the production of LH since the body has enough testosterone. This is what is called a negative feedback loop.
Clomiphene blocks the estrogen receptors in the pituitary gland enabling the production of LH to keep signaling the testes to make testosterone. High estradiol levels can stimulate breast tissue in men just as in women. Clomiphene blocks the action of estradiol on male breast tissue preventing or reducing the development of man boobs which can be a problem with direct testosterone replacement therapy. This blocking of estradiol on breast tissue is a built advantage of clomiphene that testosterone replacement preparations do not have.
Clomiphene can double and even triple testosterone levels. A typical dose is 25 mg to 50 mg of clomiphene which is a pill that is taken daily.
What Are The Advantages of Clomiphene Versus Testosterone?
Clomiphene has some built-in advantages that direct testosterone replacement does not have. Now when we speak of direct testosterone replacement, we mean the use of testosterone whether it be in the injectable, topical, buccal, or transdermal form of testosterone.
Direct testosterone replacement can cause elevation of red blood counts to unsafe levels measured by way of hemoglobin and hematocrit. This occurs most often with injectable testosterone. To deal with an unsafe elevated red blood cell count either the testosterone dose must be reduced and/or the patient will need to periodically donate blood or be phlebotomized to reduce the blood cell count.
Direct testosterone replacement actually causes decreased sperm counts reducing fertility and can cause shrinkage of the testes known as testicular atrophy. While not a health risk, most men and even many women prefer not to see small testicles. Direct testosterone replacement can cause some swelling mainly in the legs.
It is possible to achieve supraphysiologic testosterone levels with direct testosterone replacement. This means the body has more testosterone than it really needs. More is not always better especially when it comes to hormonal balance. Achieving supra-physiologic testosterone levels will increase the risk of side effects. With direct testosterone replacement, there is a chance of raising estradiol levels too high causing breast tenderness and enlargement in men. To combat this many times men have been prescribed an estrogen blocker such as anastrozole.
Below are the key advantages of clomiphene versus direct testosterone replacement preparations.
- Clomiphene is a natural estradiol blocker.
- Clomiphene will not increase testosterone above physiologic levels.
- Clomiphene comes in pill form.
- Clomiphene has less effect on blood counts.
- Clomiphene preserves and even enhances male fertility.
Are There Disadvantages to Clomiphene?
There are some disadvantages to clomiphene. In some men, clomiphene may not increase testosterone enough to improve the symptoms of low testosterone which include the following: erectile dysfunction, low libido, decreases sensitivity of genitalia, fatigue, body fat gain, loss of muscle, mood swings, or irritability. It usually takes longer for clomiphene to show results compared to direct testosterone replacement.
Side effects of clomiphene include blurred vision (which I have seen in one patient), headaches, nausea, flushing, and breast tenderness (less than testosterone replacement, however).
Clomiphene is most effective in men who still have a critical number of Leydig cells. Clomiphene can only stimulate testosterone production in functioning Leydig cells. Men with chronic diseases like diabetes, heart disease, kidney disease, obesity, etc. tend to have fewer functioning Leydig cells.
Clomiphene works really well in improving testosterone levels in men under 40 but a significant number of healthy men under age 55 will see a good rise in testosterone levels as well. I have had even some healthy men in their 60s respond to clomiphene.
Below is one of our articles on other ways to increase testosterone levels.