Clomiphene citrate may be effective in hypogonadal males with infertility.
Mechanism of action: selective estrogen receptor modulator (SERM). It binds to the estrogen receptor in the pituitary gland, which blocks the effects of estrogen.
Indication: hypogonadotropic hypogonadism
Usually, the male is middle-aged and obese.
Effects of clomiphene citrate:
(1) increase in serum FSH and LH
(2) increase in serum testosterone
(3) increased spermatogenesis and sperm motility, which may be sufficient to increase fertility
If effects are not seen within 3 or 4 months, then it is unlikely that continued therapy will be effective.
Clomiphene therapy is unlikely to be effective in patients with
(1) high levels of serum FSH.
(2) Kallmann's syndrome
The benefit of clomiphene therapy over testosterone therapy is that the latter suppresses intratesticular testosterone production and spermatogenesis. These effects would worsen infertility.
