Clomid and Men
Usually, the first course of action taken by a doctor in the treatment of infertility is to prescribe the drug clomiphene citrate, commonly sold under the name Clomid. It is the drug of choice for inducing ovulation, not only because it tends to be quite effective if the reproductive issues aren't related to estrogen, but also because it is inexpensive, easily available, and well tolerated by women. As it turns out, men are also using the drug for infertility treatments and for sports enhancement as well, even though it hasn't been approved by the FDA for male use.
Clomid - The Woman's Fertility Drug
Clomiphene is an antiestrogen and it works by fooling the pituitary gland into believing that estrogen levels in the body are low. Consequently, the pituitary starts producing more follicle stimulating hormone (FSH) and luteinizing hormone (LH), which in turn stimulate the ovaries to produce more eggs. If a woman does not produce enough estrogen, Clomid is not used. The test used to determine if there is enough estrogen produced in the woman's body is to use progestins to see if they elicit bleeding. The test is called a progestin challenge test.
Although it has been well tested for its effectiveness in fertility assistance for women, Clomid is has some downsides as well:
· The risk of multiples is increased with Clomid. There is a 10% risk of twins on the drug and a 1% risk of higher order births.
· Ovarian cysts may form following Clomid use as a result of hyperstimulation. It is usually mild and occurs more in women with PCOS.
· Side effects include hot flashes, mood swings, depression, nausea, and breast tenderness.
· As an antiestrogen, Clomid can cause cervical mucus to become too thick for sperm to pass through. If a postcoital test has negative results consistently, Clomid should be stopped and another medication used instead.
Clomid - A Man's Fertility Drug, Too?
Clomid, while approved for use by women to treat infertility, has found its way into use as a fertility drug for men as well. However, it has not been approved by the FDA to be used as a fertility treatment in men even though its use to address infertility in men is widespread.
Clomid & Male Hormones
Clomiphene works differently in men than in women in terms of the reaction of hormones in the body. Testosterone, the male androgen hormone, is made by Leydig cells in the testis. The pituitary gland releases LH which stimulates the Leydig cells to make testosterone, which is converted to the female hormone, estrogen. The estrogen causes the pituitary to stop producing LH - it works in a similar fashion to an automatic thermostat on a heater. When the temperature drops, the thermostat causes the heater to take energy to produce heat and vise versa for heat. Clomiphene (Clomid) works by blocking estrogen at the pituitary, causing the pituitary to make more LH. The increase in LH causes the Leydig cells in the testis to make more testosterone.
If a man is given the hormone testosterone, then the pituitary thinks the testis are producing adequate testosterone and luteinizing hormone levels fall. The result is that the testis stops making testosterone, lowering the level of the hormone in the testis and in the blood. Clomiphene is a way to increase blood and testis levels of testosterone simultaneously.
"Off Label" Clomid Use for Men
Clomiphene has been around for a long time and is now generic. The likelihood of testing being done on clomiphene for men is remote because of the high cost of research testing of the drug on men. However, since it is highly available and very affordable, a lot of doctors prescribe clomiphene for their male patients who are struggling with infertility issues. They order it "off label", which means that it is not FDA approved for use in men.
It is generally very well tolerated by men. There are some side effects to clomiphene use for men:
· hot flashes
· mood swings
· blurred vision
· abdominal bloating
Clomid for Men Needs Doctors' Guidance
It is not recommended for use for more than six months after which time, if infertility persists, a man should seek the next step in testing. It is important that men not arbitrarily take this drug as a method of self-treatment. Guidance of a doctor is important to gain benefit, since testosterone levels may change and the amount of the drug taken needs to be adjusted accordingly.
Clomid continues to be a well used aid in the treatment of infertility in both women and men.