Infertility drug also treats testosterone

Dear Dr. Roach: The last time I saw my urologist, I asked him to check my testosterone level. His nurse notified me that it was low and that I should make an appointment with one of his colleagues that specializes in treatment for that. When I saw that doctor, he prescribed generic Cialis for daily use and clomiphene oral tablets.

Before I picked up the clomiphene tablets, my wife looked up that medicine in a book of prescription medicines and found that it was originally prescribed for women who were having difficulty getting pregnant. We were surprised, but thought that since the book was older, the prescription may now be used as a treatment for low testosterone or low libido. Can you give me some advice on this prescription? — W.R.

Clomiphene is an anti-estrogen, and in addition to being used for female infertility, is also used by some specialists to raise testosterone levels. Estrogen causes a feedback loop to stop testosterone synthesis, so blocking estrogen stimulates testosterone production. I read many anecdotal reports and a few case studies showing good results with clomiphene.

However, this treatment is not approved by the Food and Drug Administration, and the data showing safety and efficacy not as good as treatment with testosterone. Antiestrogens are also used in men with breast cancer, and side effects noted in this population included fatigue (21%), anxiety (20%), sleep disorders (19%), decreased libido (11%) and weight gain (10%).

What I find concerning is that you haven’t told me about any symptoms you were having that prompted the testosterone test. Treatment to raise testosterone in men without clear symptoms of low testosterone and repeatedly low morning testosterone levels is not recommended.