Abstract
Clomiphene citrate (CC) is commonly used in the treatment of male hypogonadism/infertility and stimulates pituitary gonadotropin release. Patients variably respond to CC treatment, but whether baseline gonadotropin levels can be used to select patients for CC treatment is unknown. To investigate the role of baseline gonadotropins in predicting the biochemical response to CC treatment. Retrospective review of data from hypogonadal men treated with CC in two high-volume fertility centers was performed between 2013 and 2018. Patient age, body mass index (BMI), and baseline hormones (follicle stimulating hormone [FSH], luteinizing hormone [LH], and total testosterone [TT]) were obtained. Men on exogenous testosterone or gonadotropins within 6 months of CC treatment were excluded. CC starting dose varied from 25-50 mg every day to every other day. Response in treatment was measured as changes in continuous TT levels within 6 months of initiating CC treatment. Linear and curvilinear (quadratic fit) correlations were assessed between baseline gonadotropins and changes in TT levels. We defined the optimal slope transition point, fitting a piecewise linear regression at a threshold that maximized the multiple R statistics. Linear regression models adjusted for age, BMI, and time on CC therapy were fitted to assess the associations between baseline LH and FSH levels with treatment response.
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