Clomiphene citrate is effective in the treatment of the hypogonadal, subfertile male with body mass index (BMI) >25 kg/m 2

Abstract

OBJECTIVE: BMI has been shown to be negatively correlated with total testosterone (TT) and bioavailable testosterone (BT) levels in infertile males. Clomiphene citrate (CC), a selective estrogen receptor modulator, is used in the empiric treatment of subfertile males to increase testosterone levels. We sought to study the efficacy of CC for treatment of subfertile males who are overweight (OW, BMI 25-29.9 kg/m2) or obese (OB, BMI>30 kg/m2). DESIGN: Prospective observational cohort study. MATERIALS AND METHODS: Hypogonadal patients were started on CC, and TT, BT and prostate specific antigen (PSA) levels were recorded at baseline and measured at 1, 3 and 5 months during therapy. Followup semen analysis or pregnancy status was recorded. Student's t-test was used to compare pre- and post-treatment biochemical parameters. RESULTS: The study included 20 men, mean age 32.9 ± 0.9(SEM). Lower mean baseline TT levels were seen in the OB group (n=12) compared to the OW group (n=8) (TT: 237 ± 20 vs 306 ± 26 ng/dl; p=0.053). Within 1 month of CC therapy, TT and BT were significantly increased in both groups (table 1). Levels remained significantly elevated for duration of therapy. PSA levels did not increase significantly after 3 month of CC therapy (p=0.17). 4 patients demonstrated improved sperm concentration and motility at 6 months and a total of 5 subjects achieved pregnancy.Table 1Baseline vs. 1 Month Post-CC TreatmentParameterBaseline1 monthP-valueTT ng/dL (OW)306 ± 26663 ± 56< 0.001BT ng/dL (OW)187 ± 16486 ± 55< 0.002TT ng/dL (OB)237 ± 20577 ± 52< 0.001BT ng/dL (OB)155 ± 13371 ± 42< 0.001Results reported as mean ± SEM. Open table in a new tab Results reported as mean ± SEM. CONCLUSION: Significant improvement in testosterone levels are seen with the use of CC in the treatment of the subfertile male with BMI>25 kg/m2. Subfertile men who are overweight or obese can benefit from treatment with CC in order to increase testosterone levels and potentially improve semen parameters.