Clomiphene Citrate is Successful in Select Cases Of Male Hypogonadotropic Hypogonadism

Abstract

To review the management of male hypogonadotropic hypogonadism (HH) and evaluate the efficacy of clomiphene citrate (CC). Retrospective review Review of medical records of male HH patients. Eleven men (age: 28.2±5.1 years, wt: 93.4±24.6kgs) who were evaluated for infertility were diagnosed with HH. Four had Kallman’s syndrome, 4 idiopathic HH, 2 panhypopituitarism, and 1 septo-optic dysplasia. Eight patients were azoospermic, 2 oligospermic, and 1 had normal sperm concentration on presentation. The normospermic male was 17 years old and recently diagnosed with septo-optic dysplasia and presented for evaluation of future fertility potential. One of the men in the idiopathic group admitted to use of anabolic steroids for less than one month approximately five years prior to his presentation. Mean laboratory values at baseline for men who were not on replacement (n=7) were testosterone 106ng/dl, FSH 0.62mIU/mL, and LH 0.91mIU/mL. Three of the four men with adult-onset idiopathic HH responded to clomiphene citrate alone with an increase to mean laboratory values of testosterone 816ng/dl, FSH 4.8mIU/mL, and LH 6.4mIU/mL. Semen parameters in this group improved from a mean sperm concentration at baseline of 0.1 x 106/ml to 68.6 x 106/ml after three months of therapy. Two pregnancies were achieved in this group. One patient with Kallman’s established a pregnancy with HCG treatment only. Four patients (3 Kallman’s, 1 idiopathic) received HCG along with FSH, however only the patient with idiopathic HH has responded to the therapy thus far. Out of the ten men actively attempting conception, three pregnancies were achieved, all of which were in men diagnosed with adult-onset idiopathic forms of HH. Some men with adult-onset idiopathic forms of HH may benefit from a trial of clomiphene citrate. The improvement in semen and endocrine parameters are usually evident after the first three months of therapy. Those patients with Kallman’s syndrome and secondary forms of hypogonadotropic hypogonadism will likely have better success with traditional gonadotropin regimens.