Patient with hypogonadism and infertility successfully treated with clomiphene citrate

Abstract

We described 59-year-old men with history of secondary/tertiary hypogonadism, without primary hypothyroidism, elevated prolactin or hemochromatosis with structurally intact hypothalamo- hypophyseal (HT-HP) axis who was diagnosed in 2017. He was treated by different physicians with Testosterone intramuscular injections, hCG intramuscular injections and combination of hCG and FSH intramuscular injections. The patients wanted to have another child and this is why his therapy was changed from testosterone to hCG and later on to hCG and FSH injections three times a week by his urologist. Although his testosterone levels increased his semen analysis showed oligospermia. The patient was not very compliant with his Testosterone, hCG/hCG and FSH injections, because of the discomfort of intramuscular injections. This is why we started the patient from the therapy with hCG and FSH intramuscularly to Clomiphene citrate (CC) 25 mg per mouth every other day in 2021. After eight months therapy with CC the patient semen analysis normalized, Total and Free testosterone levels normalized, LH and FSH increased, his libido, morning erections improved and his erectile dysfunction resolved. Most importantly for the patient his wife become pregnant. With this case we emphasize the role of Clomiphene citrate in treating male hypogonadism if the patients desire fertility.