Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?

• Published in: International journal of impotence research Vol. 15; no. 3; pp. 156 - 165
• Main Authors: GUAY, A. T, JACOBSON, J, PEREZ, J. B, HODGE, M. B, VELASQUEZ, E
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing 01-06-2003; Nature Publishing Group
• Subjects: Aging; Androgens; Anxiety Disorders - complications; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - complications; Clomiphene; Clomiphene - therapeutic use; Coitus; Diabetes Complications; Diagnosis; Dosage and administration; Drug therapy; Erectile dysfunction; Erectile Dysfunction - blood; Erectile Dysfunction - etiology; Erectile Dysfunction - physiopathology; Gynecology. Andrology. Obstetrics; Health aspects; Humans; Hypogonadism - blood; Hypogonadism - complications; Hypogonadism - drug therapy; Impotence; Luteinizing Hormone - blood; Male; Male genital diseases; Measurement; Medical sciences; Middle Aged; Multivariate Analysis; Non tumoral diseases; Retrospective Studies; Testosterone; Testosterone - blood; Treatment Outcome; United States; Endocrinopathy; Human; Hypogonadotropic hypogonadism; Non steroidal estrogen; clomiphene citrate; Androgen; Erection disorders; Hypothalamic diseases; Clomifene; Genital diseases; erectile dysfunction; Testosterone; Chemotherapy; Treatment; Testicular hormone; Sex steroid hormone; Male genital diseases
• ISSN: 0955-9930; 1476-5489
• DOI: 10.1038/sj.ijir.3900981

Secondary hypogonadism is more common than primary gonadal failure and is seen in chronic and acute illnesses. Although testosterone has a role in erections, its importance in erectile dysfunction (ED) has been controversial. Hypogonadism produced by functional suppression of pituitary gonadotropins has been shown to correct with clomiphene citrate, but with a modest effect on sexual function. We wondered if longer treatment would produce improved results. A total of 178 men with secondary hypogonadism and ED received clomiphene citrate for 4 months. Sexual function improved in 75%, with no change in 25%, while significant increases in luteinizing hormone (P<0.001) and free testosterone (P<0.001) occurred in all patients. Multivariable analysis showed that responses decreased significantly with aging (P<0.05). Decreased responses also occurred in men with diabetes, hypertension, coronary artery disease, and multiple medication use. Since these conditions are more prevalent with aging, chronic disease may be a more important determinant of sexual dysfunction. Men with anxiety-related disorders responded better to normalization of testosterone. Assessment of androgen status should be accomplished in all men with ED. For those with lower than normal age-matched levels of testosterone treatment directed at normalizing testosterone with clomiphene citrate is a viable alternative to giving androgen supplements.