Enclomiphene
An oral medication that raises a man's own testosterone production while preserving sperm production.
The basics
Testosterone replacement shuts down the brain's signal to the testes, and sperm production often falls toward zero. Enclomiphene takes the opposite approach. It blocks estrogen's negative feedback at the hypothalamus and pituitary, so LH and FSH rise and the testes make more of their own testosterone while continuing to make sperm.
Low testosterone in middle-aged men is most often driven by excess body fat, insulin resistance, and poor sleep, so we work up the cause before we treat the number.
We review the studies, the potential uses and benefits, and the open questions in our research post, Enclomiphene, Low Testosterone, and the Men Who Still Want Children.
What the evidence looks like
Moderate. Randomized trials against topical testosterone showed that enclomiphene brought testosterone into the normal range while preserving sperm counts. The evidence that it improves symptoms is weaker than the evidence that it raises the lab value, and long-term safety data are limited.
Why patients ask about it
- Low testosterone in men who want to preserve fertility
- An oral alternative to testosterone injections or gels
- Secondary hypogonadism related to weight and metabolic health
Good to know
- The FDA has not approved enclomiphene, so it's available only from a compounding pharmacy.
- We monitor testosterone, estradiol, LH, and FSH. Side effects can include headache, mood changes, and visual symptoms, which you should report right away.
- Tell us about any history of blood clots.
Enclomiphene, Low Testosterone, and the Men Who Still Want Children
Testosterone replacement raises the lab value and shuts down sperm production. Enclomiphene raises testosterone by restarting the brain's signal to the testes instead, and the trials show it preserves sperm counts. Here's what it does, what it doesn't, and why the FDA said no.
Read the articleRelated on our formulary
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