Written by Suzanne Zuppello and medically reviewed by Dr. Gary Levy, Reproductive Endocrinologist specializing in the treatment of fertility and complex reproductive disorders with Fertility Cloud.
You may already be familiar with clomiphene citrate (Clomid), a popular brand-name prescription medication typically used for ovarian stimulation or ovulation induction. But what may be unfamiliar is that this oral fertility medication can be beneficial to people of all genders experiencing infertility. An off-label use of the medication is to treat infertility in people with testes as well — and while studies of this use of Clomid are not as abundant or thorough, the drug does show effectiveness in treating infertility in people with testes with some cases of lower numbers of sperm (oligospermia). If your physician recommended Clomid, or if you’re simply exploring your options, below is everything you need to know.
Clomid for Men 101
Clomid is most often prescribed when male infertility is suspected, with low sperm count or low motility being the more common causes. Due to the drug’s effect on the production of luteinizing hormones (LH), follicle-stimulating hormones (FSH), and testosterone, it is believed the medication — when taken at the optimal dose — can improve the total motile sperm count and, ultimately, result in higher rates of spontaneous pregnancy or allow for less invasive fertility intervention.
As with any medication — and especially one that interacts with your body’s production of hormones — there are side effects. However, most often they resolve once the medication is stopped. Side effects can become more severe or prominent with the medication dosage. Given that Clomid is most often prescribed to people with ovaries, research on the optimal dose for people with testes has yet to be published. However, the dose can range from 12.5 to 10000 milligrams per day, however typically started with 50 mg three times/week.
Can men take Clomid to treat infertility?
With limited research to draw from, much of what we know about Clomid’s effect on male infertility is anecdotal or reliant on a few, smaller studies. However the results are promising, albeit limited. Onestudy from 2015 reviewed three groups: participants taking vitamin E, participants taking Clomid, and participants taking both. Each group saw an increase in sperm concentration, with the group taking both vitamin E and Clomid having the highest increase. Further research suggests that the best candidates for Clomid are those with below-average sperm motility and shape and those with unexplained infertility with effectiveness . This research also suggests Clomid can support assisted insemination, such as ICI or IVI.
How does Clomid work and is it effective?
It’s important to know how Clomid works to understand why it can be prescribed to both biologically male and female individuals. Every body contains both estrogen and testosterone hormones. What Clomid does is prevent estrogen from interacting with the pituitary gland. Inhibition of estradiol on the pituitary gland leads to increased production of LH and FSH hormones, which promote sperm production. Treatment needs to be monitored as too high a dose can paradoxically decrease sperm production by increasing testosterone levels.
It’s important to note that it takes time to see the effect of Clomid on sperm production. On average, it takes 90-108 days from the time sperm is produced until it is ejaculated. For that reason, people with testes can expect to take the medication for at least three to four months before assessing its efficacy on fertility.
Side effects of taking Clomid in males
Side effects while taking Clomid include tenderness in the chest muscles, changes in mood (especially irritability), acne, and changes in vision. As always, should any of the side effects interfere with daily life, it’s best to consult your physician. They might choose to stop the medication entirely, lower the dose, or treat the side effects while on Clomid.
What's the correct dosage to take?
Since the use of Clomid in people with testes is still being evaluated, physicians will most likely start patients with a lower dose and titrate up as needed and tolerated — typically between 25 and 50 mg daily. While you might think a higher dose equals higher sperm count and motility, the opposite is actually true. Your doctor may monitor your hormone levels while taking the drug and adjust dosage based on the results. Too high of a dose can negatively impact fertility by decreasing sperm count and motility which is why it’s recommended to start low and slow.
Other ways of treating male factor infertility
Your doctor will review a series of factors to help determine the cause and most appropriate treatment for your infertility. A few things to consider are your age and weight, alcohol, cigarette, and drug use, and medical conditions such as diabetes, autoimmune disorders, genetic disorders and history of cancer and cancer treatment — all of which can impact fertility. Your hormone levels will also be checked to determine if there is an underlying imbalance or if the pituitary gland is functioning properly.
Once a full medical exam is conducted, doctors may determine that medication is the best course of treatment. Beyond Clomid, you might be prescribed Anastrozole, a breast cancer treatment which prevents testosterone from turning into estrogen, or hCG, which is an injection that stimulates the testes to produce testosterone. It’s also possible that surgery is the treatment for your infertility, if your doctor finds a blockage that stops the movement of sperm. Your doctor might also decide that assisted insemination is the best option for conception.
Just as female factor infertility can be treated in a variety of ways, depending on the cause and what’s best for the patient, treating male factor infertility will be a discussion between you and your doctor. There is no one-size-fits-all approach to treating infertility, however as time passes and research continues, the options for treatment will continue to grow so that you can conceive and grow your family.