The growing number of men using testosterone replacement therapy is staggering. A recent cross-sectional study published in 2024 (Selinger S, Thallapureddy A) found a relative 27% increase in testosterone prescriptions in the U.S. between 2018-2022. When evaluated by age breakdown there was an 86% increase between ages 25-34 and 45% increase between ages 35-44 during that timeframe. At the end of 2022 it was estimated that well over 1.6 million men in the U.S. were prescribed testosterone.
When seeking treatment for symptoms of low testosterone, patients have multiple options besides testosterone replacement therapy. While there are numerous benefits associated with testosterone replacement, it is not appropriate for all patients. Concerns with future fertility, pre-existing elevated red blood cells (polycythemia), patient age, and fear of injections are all reasons why patients may look for other options.
Enclomiphene citrateis an oral medication that can be used in lieu of testosterone for improvement in symptomatic declining/low testosterone levels. Enclomipheneis a selective estrogen receptor modulator (SERM) and has been used for 15+ years while its parent compound, clomiphene citrate, has been used off label in men sine the 1960’s. These medications cause stimulation of the hormonal signals in the brain that lead to increased testosterone production.
Whereas testosterone treatment causes a negative shutdown of natural testosterone production, enclomiphene can potentially amplify the output of the signaling hormones and, therefore, increase natural sperm and testosterone production. In younger symptomatic men or those where testosterone replacement is not recommended, enclomiphene may be a great option. Talk to your provider today to see if this is a good option for you.
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