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

[David Morris]

http://www.ncbi.nlm.nih.gov/pubmed/12904801

Int J Impot Res. 2003 Jun;15(3):156-65.

Clomiphene increases free testosterone levels in men with both
secondary hypogonadism and erectile dysfunction: who does and does not
benefit?
Guay AT, Jacobson J, Perez JB, Hodge MB, Velasquez E.

Center for Sexual Function (Endocrinology), Peabody, Massachusetts
01960, USA. andre.t.guay at lahey.org

Abstract
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.