Testosterone versus clomiphene citrate in managing symptoms of hypogonadism in men

INTRODUCTION Both clomiphene citrate (CC) and testosterone supplementation therapy (TST) are effective treatments for men with hypogonadism. We sought to compare changes in symptoms and treatment efficacy in hypogonadal men before and after receiving CC and TST. PATIENTS AND METHODS 52 men who received TST and 23 men who received CC for symptomatic hypogonadism were prospectively followed for change in hormone levels and symptoms after treatment. These men were also compared to eugonadal men who were not on CC or TST during the same period. Comparisons were made between baseline and posttreatment hormone levels and symptoms. Symptoms were evaluated using the androgen deficiency in aging male (ADAM) and quantitative ADAM (qADAM) questionnaires. RESULTS Serum total testosterone increased from pretreatment levels in all men (P < 0.05), regardless of therapy type (TST: 281-541 ng/dL, CC: 235.5-438 ng/dL). Men taking TST reported fewer ADAM symptoms after treatment (5-2, P < 0.05). Similarly, men taking CC reported fewer ADAM symptoms after treatment (3.5-1.5, P < 0.05). Conversely, eugonadal men had similar T levels (352 vs. 364 ng/dL) and hypogonadal symptoms (1.5 vs. 1.4) before and after follow-up. When we evaluated individual symptoms, men treated with TST showed significant increases in qADAM scores in libido, erectile function, and sports performance. However, among the men who received CC, qADAM subscore for libido was lower following treatment (3.75-3.2, P = 0.04), indicating that CC could have an adverse effect on libido in hypogonadal men. CONCLUSIONS Both TST and CC are effective medications in treating hypogonadism; however, our study indicates that TST is more effective in raising serum testosterone levels and improving hypogonadal symptoms. CC remains a viable treatment modality for hypogonadal men but its adverse effect on libido warrant further study.