Testosterone Health: Clomid Treatment Plan

Hello from Roman! This page contains your treatment plan. Be sure to take your time and read everything below, as well as the package insert included with your medication.

Learning as much as you can about your condition will help you know the questions to ask your doctors and make your relationships that much more productive. It is also essential for you to understand the potential risks and benefits of your treatment. 

Roman now is an added asset to your healthcare team. Keep your doctor informed. If you experience any of the following, log into your member account to contact your Roman provider: 

  • The medication doesn’t work or becomes less effective over time

  • You experience side effects

  • Your health status changes or you experience new symptoms

  • You are prescribed new medications or change how you are taking any of your existing medications

Quick Facts

  • You have been prescribed Clomid® (clomiphene citrate) for the treatment of low testosterone. Follow your healthcare provider’s specific instructions for your individual dosing, since your specific dose and how often you take it may vary. One typical regimen to start is half a tablet (25 mg) every other day.

  • Potential side effects include mood changes, breast tenderness, low sex drive, and visual abnormalities, including blurry vision, double vision, and rarely blindness. Tell your provider if you experience any of these side effects or other effects that you think may be due to the medication.

  • As part of your treatment monitoring, you will undergo a series of blood tests to make sure the treatment is working for you (to improve your symptoms and increase your testosterone level).

  • People who should NOT take Clomid include those with hypersensitivity or allergy to clomiphene citrate, intracranial (brain) lesions or tumors, pituitary gland tumors, liver disease, uncontrolled thyroid disease, uncontrolled adrenal dysfunction. Tell your provider if you have any of these conditions.

Clomid comes in 50 mg oral tablets. It is taken with water once a day or as prescribed. There is a wide range of dosing. The most common dosing regimens are half a tablet (25 mg) every other day or everyday, or one tablet (50 mg) every other day or everyday.

What if I miss a dose?

If you accidentally miss a dose, take it when you remember. However, if your next dose is supposed to be within a couple of hours, skip the missed dose and resume your normal schedule. Do not take a double dose. Let your provider know if you miss a dose.

What if I take more than I am prescribed?

The amount of Clomid that is toxic for humans to ingest is currently unknown. On tests done on mice, the amount of Clomid found to kill half of the test subjects was 1,700 mg/kg. And on tests done on rats, the amount of Clomid found to kill half of the test subjects was 5,750 mg/kg. Both of these doses are hundreds to thousands of times higher than the daily dose in humans (and also much higher than if you were to take an extra daily dose by accident).

However, taking more than you are prescribed may cause symptoms. These include nausea, vomiting, flushing, visual changes, and pelvic or abdominal pain. If you are experiencing any of these symptoms (or are not experiencing these symptoms but believe you may have taken too much anyway), contact your healthcare provider and poison control.

Clomid is a type of medication known as a Selective Estrogen Receptor Modulator (SERM). It tells the pituitary gland, which is like a hormone command center in the brain, to release more leutinizing hormone (LH), which, in turn, tells the testes to make more testosterone. SERMs are drugs that bind to the estrogen receptors throughout the body. Somewhat paradoxically, in some tissues Clomid blocks estrogen from having its normal effects, but in other tissues Clomid acts just like estrogen and has the same effects.

Clomid is successful at raising testosterone in most men, but not all. For men with primary testicular dysfunction, Clomid may not be able to raise testosterone levels because the testes may not be capable of manufacturing testosterone in response to stimulation from the pituitary gland (and high LH levels). Helping your body produce the testosterone it needs without the need for foreign testosterone is appealing but for some men it just isn’t possible.

However, for men in whom Clomid does raise testosterone levels, there are two possible outcomes:

  • Most men will get substantial symptom relief. Depending on your initial symptoms, this may mean increased sex drive, better energy levels, improved mood, and more.

  • Some men may experience an increase in testosterone levels but may still not have adequate symptom relief. The reasons for this are not always fully understood.

It’s important to understand that it may take 2–3 months of treatment to see an improvement in symptoms. It’s important to give it time to see if symptoms will be alleviated. Let your provider know if you’re in the smaller group of men not experiencing symptom relief. Sometimes, it merely means you need a higher dose.

As stated above, Clomid is not always successful at raising testosterone levels substantially, and sometimes it does raise testosterone levels but symptoms are not adequately controlled. One possibility that should be investigated is that the symptoms are not completely due to low T, or even not all due to low T. Symptoms of low T overlap with many other causes, including but not limited to underactive thyroid, anemia, depression, and sleep apnea.

Another possibility is that the symptoms are caused by low T and will respond to treatment with testosterone even if they do not respond to Clomid. The reasons for this aren’t fully understood either.

Your provider will use lab testing and periodic follow up visits (which will ask about symptoms and side effects) to confirm that Clomid is working for you. If Clomid isn’t helping your low T, they will help you figure out the best next steps. If Clomid does not work for you, you may need to see a healthcare provider who specializes in male hormones (urologist or endocrinologist) for further evaluation and treatment.

Producing more testosterone by taking Clomid has several benefits when compared to raising testosterone levels by adding foreign testosterone, whether by injection, cream or pill. First, Clomid will not shrink the testes or cause sperm counts to plummet. This is because Clomid does not interfere with the signaling of the pituitary gland to the testes. When men use foreign testosterone, in any form, the pituitary gland gets the signal that there are high levels of testosterone and it stops telling the testes to perform their functions—like making sperm. This interferes with sperm production and clearly is not good for men who want to maintain fertility.

Many men also like the idea of taking a pill instead of shots or creams (creams that can be transferred to females or children unintentionally). Some men simply prefer the concept of having their testes produce their needed testosterone instead of using testosterone from a foreign source. The advantages of low T treatment with Clomid include:

  • Clomid is a good option for men who want to maintain their fertility

  • It is easy to use (taken as a tablet)

  • It may have fewer side effects than testosterone

  • It is a relatively affordable drug

Clomid also has a few disadvantages compared to treatment with testosterone.

  • It is less likely to work in men with primary hypogonadism (low T due to malfunctioning testes), which is why men are first carefully selected before starting Clomid therapy

  • It is not effective in some men who do respond to testosterone

  • It has variable effects on the estrogen receptor, which causes certain side effects in some men, like decreased sex drive

  • It is an off-label medication and does not have an FDA indication for the treatment of low T