Clomiphene Citrate is Effective in Increasing Testosterone Levels in Obese Hypogonadal Young Men

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 554-583-Male Reproductive Endocrinology & Case Reports
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-574
Maria Cecilia Velarde* and Sachin Bendre
West Virginia University, Charleston, WV
Background: Obesity has been associated with hypothalamic hypogonadism and low testosterone (T) in adult males and more recently in pubertal boys as well. The standard therapy for HG (HG) adult males is supplementation with T.  However, this may lead to testicular atrophy and infertility. HG in turn may also worsen obesity, insulin resistance and dyslipidemia. Only a few studies have been done using clomiphene citrate (CC), an estrogen receptor antagonist, to increase T in obese HG men while preventing testicular atrophy. So far no studies using CC have been conducted in younger obese post-pubertal HG adults <21 year.

Objective: To determine whether CC therapy was effective in increasing serum T levels in HG post-pubertal obese males <21 year.

Materials and Method: A retrospective cohort study using data from medical and laboratory records of obese men aged 18-21 yr. Those found to be HG (early morning T level <350 ng/dl) were given 25mg CC on alternate days. Out of 20 HG patients, 12 were analyzed. Baseline serum T, LH and FSH were compared with post-treatment levels at 3 months.  Also weight and BMI z-score were compared at baseline and after 3 months of CC treatment.

Results: Baseline T levels were 233±66 ng/dl and increased to 581 ± 161 ng/dl (p < 0.0001) after 3 month of CC treatment. Baseline LH levels increased from 3.3 ±1.6 mIU/mL to 5.7 ± 1.7 mIU/mL (p=0.027). Similarly, baseline FSH levels increased from 2.8 ± 1.5 mIU/mL to 6.2 ± 3 mIU/mL after CC treatment (p=0.026). There was no correlation between weight or BMI z-score and the baseline or post treatment T, LH, or FSH levels.

Conclusion: This is the first study looking at CC therapy in obese post-pubertal HG men <21 year. The anti-estrogen CC effectively increases T in obese post-pubertal HG men, similar to efficacy of CC in adult men older than 21 years. We feel that CC should be incorporated as an initial therapy for obesity in HG young adults. Future, prospective larger studies need to be done to address this question.

Nothing to Disclose: MCV, SB

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