Real World Experience with Clomiphene Citrate for Men with Functional Secondary Hypogonadism

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SUN 176-202-Male Reproductive Endocrinology and Male Reproductive Tract (posters)
Bench to Bedside
Sunday, April 3, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SUN 201
Namitha Bhat*1, Ranjodh Singh Gill2 and Robert A Adler3
1Virginia Commonwealth University Medical Center, Richmond, VA, 2VA Commenwealth University, Richmond, VA, 3McGuire Vet Affairs Med Ctr, Richmond, VA
Aim: Hypogonadism is associated with poor sexual health and quality of life. Clomiphene citrate (CC) has been used off-label for men with functional secondary hypogonadism (SH), defined as low serum testosterone (T) without elevation of gonadotropins while lacking an anatomic cause such as a pituitary tumor. We studied the response to CC in men with functional SH in a real world setting.

Methods: We reviewed the charts of men who were prescribed CC for SH in Veterans Affairs Medical Center Endocrine Clinics. SH was diagnosed in 39 men with one or more of the following: obesity, chronic opiate use, post-traumatic stress disorder, traumatic brain injury, depression, alcohol abuse. IRB approved the review.

Results: Of the 39 patients, 7 were lost to follow up, 1 died from trauma, and 29 obtained refills of CC. Only 2 switched to T replacement. Follow up on 25 of 29 men continuing CC revealed that 19 were < 50 years old and 1/3 had BMI > 35 Kg/m2. Mean duration of CC use was about 5 months, with most on 50 mg 3 times/week. Symptomatic improvement was noted in all but 3; however, 2 noted a leveling off of clinical improvement. Despite this all but 1 patient had increase in T level; the mean increase was 357 ng/dl. LH and FSH increased in about 60% of patients tested. Two previously hypo-fertile men sired children. Drug holiday was attempted in 5 men, but T levels returned to pre-treatment levels with accompanying clinical deterioration.

Conclusion: Men with functional SH are likely to respond to off-label CC. Serum T levels improved markedly, and in most men symptoms improved as well. Continued therapy appears to be necessary, and multi-year prospective studies are needed to determine long term efficacy, safety, and post-discontinuation recovery of gonadotropin suppression.

Nothing to Disclose: NB, RSG, RAA

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