A 31-year-old man presenting with an 18-month history of sexual dysfunction resulting from severe adult-onset IHH (LH U/L, FSH U/L, T nmol/L). Initial therapy with 50 mg of clomiphene citrate (CC) three times a day for 7 days, with overnight LH pulse profiling and 9 am T levels evaluated at baseline and on completion. A 2-month washout period, followed by low-dose maintenance therapy (25-50 mg/d) for 4 months.
MAIN OUTCOME MEASURE(S):Baseline and stimulated T levels and LH pulsatility; effect on sexual function.
RESULT(S):Clomiphene therapy resulted in complete normalization of pulsatile gonadotropin secretion, serum T level, and sexual function. CONCLUSION(S):Isolated hypogonadotropic hypogonadism may result from an acquired defect of enhanced hypothalamic sensitivity to E-mediated negative feedback. Whereas direct T replacement therapy can further suppress endogenous gonadotropin secretion, treating IHH men with gonadotropins can stimulate endogenous T secretion and enhance fertility potential. On theoretical grounds, reversal of gonadotropin deficiency with CC might be expected to have a similar biological effect.
“My family doctor basically told me that I had to live with my Low T problem which was not something I wanted to hear. He told me this for 2 years and in fact it made me so mad that I am no longer his patient. I decided to get checked at TCT. After a thorough evaluation, including checking my blood, they told me that Low T was not something that I had to live with and in fact, they have helped with my other medical problems. They are treating my blood pressure, cholesterol and erection problems as well. I’m in my late forties and finally feel like I have been “tuned-up”. I feel better than I have in years which allows me to focus less on me and more on the things I find important. Thank you to everyone who helped get me where I am, including my ex-doctor. Keep up the good work TCT!” — Todd J.