Clomiphene Citrate (CC pill, or Clomid) - A Testosterone Therapy Alternative for Men

A Testosterone Therapy Alternative for Men with Low Testosterone Levels Whether you are a 30, 50, 80 or even 110 year old man, having low testosterone levels (hypogonadism) is neither fun nor healthy. The symptoms of low testosterone in men range from lack of energy, depressed mood, loss of vitality, muscle atrophy (sarcopenia), muscles aches, low libido, erectile dysfunction, and weight gain...to bone loss (osteopenia), osteoporosis, mild anemia, increased risk of Alzheimer's, increased risk of high-grade prostate cancer, and increased risk of death due to all causes.

As you may know, low testosterone in men may be caused by problems in the testes (or gonads). This is called primary hypogonadism and can be brought on by the mumps, testicular trauma, or testicular cancer, etc., and can only be treated with testosterone replacement therapy. However, the more common causes of low testosterone/hypogonadism result from problems in the pituitary gland and/or hypothalamus in a man's brain. Low testosterone levels caused by such "brain problems" are collectively described as secondary hypogonadism or hypogonadotropic hypogonadism and may result from depression/anxiety, head trauma, iron overload, anabolic steroid overdosing, diabetes, sleep deprivation, or some medications.

Traditionally, if low testosterone is diagnosed, testosterone replacement therapy is prescribed, and it most commonly comes in the form of a cream, gel, pellet, patch, and by injection. And although these types of therapy are effective, some methods are better than others, and there are side-effects with all of them. For example, testicular shrinkage, gynecomastia (breast enlargement), low sperm count/sterility, and polycythemia (overproduction of red blood cells) are common side-effects of testosterone replacement therapy (for many sufferers, these side-effects are mostly treatable or considered "worth it" by the patient).

However, specifically due to the sterility side-effect, such testosterone treatments aren't a good option for men who want to have children. In these (usually young) hypogonadal men, clomiphene citrate (CC pill, or Clomid) and/or human chorionic gonadotropin (HCG) have been used (by specialists) for decades to increase testosterone production, increase sperm production, and increase fertility. Both these therapies effectively help signal the testes to produce testosterone and thereby increase testosterone levels (assuming of course the cause of the initial problem is not in the testes' ability to make testosterone). See "David" below for an oversimplified diagram of how clomiphene, HCG, and testosterone work within the hypothalamic-pituitary-testicular axis.

In a healthy male, the pituitary gland in the brain releases luteinizing hormone (LH) into the blood stream, which signals the testes to “GO” and produce testosterone. After testosterone has been produced it naturally converts to some estrogen (yes, there’s estrogen in men too) and this estrogen acts as a “STOP” signal to the pituitary to stop making LH. It is a delicate system of checks and balances which I have simplified here for our purposes.

Clomid (clomiphene citrate, or CC pill) works by blocking estrogen at the pituitary and hypothalamus. Thus, the usual estrogen message to "STOP" production of LH is essentially silenced, and therefore the pituitary makes more LH and there is an increased "GO" signal to produce testosterone in the testes. HCG works by mimicking LH, which also increases the "GO" signal to produce more testosterone in the testes. Prescribing testosterone for a man, however, does the opposite of what clomiphene and HCG do.

With traditional testosterone replacement therapy, the brain (hypothalamus and pituitary) gets the message that there is plenty of testosterone being made in the testes, so much so that it doesn't need to make anymore. Subsequently, the pituitary stops producing LH, and the natural production of testosterone (and sperm) in the testes ceases, which is why traditional testosterone replacement results in testicular shrinkage and low sperm count...a man's testosterone and sperm manufacturing plant is essentially shut off.

Clomiphene citrate (CC pill) and/or HCG do not turn off the testosterone manufacturing plant but rather turn it back on or reboot it. While some hypogonadal men require continuous use of clomiphene, for others it can be used for a 3-6 month time period and then discontinued. And, the checks and balances system is not interrupted, so there aren't the testosterone replacement side-effects which occur due to intentional or unintentional testosterone overdosing. Most interestingly, although it used to be thought that clomiphene and/or HCG only worked on young men, in the past decade or so it has been used effectively in older men too.

The 5 Main Reasons Clomiphene Citrate (CC pill, or Clomid) May be a Good Alternative to Testosterone Replacement Therapy in Men with Low Testosterone Due to Secondary Hypogonadism:

1. Clomiphene citrate (CC pill) stimulates the body's own production of testosterone
2. Clomiphene citrate (CC pill) doesn't interfere with the body's checks and balances of testosterone
3. Clomiphene citrate (CC pill) comes as a pill easily administered by mouth
4. Clomiphene citrate (CC pill) is generic and very cheap
5. Clomiphene citrate (CC pill) has little side-effects and low risk of developing these side-effects

The 5 Main Reasons Clomiphene Citrate (CC pill, or Clomid) is Not Usually Prescribed to Men with Low Testosterone Due to Secondary Hypogonadism:

1. Most doctors aren't aware of the efficacy and safety of clomiphene use in men
2. Most doctors think of Clomid as a "women's drug" to increase fertility
3. Clomid is FDA approved only for use in women
4. Clomid use in men is considered "off label"
5. Clomiphene citrate (CC pill) is now generic and really inexpensive so it's not advertised very much

Note: HCG is more commonly known and prescribed for secondary hypogonadism in men but it involves injection and is expensive, so if clomiphene works alone I think that is preferred. The 4 Main Risks of Using Clomiphene Citrate (CC pill, or Clomid) in Men with Low Testosterone Due to Secondary Hypogonadism:

1. Very rarely, visual changes may occur which are reversible with discontinuation
2. In older men, there is a reported increased risk of pyospermia (a noninfectious increase in white blood cells in semen, with unseen detriment)
3. Clomiphene citrate (CC pill) is a drug which is not bioidentical. This means it's molecular structure doesn't mimic a compound naturally found in the human body. And, correspondingly, clomiphene citrate (CC pill) doesn't have a known natural function in the human body and thus may at some point manifest a currently unknown side-effect in men. This latter, however, is a theoretical risk because for more than 40 years clomiphene use in men has only shown the risks above.
4. Clomiphene may not work...especially in older men who in addition to secondary hypogonadism may also have primary hypogonadism; or in men with an unresolved chronic disease

In conclusion, in the appropriate male patient, clomiphene citrate (CC pill, or Clomid) may be a good alternative to both short and long-term testosterone replacement therapy. Regardless, just like testosterone replacement, clomiphene citrate (CC pill) must be administered and monitored by a competent physician.

Proper perspective on menopause can help women get help needed

Women who have a healthy understanding of menopause as well as what the journey was like for their own mothers will be well-equipped to handle it themselves when the time comes. Menopause is considered one of the most significant transitions in a woman’s life and begins when her body ceases to produce the female hormone estrogen. The absence of estrogen has a profound impact upon the female body: uncomfortable symptoms are set in motion like hot flashes and mood swings, and can contribute to heart disease and bone loss.

How long a woman will likely experience menopausesymptoms can vary and be dependent on her health and family history. Women can often follow in their own mother’s footsteps. In my practice, I have cared for women who have had menopause symptoms from one to five years, and others who experience them for more. A new study published in JAMA Internal Medicine suggests that the average American woman experiences menopausesymptoms for seven years.

Women need to first understand that the onset of symptoms does not always signal that she is in menopause. Menopause is officially diagnosed when a woman has not had her menstrual cycle for one full year. However, women can experience symptoms of menopausefor years up to that point. This transitional phase is calledperimenopause and can begin as early as 45 years of age.

Women who enter perimenopause will experience irregular or late menstrual cycles, and may begin having symptoms common with menopause: hot flashes, night sweats, sleep disturbances, vaginal dryness, painful intercourse, a shift in sexual drive, mood swings and urinary issues. The age at which a woman begins experiencing symptoms as well as the pace at which the symptoms develop play a role in the severity of symptoms. Also, a sudden loss or decline in estrogen and certain behaviors such as smoking can make symptoms more intense.

For some women, menopause may come and go without much notice, but for others, it can have a dramatic effect on their quality of life. Women need to know that there is hope and help available. In the last three years, medical science has advanced significantly to provide many treatment options to help with symptoms. Hormone replacement therapy (HRT) still remains a viable and safe option for women who experience vaginal dryness and hot flashes and helps safeguard from osteoporosis (or thinning of bones), according to the American College of Obstetrics and Gynecology.

A combination of estrogen, progesterone and testosterone can also be used to treat symptoms, and women now have non-hormonal options such as antidepressants and anti-anxiety medications, which when used in small doses can help reduce the severity of hot flashes.

Relief can also come through lifestyle changes and disease management. Avoidance of smoking, weight gain, excessive alcohol as well as controlling health issues such as high blood pressure, diabetes and thyroid disease can help lessen the severity of symptoms.

Menopause is a natural event-change that all women experience in their own personal way. That’s why a strong physician-patient relationship is so important to help each woman create an individualized approach to this time in her life.

Ashok Buddhadev, MD, is an OB/Gyn physician with Premier Health Specialists who practices at Upper Valley Women’s Center in Troy.

Originally published at: http://tdn-net.com/features/health/5354/proper-perspective-on-menopause-can-help-women-get-help-needed

Borderline Testosterone Levels – Higher Rates of Depression

Researchers at George Washington University found that men referred for tertiary or lower level care for borderline testosterone levels had much higher rates of depression and depressive symptoms than those of the general population. “In an era where more and more men are being tested for “Low T” — or lower levels of testosterone — there is very little data about the men who have borderline low testosterone levels,” said Michael S. Irwig, M.D.,associate professor of medicine and director of theCenter for Andrology at the George Washington University School of Medicine and Health Sciences. “We felt it important to explore the mental health of this population.”

The research involved 200 adult men, aged 20-77, with an average age of 48, who were referred for borderline total testosterone levels between 200 and 350 ng/dL. Depression and/or depressive symptoms were present in 56 percent of the subjects. Furthermore, one quarter of the men in the study were taking antidepressants and that the men had high rates of obesity and low rates of physical activity. The most common symptoms were erectile dysfunction, decreased libido, fewer morning erections, low energy, and sleep disturbances. When we see a male patient entering the “andropause” or male “change of life” in their late 30′s to early 50′s, we typically see a male patient who complains of:

• lack of sex drive and or erectile dysfunction
• Muscle weakness or loss of strength
• Belly fat, obesity
• Depression, mood swings
• Or, they just don’t “feel the same."

These are classic symptoms of low testosterone levels or more commonly referred to “Low T.” Men can suffer from sex hormone deficiency just as women do, and be treated for this deficiency in the same manner as women that is with prescribed hormonal replacement or supplementation. The difference of course is in the primary hormone; Estrogen for women, Testosterone for men.

So when these male patients’ testosterone levels are checked and many find that their levels are below normal or at the bottom reaches of the “normal level,” the first thing they want to know is “what can you do for me?”