Another (Off-Label) Way to Increase Testosterone

Did you ever hear the story about the girl who asked her mom why she always cut both ends off the roast before cooking it?  Her mom said b/c that's how Grandma does it.  So the girl then asked her Grandma why she cut both ends off the roast before cooking it.  Her Grandma said b/c that's how Great-Grandma does it.  Luckily, their family is long lived, so the girl asked her Great-Grandma why she cut off both ends off the roast before cooking it.  And her Great-Grandma answered b/c she didn't have a pan large enough!  At least that's how I recall the tale.

The moral of the story is that just as in medicine, we do what we're taught, rarely exploring the boundaries.  We stay within our comfort zones and never stretch ourselves or venture beyond the line drawn in the sand.  As much as I try to stay up-to-date and practice evidence-based medicine, I'm as guilty of that as anyone else.  So it's a good thing students & colleagues ask questions.  In this particular instance, I'm particularly indebted to Dr. S who asked about the off-label use of clomiphene to increase testosterone (and sperm). 

In fact, clomiphene, a selective estrogen receptor modulator, blocks estrogen receptors at the hypothalamus and pituitary, thus decreasing estrogen's inhibition of gonadotropin secretion, ergo more testosterone production.  Many studies (amongst them published in June 2003, May 2008 & December 2010) demonstrate increases in testosterone levels with some even showing an improvement in semen parameters, but apparently without any change in pregnancy rates (although it continues to be used off-label towards this endpoint).  Physicians have also commented online about the off-label use of clomiphene.

I mention this, not so that someone can become a professional bodybuilder, but so that those who are clinically hypogonadal can have another option for therapy.  Let's not forget that offering testosterone (whether in oral, sublingual, topical, pellet, or injectable form) to someone essentially renders them infertile and dependent upon (more) exogenous testosterone, whereas offering either hCG, anastrazole, or clomiphene is a way to potentially stimulate testicular production of more testosterone (assuming that the patient is not suffering from primary hypogonadism or testicular failure).

Again, I can't emphasize enough the need to work closely with a clinician who is experienced in this field of medicine and willing to provide close & regular monitoring.  Let me repeat:  this is not a do-it-yourself project.