Testosterone Supplementation Versus Clomiphene Citrate
for Hypogonadism: An Age Matched Comparison of
Satisfaction and EfFcacy
Ranjith Ramasamy, Jason M. Scovell, Jason R. Kovac and Larry I. Lipshultz*,†
Department of Urology, Baylor College of Medicine, Houston, Texas
Purpose:
We compared satisfaction and treatment efFcacy in men with symp-
tomatic hypogonadism who received clomiphene citrate or testosterone supple-
mentation therapy.
Materials and Methods:
Men treated with clomiphene citrate, or testosterone
injections or gels for symptomatic hypogonadism (total testosterone less than
300 ng/dl) reported satisfaction with the current treatment regimen using the
qADAM questionnaire.
Results:
A total of 93 men on testosterone injections (31) or gels (31), or clomi-
phene citrate (31) were age matched from a retrospective cohort of 1,150 on
testosterone supplementation therapy. We compared men who received testos-
terone supplementation therapy to 31 not on such therapy, who served as con-
trols. Median serum testosterone increased from pretreatment levels in all men
regardless of therapy with clomiphene citrate, and testosterone injections and
gels (from 247 to 504, 224 to 1,104 and 230 to 412 ng/dl, respectively, p
<
0.05).
±inal median serum total testosterone in men on clomiphene citrate (504 ng/dl)
was lower than in men receiving testosterone injections (1,014 ng/dl, p
<
0.01)
but similar to that in men on testosterone gels (412 ng/dl, p
¼
0.31). Despite
different serum testosterone levels men on all 3 therapies reported similar
satisfaction on qADAM, including a score of 35 for clomiphene citrate, 39 for
testosterone injections, 36 for testosterone gels and 34 for control treatment
(p
>
0.05). Men receiving testosterone injections reported greater libido than men
on clomiphene citrate (4 vs 3, p
¼
0.04) or testosterone gels (4 vs 3, p
¼
0.04),
or controls (4 vs 3, p
<
0.01).
Conclusions:
Testosterone supplementation regimens and clomiphene citrate
are efFcacious for improving serum total testosterone. No difference in overall
hypogonadal symptoms was noted among men on any testosterone supplemen-
tation therapy. Despite lower serum total testosterone, men on clomiphene cit-
rate and testosterone gels reported satisfaction similar to that of men treated
with testosterone injections.
Key Words:
testes, testosterone, clomiphene,
hypogonadism, questionnaires
I
DIOPATHIC
age related hypogonadism
affects almost 40% of men 45 years
old or older
1
and it is a current health
epidemic.
Hypogonadism
typically
presents with persistent nonspeciFc
symptoms of decreased libido, fatigue,
poor concentration, erectile dysfunc-
tion,
lack
of
concentration
and
depressed mood in the presence of
low serum testosterone.
2
e
4
These low
Abbreviations
and Acronyms
ADAM
¼
Androgen Deficiency
in the Aging Male
CC
¼
clomiphene citrate
qADAM
¼
quantitative ADAM
TST
¼
testosterone
supplementation therapy
Accepted for publication March 13, 2014.
Study received Baylor College of Medicine
institutional review board approval.
* Correspondence: 6624 Fannin St., Suite
1700, Houston, Texas 77030 (telephone: 713-
798-6163; FAX: 713-798-6007; e-mail: larryl@
bcm.edu
).
†
Financial interest and/or other relationship
with Auxilium, Endo and Repros.
0022-5347/14/1923-0875/0
THE JOURNAL OF UROLOGY
®
©
2014 by A
MERICAN
U
ROLOGICAL
A
SSOCIATION
E
DUCATION AND
R
ESEARCH
,I
NC
.
Vol. 192, 875-879, September 2014
Printed in U.S.A.
www.jurology.com
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