Enclomiphene is a selective estrogen receptor modulator (SERM) used to treat low testosterone (hypogonadism or “low T”) while preserving or improving fertility. Unlike traditional testosterone replacement therapy (TRT), enclomiphene stimulates the body’s natural production of testosterone. FYI, you might hear misspellings and mispronunciations that include: enclomiphene citrate, enclomifene, enclomifen, enclomephen, enclomiphen, etc. They are all referring to this same drug. The most important to note is that this is a different overall medication than clomiphene citrate, a generic of Clomid (there’s a different article on that piece).
Stimulates Natural Testosterone Production
Enclomiphene enhances the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH are the precursor hormones that stimulate the testes to produce testosterone hormone.
Take this Online Quiz to see if you have Symptoms of Low T
Improves and Preserves Fertility
Traditional TRT consists of iatrogenic synthetic testosterone administration that is known to communicate in the feedback circle of sperm production. This means synthetic testosterone (especially if supratherapeutic or higher than a normal range) will communicate within the body’s endocrine system, the hypothalamic-pituitary-gonadal (HPG) axis, to say “we have enough testosterone in the body, no need to make any more of the precursors of T (LH, FSH).” The body does not know that the secondary function of LH and FSH is that it dually stimulates sperm production. So, not having LH & FSH means suppression of sperm production by the testes. Enclomiphene, on the other hand, works more upstream – rather supporting or improving spermatogenesis, by telling the body to make more LH and FSH, making it an ideal choice for men seeking to maintain or enhance fertility.
Non-Invasive
Unlike traditional TRT (testosterone injections), enclomiphene is a standard pill medication. This avoids the need for injections, gels, or patches. Note that new oral TRT options now exist (will be discussed below).
Minimized Risk of Testicular Shrinkage
By maintaining testicular function (as discussed above), enclomiphene reduces the risk of testicular atrophy often associated with exogenous testosterone therapy. The adage “if you don’t use it, you lose it” is particularly true in human physiology. “… you shrink it” is most accurate.
Balances Hormones Naturally
Stimulates a natural hormonal balance without shutting down the HPG axis.
Choosing Between Enclomiphene and Oral TRT
Enclomiphene is ideal for men who want to maintain fertility, testicular size, and natural testosterone production. Some view the upstream activation of the HPG axis as unreliable and would rather have measured synthetic direct T administration to address their low T. Since enclomiphene is not considered a controlled substance by the Drug Enforcement Agency (DEA), various 3rd party health consultants exist that potentially overprescribe this medication under less scrutiny from DEA; make sure to do your research about the clinician who is prescribing this medication to you to validate their clinical science and evidence-based guideline adherence.
Oral TRT is great for those seeking a non-invasive, convenient solution to directly replace testosterone. Testicular size can be comanaged with combined therapy with another medication such as one from the SERM class or human chorionic gonadotropin (HCG). Note that HCG is only available as an injection. If you are only able to tolerate oral treatment protocols, oral TRT can be combined with an oral SERM such as tamoxifen or enclomiphene.
The correct dosage for enclomiphene depends on a persons goals and how the body responds to the medication.
Typical Dosage for Enclomiphene
Beginner: 12.5 mg daily
Adjustments: Incrementally titrate up to 50 mg daily
Titration and increasing of the dosage may be necessary if the initial dose is insufficient to achieve desired T levels or if symptoms of hypogonadism persist. Dosage adjustments should be guided by regular blood tests and a healthcare provider's evaluation.
Maintenance Dose: Many patients maintain 12.5 mg to 25 mg daily, depending on their response and testosterone levels.
Factors that Affect Dosage Needs
Baseline Testosterone Levels: Patients with severely low baseline T may require higher doses initially to overcome the depleted T production functions.
Fertility Goals: Lower doses may suffice for individuals focusing on maintaining or improving fertility. Especially if being used in conjunction with synthetic T.
Side Effects: Increasing doses too vigorously can cause mood changes or headaches.
Important Considerations
Enclomiphene is a medical drug and should only be taken with a valid prescription from a healthcare provider and under the guidance and management of a clinician. This is essential for monitoring testosterone levels and overall health.
Enclomiphene is not further subcategorized as a “controlled substance” by DEA (unlike Testosterone Cypionate which is a Level 3 controlled substance), hence many non-physician healthcare providers can potentially misdiagnose and mistreat patients when managing hypogonadism with this drug. The hormonal implications, risks, and benefits of enclomiphene should be viewed with similar scrutiny as you would for synthetic testosterone administration and TRT. Avoid exceeding the prescribed dose, as it could lead to hormonal imbalances or unwanted side effects.
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