Clomiphene Citrate or Clomid as it’s most commonly known, is an anti-estrogenic medication officially classified as a Selective Estrogen Receptor Modulator (SERM). Clomid is somewhat similar to another popular SERM in Tamoxifen Citrate (Nolvadex) and first appeared in the early 1970’s as a fertility aid. It is still used for that purpose today. Clomid has also been used in the fight against low testosterone due to its gonadotropin stimulating qualities and is a long standing favorite of many testosterone users. However, in most modern testosterone replacement therapy (TRT) plans, it is no longer needed.
Functions & Traits:
The SERM Clomiphene Citrate functions on the basis of opposing the negative feedback of estrogens on the Hypothalamic Pituitary Ovarian Axis (HPOA) and Hypothalamic Pituitary Testicular Axis (HPTA), which in turn enhances the release of gonadotropins. The increase in gonadotropins specifically refers to Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH), both of which are produced by the pituitary. For a female, increasing gonadotropin release, this can encourage the egg to be released, in turn increasing the chances for pregnancy.
It is the release of gonadotropins that first caught the attention of testosterone users, specifically performance enhancing athletes. Performance enhancing athletes, when they use testosterone and other anabolic steroids, they cycle on and off the compounds. This is done so that they do not permanently shut down their HPTA, which would result in a permanent low testosterone condition. Instead, the user will implement a cycle, normally in the 8-16 week range and once his steroid use is complete he will being Post Cycle Therapy (PCT). The purpose of PCT is to stimulate natural testosterone production, and the best way to do this is to enhance the release of gonadotropins with medications like Clomid. It is not the only medication that’s used for PCT, but it is an effective one. However, it does not guarantee recovery by any means.
Due to its ability to promote testosterone production, some TRT physicians will prescribe their patients to take Clomid and testosterone in an on/off fashion similar to a performance enhancing athlete. The patient will be prescribed to take testosterone for 12-24 weeks at which time he will discontinue testosterone and use only Clomid. The idea is to let your body rest from testosterone therapy and allow natural production to take over again, but there are two flaws with this approach and one very problematic outcome. Your body doesn’t need a rest from testosterone; it’s been producing it your entire life; unfortunately, you no longer produce enough on your own. The second flaw is that allowing natural production to take over won’t do anything for you; after all, you do not have the ability to naturally produce an adequate amount of testosterone. Even with the stimulation provided by Clomid, this isn’t going to be enough for a true low testosterone patient. Equally important, you can easily keep what natural production you have going while on TRT through the use of HCG (primary hypogonadism excluded). As for the problem, in most all cases, you will fall below optimal levels of testosterone during this time.
While Clomid is sometimes used as previously described in a TRT setting, in some cases, it is used as the primary means of TRT. What this means is the physician will attempt to solely rely on Clomid to do the work. This can work for young guys who are attempting to reset their HPTA. Sometimes it will be used alone, but more often it is implemented with HCG. For a middle aged man or older, this will rarely work, very rarely, and if he has low testosterone he will need direct therapy.
The final functions and traits associated with Clomid revolve around its anti-estrogenic nature. When we supplement with exogenous testosterone, this can cause our estrogen levels to increase due to testosterone converting to estrogen through the aromatase enzyme. When levels increase, this can promote gynecomastia (male breast enlargement), excess water retention and high blood pressure if water retention becomes severe. Severe excess water retention is rarely a concern for a TRT patient. Some water retention is possible, but excess amounts that promote high blood pressure are far more commonly associated with supraphysiological doses of testosterone. However, some retention and gynecomastia are possible and Clomid can help to a degree. SERM’s like Clomid function in that they bind to the estrogen receptors in the chest, thereby preventing the estrogen from binding and promoting gynecomastia. They will not lower serum estrogen levels in the body, making Aromatase Inhibitors (AI’s) the best choice for estrogenic protection during TRT.
Possible side effects of Clomid most certainly exist; overall it is one of the more well-tolerated SERM’s on the market, but urban legend has given it a bad name in some circles. Most of the side effects of Clomid are somewhat rare and largely revolve around individual response; such effects include:
- Breast Discomfort
- Hot Flashes
- Uterine Bleeding (very rare)
While fairly uncommon, some women have been noted to experience ovarian enlargement, but this may be due in part to other factors. Where the side effects of Clomid may prove to be the most problematic revolves around visual disturbances. This is the possible side effect that has scared many people away from the SERM and that’s understandable; no one wants their eyesight messed with. While some disturbance is possible, data shows that 1.5% of those who use Clomid may experience this effect, which will result in hazy or blurred vision. If visual disturbances occur, discontinue use and vision will return to normal shortly. There have been reported cases of permanent damage to the eyes, but such instances have also been linked to high dose long-term use.
The final possible side effect of Clomid is acne; this is largely dependent on genetic predispositions and is due to the enhanced release of gonadotropins and the resulting increase in testosterone. Keeping your skin clean and dry at all times will normally take care of any issue. Although not a very common side effect, it is possible but should not promote significant breakouts.
Doses & Administration:
Clomid is an oral pill that comes in 50mg tablet form. For the purpose of fertility, 50mg is taken every day for five straight days five days into the menstrual cycle. If this does not promote conception, 100mg per day will be attempted the next menstrual cycle. Normally this is repeated 5-6 times until pregnant, and it is an effective option, but if it doesn’t work alternative methods will need to be examined.
For estrogenic protection when using testosterone, 50mg per day or sometimes every other day may protect the individual from gynecomastia. However, part of successful TRT largely surrounds balancing testosterone and estrogen and as Clomid will not help with serum estrogen levels we cannot recommend it for TRT use with testosterone. The exception might be if it is used as part of a restart along with HCG, in which case 50-100mg per day along with 5-6 weeks of HCG use may reset ones HPTA. The odds are not in your favor, but it is worth a try for a young man suffering from low testosterone.