ENCLOMIPHENE
by Dr. Manuel Garcia
Enclomiphene is in a class of medications called Selective Estrogen Receptor Modulators ( SERMs ). These medications (taken in pill-form) have historically been used to treat infertility in women but have become popular as an off-label treatment for hypogonadal men (men suffering from both low testosterone and low sperm count).
How does Enclomiphene (SERMs) work?
I like to explain SERMs with a simple analogy. Think of the pituitary gland as a “thermostat” in the middle of your brain that regulates several hormone-secreting glands in the body. Two of the organs that it regulates are ovaries (in women) and testicles (in men). So, think of ovaries and testicles like “air conditioners” that the pituitary thermostat controls.
OK, let’s take this a little further. In women, the pituitary thermostat sends signals to the ovaries (air conditioner) to produce estrogen. In men, the pituitary thermostat sends signals to the testicles (air conditioner) to produce testosterone. So think of estradiol (in women) and testosterone (in men) as the “cold air” being produced by their respective air conditioners.
So, if there is enough cold air produced, the cold air will slow down the signals coming from the thermostat so the air doesn’t get too cold.
Similarly, in females, if there is enough estrogen produced by the ovaries, the estrogen will slow down the signal coming from the pituitary gland. With men, if there is enough testosterone produced by the testicles, the testosterone will also slow down the signal coming from the pituitary gland.
So far so good? let’s take this explanation a little further….
In women, estrogen is required to get eggs to mature in preparation for ovulation. Therefore, lack of estrogen production by their ovaries can lead to infertility. So one way that Infertility doctors helped women produce more estrogen was to use SERMs (Selective Estrogen Receptor Modulators). SERMs are medications (taken in pill-form) that trick the pituitary gland into thinking that there is no estrogen being produced by the ovaries. The pituitary gland responds by sending more signals to the ovaries to increase the production of estradiol in hopes of getting eggs to mature which ultimately increases the chances of pregnancy.
Because SERMs cannot tell the difference between a female’s pituitary gland and a male’s pituitary gland, they work similarly in men by tricking the male pituitary gland into thinking that there is no testosterone being produced by testicles, This subsequently causes the pituitary gland to increase it’s signals to the testicles, resulting in an increase in testosterone production.
So as you can see, the name SERMS was not the best choice for this class of medications, because not only do they block Estrogen Receptors in the pituitary gland, they also block Testosterone Receptors as well. Maybe these medications should have been called SPRMs (Selective Pituitary Receptor Modulators).
Please note that I’m purposely over-simplifying the mechanism of SERMs, but if you can understand this explanation, I’ll give you more details at the time of your consultation visit (Dr. Garcia)
Advantages of Enclomiphene (SERMs)
The most commonly prescribed SERM for men is enclomiphene, and its use has become a game-changer in the world of treating low testosterone levels and low sperm counts.
There are some men in their child-bearing years, that unfortunately experience premature testicular failure resulting in both low sperm counts and low testosterone levels. This is similar to women that experience premature ovarian failure (premature menopause). If men experience premature testicular failure (hypogonadism) and still wish to have children, then Enclomiphene may be an optimal method of indirectly getting the testicles increase the production of testosterone and sperm count.
Another big advantage of SERMs is with patients that tend to have elevated red blood cell counts while on traditional testosterone injection therapy. Because testosterone can stimulate the bone marrow into producing more Red Blood Cells (RBCs), many patients on traditional weekly or bi-weekly testosterone injections experience as rise in their Red Blood Cells (RBCs). This is called Secondary Polycythemia. Too many RBCs in circulation can cause the blood to become too thick and this increase in viscosity can lead to blood clots, organ failure, strokes, and heart attacks. In my opinion, this is the main reason why the use of testosterone should be medically supervised. Under medical supervision, if the RBC count is too high, then doctors can detect this and inform patients that they need to donate blood or come in to the office to have a therapeutic blood draw to decrease the RBC count back to normal levels. Studies have shown that elevating testosterone levels by taking SERMs (vs testosterone injections) has less effect at increasing RBC counts. I have also seen this in my patients.
Another advantage is if patients do not like the thought of injecting themselves with testosterone or undergoing pellet implantation, then SERMs (Enclomiphene) may be a great options because it is administered as a once-a day oral tablet.
Most Common Side Effects of Enclomiphene (SERMs)
The most common side effects reported by patients (when treated more than 3 years) included mood changes, visual blurring, and breast tenderness (1)
Is Enclomiphene covered by insurance?
Because we are using a SERM for off-label use, this is not a covered service.
How do I get started with Enclomiphene?
If you are experiencing testosterone deficiency symptoms and are interested in Enclomiphene, getting started is similar to that of pellet therapy and microdosing. Go to Getting Started for more details.
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