Clomiphene citrate — also known as clomiphene or by its brand name Clomid — is a medication approved to treat infertility in women by encouraging ovulation. It’s also long been used to increase men’s testosterone levels and treat male infertility, gynecomastia and hypogonadism, but there’s still no clear evidence for its effectiveness. Due to the limited data, clomiphene hasn’t been approved by regulatory bodies for use in men but you still might have heard about blokes using it. Here’s what you need to know about Clomid and male infertility.
What is male infertility?
“Male infertility is common, affecting 1 in 20 Australian men and explains up to 50% of cases of couple infertility,” says endocrinologist, andrologist and Healthy Male expert advisor, Dr Sarah Catford. Male infertility is usually caused by problems with sperm production, which can be related to hormonal problems, issues with testicular function or blockages in men’s reproductive systems. The way male infertility is treated depends on its cause. “Unfortunately in about half of cases, we don’t find a cause and therefore can’t offer a specific treatment,” Dr Catford says.
Learn more about male infertility
You can learn more about male infertility here.
What is Clomid?
Clomiphene is a selective estrogen receptor modulator (SERM) taken as an oral tablet. In men, it affects the system your body uses to control testosterone production, which is called the hypothalamic-pituitary-testicular axis. Clomiphene increases production of gonadotropin hormone-releasing hormone (GnRH) by the hypothalamus, which triggers the pituitary gland to release luteinising hormone (LH) and follicle-stimulating hormone (FSH). In men, LH stimulates Leydig cells in the testes to increase testosterone production, while FSH acts in Sertoli cells in the testes to stimulate sperm production. Most drugs used to increase testosterone usually suppress male fertility, but clomiphene does not.
Can Clomid help improve male infertility?
Short answer, possibly.
“We know that clomiphene has been used for decades to treat male infertility with the aim of improving sperm quantity and quality and we know that it is well tolerated,” Dr Catford says “What we don’t know is whether clomiphene is actually effective at improving semen parameters and pregnancy rates.”
A 2023 systematic review and meta-analysis found that clomiphene citrate increases sperm concentration and motility, without serious side effects. However, the individual studies in the meta-analysis varied in quality, with the weak studies showing an effect of Clomid and the strong studies showing no effect. A 2021 systematic review, which looked just at studies that reported negative effects of Clomid, shows that there are men who experience a negative effect on semen quality when taking Clomid.
“Data regarding the effect of clomiphene on semen parameters and pregnancy rates are mixed and mostly of poor quality,” says Dr Catford.
In Australia, clomiphene is not recommended as standard treatment for male infertility. It may help some men, but we cannot predict who will be helped and who will not. Dr Catford is currently studying whether clomiphene improves sperm quantity and quality in men with unexplained low sperm count and normal levels of GnRH.
“I chose to study clomiphene as it’s cheap, easy to administer, has a good safety profile and has been used off-label for decades in the management of male infertility,” Dr Catford says.
How long does it take for Clomid to work?
It can take a few months to see the effects of clomiphene in men, but results vary between individuals.
Clomid in Australia
The Therapeutic Goods Administration (TGA) has not approved Clomid for use in men in Australia. This is called “off-label use”, which means the drug is being prescribed for an indication, a route of administration, or a patient group that is not included in the approved product information document for that drug.
Using Clomid needs to be carefully considered and closely monitored by a healthcare practitioner with expertise in treating male infertility.
