For both men and women, an alternative to testosterone replacement is low-dose clomifene treatment, which can stimulate the body to naturally increase hormone levels while avoiding infertility and other side effects that can result from direct hormone replacement therapy.  This therapy has only been shown helpful for men with secondary hypogonadism. Recent studies have shown it can be safe and effective monotherapy for up to 2 years in patients with intact testicular function and impaired function of the HPTA( http:///ijir/journal/v15/n3/full/ ). Clomifene blocks estrogen from binding to some estrogen receptors in the hypothalamus, thereby causing an increased release gNRH and subsequently LH from the pituitary. Clomifene is a Selective Estrogen Reuptake Modulator (SERM). Generally clomifene does not have adverse effects at the doses used for this purpose. Clomifene at much higher doses is used to induce ovulation and has significant adverse effects in such a setting.
Meta-analyses of placebo-controlled trials suggest that testosterone therapy in physiological doses is significantly associated with increased haematocrit, reduced high-density lipoprotein cholesterol and prostatic symptoms. 29 , 30 If prostate cancer has been excluded, there appears to be no increased risk of induction by testosterone therapy. There is inconsistent evidence regarding the risk of cardiovascular events. 29-31 A recent meta-analysis suggested increased cardiovascular risk and reported publication biases. 32 Long-term safety data are lacking, but recent reports more strongly suggest an increased risk of cardiovascular events in older men. 3 , 4 This has prompted the Endocrine Society to issue a warning statement. 5 The results and safety of long-term prospective controlled trials of testosterone therapy are awaited.
After review of the results of the initial blood tests, if the doctor decides that it’s safe and appropriate to start testosterone replacement therapy, a prescription for one month’s testosterone replacement therapy will be authorised. A further blood test will be needed after three weeks to see how you are responding to treatment. All being well, a further five months of treatment will be authorised before another blood test is needed to check your testosterone levels , a year after treatment is initiated, and each year after that, further blood tests will then be needed to ensure that the ideal level of testosterone in your body is maintained and that your continued use of testosterone replacement therapy remains safe. We will be checking for indications of prostate or blood problems that can occur.