INDICATIONS FOR USE

Enclomiphene is used off-label to treat secondary hypogonadism in men, Enclomiphene is used off-label to treat secondary hypogonadism in men, particularly in cases of fertility preservation or recovery. Unlike exogenous testosterone, it stimulates the body’s natural production of testosterone by acting on the hypothalamic-pituitary-gonadal axis.

EVIDENCE RATING

✦✦ : Early but compelling human efficacy and safety data.

ROUTE OF ADMINISTRATION

• Oral administration

COMMON INITIAL DOSING REGIMENS

• Initial doses typically range from 12.5–25 mg daily, adjusted based on serum testosterone and luteinizing hormone (LH) levels. Lower doses (e.g., 12.5 mg every other day) may suffice for milder cases.

MECHANISM OF ACTION

• Enclomiphene is a selective estrogen receptor modulator (SERM). By blocking estrogen receptors in the hypothalamus, it inhibits negative feedback suppression caused by circulating estrogen. This leads to increased release of gonadotropin-releasing hormone (GnRH), stimulating the pituitary to secrete LH and follicle-stimulating hormone (FSH), which in turn promote testosterone production in the testes.

COMMON SIDE EFFECTS

• Endocrine: Potential for elevated estradiol levels, which can lead to gynecomastia, water retention, and mood swings.

• General: Headache, nausea, and dizziness, particularly during the initial treatment period.

• Musculoskeletal: Rarely, joint or muscle pain.

• Mood: Irritability or mood swings due to hormonal fluctuations.

CONTRAINDICATIONS

• Absolute: Known hypersensitivity to enclomiphene or related compounds.

• Relative: Use with caution in patients with untreated gynecomastia or high baseline estradiol levels, as enclomiphene may exacerbate these conditions. It may not be suitable for individuals with pituitary or testicular failure.