Enclomiphene Citrate Capsules
Now available at Town & Country Compounding!
An alternative to clomiphene citrate for men with hypogonadism
What is hypogonadism (low testosterone)?
Hypogonadism is a condition where the body doesn’t produce enough of the hormone testosterone, which is mainly made in the testes in men. Testosterone plays a key role in things like energy, mood, and sexual function. When testosterone levels are low, it can lead to a number of changes in the body such as low libido, erectile dysfunction, fatigue, and decreased muscle mass.
Signs and symptoms of hypogonadism
- Low energy
- Reduced libido
- Mood changes
- Loss of muscle mass
- Increased body fat
- Decreased bone density
- Difficulty concentrating
- Hot flashes or sweating
- Smaller testicles
- Sleep issues
There are two types of hypogonadism, primary and secondary hypogonadism.
Primary Hypogonadism occurs when the testes are unable to produce enough testosterone naturally. Testosterone replacement therapy is the typical therapy. By providing exogenous testosterone, normal testosterone levels may be restored, alleviating symptoms like low energy, reduced libido, and muscle loss.
However, this does not address potential fertility concerns, as testosterone therapy may reduce sperm production, and men with primary hypogonadism may already have reduced fertility due to testicular dysfunction.
Men who want to preserve their fertility should not use testosterone replacement therapy; there are better alternatives.
Secondary Hypogonadism occurs when the hypothalamus or pituitary gland (parts of the brain that control the testes) are not sending the right signals to the testes, resulting in low testosterone production. Testosterone replacement therapy is typically avoided in secondary hypogonadism because it only addresses the symptom (low testosterone) rather than the root cause (insufficient LH/FSH production from the hypothalamus or pituitary).
Why testosterone replacement therapy is not used in secondary hypogonadism
For primary hypogonadism, testosterone replacement therapy may be appropriate since the problem is in the testes, and external testosterone may help restore normal levels. However, for secondary hypogonadism, TRT is not ideal because it does not address the underlying problems with the hypothalamus or pituitary, leading to testicular atrophy and infertility, and creating a long-term dependence on external testosterone.
Instead, medications called selective estrogen receptor modulators (SERMs) such as clomiphene citrate and enclomiphene citrate that stimulate the natural hormone production process are preferred in secondary hypogonadism, as they work with the body’s systems to potentially restore natural testosterone production while minimizing the risks of infertility and dependence on external testosterone. These drugs act on the hypothalamus and pituitary gland to increase the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones, in turn, stimulate the testes to produce more testosterone.
Enclomiphene citrate vs clomiphene citrate
Some studies suggest that enclomiphene may lead to a more balanced hormonal profile than clomiphene, including higher testosterone levels and lower estrogen levels, which can be potentially beneficial for the overall health and well-being of men with hypogonadism.
Clomiphene citrate is a selective estrogen receptor modulator (SERM) that has been commonly used in hypogonadism and works by blocking estrogen receptors in the hypothalamus, which increases the release of gonadotropins (LH and FSH). However, it can have mixed effects, particularly on estrogen receptors in other tissues, which may limit its effectiveness in some cases and can lead to side effects like mood changes, hot flashes, and even testicular shrinkage in some men.
Enclomiphene citrate is the trans-isomer of clomiphene citrate. It is more selective in its action and primarily acts on the hypothalamus and pituitary gland to stimulate gonadotropin release (particularly LH and FSH). This targeted action may lead to a more controlled and sustained increase in testosterone production, with potentially fewer side effects related to estrogen receptor antagonism in peripheral tissues.
Enclomiphene citrate is not commercially available, therefore, the capsules must be compounded.
Hot flashes while using clomiphene citrate?
Clomiphene citrate is a mixture of two isomers: clomiphene (cis-isomer) and enclomiphene (trans-isomer). The cis-isomer (clomiphene) has stronger estrogenic effects, particularly in the hypothalamus, which can lead to more pronounced side effects like hot flashes, mood swings, and other estrogenic-related symptoms. Enclomiphene, being the trans-isomer, has a more targeted effect on stimulating gonadotropins (LH and FSH) to increase testosterone production with a lower estrogenic effect.
Because enclomiphene has less of an estrogenic impact, it tends to cause fewer hot flashes and other estrogen-related side effects compared to clomiphene citrate.
This is one reason why enclomiphene is often preferred in addressing male hypogonadism or low testosterone, as it appears to stimulate testosterone production without as many of the unwanted estrogenic side effects.
Advantages of enclomiphene citrate vs clomiphene citrate
Here are more details on the differences between the two drugs and their clinical applications.
| Category | Enclomiphene Citrate | Clomiphene Citrate |
|---|---|---|
| Side Effects | Fewer estrogenic side effects such as mood swings, hot flashes, or gynecomastia. | Higher risk of estrogenic side effects like mood swings, hot flashes, gynecomastia, and visual disturbances. |
| Mechanism of Action | Selectively stimulates LH and FSH release, promoting testosterone production while maintaining sperm production. | Blocks estrogen receptors in the hypothalamus, stimulating gonadotropin (LH, FSH) release, but may have broader estrogenic effects in peripheral tissues. |
| Effect on Testosterone Levels | May increase both total and free testosterone. | Increases testosterone but may result in suboptimal levels in some men. |
| Effect on Sperm Production | May help maintain or improve sperm count. | May improve sperm count but less consistent, especially in men with secondary hypogonadism. |
| Fertility Preservation | May support both testosterone production and spermatogenesis effectively, potentially beneficial for fertility preservation. | Can improve sperm quality but may be less reliable in maintaining fertility. |
| Targeted Action | More selective in its action, primarily targeting the hypothalamus and pituitary. | Broader effects on estrogen receptors, which can affect other tissues. |
| Use in Hypogonadism | May be a potential option for hypogonadal men who also want to preserve fertility. | Effective for hypogonadism but less effective for preserving fertility in some cases. |
| Overall Impact | May offer a more targeted approach to balancing testosterone levels and fertility with fewer side effects. | Effective but may have mixed outcomes and more side effects, particularly in peripheral tissues. |
Compounded enclomiphene citrate at Town & Country Compounding Pharmacy
Why prescribers trust Town & Country Compounding for enclomiphene
We understand that one size does not fit all when it comes to medication. Therefore, we collaborate closely with prescribers to develop tailored formulations of enclomiphene citrate, taking into account factors such as dosage adjustments, alternative delivery methods, and patient-specific preferences
The most common compounded strengths are 6.25 mg, 12.5 mg, 25 mg, and 50 mg.
Leaders in Men’s Health Medications
Town & Country Compounding is a leader in men’s health compounds. with a team of highly skilled pharmacists and professionals with extensive experience in compounding medications
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References
Thomas, J., Suarez Arbelaez, M., Narasimman, M., & et al. (2023). Efficacy of Clomiphene Citrate Versus Enclomiphene Citrate for Male Infertility Treatment: A Retrospective Study. Cureus, 15(7), e41476. https://doi.org/10.7759/cureus.41476
Tena-Sempere, M. & García-Segura, L. M. (2020). Efficacy and safety of clomiphene citrate and enclomiphene citrate for the treatment of male infertility and hypogonadism: A systematic review. Reproductive Biology and Endocrinology, 18(1), 82.
Gül, M. & Öztürk, A. (2021). Role of clomiphene citrate and enclomiphene citrate in male infertility: A retrospective study of treatment outcomes. Fertility and Sterility, 115(3), 692–700.
Ramasamy, R. & Hsieh, T. C. (2021). Clomiphene citrate versus enclomiphene citrate for male infertility: A prospective randomized study. Andrology, 9(5), 1174–1180.
Ghanem, H., & Mansour, R. (2022). Enclomiphene citrate: A promising treatment for male infertility and hypogonadism. Journal of Andrology, 43(2), 213–220.
Mills, L. & Young, C. (2023). Comparison of clomiphene citrate and enclomiphene citrate in the management of male infertility: A meta-analysis. Andrology, 11(1), 53–61.
