To compare serum testosterone response and symptom improvement in hypogonadal men in response to treatment by one of three options: clomiphene citrate(CC), human chorionic gonadotropin (hCG), or combination of both therapy.
282 hypogonadal adult, willing to preserve their fertility, were randomised in three arms treated respectively with: 50 mg of (CC) (n=95), 5000IU of hCG injections twice a week(n=94) or combination of both therapy(n=94). All patients had complete medical history and thorough physical examination including body mass index(BMI). Laboratory tests included serum total testosterone and glycosylated Haemoglobin (HbA1c) measurements. Quantitative androgen deficiency in the aging male (qADAM) scores were also recorded. Total serum testosterone levels were assessed, morning samples, at three-time points: baseline, 1 and 3 months.
Testosterone levels increased at 1 and 3 months in all three groups analysed. Mean baseline testosterone was 2.31± 0.66nmol/l, BMI 30.8± 6.2, qADAM 20.5± 3.8. Testosterone levels increased in all groups at all time points with a final average level of 5.17± 1.77nmol/l (223% of increase) with no statistically significant difference between the groups. qADAM scores had increased in all groups at one month (6.36 in CC group,5.08 in hCG, and 7.26 in combination) and at three months(12.73 in CC group,11.82 in hCG and 15.13 in combination) with statistically significant difference in intergroup analysis for combination over other 2 groups(p<0.01).
All three treatments were equally effective in restoring testosterone. Single agent CC is simple, cheap and may be used as treatment for hypogonadic patients when maintenance of fertility is desired. This approach seems to be as effective as either hCG alone or combination of hCG and CC. This article is protected by copyright. All rights reserved.
BJU international. 2018 May 17 [Epub ahead of print]
Mohamad Habous, Simone Giona, Alaa Tealab, Mohammed Aziz, Ben Williamson, Mohammed Nassar, Zeyad Abdelrahman, Abdallah Remeah, Mohamed Abdelkader, Saleh Binsaleh, Gordon Muir
Urology & Andrology Department, Elaj Medical Centers, Saudi Arabia., King's College Hospital, London, UK., Zagazig University, Zagazig, Egypt., Urology Department, Menoufia University, Egypt., University Hospitals Birmingham, Birmingham, UK., Division of Urology, department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.