Clear benefit of clomiphene in restoring HPG axis in AAS users

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Jue, 25 Sep 2014, 20:40

Clomiphene Citrate in Anabolic Steroid Users: A Retrospective Review

Mirjana Pavlic, MD, FRCPC1 and Richard Arthur Bebb, MD, FRCP2
1University of British Columbia, Vancouver, BC, Canada, 2Univ of British Columbia, Vancouver, BC, Canada
The anabolic androgenic steroids (AAS) have been used by competitive athletes since1950s, to increase performance, gain muscle and lose body fat. Furthermore, testosterone (T) has been increasingly studied as a potential, reversible male contraceptive agent. Regardless of the reason of exogenous steroid use the consequences are the same and lead to suppression of the hypothalamic-pituitary-gonadal (HPG) axis with all of its negative effects, including decrease in spermatogenesis and testosterone production lasting for several months to years following T exposure. Long-term adverse effects including loss of muscle and increased fat, loss of libido, energy and concentration with impaired quality of life pose a significant problem. More importantly, low testosterone states have been associated with increased mortality. Recommendations for treatment of endogenous testosterone suppression caused by AAS use are not available.

Clomiphene citrate (CC) is a weak estrogen receptor antagonist that competes with estradiol feedback at the pituitary and hypothalamic levels, leading to an increase in LH and FSH, improving steroidogenesis and spermatogenesis in men. There is only a limited amount of evidence to suggest benefit of CC in treatment of AAS induced HPG suppression. Several case reports have been reported, but to date, no larger retrospective studies have been performed.

We preformed a retrospective chart review aiming to assess the effect of CC on HPA axis in AAS users by analyzing T, LH and FSH levels prior and after CC use. Charts at the Men’s Health Initiative in Vancouver dating from 1998 to 2013 were searched using keywords including CC, hypogonadism and AAS use. Charts meeting criteria were reviewed and serum T, LH, FSH levels were analyzed at baseline as well as at different time points after initiating therapy to assess for efficacy and duration needed for restoration of HPG axis.

Our hypothesis was that Clomiphene significantly reduces the amount of time needed for HPA recovery in AAS users with specific aims to assess the effect of Clomiphene on HPA axis by analyzing information on testosterone, LH and FSH levels in AAS users prior and after Clomiphene use.

Our results support this as demonstrated by an increase in all three hormones following Clomiphene therapy. There was a 62.9%, 46.7% and 42.2% increase from baseline at 2 months in testosterone, LH and FSH levels respectively, and this was maintained at 57.8%, 46.6% and 43.9% at the 4 month mark (N=6). This reached statistical significance for testosterone levels with p<0.05 at both time points.

This is the first larger retrospective case series to demonstrate clear benefit of clomiphene in restoring HPG axis in AAS users.

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