How does clomiphene citrate compare with testosterone therapy?

This paper compares the effectiveness of clomiphene citrate (Clomid) and testosterone therapy in men with hypogonadism (low testosterone level).

The symptoms of hypogonadism are decreased libido, fatigue, poor concentration, erectile dysfunction, lack of concentration and depressed mood. Testosterone supplementation therapy (administering testosterone) increases testosterone level in hypogonadism. Clomiphene citrate also increases testosterone level. Clomiphene citrate is not approved by the Food and Drug Administration for hypogonadism, but it has been used in this way for many years. Studies suggest that clomiphene citrate can be used to treat male hypogonadism as it is safe, affordable and effective. 

93 men with symptoms of hypogonadism were analyzed.  Patients had to fill in a questionnaire that measured their symptoms. Of the 93 patients, 31 received clomiphene citrate, 31 received testosterone by injection and 31 received testosterone gel. Their testosterone levels were compared before and after treatment.

The average testosterone level increased after treatment in all 3 treatment types. Patients receiving testosterone injection had the largest increase in testosterone level (956ng/dl). The testosterone level of patients receiving clomiphene citrate increased by 272ng/dl. The testosterone level of patients receiving testosterone gels increased by 243ng/dl. The final average testosterone level in patients receiving clomiphene citrate was 525ng/dl. This was lower compared to patients receiving testosterone injections (1014ng/dl) but similar to patients receiving testosterone gels (412ng/dl).

Patients in all 3 treatment types reported similar levels of satisfaction with symptoms, with similar questionnaire scores.

The authors concluded that men receiving clomiphene citrate reported similar symptoms as men receiving testosterone injections and gels. This suggests that clomiphene citrate could be an alternative treatment for hypogonadism.