Editing Infertility: Nonsurgical Management (section)

== Selective estrogen receptor modulators (e.g. clomophene (clomid), tamoxifen) ==

* '''MOA: acts as an agonist or antagonist on different estrogen receptors.'''
** '''Agonists on receptors in bone, improving bone health'''
** '''Antagonists on receptors on the hypothalamus and pituitary, resulting in increased GnRH and ultimately''' '''increased LH, FSH, and intratesticular testosterone.'''
*** In men normal binding of estrogen at these receptors functions as an indirect negative feedback mechanism of endogenous testosterone production to down-regulate GnRH and subsequently pituitary gonadotropin production.
* '''Benefits'''
*# '''Increased testosterone'''
*#* Testosterone increase is more than that achieved with anastrazole
*# '''Increased sperm counts'''
*#* See Risk Calculator for expected changes for men with infertility who are given clomiphene citrate
* '''Indications'''
** '''Currently, no FDA approval for using SERMs for male hypogonadism'''
*** '''Clomiphene citrate is the most commonly used SERM for treating hypogonadism when fertility must be maintained. However, this remains an off-label use.'''
**** Enclomiphene citrate, the functional stereoisomer of clomiphene citrate, is currently in commercial development. Its potential advantage is avoidance of the estrogenic side effects of its enantiomer zuclomiphene.
** '''Consider in patients with low testosterone, borderline high/high FSH (lazy pituitary)'''
* Administration
** Typically dosing starts at 25 mg daily and can be increased up to 100 mg daily.
* '''Adverse events'''
** No specific adverse effects attributed to clomiphene or enclomiphene citrate in males.
** '''Same theoretical risk of testosterone replacement exists'''