Treating Male Infertility Through Hormones
Male fertility pills can change your hormones and get your fertility back on track. These medications increase your levels of a male sex hormone called testosterone. They also decrease your levels of estradiol (a form of estrogen, a female sex hormone). The following drugs change male hormone levels and boost fertility:
- Clomiphene (Clomid®) or enclomiphene
- Anastrazole (Arimidex)
- hCG (human chorionic gonadotropin) or hMG (human menopausal gonadotropin)
You take most of these fertility drugs by mouth. The drugs hCG and hMG are injections. These drugs have side effects like any other medication would. But don’t worry, our goal is to find the best medication for your body and its needs.
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What Are Clomiphene & Enclomiphene?
Clomid® is the brand name for clomiphene. Clomid is currently FDA-approved for female infertility. Male fertility specialists can also prescribe Clomid for men for off-label use. Some men have a low sperm count caused by low testosterone levels. Clomid helps increase your testosterone to help you produce more sperm.
Enclomiphene is a component of Clomid that is available only through compounding pharmacies. (A compounding pharmacy is a pharmacy that can mix your medication on-site.) Both Clomid and enclomiphene work the same way. Recent studies show that enclomiphene improves testosterone as effectively as Clomid. But enclomiphene has fewer side effects and treats infertility better.
How Do Clomid and Enclomiphene Work?
The pituitary gland in your brain releases certain hormones into your blood stream. These hormones help your reproductive system. Clomid and enclomiphene increase the hormones released from the pituitary gland. This increase in hormones allows your testes to make more testosterone and sperm.
Boosted levels of reproductive hormones increase your fertility:
- Reduce the symptoms of low testosterone
- Increase sperm count
- May help to improve non-obstructive azoospermia, a blockage that prevents the sperm from entering your semen
How Effective Are Clomid and Enclomiphene?
Large-scale studies have found that Clomid and enclomiphene help men who have low testosterone in the following ways:
- Increase testosterone and strength
- Reduce fatigue
- Improve erectile function
Research also showed that the sperm count of up to 10% of men with no sperm increased after three months of taking Clomid. Recent research shows that Clomid might raise testosterone more than enclomiphene. But men who take enclomiphene have 10% higher pregnancy rates than men on Clomid. In small studies, enclomiphene appears to have fewer side effects than Clomid. Enclomiphene appears to be more effective and better tolerated than Clomid. But Clomid is cheaper and more widely available, so it continues to be an excellent treatment option.
Clomid and Enclomiphene Side Effects
If you take Clomiphene, side effects may include the following:
- Changes in libido (sex drive)
- Changes in mood
- Changes in energy level
- Increased aggression
- Male-patterned baldness
- Blurred vision
- Headaches
- Increase in hemoglobin (a blood protein that transports oxygen and adds viscosity, or thickness, to your blood)
- Enlargement of the prostate gland
- Pectoral (or breast muscle) tenderness
- Mild acne
What Is Anastrozole?
Anastrozole (also known as Arimidex) was originally developed for breast cancer. But the drug’s use has evolved to help treat infertility for certain groups of men. Unlike other fertility drugs, anastrozole blocks an enzyme that turns testosterone into estradiol. This helps testosterone levels rise and lowers estrogen levels.
We monitor your hormone levels to evaluate the drug’s effectiveness during your treatment. 
How Effective Is Anastrozole?
Anastrozole reduces low testosterone symptoms such as low energy, reduced muscle mass, low libido, and erectile dysfunction. Men who have a low sperm count or no sperm also produce more sperm while on anastrozole.
Anastrozole Side Effects
You may notice side effects while taking anastrozole:
- Nausea
- Insomnia
- Bone pain
- Cough
- Increased red blood cell count
- Increased liver enzymes 
Some rare but serious side effects may include the following:
- Blood clots
- Cataracts
- Stevens-Johnson Syndrome, a serious rash caused by a drug intolerance
What Is Human Chorionic Gonadotropin (hCG)?
Human chorionic gonadotropin (hCG) is a hormonal treatment that can also increase testosterone levels in men who suffer from symptoms of low testosterone or testosterone deficiency. Men often use hCG in combination with both Clomid and anastrozole to treat infertility.
How Does hCG Work?
Human chorionic gonadotropin stimulates your testes to make their own testosterone and produce more sperm. Your body’s natural production of testosterone is important. You need your body’s testes to produce testosterone naturally to maintain testis size and sperm count.
How Effective Is hCG?
Research shows that hCG increases the energy, libido, strength, and mood in men with low testosterone. HCG can help you build testosterone no matter what causes your low testosterone levels. Sperm retrieval interventions like microTESE are typically more successful for men with little to no sperm who use hCG.
HCG Side Effects
Side effects may include the following:
- Pain at the injection site
- Changes in libido (sex drive)
- Changes in mood
- Changes in energy level
- Weight gain
- Increased red blood cell concentration and risk for blood clots
- Prostatic enlargement
Medication Monitoring
We ask that patients on any of these medications return after two weeks for lab testing and a clinic visit so we can make sure these medications are working properly. We check a semen analysis three months after your hormones are at optimal levels. It takes at least three months to see improvement in the sperm counts. We require blood tests and follow-up appointments at least every six months for patients on long-term treatment. Don’t stop taking these medicines until we instruct you to do so, unless you have an adverse reaction.
