Enclomiphene versus TRT

Testosterone is made in the testes, but the order comes from the brain. The hypothalamus sends GnRH to the pituitary, the pituitary sends LH and FSH to the testes, and the testes make testosterone and sperm. When testosterone and estrogen run high, the brain eases off. It is a thermostat.

What TRT does

Testosterone replacement adds testosterone from outside, by injection or gel. Levels go up fast and reliably. The thermostat sees plenty of hormone and cuts LH and FSH. With no LH, the testes make less of their own testosterone. With no FSH, sperm production can drop to zero.¹ Testicles often shrink. For a lot of men on TRT, fertility is the cost.

What enclomiphene does

Enclomiphene is one half of an old fertility drug, clomiphene. It blocks estrogen receptors in the hypothalamus. The brain reads that as "estrogen is low", turns the thermostat up, and sends more LH and FSH. Your own testes make more testosterone, and sperm production keeps going.²

TRT replaces the signal. Enclomiphene turns up the volume on the one you already have.

Who it suits, and who it does not

Enclomiphene works best when the testes are healthy and the signal from the brain is the weak link. That is called secondary hypogonadism. Weight, poor sleep and stress often cause it. If the testes themselves are failing, more signal will not help much, and TRT may be the honest answer.

You only know which one you are with bloodwork: total and free testosterone, LH, FSH, estradiol and haematocrit, taken in the morning. That is why we will not sell enclomiphene without a baseline panel.

The fine print

Enclomiphene is not an approved finished medicine in Nigeria, the UK or the US. Reported side effects include headaches, hot flushes and mood changes. Visual disturbances are rare, and if they happen you stop.³ Re-test at eight weeks. If the numbers did not move, it is not working for you, and we will say so.