A Comparison of Secondary Polycythemia in Hypogonadal Men Treated with Clomiphene Citrate versus Testosterone Replacement: A Multi-Institutional Study
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Purpose We evaluated the relative prevalence of secondary polycythemia in hypogonadal men treated with clomiphene citrate or testosterone replacement therapy. Materials and methods In this retrospective, multi-institutional study, we included 188 men who received clomiphene citrate and 175 who received testosterone replacement therapy with symptomatic hypogonadism. The overall prevalence and ORs of secondary polycythemia for clomiphene citrate treatment vs testosterone replacement were primarily measured, as were baseline characteristics. Subset analysis included polycythemia rates for different types of testosterone replacement therapy. Results Overall, men on testosterone replacement therapy were older than clomiphene citrate treated men (age 51.5 vs 38 years). Men on testosterone replacement had longer treatment duration than clomiphene citrate treated men (19.6 vs 9.2 months). For testosterone replacement therapy and clomiphene citrate the mean change in hematocrit was 3.0% and 0.6%, and the mean change in serum testosterone was 333.1 and 367.6 ng/dl, respectively. The prevalence of polycythemia in men on testosterone replacement was 11.2% vs 1.7% in men on clomiphene citrate (p = 0.0003). This significance remained on logistic regression after correcting for age, site, smoking history and pretreatment hematocrit. Conclusions The prevalence of polycythemia in men treated with clomiphene citrate was markedly lower than that in men on testosterone replacement therapy. The i…
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Injectable testosterone is associated with the greatest treatment-induced increases in hemoglobin/Hct compared to other modalities.
“trials have indicated that injectable testosterone is associated with the greatest treatment-induced increases in hemoglobin/Hct.”
From Evaluation and Management of Testosterone Deficiency: AUA Guideline (2018) · cites this paper as [22]
CC use has shown significantly less risk of increased hematocrit compared to testosterone therapy.
“Additionally, CC use has shown to have significantly less risk of increased hematocrit as compared to testosterone therapy (57).”
From Non-testosterone management of male hypogonadism: an examination of the existing literature (2020) · cites this paper as [57]
Advantages of SERMs over TRT include oral administration, maintenance of fertility, avoidance of supraphysiological total testosterone levels, and lower risk of erythrocytosis.
“The advantages of these SERMs over TRT include oral administration, the maintenance of fertility, the avoidance of supraphysiological total testosterone levels and the lower risk of erythrocytosis [4,49,50].”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [50]
The prevalence of secondary polycythemia is significantly lower during treatment with clomiphene citrate compared to TRT.
“The prevalence of secondary polycythemia is significantly lower during treatment with clomiphene citrate compared to TRT [49,50].”
From Treatment of Men with Central Hypogonadism: Alternatives for Testosterone Replacement Therapy (2020) · cites this paper as [50]
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References 27 · Cited by 47
- Authors
- Wheeler, K. M., Smith, R. P., Kumar, R. A., Setia, S., Costabile, R. A., & Kavoussi, P. K.
- Affiliations
- University of Virginia (US)
- University of Central Florida (US)
- Department of Reproductive Urology, Austin Fertility and Reproductive Medicine, Austin, Texas
- Venue
- Journal of Urology
- Published
- 2017-04
- Volume
- 197
- Issue
- 4
- Pages
- 1127-1131
- ISSN
- 0022-5347 (ISSN-L)
- 1527-3792
- OpenAlex
- W2544525988
- Cited by
- 47
- References
- 27
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 2 · 2020: 8 · 2019: 5 · 2018: 5 · 2017: 1
- FWCI
- 3.68
- Type
- journal article
- Language
- en
- Open access
- Locations
- The Journal of Urology (publishedVersion)
- PubMed (publishedVersion)
- Journal of International Crisis and Risk Communication Research (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- secondary polycythemia, clomiphene citrate, testosterone replacement therapy, hypogonadism, men, hematocrit, serum testosterone
- MeSH terms
- Adult, Androgens, Clomiphene, Humans, Hypogonadism, Male, Middle Aged, Polycythemia, Retrospective Studies, Testosterone, Cohort Studies, Hormone Replacement Therapy, Selective Estrogen Receptor Modulators
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