Effective Treatment of Secondary Hypogonadism with Clomiphene Citrate in a Male Patient with Secondary Polycythemia and History of Transient Ischemic Attack: A Case Report

Abstract

Testosterone replacement therapy is the mainstay treatment for both primary and secondary hypogonadism. Clinical benefits of testosterone include improvement of the muscle mass, libido, and bone density. However, there are potential risks associated with it, including hypercoagulability, prostate cancer, worsening sleep apnea, cardiovascular disease etc. There are contraindications for treatment as per current guidelines of AACE/. Therefore, initiating testosterone should be done with caution and after excluding breast, prostatic cancers, PSA above 4ng/ml or above 3ng/ml in high risk patients-AfricanAmerican or having first degree relative with prostatic cancer, untreated Congestive heart failure, untreated severe sleep apnea, thrombophilia, Stroke, Transient ischemic attack (TIA) and myocardial Infarction (MI) within 6 months, Hematocrit (HCT) above 50% or if the patient seeks fertility. Given the high prevalence of cardiovascular disease worldwide testosterone replacement therapy may not be an option for every patient. We are describing a case regarding a patient successfully treated with the SERM- Clomiphene citrate a SERM with improvement of Testosterone to normal ranges, improvement of erectile dysfunction and morning erections and libido without the side effects of testosterone injections like polycythemia.