Clomifene

What it is

Clomifene is a selective oestrogen receptor modulator that blocks oestrogen feedback at the hypothalamus and pituitary, prompting a rise in the gonadotrophins LH and FSH, and so in testosterone and sperm production. Its licensed use is in fertility treatment.

It is prescribed principally to induce ovulation in women with certain forms of infertility, and off-label by specialists for some men with secondary hypogonadism, with hormone levels measured throughout.

What’s claimed

• Restarting natural testosterone production after steroid use
• Raising testosterone without injections
• Preserving fertility

What the evidence shows

That clomifene raises LH, FSH and testosterone in men is well-supported (Gold), and specialist use for secondary hypogonadism has a reasonable evidence base. The specific performance-context claim, that a self-directed protocol reliably recovers an axis suppressed by anabolic steroids, is not established. Recovery time varies widely, some people recover without intervention, and some do not fully recover with it.

The risks

• Visual: blurred vision, floaters and light sensitivity, which can occasionally persist and are a reason to stop and seek medical advice.
• Mood: low mood, anxiety and emotional lability are commonly reported in men taking it.
• Ovarian (in women): ovarian hyperstimulation and multiple pregnancy, which is why it is a supervised treatment.
• Prescription-only: taken without a diagnosis or hormone measurement, there is no way to know whether it is addressing anything.

What needs monitoring

• Testosterone, LH, FSH and oestradiol
• Semen analysis where fertility is the concern
• Any visual disturbance means stopping and seeing a doctor: all of this belongs with a clinician.