Prolactinoma is the most common hormone-secreting pituitary tumor and secrete prolactin, a regulator of sexual function in men. In a study by Brazilian researchers, clomiphene citrate reverted hypogonadotropic hypogonadism in most men with prolactinoma who were taking traditional dopaminergic agonists, regardless of their prolactin levels.

Rogerio S. Ribeiro, MD, division of endocrinology, neuroendocrinology unit, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil, led a prospective study in which clomiphene citrate 50 mg/day was given to 12 men with persistent hypogonadotropic hypogonadism receiving dopamine-agonist treatment for tumoral hyperprolactinemia (10 macro and 2 microadenomas).

Patients had a mean age of 43 ± 3.6 years and were treated with clomiphene citrate for a total of 12 weeks.

Results showed that prolactin levels remained unchanged during clomiphene citrate treatment. Nine patients (4 with high and 5 with normal prolactin levels) were considered responders to clomiphene citrate -- serum testosterone levels increased to averages well above 300 ng/dL -- and 3 were nonresponders. Luteinizing hormone levels increased significantly, erectile function improved (P < .05), and whole-body mineral density increased (P < .05).

Insulin sensitivity, fat-free mass, as well as cholesterol and triglyceride levels did not change significantly. No adverse effects were reported.

Despite treatment with dopamine agonists, which lower levels of prolactin, hypogonadotropic hypogonadism may still persist. In such cases, testosterone has been the traditional treatment, which can cause extreme fluctuations in serum testosterone levels and does not restore fertility.

Dr. Ribeiro concluded that clomiphene citrate therapy may be an alternative to conventional testosterone replacement, due to its ability to achieve more stable serum testosterone levels and its potential to restore fertility in these patients.


[Presentation title: Clomiphene Can Restore Gonadal Function in Hypogonadal Men With Prolactinoma on Dopaminergic Agonist Therapy Abstract 822]

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