Clomiphene citrate rescue of spermatogenesis in men with infertility while remaining on finasteride: A case report

Christopher Wu, Ellen Forbes, Keith Allen Jarvi

Abstract


Finasteride is a selective inhibitor of type-2 5-alpha reductase enzyme, preventing the conversion of testosterone to dihydrotestosterone (DHT). Finasteride is used as an oral drug for the treatment of benign prostatic hyperplasia at the 5 mg/day dose and is also used for the treatment of androgenic alopecia, or male pattern hair loss, at a dosage of 1 mg orally. There are now a number of studies documenting that finasteride, even at the low dose of 1 mg, may have an adverse effect on fertility for some men.In the largest study, Samplaski et al reported that sperm counts improved over 11-fold once the men had stopped the finasteride, but most of the men did not recover to normal sperm parameters. Presently, if men using finasteride are subfertile, the recommendation is to stop the finasteride and wait for a recovery of spermatogenesis. There has been no report of the use of any hormone therapy, such as clomiphene citrate, gonadotropin, or aromatase inhibitors, to treat subfertile men on finasteride. This is the first case report of the use of clomiphene citrate to improve fertilty for a man on finasteride.

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DOI: http://dx.doi.org/10.5489/cuaj.4191