Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
PLoS One. 2022 Jan 31;17(1):e0262924. doi: 10.1371/journal.pone.0262924. eCollection 2022.
The testosterone to estradiol ratio (T/E2 ratio) reportedly exerts a stronger effect on semen quality and sexual desire than does testosterone alone. Clomiphene citrate is a selective estrogen receptor modulator that has long been used as an empirical treatment option in the management of idiopathic oligozoospermia. Clomiphene may change the hypothalamus-pituitary-gonad axis and result in the alteration of the T/E2 ratio. No reliable data are available regarding the change in the T/E2 ratio after clomiphene use in eugonadism.
This study included 24 male patients who were diagnosed with idiopathic infertility with eugonadism. They all received clomiphene citrate (25 mg/day) as empirical treatment. Blood tests for serum testosterone, estradiol, prolactin, luteinizing hormone, and follicle stimulating hormone were performed before and after 4 weeks of clomiphene use. Paired t-tests were used to evaluate the significance of the hormone level change.
Overall, the patients' T/E2 ratio did not increase significantly after clomiphene use. In the subgroup analysis, the T/E2 ratio of patients with a baseline ratio of <200 increased significantly after clomiphene use.
Clomiphene citrate may significantly increase the T/E2 ratio in eugonadal men under the premise of its ceiling effect (T/E2 ratio < 200), providing practitioners with guidance on the use of clomiphene in this demographic.
据报道，睾酮与雌二醇的比值（T/E2 比值）对精液质量和性欲的影响比睾酮单独作用更强。枸橼酸氯米酚是一种选择性雌激素受体调节剂，长期以来一直被用作特发性少精子症治疗的经验性选择。氯米酚可能会改变下丘脑-垂体-性腺轴，导致 T/E2 比值的改变。在正常生育力的情况下，关于使用氯米酚后 T/E2 比值的变化，尚无可靠的数据。
本研究纳入了 24 名被诊断为特发性不育且具有正常生育力的男性患者。他们均接受了枸橼酸氯米酚（25 mg/天）的经验性治疗。在使用氯米酚前和 4 周后，检测血清睾酮、雌二醇、催乳素、黄体生成素和卵泡刺激素水平。采用配对 t 检验评估激素水平变化的显著性。
总体而言，患者使用氯米酚后 T/E2 比值并未显著增加。在亚组分析中，基线比值<200 的患者使用氯米酚后 T/E2 比值显著增加。
在氯米酚的上限效应（T/E2 比值<200）下，枸橼酸氯米酚可能会显著增加正常生育力男性的 T/E2 比值，为临床医生在这一人群中使用氯米酚提供了指导。
