Clomiphene

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Clomiphene

Medical use

Clomiphene (clomiphene citrate) is an anti-estrogenic medical substance. In medicine, clomiphene is used for fertility treatments for both men and women. The preparation is permitted to be used only under the supervision of a gynecologist, urologist or a doctor who works in a hospital that specializes in the field.

In women, clomiphene is used to try to induce ovulation. The substance is administered in 50 to 100 milligram daily doses in certain phase of the menstrual cycle during five days.

In men, the medical dose of clomiphene accelerates testosterone secretion. The use of clomiphene aims to increase the sperm cell count of semen. The substance is usually administered in 50 milligram daily doses during 2 to 3 months. After that, the dose is paused, the extent of the pause depends on the luteinizing hormone (LH) contents measured in the serum.

Abuse

Clomiphene is a doping substance according to the Penal Code. Particularly men, who use anabolic steroids, commonly use clomiphene or other anti-estrogens (for example, tamoxifen) as an accompanying drug.

The purpose of clomiphene, in this case, is to inhibit the estrogen problems caused by the overdosed anabolic steroids, that appear when anabolic steroids convert in the body to estrogens or other metabolic products that have estrogenic effetcs. These problems, in men, include the over-growth of breasts (gynecomastia) and blood coagulation disturbances.

Even though clomiphene accelerates testosterone secretion, its muscle growth increasing effect is in practice insignificant. It should also be noted that with large doses, clomiphene changes from anti-estrogen to estrogen. Small doses block estrogen receptors, but large doses stimulate them. Because of that, clomiphene is not used in large doses.

Adverse effects

When medical doses of clomiphene are used the adverse effects appear in 10 – 20 percent of patients. Common adverse effects include, among others, headaches, dizziness, nausea and vomiting, nervousness, insomnia and visual disturbances.

In women clomiphene can cause multiple pregnancies and uterine bleeding. Before starting the use of clomiphene, women should always have a gynecologic examination.

In continuous use or in use with large doses, clomiphene can increase the risk of hormone induced cancers. Clomiphene can also cause visual disturbances, and blood clots. In men, with doses that have an estrogenic effect, it can cause the over-growth of mammary glands (gynecomastia).

Timo Seppälä
Medical Director
The Finnish Antidoping Agency FINADA

Tucker (1996): Reproductive toxicity of ovulation induction. Seminars in Reproductive Endocrinology 14(4): 345–53.



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